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Anal fissure: An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter). Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery. Signs and symptoms of an anal fissure include: - Pain, sometimes severe, during bowel movements - Pain after bowel movements that can last up to several hours - Bright red blood on the stool or toilet paper after a bowel movement - Itching or irritation around the anus - A visible crack in the skin around the anus - A small lump or skin tag on the skin near the anal fissure When to see a doctor See your doctor if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement. Common causes of anal fissure include: - Passing large or hard stools - Constipation and straining during bowel movements - Chronic diarrhea - Inflammation of the anorectal area, caused by Crohn's disease or another inflammatory bowel disease - Childbirth Less common causes of anal fissures include: - Anal cancer - HIV - Tuberculosis - Syphilis - Herpes Factors that may increase your risk of developing an anal fissure include: - Infancy. Many infants experience an anal fissure during their first year of life; experts aren't sure why. - Aging. Older adults may develop an anal fissure partly due to slowed circulation, resulting in decreased blood flow to the rectal area. - Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. - Childbirth. Anal fissures are more common in women after they give birth. - Crohn's disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing. - Anal intercourse. Complications of anal fissure can include: - Failure to heal. An anal fissure that fails to heal within six weeks is considered chronic and may need further treatment. - Recurrence. Once you've experienced an anal fissure, you are prone to having another one. - A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure. If possible, your doctor will perform a digital rectal exam, which involves inserting a gloved finger into your anal canal, or use a short, lighted tube (anoscope) to inspect your anal canal. However, if this is too painful for you, your doctor may be able to diagnose an anal fissure only by observation. An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has the tear, as well as two separate lumps or tags of skin, one internal (sentinel pile) and one external (hypertrophied papilla). The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn's disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition: - Flexible sigmoidoscopy. Your doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer. - Colonoscopy. Your doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea. Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing. If your symptoms persist, you'll likely need further treatment. Nonsurgical treatments Your doctor may recommend: - Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe. - Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief. - Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms. - Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects. Surgery If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence. Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences: - Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually. - Drink adequate fluids. Fluids help prevent constipation. - Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure. - Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear. If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently and discuss the problem with your child's doctor.
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Type 2 diabetes Noninsulin-dependent diabetes Diabetes - type II Adult-onset diabetes Diabetic - type 2 diabetes Oral hypoglycemic - type 2 diabetes High blood sugar - type 2 diabetes Summary Type 2 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes. Causes Insulin is a hormone produced in the pancreas by special cells, called beta cells. The pancreas is below and behind the stomach. Insulin is needed to move blood sugar (glucose) into cells. Inside the cells, glucose is stored and later used for energy. When you have type 2 diabetes, your fat, liver, and muscle cells do not respond correctly to insulin. This is called insulin resistance. As a result, blood sugar does not get into these cells to be stored for energy. When sugar cannot enter cells, a high level of sugar builds up in the blood. This is called hyperglycemia. The body is unable to use the glucose for energy. This leads to the symptoms of type 2 diabetes. Type 2 diabetes usually develops slowly over time. Most people with the disease are overweight or obese when they are diagnosed. Increased fat makes it harder for your body to use insulin the correct way. Type 2 diabetes can also develop in people who are not overweight or obese. This is more common in older adults. Family history and genes play a role in type 2 diabetes. Low activity level, poor diet, and excess body weight around the waist increase your chance of getting the disease. Symptoms People with type 2 diabetes often have no symptoms at first. They may not have symptoms for many years. Early symptoms of diabetes caused by a high blood sugar level may include: Bladder, kidney, skin, or other infections that are more frequent or heal slowly Fatigue Hunger Increased thirst Increased urination Blurred vision After many years, diabetes can lead to serious health problems, and as a result, many other symptoms. Exams and Tests Your doctor may suspect that you have diabetes if your blood sugar level is higher than 200 milligrams per deciliter (mg/dL) or 11.1 mmol/L. To confirm the diagnosis, one or more of the following tests must be done. Fasting blood glucose level -- Diabetes is diagnosed if it is higher than 126 mg/dL (7.0 mmol/L) two different times. Hemoglobin A1c (A1C) test -- Diabetes is diagnosed if the test result is 6.5% or higher. Oral glucose tolerance test -- Diabetes is diagnosed if the glucose level is higher than 200 mg/dL (11.1 mmol/L) 2 hours after drinking a special sugar drink. Diabetes screening is recommended for: Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years Overweight adults (BMI of 25 or higher) who have other risk factors, such as high blood pressure, or having a mother, father, sister or brother with diabetes Adults starting at age 45 every 3 years, or at a younger age if the person has risk factors If you have been diagnosed with type 2 diabetes, you need to work closely with your doctor. See your doctor as often as instructed. This may be every 3 months. The following exams and tests will help you and your doctor monitor your diabetes and prevent problems. Check the skin, nerves, and joints of your feet and legs. Check if your feet are getting numb (diabetic nerve disease). Have your blood pressure checked at least once a year (blood pressure goal should be 140/80 mm Hg or lower). Have your A1C tested every 6 months if your diabetes is well controlled. Have the test every 3 months if your diabetes is not well controlled. Have your cholesterol and triglyceride levels checked once a year. Get tests once a year to make sure your kidneys are working well (microalbuminuria and serum creatinine). Visit your eye doctor at least once a year, or more often if you have signs of diabetic eye disease. See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes. Your provider may want to check your vitamin B12 blood levels if you are taking the drug metformin. Treatment At first, the goal of treatment is to lower your high blood glucose level. Long-term goals are to prevent complications. These are health problems that can result from having diabetes. The most important way to treat and manage type 2 diabetes is by being active and eating healthy foods. Everyone with diabetes should receive proper education and support about the best ways to manage their diabetes. Ask your doctor about seeing a diabetes nurse educator and a dietitian. LEARN THESE SKILLS Learning diabetes management skills will help you live well with diabetes. These skills help prevent health problems and the need for medical care. Skills include: How to test and record your blood glucose What, when, and how much to eat How to safely increase your activity and control your weight How to take medicines, if needed How to recognize and treat low and high blood sugar How to handle sick days Where to buy diabetes supplies and how to store them It may take several months to learn these skills. Keep learning about diabetes, its complications, and how to control and live well with the disease. Stay up-to-date on new research and treatments. Make sure you are getting information from trustworthy sources, such as your doctor and diabetes educator. MANAGING YOUR BLOOD SUGAR Checking your blood sugar level yourself and writing down the results tells you how well you are managing your diabetes. Talk to your doctor and diabetes educator about how often to check. To check your blood sugar level, you use a device called a glucose meter. Usually, you prick your finger with a small needle, called a lancet. This gives you a tiny drop of blood. You place the blood on a test strip and put the strip into the meter. The meter gives you a reading that tells you the level of your blood sugar. Your doctor or diabetes educator will help set up a testing schedule for you. Your doctor will help you set a target range for your blood sugar numbers. Keep these factors in mind: Most people with type 2 diabetes only need to check their blood sugar once or twice a day. If your blood sugar level is under control, you may only need to check it a few times a week. You may test yourself when you wake up, before meals, and at bedtime. You may need to test more often when you are sick or under stress. You may need to test more often if you are having more frequent low blood sugar symptoms. Keep a record of your blood sugar for yourself and your doctor. Based on your numbers, you may need to make changes to your meals, activity, or medicines to keep your blood sugar level in the right range. Your doctor may recommend that you use a continuous glucose monitor (CGM) to measure blood sugar if: You are using insulin injections many times a day You have had an episode of severe low blood sugar Your blood sugar level varies a lot The CGM has a sensor that is inserted just under the skin to measure glucose in your tissue fluid every 5 minutes. HEALTHY EATING AND WEIGHT CONTROL Work closely with your health care providers to learn how much fat, protein, and carbohydrates you need in your diet. Your meal plans should fit your lifestyle and habits and should include foods that you like. Managing your weight and having a well-balanced diet are important. Some people with type 2 diabetes can stop taking medicines after losing weight. This does not mean that their diabetes is cured. They still have diabetes. Obese people whose diabetes is not well managed with diet and medicine may consider weight loss (bariatric) surgery. REGULAR PHYSICAL ACTIVITY Regular activity is important for everyone. It is even more important when you have diabetes. Exercise is good for your health because it: Lowers your blood sugar level without medicine Burns extra calories and fat to help manage your weight Improves blood flow and blood pressure Increases your energy level Improves your ability to handle stress Talk to your doctor before starting any exercise program. People with type 2 diabetes may need to take special steps before, during, and after physical activity or exercise, including adjusting doses of insulin if needed. MEDICINES TO TREAT DIABETES If diet and exercise do not help keep your blood sugar at normal or near-normal levels, your doctor may prescribe medicine. Since these drugs help lower your blood sugar level in different ways, your doctor may have you take more than one drug. Some of the most common types of medicines are listed below. They are taken by mouth or injection. Alpha-glucosidase inhibitors Biguanides Bile acid sequestrants DPP-4 inhibitors Injectable medicines (GLP-1 analogs) Meglitinides SGLT2 inhibitors Sulfonylureas Thiazolidinediones You may need to take insulin if your blood sugar cannot be controlled with any of the above medicines. Most commonly, insulin is injected under the skin using a syringe, insulin pen, or pump. Another form of insulin is the inhaled type. Insulin cannot be taken by mouth because the acid in the stomach destroys the insulin. PREVENTING COMPLICATIONS Your doctor may prescribe medicines or other treatments to reduce your chance of developing some of the more common complications of diabetes, including: Eye disease Kidney disease Heart disease and stroke FOOT CARE People with diabetes are more likely than those without diabetes to have foot problems. Diabetes damages the nerves. This can make your feet less able to feel pressure, pain, heat, or cold. You may not notice a foot injury until you have severe damage to the skin and tissue below, or you get a severe infection. Diabetes can also damage blood vessels. Small sores or breaks in the skin may become deeper skin sores (ulcers). The affected limb may need to be amputated if these skin ulcers do not heal or become larger, deeper, or infected. To prevent problems with your feet: Stop smoking if you smoke. Improve control of your blood sugar. Get a foot exam by your doctor at least twice a year to learn if you have nerve damage. Ask your doctor to check your feet for problems such as a bunion or hammertoe. These need to be treated to prevent skin breakdown and ulcers. Check and care for your feet every day. This is very important when you already have nerve or blood vessel damage or foot problems. Treat minor infections, such as athlete's foot, right away. Use moisturizing lotion on dry skin. Make sure you wear the right kind of shoes. Ask your doctor what type of shoe is right for you. EMOTIONAL HEALTH Living with diabetes can be stressful. You may feel overwhelmed by everything you need to do to manage your diabetes. But taking care of your emotional health is just as important as your physical health. Ways to relieve stress include: Listening to relaxing music Meditating to take your mind off your worries Deep breathing to help relieve physical tension Doing yoga, taichi, or progressive relaxation Feeling sad or down (depressed) or anxious sometimes is normal. But if you have these feelings often and they're getting in the way of managing your diabetes, talk with your health care team. They can find ways to help you feel better. Support Groups There are many diabetes resources that can help you understand more about type 2 diabetes. You can also learn ways to manage your condition so you can live well with diabetes. Outlook (Prognosis) Diabetes is a lifelong disease and there is no cure. Some people with type 2 diabetes no longer need medicine if they lose weight and become more active. When they reach their ideal weight, their body's own insulin and a healthy diet can control their blood sugar level. Possible Complications After many years, diabetes can lead to serious health problems: You could have eye problems, including trouble seeing (especially at night), and light sensitivity. You could become blind. Your feet and skin can develop sores and infections. If the wounds do not heal properly, your foot or leg may need to be amputated. Infections can also cause pain and itching in the skin. Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart attack, stroke, and other problems. It can become harder for blood to flow to your legs and feet. Nerves in your body can get damaged, causing pain, tingling, and numbness. Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can make it harder for men to have an erection. High blood sugar and other problems can lead to kidney damage. Your kidneys may not work as well as they used to. They may even stop working so that you need dialysis or a kidney transplant. When to Contact a Medical Professional Call 911 right away if you have: Chest pain or pressure Fainting, confusion or unconsciousness Seizure Shortness of breath These symptoms can quickly get worse and become emergency conditions (such as seizures, hypoglycemic coma or hyperglycemic coma). Also call your doctor if you have: Numbness, tingling, or pain in your feet or legs Problems with your eyesight Sores or infections on your feet Symptoms of high blood sugar (extreme thirst, blurry vision, dry skin, weakness or fatigue, the need to urinate a lot) Symptoms of low blood sugar (weakness or fatigue, trembling, sweating, irritability, trouble thinking clearly, fast heartbeat, double or blurry vision, uneasy feeling) Frequent feelings of depression or anxiety Prevention You can help prevent type 2 diabetes by staying at a healthy body weight. You can get to a healthy weight by eating healthy foods, controlling your portion sizes, and leading an active lifestyle. Some medicines can also delay or prevent type 2 diabetes in people at risk of developing the disease. Review Date 2/22/2018 Updated by: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Spina bifida Overview Spina bifida is a birth defect that occurs when the spine and spinal cord don't form properly. It falls under the broader category of neural tube defects. The neural tube is the embryonic structure that eventually develops into the baby's brain and spinal cord and the tissues that enclose them. Normally, the neural tube forms early in pregnancy, and it closes by the 28th day after conception. In babies with spina bifida, a portion of the neural tube fails to develop or close properly, causing defects in the spinal cord and in the bones of the spine. Spina bifida can range from mild to severe, depending on the type of defect, size, location and complications. When early treatment for spina bifida is necessary, it's done surgically, although such treatment doesn't always completely resolve the problem. Types Spina bifida can occur in different forms: spina bifida occulta, meningocele (muh-NING-go-seel) or myelomeningocele (my-uh-lo-muh-NING-go-seel). The severity of spina bifida depends on the type, size, location and complications. "Occulta" means hidden. The mildest form, spina bifida occulta results in a small separation or gap in one or more of the bones of the spine (vertebrae). Many people who have spina bifida occulta don't even know it, unless the condition is discovered during an imaging test done for unrelated reasons. In a form of spina bifida called meningocele, the protective membranes around the spinal cord (meninges) push out through the opening in the vertebrae, forming a sac filled with fluid. But this sac doesn't include the spinal cord, so nerve damage is less likely, though later complications are possible. Also known as open spina bifida, myelomeningocele is the most severe form. The spinal canal is open along several vertebrae in the lower or middle back. The membranes and spinal nerves push through this opening at birth, forming a sac on the baby's back, typically exposing tissues and nerves. This makes the baby prone to life-threatening infections. Symptoms Signs and symptoms of spina bifida vary by type and severity. Symptoms can also differ for each person. - Spina bifida occulta. Because the spinal nerves usually aren't involved, typically there are no signs or symptoms. But visible indications can sometimes be seen on the newborn's skin above the spinal defect, including an abnormal tuft of hair, or a small dimple or birthmark. - Meningocele. The membranes around the spinal cord push out through an opening in the vertebrae, forming a sac filled with fluid, but this sac doesn't include the spinal cord. - Myelomeningocele. In this severe form of spina bifida: - The spinal canal remains open along several vertebrae in the lower or middle back. - Both the membranes and the spinal cord or nerves protrude at birth, forming a sac. - Tissues and nerves usually are exposed, though sometimes skin covers the sac. When to see a doctor Typically, meningocele and myelomeningocele are diagnosed before or right after birth, when medical care is available. These children should be followed by a specialized team of doctors throughout their lives and families should be educated on the different complications to watch for. Children with spina bifida occulta typically don't have any symptoms or complications, so usually only routine pediatric care is needed. Causes Doctors aren't certain what causes spina bifida. As with many other problems, it appears to result from a combination of genetic and environmental risk factors, such as a family history of neural tube defects and folate deficiency. Risk factors Spina bifida is more common among whites and Hispanics, and females are affected more often than males. Although doctors and researchers don't know for sure why spina bifida occurs, they have identified some risk factors: - Folate deficiency. Folate (vitamin B-9) is important to the healthy development of a baby. Folate is the natural form of vitamin B-9. The synthetic form, found in supplements and fortified foods, is called folic acid. A folate deficiency increases the risk of spina bifida and other neural tube defects. - Family history of neural tube defects. Couples who've had one child with a neural tube defect have a slightly higher chance of having another baby with the same defect. That risk increases if two previous children have been affected by the condition. In addition, a woman who was born with a neural tube defect has a greater chance of giving birth to a child with spina bifida. However, most babies with spina bifida are born to parents with no known family history of the condition. - Some medications. For example, anti-seizure medications, such as valproic acid (Depakene), seem to cause neural tube defects when taken during pregnancy, possibly because they interfere with the body's ability to use folate and folic acid. - Diabetes. Women with diabetes who don't control their blood sugar well have a higher risk of having a baby with spina bifida. - Obesity. Pre-pregnancy obesity is associated with an increased risk of neural tube birth defects, including spina bifida. - Increased body temperature. Some evidence suggests that increased body temperature (hyperthermia) in the early weeks of pregnancy may increase the risk of spina bifida. Elevating your core body temperature, due to fever or the use of saunas or hot tubs, has been associated with a possible slight increased risk of spina bifida. If you have known risk factors for spina bifida, talk with your doctor to determine if you need a larger dose or prescription dose of folic acid, even before a pregnancy begins. If you take medications, tell your doctor. Some medications can be adjusted to diminish the potential risk of spina bifida, if plans are made ahead of time. Complications Spina bifida may cause minimal symptoms or only minor physical disabilities. If the spina bifida is severe, sometimes it leads to more significant physical disabilities. Severity is affected by: - The size and location of the neural tube defect - Whether skin covers the affected area - Which spinal nerves come out of the affected area of the spinal cord This list of possible complications may seem overwhelming, but not all children with spina bifida get all these complications. And these conditions can be treated. - Walking and mobility problems. The nerves that control the leg muscles don't work properly below the area of the spina bifida defect, causing muscle weakness of the legs, sometimes involving paralysis. Whether a child can walk typically depends on where the defect is, its size, and the care received before and after birth. - Orthopedic complications. Children with myelomeningocele can have a variety of problems in the legs and spine because of weak muscles in the legs and back. The types of problems depend on the level of the defect. Possible problems include a curved spine (scoliosis), abnormal growth or dislocation of the hip, bone and joint deformities, muscle contractures and other orthopedic concerns. - Bowel and bladder problems. Nerves that supply the bladder and bowels usually don't work properly when children have myelomeningocele. This is because the nerves that supply the bowel and bladder come from the lowest level of the spinal cord. - Accumulation of fluid in the brain (hydrocephalus). Babies born with myelomeningocele commonly experience accumulation of fluid in the brain, a condition known as hydrocephalus. - Shunt malfunction. Shunts can stop working or become infected. Warning signs may vary. Some of the warning signs of a shunt that isn't working include headaches, vomiting, sleepiness, irritability, swelling or redness along the shunt, confusion, changes in the eyes (fixed downward gaze), trouble feeding, or seizures. - Chiari malformation type II. Chiari malformation (kee-AH-ree mal-for-MAY-shun) type II is a common brain abnormality in children with the myelomeningocele form of spina bifida. The brainstem, or lowest part of the brain above the spinal cord, is elongated and positioned lower than usual. This can cause problems with breathing and swallowing. Rarely, compression on this area of the brain occurs and surgery is needed to relieve the pressure. - Infection in the tissues surrounding the brain (meningitis). Some babies with myelomeningocele may develop meningitis, an infection in the tissues surrounding the brain. This potentially life-threatening infection may cause brain injury. - Tethered spinal cord. Tethered spinal cord results when the spinal nerves become bound to the scar where the defect was closed surgically, making the spinal cord less able to grow as the child grows. This progressive tethering can cause loss of muscle function to the legs, bowel or bladder. Surgery can limit the degree of disability. - Sleep-disordered breathing. Both children and adults with spina bifida, particularly myelomeningocele, may have sleep apnea or other sleep disorders. Assessment for a sleep disorder in those with myelomeningocele helps detect sleep-disordered breathing, such as sleep apnea, which warrants treatment to improve health and quality of life. - Skin problems. Children with spina bifida may get wounds on their feet, legs, buttocks or back. They can't feel when they get a blister or sore. Sores or blisters can turn into deep wounds or foot infections that are hard to treat. Children with myelomeningocele have a higher risk of wound problems in casts. - Latex allergy. Children with spina bifida have a higher risk of latex allergy, an allergic reaction to natural rubber or latex products. Latex allergy may cause rash, sneezing, itching, watery eyes and a runny nose. It can also cause anaphylaxis, a potentially life-threatening condition in which swelling of the face and airways can make breathing difficult. So it's best to use latex-free gloves and equipment at delivery time and when caring for a child with spina bifida. - Other complications. More problems may arise as children with spina bifida get older, such as urinary tract infections, gastrointestinal (GI) disorders and depression. Children with myelomeningocele may develop learning disabilities, such as problems paying attention, and difficulty learning reading and math. Diagnosis If you're pregnant, you'll be offered prenatal screening tests to check for spina bifida and other birth defects. The tests aren't perfect. Some mothers who have positive blood tests have normal babies. Even if the results are negative, there's still a small chance that spina bifida is present. Talk to your doctor about prenatal testing, its risks and how you might handle the results. Blood tests Your doctor will most likely check for spina bifida by first performing these tests: - Maternal serum alpha-fetoprotein (MSAFP) test. For the MSAFP test, a sample of the mother's blood is drawn and tested for alpha-fetoprotein (AFP) - a protein produced by the baby. It's normal for a small amount of AFP to cross the placenta and enter the mother's bloodstream. But abnormally high levels of AFP suggest that the baby has a neural tube defect, such as spina bifida, though some spina bifida cases don't produce high levels of AFP. - Test to confirm high AFP levels. Varying levels of AFP can be caused by other factors - including a miscalculation in fetal age or multiple babies - so your doctor may order a follow-up blood test for confirmation. If the results are still high, you'll need further evaluation, including an ultrasound exam. - Other blood tests. Your doctor may perform the MSAFP test with two or three other blood tests. These tests are commonly done with the MSAFP test, but their objective is to screen for other abnormalities, such as trisomy 21 (Down syndrome), not neural tube defects. Ultrasound Many obstetricians rely on ultrasonography to screen for spina bifida. If blood tests indicate high AFP levels, your doctor will suggest an ultrasound exam to help determine why. The most common ultrasound exams bounce high-frequency sound waves off tissues in your body to form images on a video monitor. The information these images provide can help establish whether there's more than one baby and can help confirm gestational age, two factors that can affect AFP levels. An advanced ultrasound also can detect signs of spina bifida, such as an open spine or particular features in your baby's brain that indicate spina bifida. Amniocentesis If a blood test shows high levels of AFP in your blood but the ultrasound is normal, your doctor may offer amniocentesis. During amniocentesis, your doctor uses a needle to remove a sample of fluid from the amniotic sac that surrounds the baby. An analysis of the sample indicates the level of AFP present in the amniotic fluid. A small amount of AFP is normally found in amniotic fluid. However, when an open neural tube defect is present, the amniotic fluid contains an elevated amount of AFP because the skin surrounding the baby's spine is gone and AFP leaks into the amniotic sac. Discuss the risks of amniocentesis, including a slight risk of loss of the pregnancy, with your doctor. Treatment Spina bifida treatment depends on the severity of the condition. Spina bifida occulta often doesn't require treatment at all, but other types of spina bifida do. Surgery before birth Nerve function in babies with spina bifida can worsen after birth if it's not treated. Prenatal surgery for spina bifida (fetal surgery) takes place before the 26th week of pregnancy. Surgeons expose a pregnant mother's uterus surgically, open the uterus and repair the baby's spinal cord. Research suggests that children with spina bifida who had fetal surgery may have reduced disability and be less likely to need crutches or other walking devices. In addition, fetal surgery may reduce the risk of hydrocephalus. Ask your doctor whether this procedure may be appropriate for you. Discuss the risks, such as possible premature delivery and other complications, and potential benefits for you and your baby. It's important to have a comprehensive evaluation to determine whether fetal surgery is feasible. This specialized surgery should only be done at a health care facility that has experienced fetal surgery experts, a multispecialty team approach and neonatal intensive care. Typically the team includes a fetal surgeon, pediatric neurosurgeon, maternal-fetal medicine specialist, fetal cardiologist and neonatologist. Cesarean birth Many babies with myelomeningocele tend to be in a feet-first (breech) position. If your baby is in this position or if your doctor has detected a large cyst or sac, cesarean birth may be a safer way to deliver your baby. Surgery after birth Meningocele involves surgery to put the meninges back in place and close the opening in the vertebrae. Because the spinal cord develops normally in babies with meningocele, these membranes often can be removed by surgery with little or no damage to nerve pathways. Myelomeningocele also requires surgery. Performing the surgery early can help minimize risk of infection that's associated with the exposed nerves and may also help protect the spinal cord from more trauma. During the procedure, a neurosurgeon places the spinal cord and exposed tissue inside the baby's body and covers them with muscle and skin. Sometimes a shunt to control hydrocephalus in the baby's brain is placed during the operation on the spinal cord. Treatment for complications In babies with myelomeningocele, irreparable nerve damage has likely already occurred and ongoing care from a multispecialty team of surgeons, physicians and therapists is usually needed. Babies with myelomeningocele may need more surgery for a variety of complications. Treatment for complications - such as weak legs, bladder and bowel problems or hydrocephalus - typically begins soon after birth. Depending on the severity of spina bifida and the complications, treatment may include, for example: - Walking and mobility aids. Some babies may start exercises to prepare their legs for walking with braces or crutches when they're older. Some children may need walkers or a wheelchair. Mobility aids, along with regular physical therapy, can help a child become independent. - Bowel and bladder management. Routine bowel and bladder evaluations and management plans help reduce the risk of organ damage and illness. Evaluations include X-rays, kidney scans, ultrasounds, blood tests and bladder function studies. These evaluations will be more frequent in the first few years of life, but less often as children grow. - Bowel management may include oral medications, suppositories, enemas, surgery, or a combination of these approaches. - Bladder management may include medications, using catheters to empty the bladder, surgery, or a combination. - For children, a specialist in pediatric urology with experience in evaluating and performing surgery on children with spina bifida is the best choice. - Surgery for hydrocephalus. Most babies with myelomeningocele will need a ventricular shunt - a surgically placed tube that allows fluid in the brain to drain into the abdomen. This tube might be placed just after birth, during the surgery to close the sac on the lower back or later as fluid accumulates. A less invasive procedure, called endoscopic third ventriculostomy, may be used, but candidates must be carefully chosen and meet certain criteria. The surgeon uses a small video camera to see inside the brain and makes a hole in the bottom of or between the ventricles so cerebrospinal fluid can flow out of the brain. - Treatment and management of other complications. To help with functioning, special equipment such as bath chairs, commode chairs and standing frames may be needed. Whatever the issue - orthopedic complications, tethered spinal cord, GI issues, skin problems, or others - most spina bifida complications can be treated or at least managed to improve quality of life. Ongoing care Children with spina bifida need close follow-up care and observation. Their primary care doctors follow growth, the need for immunizations and general medical issues. They coordinate your child's medical care. Children with spina bifida also often need treatment and ongoing care from: - Physical medicine and rehabilitation - Neurology - Neurosurgery - Urology - Orthopedics - Physical therapy - Occupational therapy - Special education teachers - Social workers - Dietitians Parents and other caregivers are a key part of the team, learning how to help manage their child's condition and how to encourage and support their child emotionally and socially. Keep in mind that children with spina bifida can go on to college, hold jobs and have families. Special accommodations may be necessary along the way, but encourage your child to be as independent as possible.
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Pancreatic Cancer: The pancreas lies behind the stomach and in front of the spine. There are two kinds of cells in the pancreas. Exocrine pancreas cells make enzymes that are released into the small intestine to help the body digest food. Neuroendocrine pancreas cells (such as islet cells) make several hormones, including insulin and glucagon, that help control sugar levels in the blood. Most pancreatic cancers form in exocrine cells. These tumors do not secrete hormones and do not cause signs or symptoms. This makes it hard to diagnose this type of pancreatic cancer early. For most patients with exocrine pancreatic cancer, current treatments do not cure the cancer. Some types of malignant pancreatic neuroendocrine tumors, such as islet cell tumors, have a better prognosis than pancreatic exocrine cancers. - Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas. - Smoking and health history can affect the risk of pancreatic cancer. - Signs and symptoms of pancreatic cancer include jaundice, pain, and weight loss. - Pancreatic cancer is difficult to detect (find) and diagnose early. - Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer. - Certain factors affect prognosis (chance of recovery) and treatment options. - Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas. - Smoking and health history can affect the risk of pancreatic cancer. - Signs and symptoms of pancreatic cancer include jaundice, pain, and weight loss. - Pancreatic cancer is difficult to detect (find) and diagnose early. - Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer. - Certain factors affect prognosis (chance of recovery) and treatment options. - Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for pancreatic cancer: - Stage 0 (Carcinoma in Situ) - Stage I - Stage II - Stage III - Stage IV - Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for pancreatic cancer: - Stage 0 (Carcinoma in Situ) - Stage I - Stage II - Stage III - Stage IV - There are different types of treatment for patients with pancreatic cancer. - Five types of standard treatment are used: - Surgery - Radiation therapy - Chemotherapy - Chemoradiation therapy - Targeted therapy - There are treatments for pain caused by pancreatic cancer. - Patients with pancreatic cancer have special nutritional needs. - New types of treatment are being tested in clinical trials. - Biologic therapy - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed - There are different types of treatment for patients with pancreatic cancer. - Five types of standard treatment are used: - Surgery - Radiation therapy - Chemotherapy - Chemoradiation therapy - Targeted therapy - There are treatments for pain caused by pancreatic cancer. - Patients with pancreatic cancer have special nutritional needs. - New types of treatment are being tested in clinical trials. - Biologic therapy - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed Stages I and II Pancreatic Cancer Treatment of stage I and stage II pancreatic cancer may include the following: - Surgery. - Surgery followed by chemotherapy. - Surgery followed by chemoradiation. - A clinical trial of combination chemotherapy. - A clinical trial of chemotherapy and targeted therapy, with or without chemoradiation. - A clinical trial of chemotherapy and/or radiation therapy before surgery. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage III Pancreatic Cancer Treatment of stage III pancreatic cancer may include the following: - Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine. - Chemotherapy followed by chemoradiation. - Chemoradiation followed by chemotherapy. - Chemotherapy with or without targeted therapy. - A clinical trial of new anticancer therapies together with chemotherapy or chemoradiation. - A clinical trial of radiation therapy given during surgery or internal radiation therapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage IV Pancreatic Cancer Treatment of stage IV pancreatic cancer may include the following: - Palliative treatments to relieve pain, such as nerve blocks, and other supportive care. - Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine. - Chemotherapy with or without targeted therapy. - Clinical trials of new anticancer agents with or without chemotherapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. - Pancreatic neuroendocrine tumors form in hormone-making cells (islet cells) of the pancreas. - Pancreatic NETs may or may not cause signs or symptoms. - There are different kinds of functional pancreatic NETs. - Having certain syndromes can increase the risk of pancreatic NETs. - Different types of pancreatic NETs have different signs and symptoms. - Lab tests and imaging tests are used to detect (find) and diagnose pancreatic NETs. - Other kinds of lab tests are used to check for the specific type of pancreatic NETs. - Certain factors affect prognosis (chance of recovery) and treatment options. - Pancreatic neuroendocrine tumors form in hormone-making cells (islet cells) of the pancreas. - Pancreatic NETs may or may not cause signs or symptoms. - There are different kinds of functional pancreatic NETs. - Having certain syndromes can increase the risk of pancreatic NETs. - Different types of pancreatic NETs have different signs and symptoms. - Lab tests and imaging tests are used to detect (find) and diagnose pancreatic NETs. - Other kinds of lab tests are used to check for the specific type of pancreatic NETs. - Certain factors affect prognosis (chance of recovery) and treatment options. - The plan for cancer treatment depends on where the NET is found in the pancreas and whether it has spread. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The plan for cancer treatment depends on where the NET is found in the pancreas and whether it has spread. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - There are different types of treatment for patients with pancreatic NETs. - Six types of standard treatment are used: - Surgery - Chemotherapy - Hormone therapy - Hepatic arterial occlusion or chemoembolization - Targeted therapy - Supportive care - New types of treatment are being tested in clinical trials. - Treatment for pancreatic neuroendocrine tumors may cause side effects. - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed. - There are different types of treatment for patients with pancreatic NETs. - Six types of standard treatment are used: - Surgery - Chemotherapy - Hormone therapy - Hepatic arterial occlusion or chemoembolization - Targeted therapy - Supportive care - New types of treatment are being tested in clinical trials. - Treatment for pancreatic neuroendocrine tumors may cause side effects. - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed. Gastrinoma Treatment of gastrinoma may include supportive care and the following: - For symptoms caused by too much stomach acid, treatment may be a drug that decreases the amount of acid made by the stomach. - For a single tumor in the head of the pancreas: - Surgery to remove the tumor. - Surgery to cut the nerve that causes stomach cells to make acid and treatment with a drug that decreases stomach acid. - Surgery to remove the whole stomach (rare). - For a single tumor in the body or tail of the pancreas, treatment is usually surgery to remove the body or tail of the pancreas. - For several tumors in the pancreas, treatment is usually surgery to remove the body or tail of the pancreas. If tumor remains after surgery, treatment may include either: - Surgery to cut the nerve that causes stomach cells to make acid and treatment with a drug that decreases stomach acid; or - Surgery to remove the whole stomach (rare). - For one or more tumors in the duodenum (the part of the small intestine that connects to the stomach), treatment is usually pancreatoduodenectomy (surgery to remove the head of the pancreas, the gallbladder, nearby lymph nodes and part of the stomach, small intestine, and bile duct). - If no tumor is found, treatment may include the following: - Surgery to cut the nerve that causes stomach cells to make acid and treatment with a drug that decreases stomach acid. - Surgery to remove the whole stomach (rare). - If the cancer has spread to the liver, treatment may include: - Surgery to remove part or all of the liver. - Radiofrequency ablation or cryosurgical ablation. - Chemoembolization. - If cancer has spread to other parts of the body or does not get better with surgery or drugs to decrease stomach acid, treatment may include: - Chemotherapy. - Hormone therapy. - If the cancer mostly affects the liver and the patient has severe symptoms from hormones or from the size of tumor, treatment may include: - Hepatic arterial occlusion, with or without systemic chemotherapy. - Chemoembolization, with or without systemic chemotherapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Insulinoma Treatment of insulinoma may include the following: - For one small tumor in the head or tail of the pancreas, treatment is usually surgery to remove the tumor. - For one large tumor in the head of the pancreas that cannot be removed by surgery, treatment is usually pancreatoduodenectomy (surgery to remove the head of the pancreas, the gallbladder, nearby lymph nodes and part of the stomach, small intestine, and bile duct). - For one large tumor in the body or tail of the pancreas, treatment is usually a distal pancreatectomy (surgery to remove the body and tail of the pancreas). - For more than one tumor in the pancreas, treatment is usually surgery to remove any tumors in the head of the pancreas and the body and tail of the pancreas. - For tumors that cannot be removed by surgery, treatment may include the following: - Combination chemotherapy. - Palliative drug therapy to decrease the amount of insulin made by the pancreas. - Hormone therapy. - Radiofrequency ablation or cryosurgical ablation. - For cancer that has spread to lymph nodes or other parts of the body, treatment may include the following: - Surgery to remove the cancer. - Radiofrequency ablation or cryosurgical ablation, if the cancer cannot be removed by surgery. - If the cancer mostly affects the liver and the patient has severe symptoms from hormones or from the size of tumor, treatment may include: - Hepatic arterial occlusion, with or without systemic chemotherapy. - Chemoembolization, with or without systemic chemotherapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Glucagonoma Treatment may include the following: - For one small tumor in the head or tail of the pancreas, treatment is usually surgery to remove the tumor. - For one large tumor in the head of the pancreas that cannot be removed by surgery, treatment is usually pancreatoduodenectomy (surgery to remove the head of the pancreas, the gallbladder, nearby lymph nodes and part of the stomach, small intestine, and bile duct). - For more than one tumor in the pancreas, treatment is usually surgery to remove the tumor or surgery to remove the body and tail of the pancreas. - For tumors that cannot be removed by surgery, treatment may include the following: - Combination chemotherapy. - Hormone therapy. - Radiofrequency ablation or cryosurgical ablation. - For cancer that has spread to lymph nodes or other parts of the body, treatment may include the following: - Surgery to remove the cancer. - Radiofrequency ablation or cryosurgical ablation, if the cancer cannot be removed by surgery. - If the cancer mostly affects the liver and the patient has severe symptoms from hormones or from the size of tumor, treatment may include: - Hepatic arterial occlusion, with or without systemic chemotherapy. - Chemoembolization, with or without systemic chemotherapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Other Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) For VIPoma, treatment may include the following: - Fluids and hormone therapy to replace fluids and electrolytes that have been lost from the body. - Surgery to remove the tumor and nearby lymph nodes. - Surgery to remove as much of the tumor as possible when the tumor cannot be completely removed or has spread to distant parts of the body. This is palliative therapy to relieve symptoms and improve the quality of life. - For tumors that have spread to lymph nodes or other parts of the body, treatment may include the following: - Surgery to remove the tumor. - Radiofrequency ablation or cryosurgical ablation, if the tumor cannot be removed by surgery. - For tumors that continue to grow during treatment or have spread to other parts of the body, treatment may include the following: - Chemotherapy. - Targeted therapy. For somatostatinoma, treatment may include the following: - Surgery to remove the tumor. - For cancer that has spread to distant parts of the body, surgery to remove as much of the cancer as possible to relieve symptoms and improve quality of life. - For tumors that continue to grow during treatment or have spread to other parts of the body, treatment may include the following: - Chemotherapy. - Targeted therapy. Treatment of other types of pancreatic neuroendocrine tumors (NETs) may include the following: - Surgery to remove the tumor. - For cancer that has spread to distant parts of the body, surgery to remove as much of the cancer as possible or hormone therapy to relieve symptoms and improve quality of life. - For tumors that continue to grow during treatment or have spread to other parts of the body, treatment may include the following: - Chemotherapy. - Targeted therapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Recurrent or Progressive Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment of pancreatic neuroendocrine tumors (NETs) that continue to grow during treatment or recur (come back) may include the following: - Surgery to remove the tumor. - Chemotherapy. - Hormone therapy. - Targeted therapy. - For liver metastases: - Regional chemotherapy. - Hepatic arterial occlusion or chemoembolization, with or without systemic chemotherapy. - A clinical trial of a new therapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
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Psoriasis Plaque psoriasis Psoriasis vulgaris Guttate psoriasis Pustular psoriasis Summary Psoriasis is a skin condition that causes skin redness and irritation. Most people with psoriasis have thick, red, well-defined patches of skin with flaky, silver-white scales. These patches are called plaques. Causes Psoriasis is very common. Anyone can develop it, but it most often begins between ages 15 and 35, or as people get older. Psoriasis isn't contagious. This means it doesn't spread to other people. Psoriasis seems to be passed down through families. Normal skin cells grow deep in the skin and rise to the surface about once a month. When you have psoriasis, this process takes place in days rather than in 3 to 4 weeks. This results in dead skin cells building up on the skin's surface, forming the collections of scales. The following may trigger an attack of psoriasis or make it harder to treat: Infections from bacteria or viruses, including strep throat and upper respiratory infections Dry air or dry skin Injury to the skin, including cuts, burns, insect bites, and other skin rashes Some medicines, including antimalaria drugs, beta-blockers, and lithium Stress Too little sunlight Too much sunlight (sunburn) Psoriasis may be worse in people who have a weak immune system, including people with HIV/AIDS. Some people with psoriasis also have arthritis (psoriatic arthritis). In addition, people with psoriasis have an increased risk of fatty liver disease and cardiovascular disorders, such as heart disease and stroke. Symptoms Psoriasis can appear suddenly or slowly. Many times, it goes away and then comes back. The main symptom of the condition is irritated, red, flaky plaques of skin. Plaques are most often seen on the elbows, knees, and middle of the body. But they can appear anywhere, including on the scalp, palms, soles of the feet, and genitalia. The skin may be: Itchy Dry and covered with silver, flaky skin (scales) Pink-red in color Raised and thick Other symptoms may include: Joint or tendon pain or aching Nail changes, including thick nails, yellow-brown nails, dents in the nail, and a lifting of the nail from the skin underneath Severe dandruff on the scalp There are five main types of psoriasis: Erythrodermic -- The skin redness is very intense and covers a large area. Guttate -- Small, pink-red spots appear on the skin. This form is often linked to strep infections, especially in children. Inverse -- Skin redness and irritation occur in the armpits, groin, and in between overlapping skin rather than the more common areas of the elbows and knees. Plaque -- Thick, red patches of skin are covered by flaky, silver-white scales. This is the most common type of psoriasis. Pustular -- Yellow pus-filled blisters (pustules) are surrounded by red, irritated skin. Exams and Tests Your health care provider can usually diagnose this condition by looking at your skin. Sometimes, a skin biopsy is done to rule out other possible conditions. If you have joint pain, your provider may order imaging studies. Treatment The goal of treatment is to control your symptoms and prevent infection. Three treatment options are available: Skin lotions, ointments, creams, and shampoos -- These are called topical treatments. Pills or injections that affect the body's immune response, not just the skin -- These are called systemic, or body-wide, treatments. Phototherapy, which uses ultraviolet light to treat psoriasis. TREATMENTS USED ON THE SKIN (TOPICAL) Most of the time, psoriasis is treated with medicines that are placed directly on the skin or scalp. These may include: Cortisone creams and ointments Other anti-inflammatory creams and ointments Creams or ointments that contain coal tar or anthralin Creams to remove the scaling (usually salicylic acid or lactic acid) Dandruff shampoos (over-the-counter or prescription) Moisturizers Prescription medicines containing vitamin D or vitamin A (retinoids) SYSTEMIC (BODY-WIDE) TREATMENTS If you have very severe psoriasis, your provider will likely recommend medicines that suppress the immune system's faulty response. These medicines include methotrexate or cyclosporine. Retinoids, such as acetretin, can also be used. Newer drugs, called biologics, are used when other treatments do not work. Biologics approved for the treatment of psoriasis include: Adalimumab (Humira) Abatacept (Orencia) Apremilast (Otezla) Brodalumab (Siliq) Certolizumab pegol (Cimzia) Etanercept (Enbrel) Infliximab (Remicade) Ixekizumab (Taltz) Golimumab (Simponi) Guselkumab (Tremfya) Ustekinumab (Stelara) Secukinumab (Cosentyx) PHOTOTHERAPY Some people may choose to have phototherapy, which is safe and can be very effective: This is treatment in which your skin is carefully exposed to ultraviolet light. It may be given alone or after you take a drug that makes the skin sensitive to light. Phototherapy for psoriasis can be given as ultraviolet A (UVA) or ultraviolet B (UVB) light. OTHER TREATMENTS If you have an infection, your provider will prescribe antibiotics. HOME CARE Following these tips at home may help: Taking a daily bath or shower -- Try not to scrub too hard, because this can irritate the skin and trigger an attack. Oatmeal baths may be soothing and may help to loosen scales. You can use over-the-counter oatmeal bath products. Or, you can mix 1 cup (240 mL) of oatmeal into a tub (bath) of warm water. Keeping your skin clean and moist, and avoiding your specific psoriasis triggers may help reduce the number of flare-ups. Sunlight may help your symptoms go away. Be careful not to get sunburned. Relaxation and anti-stress techniques -- The link between stress and flares of psoriasis is not well understood. Support Groups Some people may benefit from a psoriasis support group. The National Psoriasis Foundation is a good resource: www.psoriasis.org. Outlook (Prognosis) Psoriasis can be a lifelong condition that can be usually controlled with treatment. It may go away for a long time and then return. With proper treatment, it will not affect your overall health. But be aware that there is a strong link between psoriasis and other health problems, such as heart disease. When to Contact a Medical Professional Call your provider if you have symptoms of psoriasis or if your skin irritation continues despite treatment. Tell your provider if you have joint pain or fever with your psoriasis attacks. If you have symptoms of arthritis, talk to your dermatologist or rheumatologist. Go to the emergency room or call the local emergency number (such as 911) if you have a severe outbreak that covers all or most of your body. Prevention There is no known way to prevent psoriasis. Keeping the skin clean and moist and avoiding your psoriasis triggers may help reduce the number of flare-ups. Providers recommend daily baths or showers for people with psoriasis. Avoid scrubbing too hard, because this can irritate the skin and trigger an attack. Review Date 2/27/2018 Updated by: David L. Swanson, MD, Vice Chair of Medical Dermatology, Associate Professor of Dermatology, Mayo Medical School, Scottsdale, AZ. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Gastroparesis Definition and Facts Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines. What is gastroparesis? Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine. Normally, after you swallow food, the muscles in the wall of your stomach grind the food into smaller pieces and push them into your small intestine to continue digestion. When you have gastroparesis, your stomach muscles work poorly or not at all, and your stomach takes too long to empty its contents. Gastroparesis can delay digestion, which can lead to various symptoms and complications. How common is gastroparesis? Gastroparesis is not common. Out of 100,000 people, about 10 men and about 40 women have gastroparesis1. However, symptoms that are similar to those of gastroparesis occur in about 1 out of 4 adults in the United States2, 3. Who is more likely to get gastroparesis? You are more likely to get gastroparesis if youhave diabetes had surgery on your esophagus, stomach, or small intestine, which may injure the vagus nerve . The vagus nerve controls the muscles of the stomach and small intestine. had certain cancer treatments, such as radiation therapy on your chest or stomach area What other health problems do people with gastroparesis have? People with gastroparesis may have other health problems, such asdiabetes scleroderma hypothyroidism nervous system disorders, such as migraine, Parkinson's disease, and multiple sclerosis gastroesophageal reflux disease (GERD) eating disorders amyloidosis What are the complications of gastroparesis? Complications of gastroparesis may includedehydration due to repeated vomiting malnutrition due to poor absorption of nutrients blood glucose, also called blood sugar, levels that are harder to control, which can worsen diabetes low calorie intake bezoars losing weight without trying lower quality of life Definition & Facts Symptoms and Causes The symptoms of gastroparesis may include feeling full shortly after starting a meal, feeling full long after eating a meal, nausea, and vomiting. Diabetes is the most common known cause of gastroparesis. What are the symptoms of gastroparesis? The symptoms of gastroparesis may includefeeling full soon after starting a meal feeling full long after eating a meal nausea vomiting too much bloating too much belching pain in your upper abdomen heartburn poor appetiteCertain medicines may delay gastric emptying or affect motility, resulting in symptoms that are similar to those of gastroparesis. If you have been diagnosed with gastroparesis, these medicines may make your symptoms worse. Medicines that may delay gastric emptying or make symptoms worse include the following:narcotic pain medicines, such as codeine , hydrocodone , morphine , oxycodone , and tapentadol some antidepressants , such as amitriptyline , nortriptyline , and venlafaxine some anticholinergics -medicines that block certain nerve signals some medicines used to treat overactive bladder pramlintideThese medicines do not cause gastroparesis. When should I seek a doctor’s help? You should seek a doctor's help right away if you have any of the following signs or symptoms:severe pain or cramping in your abdomen blood glucose levels that are too high or too low red blood in your vomit, or vomit that looks like coffee grounds sudden, sharp stomach pain that doesn't go away vomiting for more than an hour feeling extremely weak or fainting difficulty breathing feverYou should seek a doctor's help if you have any signs or symptoms of dehydration, which may includeextreme thirst and dry mouth urinating less than usual feeling tired dark-colored urine decreased skin turgor, meaning that when your skin is pinched and released, the skin does not flatten back to normal right away sunken eyes or cheeks light-headedness or faintingYou should seek a doctor's help if you have any signs or symptoms of malnutrition, which may includefeeling tired or weak all the time losing weight without trying feeling dizzy loss of appetite abnormal paleness of the skin Symptoms & Causes In most cases, doctors aren't able to find the underlying cause of gastroparesis, even with medical tests. Gastroparesis without a known cause is called idiopathic gastroparesis.Diabetes is the most common known underlying cause of gastroparesis. Diabetes can damage nerves, such as the vagus nerve and nerves and special cells, called pacemaker cells, in the wall of the stomach. The vagus nerve controls the muscles of the stomach and small intestine. If the vagus nerve is damaged or stops working, the muscles of the stomach and small intestine do not work normally. The movement of food through the digestive tract is then slowed or stopped. Similarly, if nerves or pacemaker cells in the wall of the stomach are damaged or do not work normally, the stomach does not empty.In addition to diabetes, other known causes of gastroparesis includeinjury to the vagus nerve due to surgery on your esophagus, stomach, or small intestine hypothyroidism certain autoimmune diseases, such as scleroderma certain nervous system disorders, such as Parkinson's disease and multiple sclerosis viral infections of your stomach Diagnosis Doctors diagnose gastroparesis based on your medical history, a physical exam, symptoms, and medical tests, such as tests to measure stomach emptying. Your doctor may use medical tests to look for gastroparesis complications. How do doctors diagnose gastroparesis? Doctors diagnose gastroparesis based on your medical history, a physical exam, your symptoms, and medical tests. Your doctor may also perform medical tests to look for signs of gastroparesis complications and to rule out other health problems that may be causing your symptoms.Your doctor will ask about your medical history. He or she will ask for details about your current symptoms and medicines, and current and past health problems such as diabetes, scleroderma, nervous system disorders, and hypothyroidism.Your doctor may also ask aboutthe types of medicines you are taking. Be sure to tell your doctor about all prescription medicines, over-the-counter medicines, and dietary supplements you are taking. whether you've had surgery on your esophagus, stomach, or small intestine whether you've had radiation therapy on your chest or stomach areaDuring a physical exam, your doctor willcheck your blood pressure, temperature, and heart rate check for signs of dehydration and malnutrition check your abdomen for unusual sounds, tenderness, or pain Diagnosis Doctors use lab tests, upper gastrointestinal (GI) endoscopy, imaging tests, and tests to measure how fast your stomach is emptying its contents to diagnose gastroparesis.Your doctor may use the following lab tests:Blood tests can show signs of dehydration, malnutrition, inflammation, and infection. Blood tests can also show whether your blood glucose levels are too high or too low. Urine tests can show signs of diabetes, dehydration, infection, and kidney problems.Your doctor may perform an upper GI endoscopy to look for problems in your upper digestive tract that may be causing your symptoms.Imaging tests can show problems, such as stomach blockage or intestinal obstruction, that may be causing your symptoms. Your doctor may perform the following imaging tests:upper GI series ultrasound of your abdomenYour doctor may perform one of more of the following tests to see how fast your stomach is emptying its contents.Gastric emptying scan, also called gastric emptying scintigraphy. For this test, you eat a bland meal-such as eggs or an egg substitute-that contains a small amount of radioactive material. A camera outside your body scans your abdomen to show where the radioactive material is located. By tracking the radioactive material, a health care professional can measure how fast your stomach empties after the meal. The scan usually takes about 4 hours. Gastric emptying breath test. For this test, you eat a meal that contains a substance that is absorbed in your intestines and eventually passed into your breath. After you eat the meal, a health care professional collects samples of your breath over a period of a few hours-usually about 4 hours. The test can show how fast your stomach empties after the meal by measuring the amount of the substance in your breath. Wireless motility capsule, also called a SmartPill. The SmartPill is a small electronic device that you swallow. The capsule moves through your entire digestive tract and sends information to a recorder hung around your neck or clipped to your belt. A health care professional uses the information to find out how fast or slow your stomach empties, and how fast liquid and food move through your small intestine and large intestine. The capsule will pass naturally out of your body with a bowel movement. Treatment How doctors treat gastroparesis depends on the cause, how bad your symptoms and complications are, and how well you respond to different treatments. If diabetes is causing your gastroparesis, your doctor will help you control your blood glucose levels. How do doctors treat gastroparesis? How doctors treat gastroparesis depends on the cause, how severe your symptoms and complications are, and how well you respond to different treatments. Sometimes, treating the cause may stop gastroparesis. If diabetes is causing your gastroparesis, your health care professional will work with you to help control your blood glucose levels. When the cause of your gastroparesis is not known, your doctor will provide treatments to help relieve your symptoms and treat complications.Changing your eating habits can help control gastroparesis and make sure you get the right amount of nutrients, calories, and liquids. Getting the right amount of nutrients, calories, and liquids can also treat the disorder's two main complications: malnutrition and dehydration.Your doctor may recommend that youeat foods low in fat and fiber eat five or six small, nutritious meals a day instead of two or three large meals chew your food thoroughly eat soft, well-cooked foods avoid carbonated, or fizzy, beverages avoid alcohol drink plenty of water or liquids that contain glucose and electrolytes, such as low-fat broths or clear soups naturally sweetened, low-fiber fruit and vegetable juices sports drinks oral rehydration solutions do some gentle physical activity after a meal, such as taking a walk avoid lying down for 2 hours after a meal take a multivitamin each dayIf your symptoms are moderate to severe, your doctor may recommend drinking only liquids or eating well-cooked solid foods that have been processed into very small pieces or paste in a blender.If you have gastroparesis and diabetes, you will need to control your blood glucose levels, especially hyperglycemia. Hyperglycemia may further delay the emptying of food from your stomach. Your doctor will work with you to make sure your blood glucose levels are not too high or too low and don't keep going up or down. Your doctor may recommendtaking insulin more often, or changing the type of insulin you take taking insulin after, instead of before, meals checking your blood glucose levels often after you eat, and taking insulin when you need itYour doctor will give you specific instructions for taking insulin based on your needs and the severity of your gastroparesis.Your doctor may prescribe medicines that help the muscles in the wall of your stomach work better. He or she may also prescribe medicines to control nausea and vomiting and reduce pain.Your doctor may prescribe one or more of the following medicines:Metoclopramide. This medicine increases the tightening, or contraction, of the muscles in the wall of your stomach and may improve gastric emptying. Metoclopramide may also help relieve nausea and vomiting. Domperidone. This medicine also increases the contraction of the muscles in the wall of your stomach and may improve gastric emptying. However, this medicine is available for use only under a special program administered by the U.S. Food and Drug Administration. Erythromycin. This medicine also increases stomach muscle contraction and may improve gastric emptying. Antiemetics. Antiemetics are medicines that help relieve nausea and vomiting. Prescription antiemetics include ondansetron , prochlorperazine , and promethazine. Over-the-counter antiemetics include bismuth subsalicylate and diphenhydramine . Antiemetics do not improve gastric emptying. Antidepressants. Certain antidepressants, such as mirtazapine, may help relieve nausea and vomiting. These medicines may not improve gastric emptying. Pain medicines. Pain medicines that are not narcotic pain medicines may reduce pain in your abdomen due to gastroparesis.In some cases, your doctor may recommend oral or nasal tube feeding to make sure you're getting the right amount of nutrients and calories. A health care professional will put a tube either into your mouth or nose, through your esophagus and stomach, to your small intestine. Oral and nasal tube feeding bypass your stomach and deliver a special liquid food directly into your small intestine.If you aren't getting enough nutrients and calories from other treatments, your doctor may recommend jejunostomy tube feeding. Jejunostomy feedings are a longer term method of feeding, compared to oral or nasal tube feeding.Jejunostomy tube feeding is a way to feed you through a tube placed into part of your small intestine called the jejunum. To place the tube into the jejunum, a doctor creates an opening, called a jejunostomy, in your abdominal wall that goes into your jejunum. The feeding tube bypasses your stomach and delivers a liquid food directly into your jejunum.Your doctor may recommend parenteral, or intravenous (IV), nutrition if your gastroparesis is so severe that other treatments are not helping. Parenteral nutrition delivers liquid nutrients directly into your bloodstream. Parenteral nutrition may be short term, until you can eat again. Parenteral nutrition may also be used until a tube can be placed for oral, nasal, or jejunostomy tube feeding. In some cases, parental nutrition may be long term.Your doctor may recommend a venting gastrostomy to relieve pressure inside your stomach. A doctor creates an opening, called a gastrostomy, in your abdominal wall and into your stomach. The doctor then places a tube through the gastrostomy into your stomach. Stomach contents can then flow out of the tube and relieve pressure inside your stomach.Gastric electrical stimulation (GES) uses a small, battery-powered device to send mild electrical pulses to the nerves and muscles in the lower stomach. A surgeon puts the device under the skin in your lower abdomen and attaches wires from the device to the muscles in the wall of your stomach. GES can help decrease long-term nausea and vomiting.GES is used to treat people with gastroparesis due to diabetes or unknown causes only, and only in people whose symptoms can't be controlled with medicines. Treatment Gastroparesis without a known cause, called idiopathic gastroparesis, cannot be prevented.If you have diabetes, you can prevent or delay nerve damage that can cause gastroparesis by keeping your blood glucose levels within the target range that your doctor thinks is best for you. Meal planning, physical activity, and medicines, if needed, can help you keep your blood glucose levels within your target range. Eating, Diet, and Nutrition What you eat can help relieve gastroparesis symptoms. What you eat can also help make sure you get the right amount of nutrients, calories, and liquids if you are malnourished or dehydrated due to gastroparesis. How can my diet help prevent or relieve gastroparesis? What you eat can help prevent or relieve your gastroparesis symptoms. If you have diabetes, following a healthy meal plan can help you manage your blood glucose levels. What you eat can also help make sure you get the right amount of nutrients, calories, and liquids if you are malnourished or dehydrated from gastroparesis. What should I eat and drink if I have gastroparesis? If you have gastroparesis, your doctor may recommend that you eat or drinkfoods and beverages that are low in fat foods and beverages that are low in fiber five or six small, nutritious meals a day instead of two or three large meals soft, well-cooked foodsIf you are unable to eat solid foods, your doctor may recommend that you drinkliquid nutrition meals solid foods pureed in a blenderYour doctor may also recommend that you drink plenty of water or liquids that contain glucose and electrolytes, such aslow-fat broths and clear soups low-fiber fruit and vegetable juices sports drinks oral rehydration solutionsIf your symptoms are moderate to severe, your doctor may recommend drinking only liquids or eating well-cooked solid foods that have been processed into very small pieces or paste in a blender. Eating, Diet, & Nutrition If you have gastroparesis, you should avoidfoods and beverages that are high in fat foods and beverages that are high in fiber foods that can't be chewed easily carbonated, or fizzy, beverages alcoholYour doctor may refer you to a dietitian to help you plan healthy meals that are easy for you to digest and give you the right amount of nutrients, calories, and liquids.
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Felodipine Why is this medication prescribed? Felodipine is used to treat high blood pressure. Felodipine is in a class of medications called calcium channel blockers. It works by relaxing the blood vessels so your heart does not have to pump as hard. High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation. How should this medicine be used? Felodipine comes as an extended release tablet to take by mouth. It is usually taken once a day. To help you remember to take felodipine, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take felodipine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow the tablets whole; do not split, chew, or crush them. Felodipine controls high blood pressure but does not cure it. Continue to take felodipine even if you feel well. Do not stop taking felodipine without talking to your doctor. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? <h3>Before taking felodipine,</h3> /h3> tell your doctor and pharmacist if you are allergic to felodipine, any other medications, or any ingredients in felodipine tablets. Ask your pharmacist for a list of the ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antiseizure medicines such as carbamazepine (Carbatrol, Equetro, Tegretol), phenytoin (Dilantin, Phenytek), and phenobarbital; cimetidine (Tagamet); erythromycin (E.E.S., Eryc, Ery-tab); itraconazole (Sporanox); ketoconazole (Nizoral); ranitidine (Zantac); and tacrolimus (Astagraf SL, Prograf). tell your doctor if you have or have ever had heart, liver, or kidney disease. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking felodipine, call your doctor. if you are having surgery, including dental surgery, tell your doctor or dentist that you take felodipine. What special dietary instructions should I follow? Talk to your doctor about drinking grapefruit juice or eating grapefruit while taking felodipine. Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully. What should I do if I forget a dose? Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? <h3>Felodipine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: </h3> /h3> headache flushing dizziness or lightheadedness weakness fast heartbeat heartburn constipation enlargement of gum tissue around teeth <h3>Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: </h3> /h3> swelling of the face, eyes, lips, tongue, arms, or legs difficulty breathing or swallowing fainting rash If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). What should I know about storage and disposal of this medication? Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location - one that is up and away and out of their sight and reach. http://www.upandaway.org Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. In case of emergency/overdose In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911. What other information should I know? Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to felodipine. Good dental hygiene decreases the chance and severity of gum swelling. Brush your teeth regularly and schedule dental cleanings every 6 months. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. Brand names Plendil Brand names of combination products Lexxel (containing Enalapril, Felodipine)
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COPD COPD Español Also known as chronic obstructive pulmonary disease; chronic bronchitis; or emphysema. COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe. Progressive means the disease gets worse over time. COPD can cause coughing that produces large amounts of a slimy substance called mucus, wheezing, shortness of breath, chest tightness, and other symptoms. Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. However, up to 25 percent of people with COPD never smoked. Long-term exposure to other lung irritants—such as air pollution, chemical fumes, or dusts—also may contribute to COPD. A rare genetic condition called alpha-1 antitrypsin (AAT) deficiency can also cause the disease. Overview To understand COPD, it helps to understand how the lungs work. The air that you breathe goes down your windpipe into tubes in your lungs called bronchial tubes or airways. Within the lungs, your bronchial tubes branch many times into thousands of smaller, thinner tubes called bronchioles. These tubes end in bunches of tiny round air sacs called alveoli. Small blood vessels called capillaries run along the walls of the air sacs. When air reaches the air sacs, oxygen passes through the air sac walls into the blood in the capillaries. At the same time, a waste product, called carbon dioxide (CO2) gas, moves from the capillaries into the air sacs. This process, called gas exchange, brings in oxygen for the body to use for vital functions and removes the CO2. The airways and air sacs are elastic or stretchy. When you breathe in, each air sac fills up with air, like a small balloon. When you breathe out, the air sacs deflate and the air goes out. In COPD, less air flows in and out of the airways because of one or more of the following: The airways and air sacs lose their elastic quality. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed. The airways make more mucus than usual and can become clogged. Normal Lungs and Lungs With COPD In the United States, the term COPD includes two main conditions—emphysema and chronic bronchitis. In emphysema, the walls between many of the air sacs are damaged. As a result, the air sacs lose their shape and become floppy. This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced. In chronic bronchitis, the lining of the airways stays constantly irritated and inflamed, and this causes the lining to swell. Lots of thick mucus forms in the airways, making it hard to breathe. Most people who have COPD have both emphysema and chronic bronchitis, but the severity of each condition varies from person to person. Thus, the general term COPD is more accurate. Outlook COPD is a major cause of disability, and it is the third leading cause of death in the United States. Currently, 16 million people are diagnosed with COPD. Many more people may have the disease and not even know it. COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself. Most of the time, COPD is diagnosed in middle-aged or older adults. The disease is not contagious, meaning it cannot be passed from person to person. COPD has no cure yet, and doctors do not know how to reverse the damage to the lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease. Causes Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD. In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled. Breathing in secondhand smoke, which is in the air from other people smoking; air pollution; or chemical fumes or dusts from the environment or workplace also can contribute to COPD. Rarely, a genetic condition called alpha-1 antitrypsin deficiency may play a role in causing COPD. People who have this condition have low blood levels of alpha-1 antitrypsin (AAT)—a protein made in the liver. Having a low level of the AAT protein can lead to lung damage and COPD if you are exposed to smoke or other lung irritants. If you have alpha-1 antitrypsin deficiency and also smoke, COPD can worsen very quickly. Some people who have asthma can develop COPD. Asthma is a chronic lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing that occurs in asthma. Risk Factors The main risk factor for COPD is smoking. Up to 75 percent of people who have COPD smoke or used to smoke. People who have a family history of COPD are more likely to develop the disease if they smoke. Long-term exposure to other lung irritants also is a risk factor for COPD. Examples of other lung irritants include air pollution, chemical fumes and dusts from the environment or workplace, and secondhand smoke, which is smoke in the air from other people smoking. Most people who have COPD are at least 40 years old when symptoms begin. Although uncommon, people younger than 40 can have COPD. This may occur, for example, if a person has a predisposing health issue, such as the genetic condition known as alpha-1 antitrypsin deficiency. Signs & Symptoms At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. Common signs and symptoms of COPD include: An ongoing cough or a cough that produces a lot of mucus; this is often called smoker's cough. Shortness of breath, especially with physical activity Wheezing or a whistling or squeaky sound when you breathe Chest tightness If you have COPD, you also may often have colds or other respiratory infections such as the flu, or influenza. Not everyone who has the symptoms described above has COPD. Likewise, not everyone who has COPD has these symptoms. Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can determine if you have COPD. If your symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs. Over time, symptoms may become severe enough to cause you to see a doctor. For example, you may become short of breath during physical exertion. The severity of your symptoms will depend on how much lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking. Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs; weight loss; and lower muscle endurance. Some severe symptoms may require treatment in a hospital. You—or, if you are unable, family members or friends—should seek emergency care if you are experiencing the following: You are having a hard time catching your breath or talking. Your lips or fingernails turn blue or gray, a sign of a low oxygen level in your blood. People around you notice that you are not mentally alert. Your heartbeat is very fast. The recommended treatment for symptoms that are getting worse is not working. Diagnosis Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results. Your doctor may ask whether you smoke or have had contact with lung irritants, such as secondhand smoke, air pollution, chemical fumes, or dusts. If you have an ongoing cough, let your doctor know how long you've had it, how much you cough, and how much mucus comes up when you cough. Also, let your doctor know whether you have a family history of COPD. Your doctor will examine you and use a stethoscope to listen for wheezing or other abnormal chest sounds. He or she also may recommend one or more tests to diagnose COPD. Pulmonary Function Tests Pulmonary function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. The main test for COPD is spirometry. Other lung function tests, such as a lung diffusion capacity test, also might be used. Read Pulmonary Function Tests for more information. Spirometry During this painless test, a technician will ask you to take a deep breath in. Then, you'll blow as hard as you can into a tube connected to a small machine. The machine is called a spirometer. The machine measures how much air you breathe out. It also measures how fast you can blow air out. Spirometry Your doctor may have you inhale, or breathe in, medicine that helps open your airways and then blow into the tube again. He or she can then compare your test results before and after taking the medicine. Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals. The test results also may help find out whether another condition, such as asthma or heart failure, is causing your symptoms. Other Tests Your doctor may recommend other tests, such as: A chest x ray or chest CT scan. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms. An arterial blood gas test. This blood test measures the oxygen level in your blood using a sample of blood taken from an artery. The results from this test can show how severe your COPD is and whether you need oxygen therapy. Treatment COPD has no cure yet. However, lifestyle changes and treatments can help you feel better, stay more active, and slow the progress of the disease. The goals of COPD treatment include: Relieving your symptoms Slowing the progress of the disease Improving your exercise tolerance or your ability to stay active Preventing and treating complications Improving your overall health To assist with your treatment, your family doctor may advise you to see a pulmonologist. This is a doctor who specializes in treating lung disorders. Lifestyle Changes Quit Smoking and Avoid Lung Irritants Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid secondhand smoke and places with dusts, fumes, or other toxic substances that you may inhale. For more information about how to quit smoking, read Smoking and Your Heart and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Other Lifestyle Changes If you have COPD, especially more severe forms, you may have trouble eating enough because of symptoms such as shortness of breath and fatigue. As a result, you may not get all of the calories and nutrients you need, which can worsen your symptoms and raise your risk for infections. Talk with your doctor about following an eating plan that will meet your nutritional needs. Your doctor may suggest eating smaller, more frequent meals; resting before eating; and taking vitamins or nutritional supplements. Also, talk with your doctor about what types of activity are safe for you. You may find it hard to remain active with your symptoms. However, physical activity can strengthen the muscles that help you breathe and improve your overall wellness. Medicines Bronchodilators Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier. Depending on the severity of your COPD, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators last about 4–6 hours and should be used only when needed. Long-acting bronchodilators last about 12 hours or more and are used every day. Most bronchodilators are taken using a device called an inhaler. This device allows the medicine to go straight to your lungs. Not all inhalers are used the same way. Ask your health care providers to show you the correct way to use your inhaler. If your COPD is mild, your doctor may only prescribe a short-acting inhaled bronchodilator. In this case, you may use the medicine only when symptoms occur. If your COPD is moderate or severe, your doctor may prescribe regular treatment with short- and long-acting bronchodilators. Combination Bronchodilators Plus Inhaled Glucocorticosteroids (Steroids) In general, using inhaled steroids alone is not a preferred treatment. If your COPD is more severe, or if your symptoms flare up often, your doctor may prescribe a combination of medicines that includes a bronchodilator and an inhaled steroid. Steroids help reduce airway inflammation. Your doctor may ask you to try inhaled steroids with the bronchodilator for a trial period of 6 weeks to 3 months to see whether the addition of the steroid helps relieve your breathing problems. Vaccines Flu Shots The flu, or influenza, can cause serious problems for people who have COPD. Flu shots can reduce your risk of getting the flu. Talk with your doctor about getting a yearly flu shot. Pneumococcal Vaccine This vaccine lowers your risk for pneumococcal pneumonia and its complications. People who have COPD are at higher risk for pneumonia than people who do not have COPD. Talk with your doctor about whether you should get this vaccine. Pulmonary Rehabilitation Pulmonary rehabilitation or rehab is a broad program that helps improve the well-being of people who have chronic breathing problems. Rehab may include an exercise program, disease management training, and nutritional and psychological counseling. The program's goal is to help you stay active and carry out your daily activities. Your rehab team may include doctors, nurses, physical therapists, respiratory therapists, exercise specialists, and dietitians. These health professionals will create a program that meets your needs. Oxygen Therapy If you have severe COPD and low levels of oxygen in your blood, oxygen therapy can help you breathe better. For this treatment, oxygen is delivered through nasal prongs or a mask. You may need extra oxygen all the time or only at certain times. For some people who have severe COPD, using extra oxygen for most of the day can help them: Do tasks or activities while experiencing fewer symptoms Protect their hearts and other organs from damage Sleep more during the night and improve alertness during the day Live longer Surgery Surgery may benefit some people who have COPD. Surgery usually is a last resort for people who have severe symptoms that have not improved from taking medicines. Surgeries for people who have COPD that is mainly related to emphysema include bullectomy and lung volume reduction surgery (LVRS). A lung transplant might be an option for people who have very severe COPD. Bullectomy When the walls of the air sacs are destroyed, larger air spaces called bullae form. These air spaces can become so large that they interfere with breathing. In a bullectomy, doctors remove one or more very large bullae from the lungs. Lung Volume Reduction Surgery In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In carefully selected patients, LVRS can improve breathing and quality of life. Lung Transplant During a lung transplant, doctors remove your damaged lung and replace it with a healthy lung from a donor. A lung transplant can improve your lung function and quality of life. However, lung transplants have many risks, such as infections and rejection of the transplanted lung. If you have very severe COPD, talk with your doctor about whether a lung transplant is an option. Ask your doctor about the benefits and risks of this type of surgery. Managing Complications COPD symptoms usually worsen slowly over time. However, they can worsen suddenly. For instance, a cold, flu, or lung infection may cause your symptoms to quickly worsen. You may have a much harder time catching your breath. You also may have chest tightness, more coughing, changes in the color or amount of your sputum or spit, and a fever. Call your doctor right away if your symptoms worsen suddenly. He or she may prescribe antibiotics to treat the infection, along with other medicines, such as bronchodilators and inhaled steroids, to help you breathe. Some severe symptoms may require treatment in a hospital. For more information, read Signs and Symptoms. Prevention You can take steps to prevent COPD before it starts. If you already have COPD, you can take steps to prevent complications and slow the progression of the disease. Prevent COPD Before It Starts The best way to prevent COPD is to not start smoking or to quit smoking. Smoking is the leading cause of COPD. If you smoke, talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid lung irritants that can contribute to COPD, such as air pollution, chemical fumes, dusts, and secondhand smoke, which is smoke in the air from other people smoking. For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Prevent Complications and Slow the Progression of COPD If you have COPD, the most important step you can take is to quit smoking. Quitting can help prevent complications and slow the progression of the disease. You also should avoid exposure to the lung irritants mentioned above. Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms. Talk with your doctor about whether and when you should get flu, or influenza, and pneumonia vaccines. These vaccines can lower your chances of getting these illnesses, which are major health risks for people who have COPD. Living With COPD has no cure yet. However, you can take steps to manage your symptoms and slow the progression of the disease. Avoid lung irritants. Get ongoing care. Manage the disease and its symptoms. Prepare for emergencies. Avoid Lung Irritants If you smoke, quit. Smoking is the leading cause of COPD. Talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Also, try to avoid lung irritants that can contribute to COPD, such as air pollution, chemical fumes, dusts, and secondhand smoke, which is smoke in the air from other people smoking. Keep these irritants out of your home. If you are getting your home painted or sprayed for insects, have it done when you can stay away for a while. If possible, keep your windows closed and stay at home when there is a lot of air pollution or dusts outside. Get Ongoing Care If you have COPD, it is important to get ongoing medical care. Take all your medicines as your doctor prescribes. Make sure to refill your prescriptions before they run out. Bring a list of all the medicines you are taking when you have medical checkups. Talk with your doctor about whether and when you should get flu, or influenza, and pneumonia vaccines. Also, ask him or her about other diseases for which COPD may increase your risk, such as heart disease, lung cancer, and pneumonia. Manage COPD and Its Symptoms You can do things to help manage COPD and its symptoms. For example: Do activities slowly. Put items you use often in one easy-to-reach place. Find simple ways to cook, clean, and do other chores. For example, you might want to use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things. Ask for help in making things more accessible in your house so that you won't need to climb stairs as often. Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off. Depending on how severe your disease is, you may want to ask your family and friends for help with daily tasks. Prepare for Emergencies If you have COPD, know when and where to seek help for your symptoms. You should get emergency care if you have severe symptoms, such as trouble catching your breath or talking. For more information on severe symptoms of COPD, read Signs and Symptoms. Call your doctor if you notice that your symptoms are worsening or if you have signs of an infection, such as a fever. Your doctor may change or adjust your treatments to relieve and treat symptoms. Keep phone numbers handy for your doctor, hospital, and someone who can take you for medical care. You also should have on hand directions to the doctor's office and hospital and a list of all the medicines you are taking. Emotional Issues and Support Living with COPD may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also might help. If you are depressed, your doctor may recommend medicines or other treatments that can improve your quality of life. Joining a patient support group may help you adjust to living with COPD. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center. Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you. More Information NHLBI resources Alpha-1 Antitrypsin Deficiency Asthma Breathing Better With a COPD Diagnosis (also available in Spanish) Bronchitis COPD: Are You at Risk? (also available in Spanish) Chest X Ray Chest CT Scan COPD Learn More Breathe Better® COPD National Action Plan Cough Fact Sheet: Long-Term Oxygen Treatment Trial (LOTT) Frequently Asked Questions How the Lungs Work Lung Transplant Oxygen Therapy Pneumonia Pulmonary Function Tests Pulmonary Rehabilitation Smoking and Your Heart Story of Success: COPD Your Guide to a Healthy Heart Other resources Chronic Bronchitis (National Library of Medicine [NLM] MedlinePlus) COPD (NLM MedlinePlus) Emphysema (NLM MedlinePlus) Smokefree.gov (National Cancer Institute [NCI]) Quitlines and the Expansion of Smoking Cessation Support (NCI) ____________________ ® COPD Learn More Breathe Better is a registered trademark of the U.S. Department of Health and Human Services.
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Anal fissure Overview An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter). Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery. Symptoms Signs and symptoms of an anal fissure include: - Pain, sometimes severe, during bowel movements - Pain after bowel movements that can last up to several hours - Bright red blood on the stool or toilet paper after a bowel movement - Itching or irritation around the anus - A visible crack in the skin around the anus - A small lump or skin tag on the skin near the anal fissure When to see a doctor See your doctor if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement. Causes Common causes of anal fissure include: - Passing large or hard stools - Constipation and straining during bowel movements - Chronic diarrhea - Inflammation of the anorectal area, caused by Crohn's disease or another inflammatory bowel disease - Childbirth Less common causes of anal fissures include: - Anal cancer - HIV - Tuberculosis - Syphilis - Herpes Risk factors Factors that may increase your risk of developing an anal fissure include: - Infancy. Many infants experience an anal fissure during their first year of life; experts aren't sure why. - Aging. Older adults may develop an anal fissure partly due to slowed circulation, resulting in decreased blood flow to the rectal area. - Constipation. Straining during bowel movements and passing hard stools increase the risk of tearing. - Childbirth. Anal fissures are more common in women after they give birth. - Crohn's disease. This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to tearing. - Anal intercourse. Complications Complications of anal fissure can include: - Failure to heal. An anal fissure that fails to heal within six weeks is considered chronic and may need further treatment. - Recurrence. Once you've experienced an anal fissure, you are prone to having another one. - A tear that extends to surrounding muscles. An anal fissure may extend into the ring of muscle that holds your anus closed (internal anal sphincter), making it more difficult for your anal fissure to heal. An unhealed fissure can trigger a cycle of discomfort that may require medications or surgery to reduce the pain and to repair or remove the fissure. Diagnosis If possible, your doctor will perform a digital rectal exam, which involves inserting a gloved finger into your anal canal, or use a short, lighted tube (anoscope) to inspect your anal canal. However, if this is too painful for you, your doctor may be able to diagnose an anal fissure only by observation. An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has the tear, as well as two separate lumps or tags of skin, one internal (sentinel pile) and one external (hypertrophied papilla). The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn's disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition: - Flexible sigmoidoscopy. Your doctor will insert a thin, flexible tube with a tiny video into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer. - Colonoscopy. Your doctor will insert a flexible tube into your rectum to inspect the entire colon. This test may be done if you are older than age 50 or you have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea. Treatment Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing. If your symptoms persist, you'll likely need further treatment. Nonsurgical treatments Your doctor may recommend: - Externally applied nitroglycerin (Rectiv), to help increase blood flow to the fissure and promote healing and to help relax the anal sphincter. Nitroglycerin is generally considered the medical treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe. - Topical anesthetic creams such as lidocaine hydrochloride (Xylocaine) may be helpful for pain relief. - Botulinum toxin type A (Botox) injection, to paralyze the anal sphincter muscle and relax spasms. - Blood pressure medications, such as oral nifedipine (Procardia) or diltiazem (Cardizem) can help relax the anal sphincter. These medications may be taken by mouth or applied externally and may be used when nitroglycerin is not effective or causes significant side effects. Surgery If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence. Lifestyle and home remedies Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences: - Add fiber to your diet. Eating about 25 to 30 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually. - Drink adequate fluids. Fluids help prevent constipation. - Exercise regularly. Engage in 30 minutes or more of moderate physical activity, such as walking, most days of the week. Exercise promotes regular bowel movements and increases blood flow to all parts of your body, which may promote healing of an anal fissure. - Avoid straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear. If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently and discuss the problem with your child's doctor.
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Bulimia nervosa Overview Bulimia nervosa, often called bulimia, is a type of eating disorder. People with bulimia eat large amounts of food at one time, then try to get rid of the food or weight gain by throwing up, taking laxatives, fasting (not eating anything), or exercising a lot more than normal. Bulimia affects more girls and women than boys and men. Bulimia is a serious health problem, but people with bulimia can get better with treatment. What is bulimia? Bulimia nervosa, often called bulimia, is a type of eating disorder. Eating disorders are mental health problems that cause extreme and dangerous eating behaviors. These extreme eating behaviors cause other serious health problems and sometimes death. Some eating disorders also involve extreme exercise. Women with bulimia eat a lot of food in a short amount of time and feel a lack of control over eating during this time (called binging). People with bulimia then try to prevent weight gain by getting rid of the food (called purging). Purging may be done by: Women with bulimia may also try to prevent weight gain after binging by exercising a lot more than normal, eating very little or not at all (fasting), or taking pills to urinate often. Women with bulimia usually have self-esteem that is closely linked to their body image. What is the difference between bulimia and other eating disorders? Women with eating disorders, such as bulimia, anorexia, and binge eating disorder, have a mental health condition that affects how they eat, and sometimes how they exercise. These eating disorders threaten their health. Unlike women with anorexia, women with bulimia often have a normal weight. Unlike women with binge eating disorder, women with bulimia purge, or try to get rid of the food or weight after binging. Binging and purging are usually done in private. This can make it difficult to tell if a loved one has bulimia or another eating disorder. It is possible to have more than one eating disorder in your lifetime. Regardless of what type of eating disorder you may have, you can get better with treatment. Who is at risk for bulimia? Bulimia affects more women than men. It affects up to 2% of women1 and happens to women of all races and ethnicities.2 Bulimia affects more girls and younger women than older women. On average, women develop bulimia at 18 or 19.3 Teen girls between 15 and 19 and young women in their early 20s are most at risk. But eating disorders are happening more often in older women. In one recent study, 13% of American women over 50 had signs of an eating disorder.4 What are the symptoms of bulimia? Someone with bulimia may be thin, overweight, or have a normal weight. It can be difficult to tell based on a person's weight whether someone has bulimia. This is because binging and purging is most often done in private. However, family or friends may see empty food wrappers in unexpected places or vomit in the home. Over time, some symptoms of bulimia may include:5 Girls or women with bulimia may also have behavior changes such as: People with bulimia often have other mental health problems, including depression, anxiety, or substance abuse.6 What causes bulimia? Researchers are not sure exactly what causes bulimia and other eating disorders. Researchers think that eating disorders might happen because of a combination of a person's biology and life events. This combination includes having specific genes, a person's biology, body image and self-esteem, social experiences, family health history, and sometimes other mental health illnesses. Researchers are also studying unusual activity in the brain, such as changing levels of serotonin or other chemicals, to see how it may affect eating. Learn more about current research on bulimia. How does bulimia affect a woman's health? Purging through vomiting or taking laxatives can prevent your body from getting the important nutrients it needs from food. Over time, bulimia can affect your body in the following ways:5,7,8 Long-term studies of 20 years or more show that women who had an eating disorder in the past usually reach and maintain a healthy weight after treatment.9 How is bulimia diagnosed? Your doctor or nurse will ask you questions about your symptoms and medical history. It may be difficult to talk to a doctor or nurse about secret eating, purging, or exercise behaviors. But doctors and nurses want to help you get better. Being honest about your eating behaviors with a doctor or nurse is a good way to ask for help. Your doctor may do blood or urine tests to rule out other possible causes of your symptoms. Your doctor may also do other tests to see whether you have any other health problems caused by bulimia. These tests may include kidney function tests or an electrocardiogram (ECG or EKG) to see if or how repeated binging and purging has affected your health. How is bulimia treated? Your doctor may refer you to a team of doctors, nutritionists, and therapists who will work to help you get better. Treatment plans may include one or more of the following:6 Most girls and women do get better with treatment and are able to eat and exercise in healthy ways again.12 Some may get better after the first treatment. Others get well but may relapse and need treatment again. How does bulimia affect pregnancy? Bulimia can cause problems getting pregnant and during pregnancy. Repeated purging and binging can make your menstrual cycle irregular (your period comes some months but not others) or your period may stop for several months. Irregular or missing periods mean you may not ovulate, or release an egg from the ovary, every month. This can make it difficult to get pregnant.13 However, if you do not want to have children right now and you have sex, you should use birth control. Bulimia can also cause problems during pregnancy. Bulimia raises your risk for: If I had an eating disorder in the past, can I still get pregnant? Women who have recovered from bulimia and have normal menstrual cycles have a better chance of getting pregnant and having a safe and healthy pregnancy. If you had an eating disorder in the past, it may take you a little longer to get pregnant (about six months to a year) compared to women who never had an eating disorder.17 Tell your doctor if you had an eating disorder in the past and are trying to become pregnant. If I take medicine to treat bulimia, can I breastfeed my baby? Maybe. Some medicines used to treat bulimia can pass through breastmilk. Certain antidepressants can be used safely during breastfeeding. Talk to your doctor to find out what medicine works best for you. Learn more about medicines and breastfeeding in our Breastfeeding section. You can also enter a medicine into the LactMed database to find out if the medicine passes through breastmilk and any about possible side effects for your nursing baby. Did we answer your question about bulimia? For more information about bulimia, call the OWH Helpline at 1-800-994-9662 or contact the following organizations: Sources
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Obsessive-compulsive disorder (OCD) Overview Obsessive-compulsive disorder (OCD) features a pattern of unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress. You may try to ignore or stop your obsessions, but that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts to try to ease your stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior - the vicious cycle of OCD. OCD often centers around certain themes - for example, a fear of getting contaminated by germs. To ease your contamination fears, you may compulsively wash your hands until they're sore and chapped. If you have OCD, you may be ashamed and embarrassed about the condition, but treatment can be effective. Symptoms Obsessive-compulsive disorder usually includes both obsessions and compulsions. But it's also possible to have only obsession symptoms or only compulsion symptoms. You may or may not realize that your obsessions and compulsions are excessive or unreasonable, but they take up a great deal of time and interfere with your daily routine and social or work functioning. OCD obsessions are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by performing a compulsive behavior or ritual. These obsessions typically intrude when you're trying to think of or do other things. Obsessions often have themes to them, such as: - Fear of contamination or dirt - Needing things orderly and symmetrical - Aggressive or horrific thoughts about harming yourself or others - Unwanted thoughts, including aggression, or sexual or religious subjects Examples of obsession signs and symptoms include: - Fear of being contaminated by touching objects others have touched - Doubts that you've locked the door or turned off the stove - Intense stress when objects aren't orderly or facing a certain way - Images of hurting yourself or someone else that are unwanted and make you uncomfortable - Thoughts about shouting obscenities or acting inappropriately that are unwanted and make you uncomfortable - Avoidance of situations that can trigger obsessions, such as shaking hands - Distress about unpleasant sexual images repeating in your mind OCD compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors or mental acts are meant to prevent or reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety. You may make up rules or rituals to follow that help control your anxiety when you're having obsessive thoughts. These compulsions are excessive and often are not realistically related to the problem they're intended to fix. As with obsessions, compulsions typically have themes, such as: - Washing and cleaning - Checking - Counting - Orderliness - Following a strict routine - Demanding reassurances Examples of compulsion signs and symptoms include: - Hand-washing until your skin becomes raw - Checking doors repeatedly to make sure they're locked - Checking the stove repeatedly to make sure it's off - Counting in certain patterns - Silently repeating a prayer, word or phrase - Arranging your canned goods to face the same way OCD usually begins in the teen or young adult years. Symptoms usually begin gradually and tend to vary in severity throughout life. Symptoms generally worsen when you experience greater stress. OCD, usually considered a lifelong disorder, can have mild to moderate symptoms or be so severe and time-consuming that it becomes disabling. There's a difference between being a perfectionist - someone who requires flawless results or performance, for example - and having OCD. OCD thoughts aren't simply excessive worries about real problems in your life or liking to have things clean or arranged in a specific way. If your obsessions and compulsions are affecting your quality of life, see your doctor or mental health professional. Causes The cause of obsessive-compulsive disorder isn't fully understood. Main theories include: - Biology. OCD may be a result of changes in your body's own natural chemistry or brain functions. - Genetics. OCD may have a genetic component, but specific genes have yet to be identified. - Environment. Some environmental factors such as infections are suggested as a trigger for OCD, but more research is needed. Risk factors Factors that may increase the risk of developing or triggering obsessive-compulsive disorder include: - Family history. Having parents or other family members with the disorder can increase your risk of developing OCD. - Stressful life events. If you've experienced traumatic or stressful events, your risk may increase. This reaction may, for some reason, trigger the intrusive thoughts, rituals and emotional distress characteristic of OCD. - Other mental health disorders. OCD may be related to other mental health disorders, such as anxiety disorders, depression, substance abuse or tic disorders. Complications Problems resulting from OCD may include, among others: - Health issues, such as contact dermatitis from frequent hand-washing - Inability to attend work, school or social activities - Troubled relationships - Overall poor quality of life - Suicidal thoughts and behavior Diagnosis Steps to help diagnose OCD may include: - Physical exam. This may be done to help rule out other problems that could be causing your symptoms and to check for any related complications. - Lab tests. These may include, for example, a complete blood count (CBC), a check of your thyroid function, and screening for alcohol and drugs. - Psychological evaluation. This includes discussing your thoughts, feelings, symptoms and behavior patterns. With your permission, this may include talking to your family or friends. - Diagnostic criteria for OCD. Your doctor may use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Diagnostic challenges It's sometimes difficult to diagnose OCD because symptoms can be similar to those of obsessive-compulsive personality disorder, anxiety disorders, depression, schizophrenia or other mental health disorders. And it's possible to have both OCD and another mental disorder. Work with your doctor so that you can get the appropriate diagnosis and treatment. Treatment Obsessive-compulsive disorder treatment may not result in a cure, but it can help bring symptoms under control so that they don't rule your daily life. Some people need treatment for the rest of their lives. The two main treatments for OCD are psychotherapy and medications. Often, treatment is most effective with a combination of these. Psychotherapy Cognitive behavioral therapy (CBT), a type of psychotherapy, is effective for many people with OCD. Exposure and response prevention (ERP), a type of CBT therapy, involves gradually exposing you to a feared object or obsession, such as dirt, and having you learn healthy ways to cope with your anxiety. ERP takes effort and practice, but you may enjoy a better quality of life once you learn to manage your obsessions and compulsions. Therapy may take place in individual, family or group sessions. Medications Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first. Antidepressants approved by the Food and Drug Administration (FDA) to treat OCD include: - Clomipramine (Anafranil) for adults and children 10 years and older - Fluoxetine (Prozac) for adults and children 7 years and older - Fluvoxamine for adults and children 8 years and older - Paroxetine (Paxil, Pexeva) for adults only - Sertraline (Zoloft) for adults and children 6 years and older However, your doctor may prescribe other antidepressants and psychiatric medications. Medications: What to consider Here are some issues to discuss with your doctor about medications for OCD: - Choosing a medication. In general, the goal is to effectively control symptoms at the lowest possible dosage. It's not unusual to try several drugs before finding one that works well. Your doctor might recommend more than one medication to effectively manage your symptoms. It can take weeks to months after starting a medication to notice an improvement in symptoms. - Side effects. All psychiatric medications have potential side effects. Talk to your doctor about possible side effects and about any health monitoring needed while taking psychiatric drugs. And let your doctor know if you experience troubling side effects. - Suicide risk. Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. If suicidal thoughts occur, immediately contact your doctor or get emergency help. Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood. - Interactions with other substances. When taking an antidepressant, tell your doctor about any other prescription or over-the-counter medications, herbs or other supplements you take. Some antidepressants can cause dangerous reactions when combined with certain medications or herbal supplements. - Stopping antidepressants. Antidepressants aren't considered addictive, but sometimes physical dependence (which is different from addiction) can occur. So stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, sometimes called discontinuation syndrome. Don't stop taking your medication without talking to your doctor, even if you're feeling better - you may have a relapse of OCD symptoms. Work with your doctor to gradually and safely decrease your dose. Talk to your doctor about the risks and benefits of using specific medications. Other treatment Sometimes, medications and psychotherapy aren't effective enough to control OCD symptoms. Research continues on the potential effectiveness of deep brain stimulation (DBS) for treating OCD that doesn't respond to traditional treatment approaches. Because DBS hasn't been thoroughly tested for use in treating OCD, make sure you understand all the pros and cons and possible health risks. Lifestyle and home remedies Obsessive-compulsive disorder is a chronic condition, which means it may always be part of your life. While OCD warrants treatment by a professional, you can do some things for yourself to build on your treatment plan: - Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, OCD symptoms are likely to return. - Pay attention to warning signs. You and your doctor may have identified issues that can trigger your OCD symptoms. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. - Check first before taking other medications. Contact the doctor who's treating you for OCD before you take medications prescribed by another doctor or before taking any over-the-counter medications, vitamins, herbal remedies or other supplements to avoid possible interactions. - Practice what you learn. Work with your mental health professional to identify techniques and skills that help manage symptoms, and practice these regularly.
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Chickenpox Varicella Chicken pox Summary Chickenpox is a viral infection in which a person develops very itchy blisters all over the body. It was more common in the past. The illness is rare today because of the chickenpox vaccine. Causes Chickenpox is caused by the varicella-zoster virus. It is a member of the herpesvirus family. The same virus also causes shingles in adults. Chickenpox can be spread very easily to others from 1 to 2 days before blisters appear until all the blisters have crusted over. You may get chickenpox: From touching the fluids from a chickenpox blister If someone with the disease coughs or sneezes near you Most cases of chickenpox occur in children younger than age 10. The disease is most often mild, although serious complications may occur. Adults and older children get sicker than younger children in most cases. Children whose mothers have had chickenpox or have received the chickenpox vaccine are not very likely to catch it before they are 1 year old. If they do catch chickenpox, they often have mild cases. This is because antibodies from their mothers' blood help protect them. Children under 1 year old whose mothers have not had chickenpox or the vaccine can get severe chickenpox. Severe chickenpox symptoms are more common in children whose immune system does not work well. Symptoms Most children with chickenpox have the following symptoms before the rash appears: Fever Headache Stomach ache The chickenpox rash occurs about 10 to 21 days after coming into contact with someone who had the disease. In most cases, a child will develop 250 to 500 small, itchy, fluid-filled blisters over red spots on the skin. The blisters are most often first seen on the face, middle of the body, or scalp. After a day or two, the blisters become cloudy and then scab. Meanwhile, new blisters form in groups. They often appear in the mouth, in the vagina, and on the eyelids. Children with skin problems, such as eczema, may get thousands of blisters. Most pox will not leave scars unless they become infected with bacteria from scratching. Some children who have had the vaccine will still develop a mild case of chickenpox. In most cases, they recover much more quickly and have only a few poxes (fewer than 30). These cases are often harder to diagnose. However, these children can still spread chickenpox to others. Exams and Tests Your health care provider can most often diagnose chickenpox by looking at the rash and asking questions about the person's medical history. Small blisters on the scalp confirm the diagnosis in most cases. Lab tests can help confirm the diagnosis, if needed. Treatment Treatment involves keeping the person as comfortable as possible. Here are things to try: Avoid scratching or rubbing the itchy areas. Keep fingernails short to avoid damaging the skin from scratching. Wear cool, light, loose bedclothes. Avoid wearing rough clothing, particularly wool, over an itchy area. Take lukewarm baths using little soap and rinse thoroughly. Try a skin-soothing oatmeal or cornstarch bath. Apply a soothing moisturizer after bathing to soften and cool the skin. Avoid prolonged exposure to excessive heat and humidity. Try over-the-counter oral antihistamines such as diphenhydramine (Benadryl), but be aware of possible side effects, such as drowsiness. Try over-the-counter hydrocortisone cream on itchy areas. Medicines that fight the chickenpox virus are available, but not given to everyone. To work well, the medicine should be started within the first 24 hours of the rash. Antiviral drugs are not very often prescribed to otherwise healthy children who do not have severe symptoms. Adults and teens, who are at risk for more severe symptoms, may benefit from antiviral medicine if it is given early. Antiviral medicine may be very important for those who have skin conditions (such as eczema or recent sunburn), lung conditions (such as asthma), or who have recently taken steroids. Some providers also give antiviral medicines to people in the same household who also develop chickenpox, because they will most often develop more severe symptoms. DO NOT give aspirin or ibuprofen to someone who may have chickenpox. Use of aspirin has been associated with a serious condition called Reye syndrome. Ibuprofen has been associated with more severe secondary infections. Acetaminophen (Tylenol) may be used. A child with chickenpox should not return to school or play with other children until all chickenpox sores have crusted over or dried out. Adults should follow this same rule while considering when to return to work or be around others. Outlook (Prognosis) In most cases, a person recovers without complications. Once you have had chickenpox, the virus often remains dormant or asleep in your body for your lifetime. About 1 in 10 adults will have shingles when the virus re-emerges during a period of stress. Possible Complications Rarely, infection of the brain has occurred. Other problems may include: Reye syndrome Infection of the heart muscle Pneumonia Joint pain or swelling Cerebellar ataxia may appear during the recovery phase or later. This involves a very unsteady walk. Women who get chickenpox during pregnancy can pass the infection to the developing baby. Newborns are at risk for severe infection. When to Contact a Medical Professional Call your provider if you think that your child has chickenpox or if your child is over 12 months of age and has not been vaccinated against chickenpox. Prevention Because chickenpox is airborne and spreads very easily even before the rash appears, it is hard to avoid. A vaccine to prevent chickenpox is part of a child's routine vaccine schedule. The vaccine often prevents the chickenpox disease completely or makes the illness very mild. Talk to your provider if you think your child might be at high risk for complications and might have been exposed. Taking preventive steps right away may be important. Giving the vaccine early after exposure may still reduce the severity of the disease. Review Date 9/5/2017 Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Gastritis What is gastritis? Gastritis is a condition in which the stomach lining-known as the mucosa-is inflamed, or swollen. The stomach lining contains glands that produce stomach acid and an enzyme called pepsin. The stomach acid breaks down food and pepsin digests protein. A thick layer of mucus coats the stomach lining and helps prevent the acidic digestive juice from dissolving the stomach tissue. When the stomach lining is inflamed, it produces less acid and fewer enzymes. However, the stomach lining also produces less mucus and other substances that normally protect the stomach lining from acidic digestive juice.Gastritis may be acute or chronic:Acute gastritis starts suddenly and lasts for a short time. Chronic gastritis is long lasting. If chronic gastritis is not treated, it may last for years or even a lifetime.Gastritis can be erosive or nonerosive:Erosive gastritis can cause the stomach lining to wear away, causing erosions-shallow breaks in the stomach lining-or ulcers-deep sores in the stomach lining. Nonerosive gastritis causes inflammation in the stomach lining; however, erosions or ulcers do not accompany nonerosive gastritis.A health care provider may refer a person with gastritis to a gastroenterologist-a doctor who specializes in digestive diseases. What causes gastritis? Common causes of gastritis includeHelicobacter pylori (H. pylori) infection damage to the stomach lining, which leads to reactive gastritis an autoimmune responseH. pylori infection. H. pylori is a type of bacteria-organisms that may cause an infection. H. pylori infectioncauses most cases of gastritis typically causes nonerosive gastritis may cause acute or chronic gastritisH. pylori infection is common, particularly in developing countries, and the infection often begins in childhood. Many people who are infected with H. pylori never have any symptoms. Adults are more likely to show symptoms when symptoms do occur.Researchers are not sure how the H. pylori infection spreads, although they think contaminated food, water, or eating utensils may transmit the bacteria. Some infected people have H. pylori in their saliva, which suggests that infection can spread through direct contact with saliva or other body fluids.Damage to the stomach lining, which leads to reactive gastritis. Some people who have damage to the stomach lining can develop reactive gastritis.Reactive gastritismay be acute or chronic may cause erosions may cause little or no inflammationReactive gastritis may also be called reactive gastropathy when it causes little or no inflammation.The causes of reactive gastritis may includenonsteroidal anti-inflammatory drugs (NSAIDs), a type of over-the-counter medication. Aspirin and ibuprofen are common types of NSAIDs. drinking alcohol. using cocaine. exposure to radiation or having radiation treatments. reflux of bile from the small intestine into the stomach. Bile reflux may occur in people who have had part of their stomach removed. a reaction to stress caused by traumatic injuries, critical illness, severe burns, and major surgery. This type of reactive gastritis is called stress gastritis.An autoimmune response. In autoimmune gastritis, the immune system attacks healthy cells in the stomach lining. The immune system normally protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. Autoimmune gastritis is chronic and typically nonerosive.Less common causes of gastritis may includeCrohn's disease, which causes inflammation and irritation of any part of the gastrointestinal (GI) tract. sarcoidosis, a disease that causes inflammation that will not go away. The chronic inflammation causes tiny clumps of abnormal tissue to form in various organs in the body. The disease typically starts in the lungs, skin, and lymph nodes. allergies to food, such as cow's milk and soy, especially in children. infections with viruses, parasites, fungi, and bacteria other than H. pylori, typically in people with weakened immune systems. What are the signs and symptoms of gastritis? Some people who have gastritis have pain or discomfort in the upper part of the abdomen-the area between the chest and hips. However, many people with gastritis do not have any signs and symptoms. The relationship between gastritis and a person's symptoms is not clear. The term "gastritis" is sometimes mistakenly used to describe any symptoms of pain or discomfort in the upper abdomen.When symptoms are present, they may includeupper abdominal discomfort or pain nausea vomitingSeek Help for Symptoms of Bleeding in the Stomach Erosive gastritis may cause ulcers or erosions in the stomach lining that can bleed. Signs and symptoms of bleeding in the stomach include shortness of breath dizziness or feeling faint red blood in vomit black, tarry stools red blood in the stool weakness paleness A person with any signs or symptoms of bleeding in the stomach should call or see a health care provider right away. What are the complications of chronic and acute gastritis? The complications of chronic gastritis may includepeptic ulcers. Peptic ulcers are sores involving the lining of the stomach or duodenum, the first part of the small intestine. NSAID use and H. pylori gastritis increase the chance of developing peptic ulcers. atrophic gastritis. Atrophic gastritis happens when chronic inflammation of the stomach lining causes the loss of the stomach lining and glands. Chronic gastritis can progress to atrophic gastritis. anemia. Erosive gastritis can cause chronic bleeding in the stomach, and the blood loss can lead to anemia. Anemia is a condition in which red blood cells are fewer or smaller than normal, which prevents the body's cells from getting enough oxygen. Red blood cells contain hemoglobin, an iron-rich protein that gives blood its red color and enables the red blood cells to transport oxygen from the lungs to the tissues of the body. Research suggests that H. pylori gastritis and autoimmune atrophic gastritis can interfere with the body's ability to absorb iron from food, which may also cause anemia. vitamin B12 deficiency and pernicious anemia. People with autoimmune atrophic gastritis do not produce enough intrinsic factor. Intrinsic factor is a protein made in the stomach and helps the intestines absorb vitamin B12. The body needs vitamin B12 to make red blood cells and nerve cells. Poor absorption of vitamin B12 may lead to a type of anemia called pernicious anemia. growths in the stomach lining. Chronic gastritis increases the chance of developing benign, or noncancerous, and malignant, or cancerous, growths in the stomach lining. Chronic H. pylori gastritis increases the chance of developing a type of cancer called gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Read more about MALT lymphoma and gastric cancer at www.cancer.gov.In most cases, acute gastritis does not lead to complications. In rare cases, acute stress gastritis can cause severe bleeding that can be life threatening. How is gastritis diagnosed? A health care provider diagnoses gastritis based on the following:medical history physical exam upper GI endoscopy other testsMedical HistoryTaking a medical history may help the health care provider diagnose gastritis. He or she will ask the patient to provide a medical history. The history may include questions about chronic symptoms and travel to developing countries.Physical ExamA physical exam may help diagnose gastritis. During a physical exam, a health care provider usuallyexamines a patient's body uses a stethoscope to listen to sounds in the abdomen taps on the abdomen checking for tenderness or painUpper Gastrointestinal EndoscopyUpper GI endoscopy is a procedure that uses an endoscope-a small, flexible camera with a light-to see the upper GI tract. A health care provider performs the test at a hospital or an outpatient center. The health care provider carefully feeds the endoscope down the esophagus and into the stomach and duodenum. The small camera built into the endoscope transmits a video image to a monitor, allowing close examination of the GI lining. A health care provider may give a patient a liquid anesthetic to gargle or may spray anesthetic on the back of the patient's throat before inserting the endoscope. A health care provider will place an intravenous (IV) needle in a vein in the arm to administer sedation. Sedatives help patients stay relaxed and comfortable. The test may show signs of inflammation or erosions in the stomach lining.The health care provider can use tiny tools passed through the endoscope to perform biopsies. A biopsy is a procedure that involves taking a piece of tissue for examination with a microscope by a pathologist-a doctor who specializes in examining tissues to diagnose diseases. A health care provider may use the biopsy to diagnose gastritis, find the cause of gastritis, and find out if chronic gastritis has progressed to atrophic gastritis.Other TestsA health care provider may have a patient complete other tests to identify the cause of gastritis or any complications. These tests may include the following:Upper GI series. Upper GI series is an x-ray exam that provides a look at the shape of the upper GI tract. An x-ray technician performs this test at a hospital or an outpatient center, and a radiologist-a doctor who specializes in medical imaging-interprets the images. This test does not require anesthesia. A patient should not eat or drink before the procedure, as directed by the health care provider. Patients should check with their health care provider about what to do to prepare for an upper GI series. During the procedure, the patient will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the esophagus, stomach, and small intestine so the radiologist and health care provider can see these organs' shapes more clearly on x-rays. A patient may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract may cause white or light-colored stools. A health care provider will give the patient specific instructions about eating and drinking after the test. Blood tests. A health care provider may use blood tests to check for anemia or H. pylori. A health care provider draws a blood sample during an office visit or at a commercial facility and sends the sample to a lab for analysis. Stool test. A health care provider may use a stool test to check for blood in the stool, another sign of bleeding in the stomach, and for H. pylori infection. A stool test is an analysis of a sample of stool. The health care provider will give the patient a container for catching and storing the stool. The patient returns the sample to the health care provider or a commercial facility that will send the sample to a lab for analysis. Urea breath test. A health care provider may use a urea breath test to check for H. pylori infection. The patient swallows a capsule, liquid, or pudding that contains urea-a waste product the body produces as it breaks down protein. The urea is "labeled" with a special carbon atom. If H. pylori are present, the bacteria will convert the urea into carbon dioxide. After a few minutes, the patient breathes into a container, exhaling carbon dioxide. A nurse or technician will perform this test at a health care provider's office or a commercial facility and send the samples to a lab. If the test detects the labeled carbon atoms in the exhaled breath, the health care provider will confirm an H. pylori infection in the GI tract. How is gastritis treated? Health care providers treat gastritis with medications toreduce the amount of acid in the stomach treat the underlying causeReduce the Amount of Acid in the StomachThe stomach lining of a person with gastritis may have less protection from acidic digestive juice. Reducing acid can promote healing of the stomach lining. Medications that reduce acid includeantacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan. Many brands use different combinations of three basic salts-magnesium, aluminum, and calcium-along with hydroxide or bicarbonate ions to neutralize stomach acid. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt can cause constipation. Magnesium and aluminum salts are often combined in a single product to balance these effects. Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can cause constipation. H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75). H2 blockers decrease acid production. They are available in both over-the-counter and prescription strengths. proton pump inhibitors (PPIs) include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), dexlansoprazole (Dexilant), pantoprazole (Protonix), rabeprazole (AcipHex), and esomeprazole (Nexium). PPIs decrease acid production more effectively than H2 blockers. All of these medications are available by prescription. Omeprazole and lansoprazole are also available in over-the-counter strength.Treat the Underlying CauseDepending on the cause of gastritis, a health care provider may recommend additional treatments.Treating H. pylori infection with antibiotics is important, even if a person does not have symptoms from the infection. Curing the infection often cures the gastritis and decreases the chance of developing complications, such as peptic ulcer disease, MALT lymphoma, and gastric cancer. Avoiding the cause of reactive gastritis can provide some people with a cure. For example, if prolonged NSAID use is the cause of the gastritis, a health care provider may advise the patient to stop taking the NSAIDs, reduce the dose, or change pain medications. Health care providers may prescribe medications to prevent or treat stress gastritis in a patient who is critically ill or injured. Medications to protect the stomach lining include sucralfate (Carafate), H2 blockers, and PPIs. Treating the underlying illness or injury most often cures stress gastritis. Health care providers may treat people with pernicious anemia due to autoimmune atrophic gastritis with vitamin B12 injections. How can gastritis be prevented? People may be able to reduce their chances of getting gastritis by preventing H. pylori infection. No one knows for sure how H. pylori infection spreads, so prevention is difficult. To help prevent infection, health care providers advise people towash their hands with soap and water after using the bathroom and before eating eat food that has been washed well and cooked properly drink water from a clean, safe source Eating, Diet, and Nutrition Researchers have not found that eating, diet, and nutrition play a major role in causing or preventing gastritis. Gastritis The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.What are clinical trials, and are they right for you?Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.What clinical trials are open?Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.
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Nicotine dependence: Nicotine dependence -- also called tobacco dependence -- is an addiction to tobacco products caused by the drug nicotine. Nicotine dependence means you can't stop using the substance, even though it's causing you harm. Nicotine produces physical and mood-altering effects in your brain that are temporarily pleasing. These effects make you want to use tobacco and lead to dependence. At the same time, stopping tobacco use causes withdrawal symptoms, including irritability and anxiety. While it's the nicotine in tobacco that causes nicotine dependence, the toxic effects of tobacco result from other substances in tobacco. Smokers have much higher rates of heart disease, stroke and cancer than nonsmokers do. Regardless of how long you've smoked, stopping smoking can improve your health. Many effective treatments for nicotine dependence are available to help you manage withdrawal and stop smoking for good. Ask your doctor for help. For some people, using any amount of tobacco can quickly lead to nicotine dependence. Signs that you may be addicted include: - You can't stop smoking. You've made one or more serious, but unsuccessful, attempts to stop. - You experience withdrawal symptoms when you try to stop. Your attempts at stopping have caused physical and mood-related symptoms, such as strong cravings, anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration, anger, increased hunger, insomnia, constipation or diarrhea. - You keep smoking despite health problems. Even though you've developed health problems with your lungs or your heart, you haven't been able to stop. - You give up social or recreational activities in order to smoke. You may stop going to smoke-free restaurants or stop socializing with certain family members or friends because you can't smoke in these locations or situations. You're not alone if you've tried to stop smoking but haven't been able to stop for good. Most smokers make many attempts to stop smoking before they achieve stable, long-term abstinence from smoking. You're more likely to stop for good if you follow a treatment plan that addresses both the physical and the behavioral aspects of nicotine dependence. Using medications and working with a counselor specially trained to help people stop smoking (a tobacco treatment specialist) will significantly boost your chances of success. Ask your doctor, counselor or therapist to help you develop a treatment plan that works for you or to advise you on where to get help to stop smoking. Nicotine is the chemical in tobacco that keeps you smoking. Nicotine is very addictive when delivered by inhaling tobacco smoke into the lungs, which quickly releases nicotine into the blood allowing it to get into the brain within seconds of taking a puff. In the brain nicotine increases the release of brain chemicals called neurotransmitters, which help regulate mood and behavior. Dopamine, one of these neurotransmitters, is released in the "reward center" of the brain and causes improved mood and feelings of pleasure. Experiencing these effects from nicotine is what makes tobacco so addictive. Nicotine dependence involves behavioral (routines, habits, feelings) as well as physical factors. These behavioral associations with smoking may act as triggers - situations or feelings that activate a craving for tobacco, even if you have not smoked for some time. Behaviors and cues that you may associate with smoking include: - Certain times of the day, such as first thing in the morning, with morning coffee or during breaks at work - After a meal - Drinking alcohol - Certain places or friends - Talking on the phone - Stressful situations or when you're feeling down - Sight or smell of a burning cigarette - Driving your car To overcome your dependence on tobacco, you need to become aware of your triggers and develop a plan to deal with the behaviors and routines that you associate with smoking. Anyone who smokes or uses other forms of tobacco is at risk of becoming dependent. Factors that influence who will use tobacco include: - Genetics. The likelihood that you will start smoking and keep smoking may be partly inherited - genetic factors may influence how receptors on the surface of your brain's nerve cells respond to high doses of nicotine delivered by cigarettes. - Home and peer influence. Children who grow up with parents who smoke are more likely to become smokers. Children with friends who smoke also are more likely to try cigarettes. Evidence suggests that smoking shown in movies and on the Internet can encourage young people to smoke. - Age. Most people begin smoking during childhood or the teen years. The younger you are when you begin smoking, the greater the chance that you'll become a heavy smoker as an adult. - Depression or other mental illness. Many studies show an association between depression and smoking. People who have depression, schizophrenia, post-traumatic stress disorder (PTSD) or other forms of mental illness are more likely to be smokers. - Substance use. People who abuse alcohol and illegal drugs are more likely to be smokers. Tobacco smoke contains more than 60 known cancer-causing chemicals and thousands of other harmful substances. Even "all natural" or herbal cigarettes have chemicals that are harmful to your health. Smoking harms almost every organ of your body and impairs your body's immune system. About half of all regular smokers will die of a disease caused by tobacco. Women smokers are now at equal risk to men smokers of dying from lung cancer, COPD and cardiovascular disease caused by using tobacco. The negative health effects include: - Lung cancer and other lung diseases. Smoking causes nearly 9 out of 10 lung cancer cases. In addition, smoking causes other lung diseases, such as emphysema and chronic bronchitis. Smoking also makes asthma worse. - Other cancers. Smoking is a major cause of cancers of the esophagus, larynx, throat (pharynx) and mouth and is related to cancers of the bladder, pancreas, kidney and cervix, and some leukemias. Overall, smoking causes 30 percent of all cancer deaths. - Heart and circulatory system problems. Smoking increases your risk of dying of heart and blood vessel (cardiovascular) disease, including heart attack and stroke. Even smoking just one to four cigarettes daily increases your risk of heart disease. If you have heart or blood vessel disease, such as heart failure, smoking worsens your condition. However, stopping smoking reduces your risk of having a heart attack by 50 percent in the first year. - Diabetes. Smoking increases insulin resistance, which can set the stage for the development of type 2 diabetes. If you have diabetes, smoking can speed the progress of complications, such as kidney disease and eye problems. - Eye problems. Smoking can increase your risk of serious eye problems such as cataracts and loss of eyesight from macular degeneration. - Infertility and impotence. Smoking increases the risk of reduced fertility in women and the risk of impotence in men. - Pregnancy and newborn complications. Mothers who smoke while pregnant face a higher risk of miscarriage, preterm delivery, lower birth weight and sudden infant death syndrome (SIDS) in their newborns. - Cold, flu and other illnesses. Smokers are more prone to respiratory infections, such as colds, flu and bronchitis. - Weakened senses. Smoking deadens your senses of taste and smell, so food isn't as appetizing. - Teeth and gum disease. Smoking is associated with an increased risk of developing inflammation of the gum (gingivitis) and a serious gum infection that can destroy the support system for teeth (periodontitis). - Physical appearance. The chemicals in tobacco smoke can change the structure of your skin, causing premature aging and wrinkles. Smoking also yellows your teeth, fingers and fingernails. - Risks to your family. Nonsmoking spouses and partners of smokers have a higher risk of lung cancer and heart disease compared with people who don't live with a smoker. If you smoke, your children will be more prone to SIDS, worsening asthma, ear infections and colds. Your doctor may ask you questions or have you complete a questionnaire to get a sense of how dependent you are on nicotine. The more cigarettes you smoke each day and the sooner you smoke after awakening, the more dependent you are. Knowing your degree of dependence will help your doctor determine the best treatment plan for you. Like most smokers, you've probably made at least one serious attempt to stop. But it's rare to stop smoking on your first attempt - especially if you try to do it without help. You're much more likely to stop if you use medications and counseling, which have both been proved effective, especially in combination. Medications Many treatments, including nicotine replacement therapy and non-nicotine medications, have been approved as safe and effective in treating nicotine dependence. Using more than one medication may help you get better results. For example, combining a longer acting medication with a short-acting nicotine replacement product may be beneficial. Talk to your health care provider about the right treatment for you. If you're pregnant or breast-feeding, you smoke fewer than 10 cigarettes a day, or you're under age 18, talk to your doctor before taking any over-the-counter nicotine replacement products. Nicotine replacement therapy Nicotine replacement therapy gives you nicotine without tobacco and the harmful chemicals in tobacco smoke. Nicotine replacement products help relieve withdrawal symptoms and cravings. The best time to start using nicotine replacement medication is on the date you've set to stop smoking. Some smokers start earlier in order to reduce smoking on their way to stopping altogether. The following nicotine replacement products are available over-the-counter: - Nicotine patch (NicoDerm CQ, Habitrol, others). The patch delivers nicotine through your skin and into your bloodstream. You wear a new patch each day. You typically use the patch for eight weeks or longer. If you haven't been able to stop smoking completely after two weeks of wearing the patch, ask your doctor about adjusting the dose or adding another nicotine replacement product. Common side effects include skin irritation, insomnia and vivid dreams. - Nicotine gum (Nicorette, others). This gum delivers nicotine to your blood through the lining of your mouth. Nicotine gum is often recommended to curb cravings. Chew the gum for a few times until you feel a mild tingling or peppery taste, then park the gum between your cheek and gumline for several minutes. This chewing and parking allows nicotine to be gradually absorbed in your bloodstream. Mouth irritation is a common side effect. Other side effects are often a result of overly vigorous chewing that releases nicotine too quickly. These include heartburn, nausea and hiccups. - Nicotine lozenge (Commit, Nicorette mini lozenge, others). This lozenge dissolves in your mouth and, like nicotine gum, delivers nicotine through the lining of your mouth. Place the lozenge in your mouth between your gumline and cheek or under your tongue and allow it to dissolve. You'll start with one lozenge every one to two hours and gradually increase the time between lozenges. Avoid drinking anything right before, while using or right after the lozenge. Side effects include mouth irritation as well as nicotine-related effects such as heartburn, nausea and hiccups. These nicotine replacement products are available by prescription: - Nicotine nasal spray (Nicotrol NS). The nicotine in this product, sprayed directly into each nostril, is absorbed through your nasal membranes into your blood vessels. The nasal spray delivers nicotine a bit quicker than gum, lozenges or the patch, but not as rapidly as smoking a cigarette. It's usually prescribed for three-month periods for up to six months. Nasal and throat irritation, runny nose, sneezing and coughing are common side effects. - Nicotine inhaler (Nicotrol). This device is shaped something like a cigarette holder. You puff on it, and it delivers nicotine vapor into your mouth. You absorb the nicotine through the lining in your mouth, where it then enters your bloodstream. Common side effects are mouth and throat irritation and occasional coughing. Non-nicotine medications Medications that don't contain nicotine and are available by prescription include: - Bupropion (Zyban). The antidepressant drug bupropion increases levels of dopamine and norepinephrine, brain chemicals that are also boosted by nicotine. Typically your doctor will advise you to start bupropion one week before you stop smoking. Bupropion has the advantage of helping to minimize weight gain after you quit smoking. Common side effects include insomnia, agitation, headache and dry mouth. If you have a history of seizures or serious head trauma, such as a skull fracture, you shouldn't take this drug. - Varenicline (Chantix). This medication acts on the brain's nicotine receptors, decreasing withdrawal symptoms and reducing the feelings of pleasure you get from smoking. Typically your doctor will advise you to start varenicline one week before you stop smoking. Common side effects include nausea, headache, insomnia and vivid dreams. Rarely, varenicline has been associated with serious psychiatric symptoms, such as depressed mood and suicidal thoughts. - Nortriptyline (Pamelor). This medication may be prescribed if other medications haven't helped. This tricyclic antidepressant acts by increasing the levels of the brain neurotransmitter norepinephrine. Common side effects may include dry mouth, drowsiness, dizziness and constipation. Counseling, support groups and other programs Combining medications with behavioral counseling provides the best chance for establishing long-term smoking abstinence. Medications help you cope by reducing withdrawal symptoms including tobacco craving, while behavioral treatments help you develop the skills you need to avoid tobacco over the long run. The more time you spend with a counselor, the better your treatment results will be. Several types of counseling and support can help with stopping smoking: - Telephone counseling. No matter where you live, you can take advantage of phone counseling to help you give up tobacco. Every state in the U.S. has a telephone quit line, and some have more than one. To find the options in your state, call 800-QUIT-NOW (800-784-8669). - Individual or group counseling program. Your doctor may recommend local support groups or a treatment program where counseling is provided by a tobacco treatment specialist. Counseling helps you learn techniques for preparing to stop smoking and provides support for you during the process. Many hospitals, health care plans, health care providers and employers offer treatment programs or have tobacco treatment specialists who are certified to provide treatment for nicotine dependence. Nicotine Anonymous groups are available in many locations to provide support for smokers trying to quit. Some medical centers provide residential treatment programs - the most intensive treatment available. - Internet-based programs. Several websites offer support and strategies for people who want to stop smoking. BecomeAnEX is free and provides information and techniques as well as blogs, community forums, ask the expert and many other features. Text messaging services, including personalized reminders about a quit-smoking plan, also may prove helpful. Methods to avoid It's not a good idea to substitute another type of tobacco use for cigarette smoking. Tobacco in any form is not safe. Even products that deliver nicotine without tobacco are risky. Stick with proven stop-smoking aids and steer clear of the following products: - Dissolvable tobacco products. Tobacco pouches, lozenges, strips or other products contain small amounts of tobacco and nicotine you hold or dissolve in your mouth. There is no evidence they will help you stop smoking and little is known about their health effects. - E-cigarettes. Electronic cigarettes, or e-cigarettes, are battery-powered devices that heat liquid containing nicotine into a vapor to be inhaled. Because these products are new, there isn't much data about possible safety risks. Studies of e-cigarettes for smoking cessation have shown mixed results. For these reasons, e-cigarettes aren't recommended for people trying to quit smoking. - Flavored cigarettes. Clove cigarettes (kreteks) and flavored cigarettes (bidis) carry the same health risks as smoking regular cigarettes and can cause additional health problems. Although they're banned in the United States, flavored cigarettes are available in other countries. - Hookahs (narghiles). These are water pipes that burn tobacco, and the smoke is inhaled through a hose. They are not safer than cigarettes. The water does not filter out toxins in the smoke, and the water and pipe have a risk of transmitting infections. - Nicotine lollipops and balms. Products containing nicotine salicylate are not approved by the Food and Drug Administration, and they pose a risk for accidental use by children. - Pipes and cigars. These products have similar, though less frequent, health risks as cigarettes, and they are not a safe alternative. - Smokeless tobacco and snuff (snus). These products contain nicotine in amounts similar to cigarettes and increase your risk of mouth and throat cancer, tooth and gum diseases, and other health problems. It's important to have a plan for managing nicotine withdrawal symptoms. Withdrawal symptoms are usually the most intense during the first week after you stop smoking. They may continue for several weeks, with declining intensity. Although most nicotine withdrawal symptoms pass within a month, you may occasionally experience a strong urge or craving to smoke months after stopping. Triggers or cues that were associated with your smoking can provoke these urges or cravings. Here's what you can do to help manage nicotine withdrawal symptoms: - Exercise regularly. Regular physical activity has been found to reduce withdrawal symptoms and help people stop smoking. Exercise also helps avoid potential weight gain often associated with stopping. - Wait out cravings. Cravings or urges usually last less than five minutes. Wash the dishes, go for a walk or have a healthy snack, such as carrots, an apple or sunflower seeds, which will keep your mouth busy. Do something that keeps your hands busy, and before you know it, the urge will have passed. This is why you want to get rid of tobacco supplies when you decide to quit. You don't want to have any on hand when a craving hits. - Identify rationalizations. If you find yourself thinking, "I'll just smoke one to get through this tough time" or "Just one won't hurt," recognize it as a message that can derail your plan. Review your reasons for quitting, and replace that thought with something positive to support your stopping. - Talk to a support person. If you're feeling anxious or depressed or need encouragement, a support person can help you get through a difficult craving. - Avoid high-risk situations. Know your triggers, and stay away from people, places and situations that tempt you to smoke. - Eat regular, healthy meals. Include plenty of fruits and vegetables, and drink more water. Many products claim to be smoking-cessation aids. Many also claim to be "natural." Just remember that "natural" doesn't necessarily mean "safe." Talk with your doctor before trying any alternative medicine treatments. - Acupuncture. Acupuncture involves stimulating points on the body, typically with thin, solid, metallic needles. Several studies have been conducted on the effects of acupuncture or acupressure for smoking cessation, but there's no definitive evidence that it works. - Herbs and supplements. A few studies have been conducted on the dietary supplements SAMe, silver acetate and St. John's wort for the treatment of tobacco dependence, but there is no current evidence that any natural product improves smoking cessation rates. - Hypnosis. Although no evidence supports the use of hypnosis - also called hypnotherapy - in smoking cessation, some people find it helpful. If you choose to pursue hypnosis, talk to your doctor about finding a reputable therapist. - Meditation. Although no evidence supports the effectiveness of meditation in smoking cessation, some people find it helpful to reduce symptoms of anxiety.
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Migraine Headache - migraine Vascular headache - migraine Summary A migraine is a type of headache. It may occur with symptoms such as nausea, vomiting, or sensitivity to light and sound. In many people, a throbbing pain is felt only on one side of the head. Causes A migraine headache is caused by abnormal brain activity. This activity can be triggered by many things. But the exact chain of events remains unclear. Most medical experts believe the attack begins in the brain and involves nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues. Migraine headaches tend to first appear between the ages of 10 and 45. Sometimes, they begin earlier or later. Migraines may run in families. Migraines occur more often in women than men. Some women, but not all, have fewer migraines when they are pregnant. Migraine attacks may be triggered by any of the following: Caffeine withdrawal Changes in hormone levels during a woman's menstrual cycle or with the use of birth control pills Changes in sleep patterns, such as not getting enough sleep Drinking alcohol Exercise or other physical stress Loud noises or bright lights Missed meals Odors or perfumes Smoking or exposure to smoke Stress and anxiety Migraines can also be triggered by certain foods. Most common are: Chocolate Dairy foods, especially certain cheeses Foods with monosodium glutamate (MSG) Foods with tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans Fruits (avocado, banana, citrus fruit) Meats containing nitrates (bacon, hot dogs, salami, cured meats) Onions Peanuts and other nuts and seeds Processed, fermented, pickled, or marinated foods True migraine headaches are not a result of a brain tumor or other serious medical problem. Only a health care provider who specializes in headaches can determine if your symptoms are due to a migraine or other condition. Symptoms There are two main types of migraines: Migraine with aura (classic migraine) Migraine without aura (common migraine) An aura is a group of nervous system (neurologic) symptoms. These symptoms are considered a warning sign that a migraine is coming. Most often, the vision is affected and can include any or all of the following: Temporary blind spots or colored spots Blurred vision Eye pain Seeing stars, zigzag lines, or flashing lights Tunnel vision (only able to see objects close to the center of the field of view) Other nervous system symptoms include yawning, difficulty concentrating, nausea, trouble finding the right words, dizziness, weakness, numbness, and tingling. Some of these symptoms are much less common with migraine headaches. If you have any of these symptoms, your provider will likely order tests to find the cause. An aura often occurs 10 to 15 minutes before the headache, but can occur just a few minutes to 24 hours beforehand. A headache does not always follow an aura. The headaches usually: Start as a dull ache and get worse within minutes to hours Are throbbing, pounding, or pulsating Are worse on one side of the head with pain behind the eye or in the back of the head and neck Last 6 to 48 hours Other symptoms that may occur with the headache include: Chills Increased urination Fatigue Loss of appetite Nausea and vomiting Sensitivity to light or sound Sweating Symptoms may linger, even after the migraine goes away. This is called a migraine hangover. Symptoms can include: Feeling mentally dull, like your thinking is not clear or sharp Needing more sleep Neck pain Exams and Tests Your provider can diagnose migraine headache by asking about your symptoms and family history of migraines. A complete physical exam will be done to determine if your headaches are due to muscle tension, sinus problems, or a brain disorder. There is no specific test to prove that your headache is actually a migraine. In most cases, no special tests are needed. Your provider may order a brain CT or MRI scan if you have never had one before. The test may also be ordered if you have unusual symptoms with your migraine, including weakness, memory problems, or loss of alertness. An EEG may be needed to rule out seizures. A lumbar puncture (spinal tap) might be done. Treatment There is no specific cure for migraine headaches. The goal is to treat your migraine symptoms right away, and to prevent symptoms by avoiding or changing your triggers. A key step is learning how to manage your migraines at home. A headache diary can help you identify your headache triggers. Then you and your doctor can plan how to avoid these triggers. Lifestyle changes include: Better sleep habits, such as getting enough sleep and going to bed at the same time each night Better eating habits, including not skipping meals and avoiding your food triggers Managing stress Losing weight, if you're overweight If you have frequent migraines, your provider may prescribe medicine to reduce the number of attacks. You need to take the medicine every day for it to be effective. Medicines may include: Antidepressants Blood pressure medicines, such as beta blockers Seizure medicines Calcitonin gene-related peptide agents Botulinum toxin type A (Botox) injections may also help reduce migraine attacks if they occur more than 15 days a month. Some people find relief with minerals and vitamins. Check with your provider to see if riboflavin or magnesium is right for you. TREATING AN ATTACK Other medicines are taken at the first sign of a migraine attack. Over-the-counter (OTC) pain medicines, such as acetaminophen, ibuprofen, or aspirin are often helpful when your migraine is mild. Be aware that: Taking medicines more than 3 days a week may lead to rebound headaches. These are headaches that keep coming back due to overuse of pain medicine. Taking too much acetaminophen can damage your liver. Too much ibuprofen or aspirin can irritate your stomach or kidneys. If these treatments do not help, ask your provider about prescription medicines. These include nasal sprays, suppositories, or injections. The group of medicines most often used is called triptans. Some migraine medicines narrow the blood vessels. If you are at risk for having a heart attack or have heart disease, talk with your provider before using these medicines. Some migraine medicines should not be used by pregnant women. Talk with your provider about which medicine is right for you if you are pregnant or planning to become pregnant. Other medicines treat symptoms of migraine, such as nausea and vomiting. They may be used alone or along with the other drugs that treat the migraine itself. Feverfew is an herb for migraines. It can be effective for some people. Before using feverfew, make sure your provider approves. Herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs. Support Groups These resources can provide more information on migraines: American Headache Society -- americanheadachesociety.org American Migraine Foundation -- americanmigrainefoundation.org National Headache Foundation -- headaches.org Outlook (Prognosis) Each person responds differently to treatment. Some people have migraines only rarely and need little to no treatment. Others need to take several medicines or even go to the hospital sometimes. Migraine headache is a risk factor for stroke. Risk is higher in people who smoke, more so in women who have migraines that occur with aura. In addition to not smoking, people with migraines should avoid other risk factors for stroke. These include: Taking birth control pills Eating unhealthy foods, which can cause high cholesterol or high blood pressure When to Contact a Medical Professional Call 911 if: You are experiencing "the worst headache of your life." You have speech, vision, or movement problems or loss of balance, especially if you have not had these symptoms with a migraine before. A headache starts suddenly. Schedule an appointment or call your provider if: Your headache pattern or pain changes. Treatments that once worked no longer help. You have side effects from your medicine. You are taking birth control pills and have migraine headaches. Your headaches are more severe when lying down. Review Date 11/22/2017 Updated by: Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Surgery at Providence Medical Center, Medford, OR; Department of Surgery at Ashland Community Hospital, Ashland, OR; Department of Maxillofacial Surgery at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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COPD Overview Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It's caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions. Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It's characterized by daily cough and mucus (sputum) production. Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter. COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions. COPD care at Mayo Clinic Symptoms COPD symptoms often don't appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. For chronic bronchitis, the main symptom is a daily cough and mucus (sputum) production at least three months a year for two consecutive years. Other signs and symptoms of COPD may include: - Shortness of breath, especially during physical activities - Wheezing - Chest tightness - Having to clear your throat first thing in the morning, due to excess mucus in your lungs - A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish - Blueness of the lips or fingernail beds (cyanosis) - Frequent respiratory infections - Lack of energy - Unintended weight loss (in later stages) - Swelling in ankles, feet or legs People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days. Causes The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes. Only about 20 to 30 percent of chronic smokers may develop clinically apparent COPD, although many smokers with long smoking histories may develop reduced lung function. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed. Air travels down your windpipe (trachea) and into your lungs through two large tubes (bronchi). Inside your lungs, these tubes divide many times - like the branches of a tree - into many smaller tubes (bronchioles) that end in clusters of tiny air sacs (alveoli). The air sacs have very thin walls full of tiny blood vessels (capillaries). The oxygen in the air you inhale passes into these blood vessels and enters your bloodstream. At the same time, carbon dioxide - a gas that is a waste product of metabolism - is exhaled. Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air out of your body. COPD causes them to lose their elasticity and overexpand, which leaves some air trapped in your lungs when you exhale. Causes of airway obstruction include: - Emphysema. This lung disease causes destruction of the fragile walls and elastic fibers of the alveoli. Small airways collapse when you exhale, impairing airflow out of your lungs. - Chronic bronchitis. In this condition, your bronchial tubes become inflamed and narrowed and your lungs produce more mucus, which can further block the narrowed tubes. You develop a chronic cough trying to clear your airways. In the vast majority of cases, the lung damage that leads to COPD is caused by long-term cigarette smoking. But there are likely other factors at play in the development of COPD, such as a genetic susceptibility to the disease, because only about 20 to 30 percent of smokers may develop COPD. Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution and workplace exposure to dust, smoke or fumes. In about 1 percent of people with COPD, the disease results from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin. Alpha-1-antitrypsin (AAt) is made in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1-antitrypsin deficiency can affect the liver as well as the lungs. Damage to the lung can occur in infants and children, not only adults with long smoking histories. For adults with COPD related to AAt deficiency, treatment options include those used for people with more-common types of COPD. In addition, some people can be treated by replacing the missing AAt protein, which may prevent further damage to the lungs. Risk factors Risk factors for COPD include: - Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers also may be at risk, as well as people exposed to large amounts of secondhand smoke. - People with asthma who smoke. The combination of asthma, a chronic inflammatory airway disease, and smoking increases the risk of COPD even more. - Occupational exposure to dusts and chemicals. Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs. - Exposure to fumes from burning fuel. In the developing world, people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes are at higher risk of developing COPD. - Age. COPD develops slowly over years, so most people are at least 40 years old when symptoms begin. - Genetics. The uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease. Complications COPD can cause many complications, including: - Respiratory infections. People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. An annual flu vaccination and regular vaccination against pneumococcal pneumonia can prevent some infections. - Heart problems. For reasons that aren't fully understood, COPD can increase your risk of heart disease, including heart attack. Quitting smoking may reduce this risk. - Lung cancer. People with COPD have a higher risk of developing lung cancer. Quitting smoking may reduce this risk. - High blood pressure in lung arteries. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension). - Depression. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to development of depression. Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression. Diagnosis COPD is commonly misdiagnosed - former smokers may sometimes be told they have COPD, when in reality they may have simple deconditioning or another less common lung condition. Likewise, many people who have COPD may not be diagnosed until the disease is advanced and interventions are less effective. To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical history, and discuss any exposure you've had to lung irritants - especially cigarette smoke. Your doctor may order several tests to diagnose your condition. Tests may include: - Lung (pulmonary) function tests. Pulmonary function tests measure the amount of air you can inhale and exhale, and if your lungs are delivering enough oxygen to your blood. Spirometry is the most common lung function test. During this test, you'll be asked to blow into a large tube connected to a small machine called a spirometer. This machine measures how much air your lungs can hold and how fast you can blow the air out of your lungs. Spirometry can detect COPD even before you have symptoms of the disease. It can also be used to track the progression of disease and to monitor how well treatment is working. Spirometry often includes measurement of the effect of bronchodilator administration. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry. - Chest X-ray. A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure. - CT scan. A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD. CT scans can also be used to screen for lung cancer. - Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide. - Laboratory tests. Laboratory tests aren't used to diagnose COPD, but they may be used to determine the cause of your symptoms or rule out other conditions. For example, laboratory tests may be used to determine if you have the genetic disorder alpha-1-antitrypsin (AAt) deficiency, which may be the cause of some cases of COPD. This test may be done if you have a family history of COPD and develop COPD at a young age, such as under age 45. Treatment A diagnosis of COPD is not the end of the world. Most people have mild forms of the disease for which little therapy is needed other than smoking cessation. Even for more advanced stages of disease, effective therapy is available that can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life. Smoking cessation The most essential step in any treatment plan for COPD is to stop all smoking. It's the only way to keep COPD from getting worse - which can eventually reduce your ability to breathe. But quitting smoking isn't easy. And this task may seem particularly daunting if you've tried to quit and have been unsuccessful. Talk to your doctor about nicotine replacement products and medications that might help, as well as how to handle relapses. Your doctor may also recommend a support group for people who want to quit smoking. It's also a good idea to avoid secondhand smoke exposure whenever possible. Medications Doctors use several kinds of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed. These medications - which usually come in an inhaler - relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day or both. Short-acting bronchodilators include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA), and ipratropium (Atrovent). The long-acting bronchodilators include tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil, Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium (Tudorza). Inhaled corticosteroid medications can reduce airway inflammation and help prevent exacerbations. Side effects may include bruising, oral infections and hoarseness. These medications are useful for people with frequent exacerbations of COPD. Fluticasone (Flovent HFA, Flonase, others) and budesonide (Pulmicort Flexhaler, Uceris, others) are examples of inhaled steroids. Some medications combine bronchodilators and inhaled steroids. Salmeterol and fluticasone (Advair) and formoterol and budesonide (Symbicort) are examples of combination inhalers. For people who have a moderate or severe acute exacerbation, short courses (for example, five days) of oral corticosteroids prevent further worsening of COPD. However, long-term use of these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection. A new type of medication approved for people with severe COPD and symptoms of chronic bronchitis is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and relaxes the airways. Common side effects include diarrhea and weight loss. This very inexpensive medication may help improve breathing and prevent exacerbations. Side effects may include nausea, headache, fast heartbeat and tremor. Side effects are dose related, and low doses are recommended. Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics help treat acute exacerbations, but they aren't generally recommended for prevention. However, a recent study shows that the antibiotic azithromycin prevents exacerbations, but it isn't clear whether this is due to its antibiotic effect or its anti-inflammatory properties. Lung therapies Doctors often use these additional therapies for people with moderate or severe COPD: - Oxygen therapy. If there isn't enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town. Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time. Oxygen therapy can improve quality of life and is the only COPD therapy proven to extend life. Talk to your doctor about your needs and options. - Pulmonary rehabilitation program. These programs generally combine education, exercise training, nutrition advice and counseling. You'll work with a variety of specialists, who can tailor your rehabilitation program to meet your needs. Pulmonary rehabilitation may shorten hospitalizations, increase your ability to participate in everyday activities and improve your quality of life. Talk to your doctor about referral to a program. Managing exacerbations Even with ongoing treatment, you may experience times when symptoms become worse for days or weeks. This is called an acute exacerbation, and it may lead to lung failure if you don't receive prompt treatment. Exacerbations may be caused by a respiratory infection, air pollution or other triggers of inflammation. Whatever the cause, it's important to seek prompt medical help if you notice a sustained increase in coughing, a change in your mucus or if you have a harder time breathing. When exacerbations occur, you may need additional medications (such as antibiotics, steroids or both), supplemental oxygen or treatment in the hospital. Once symptoms improve, your doctor will talk with you about measures to prevent future exacerbations, such as quitting smoking, taking inhaled steroids, long-acting bronchodilators or other medications, getting your annual flu vaccine, and avoiding air pollution whenever possible. Surgery Surgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone. Surgical options include: - Lung volume reduction surgery. In this surgery, your surgeon removes small wedges of damaged lung tissue from the upper lungs. This creates extra space in your chest cavity so that the remaining healthier lung tissue can expand and the diaphragm can work more efficiently. In some people, this surgery can improve quality of life and prolong survival. - Lung transplant. Lung transplantation may be an option for certain people who meet specific criteria. Transplantation can improve your ability to breathe and to be active. However, it's a major operation that has significant risks, such as organ rejection, and it's necessary to take lifelong immune-suppressing medications. - Bullectomy. Large air spaces (bullae) form in the lungs when the walls of the air sacs are destroyed. These bullae can become very large and cause breathing problems. In a bullectomy, doctors remove bullae from the lungs to help improve air flow. Lifestyle and home remedies If you have COPD, you can take steps to feel better and slow the damage to your lungs: - Control your breathing. Talk to your doctor or respiratory therapist about techniques for breathing more efficiently throughout the day. Also be sure to discuss breathing positions and relaxation techniques that you can use when you're short of breath. - Clear your airways. With COPD, mucus tends to collect in your air passages and can be difficult to clear. Controlled coughing, drinking plenty of water and using a humidifier may help. - Exercise regularly. It may seem difficult to exercise when you have trouble breathing, but regular exercise can improve your overall strength and endurance and strengthen your respiratory muscles. Discuss with your doctor which activities are appropriate for you. - Eat healthy foods. A healthy diet can help you maintain your strength. If you're underweight, your doctor may recommend nutritional supplements. If you're overweight, losing weight can significantly help your breathing, especially during times of exertion. - Avoid smoke and air pollution. In addition to quitting smoking, it's important to avoid places where others smoke. Secondhand smoke may contribute to further lung damage. Other types of air pollution also can irritate your lungs. - See your doctor regularly. Stick to your appointment schedule, even if you're feeling fine. It's important to steadily monitor your lung function. And be sure to get your annual flu vaccine in the fall to help prevent infections that can worsen your COPD. Ask your doctor when you need the pneumococcal vaccine. Let your doctor know if you have worsening symptoms or you notice signs of infection.
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COPD What is COPD? Chronic obstructive pulmonary disease, or COPD, is a progressive lung disease in which the airways of the lungs become damaged, making it hard to breathe. You may also have heard COPD called other names, like emphysema or chronic bronchitis. In people who have COPD, the airways that carry air in and out of the lungs are partially blocked, making it difficult to get air in and out. COPD is a major cause of death and illness throughout the world. It kills more than 120,000 Americans each year. That's one death every 4 minutes. How COPD Affects Airways The "airways" are the tubes that carry air in and out of the lungs through the nose and mouth. The airways of the lungs branch out like an upside-down tree. At the end of each branch are many small, balloon-like air sacs. In healthy people, the airways and air sacs are elastic (stretchy). When you breathe in, each air sac fills up with air, like a small balloon, and when you breathe out, the balloon deflates and the air goes out. In people with COPD, the airways and air sacs lose their shape and become floppy. Less air gets in and less air goes out of the airways because - The airways and air sacs lose their elasticity like an old rubber band. - The walls between many of the air sacs are destroyed. - The walls of the airways become thick and inflamed or swollen. - Cells in the airways make more mucus or sputum than usual, which tends to clog the airways. The airways and air sacs lose their elasticity like an old rubber band. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed or swollen. Cells in the airways make more mucus or sputum than usual, which tends to clog the airways. COPD Develops Slowly, Has No Cure When COPD is severe, shortness of breath and other symptoms of COPD can get in the way of even the most basic tasks, such as doing light housework, taking a walk, even washing and dressing. COPD develops slowly, and it may be many years before you notice symptoms like feeling short of breath. Most of the time, COPD is diagnosed in middle-aged or older people. There is no cure for COPD. The damage to your airways and lungs cannot be reversed, but there are things you can do to control the disabling effects of the disease. COPD is not contagious. You cannot catch it from someone else. Causes Smoking Most cases of COPD develop over time, from breathing in fumes and other things that irritate the lungs. Some of the things that put you at risk for COPD include smoking, environmental exposure, and genetic factors. Cigarette smoking is the most common cause of COPD in the United States (either current or former smokers). Pipe, cigar, and other types of tobacco smoking can also cause COPD, especially if the smoke is inhaled. Environmental Exposure COPD can also occur in people who have had long-term exposure to things that can irritate your lungs, like chemical fumes, or dust from the environment or workplace. Heavy or long-term exposure to secondhand smoke or other air pollutants may also contribute to COPD even if you have never smoked or had long-term exposure to harmful pollutants. Secondhand smoke is smoke in the air from other people smoking. Genetic Factors In a small number of people, COPD is caused by a genetic condition known as alpha-1 antitrypsin, or AAT, deficiency. People who have this condition have low levels of alpha-1 antitrypsin (AAT)—a protein made in the liver. Having a low level of the AAT protein can lead to lung damage and COPD if you're exposed to smoke or other lung irritants. If you have this condition and smoke, COPD can worsen very quickly. While very few people know if they have AAT deficiency, it is estimated that about 1 in every 1,600 people to about 1 in every 5,000 people have it. People with AAT deficiency can get COPD even if they have never smoked or had long-term exposure to harmful pollutants. Asthma Although uncommon, some people who have asthma can develop COPD. Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing. However, if not, COPD can develop. Preventing Complications If you have COPD, you can take these steps to prevent complications and control the disabling effects of the disease. - Quit smoking. - Avoid exposure to pollutants and lung irritants. - Take precautions against the flu. - Talk to your doctor about the flu and pneumonia vaccines. - See your doctor on a regular basis. - Follow your treatments for COPD exactly as your doctor prescribes. Quit smoking. Avoid exposure to pollutants and lung irritants. Take precautions against the flu. Talk to your doctor about the flu and pneumonia vaccines. See your doctor on a regular basis. Follow your treatments for COPD exactly as your doctor prescribes. Quit Smoking If you smoke, the most important thing you can do to prevent more lung damage is to stop smoking. Quitting can help prevent complications and slow the progress of the disease. It is also important to stay away from people who smoke and places where you know there will be smokers. To help you quit, there are many online resources and several new aids available from your doctor or health care provider. The National Cancer Institute (NCI) has information on smoking cessation. Visit SmokeFree.gov , or check out NCI's Clear Horizons, a quit smoking guide for people 50+. You can also visit The American Lung Association, or call 1-800-QUIT NOW (1-800-784-8669). Avoid Exposure to Pollutants and Lung Irritants Try to stay away from other things that could irritate your lungs, like dust and strong fumes. Stay indoors when the outside air quality is poor. You should also stay away from places where there might be cigarette smoke. Take Precautions Against the Flu The flu (influenza) can cause serious problems for people who have COPD. Do your best to avoid crowds during flu season. In addition to avoiding people with the flu, remembering to wash and sanitize your hands can be one of the best ways to guard against getting sick. Talk to Your Doctor About the Flu (influenza) and Pneumonia Vaccines Talk with your doctor about getting a yearly flu shot and whether and when you should get the pneumonia vaccine. Flu shots can reduce your risk of getting the flu, and the pneumonia vaccine lowers your risk for pneumococcal pneumonia (NU-mo-KOK-al nu-MO-ne-ah) and its complications. Both of these illnesses are major health risks for people who have COPD. See Your Doctor Regularly See your doctor or health care provider regularly even if you are feeling fine. Make a list of your breathing symptoms and think about any activities that you can no longer do because of shortness of breath. Be sure to bring a list of all the medicines you are taking to each office visit. Follow Your Treatments Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms. Symptoms and Diagnosis Common Symptoms The most common symptoms of COPD are - a cough that does not go away - coughing up lots of sputum (mucus). a cough that does not go away coughing up lots of sputum (mucus). These symptoms often start years before the flow of air in and out of the lungs is reduced. Not everyone who has a cough and sputum goes on to develop COPD. Other common symptoms of COPD include - shortness of breath while doing activities you used to be able to do - wheezing (a whistling sound when you breathe) - tightness in the chest. shortness of breath while doing activities you used to be able to do wheezing (a whistling sound when you breathe) tightness in the chest. Getting a Diagnosis Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results. If your doctor thinks you may have COPD, he or she will examine you, listen to your lungs, and ask you questions about your medical history, and what lung irritants you may have been around for long periods of time. The Spirometry Test To confirm a diagnosis of COPD, your doctor will use a breathing test called spirometry. The test is easy and painless and shows how much air you can breathe out and measures how fast you can breathe it out. In a spirometry test, you breathe hard into a large hose connected to a machine called a spirometer. When you breathe out, the spirometer measures how much air your lungs can hold and how fast you can blow air out of your lungs. Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals. The test results also may help find out whether another condition, such as asthma or heart failure, is causing your symptoms. Determining COPD Severity Based on this test, your doctor can determine if you have COPD and how severe it is. There are four levels of severity for COPD: - people at risk for COPD - people with mild COPD - people with moderate COPD - people with severe COPD. people at risk for COPD people with mild COPD people with moderate COPD people with severe COPD. People at risk for developing COPD have a normal breathing test and mild symptoms such as chronic cough and sputum (mucus) production. People with mild COPD have mild breathing limitation. Symptoms may include a chronic cough and sputum (mucus) production. At this stage, you may not be aware that airflow in your lungs is reduced. People with moderate COPD have a breathing test that shows worsening airflow blockages. Symptoms may be worse than with mild COPD and you may experience shortness of breath while working hard, walking fast, or doing brisk activity. At this stage, you would seek medical attention. People with severe COPD have a breathing test that shows severe limitation of the airflow. People with severe COPD will be short of breath after just a little activity. In very severe COPD, complications like respiratory failure or signs of heart failure may develop. At this stage, quality of life is impaired and worsening symptoms may be life-threatening. Other Tests Other tests are used to rule out other causes of the symptoms. - Bronchodilator reversibility testing uses the spirometer and medications called bronchodilators to assess whether breathing problems may be caused by asthma. Bronchodilator reversibility testing uses the spirometer and medications called bronchodilators to assess whether breathing problems may be caused by asthma. - A chest X-ray or a chest CT scan may also be ordered by your doctor. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms. A chest X-ray or a chest CT scan may also be ordered by your doctor. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms. - An arterial blood gas test is another test that is used. This blood test shows the oxygen level in the blood to see how severe your COPD is and whether you need oxygen therapy. An arterial blood gas test is another test that is used. This blood test shows the oxygen level in the blood to see how severe your COPD is and whether you need oxygen therapy. Treating COPD Although there is no cure for COPD, treatments and lifestyle changes can help manage symptoms. Quit Smoking Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and products that can help you quit. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid secondhand smoke and places with dust, fumes, or other toxic substances that you may inhale. (Secondhand smoke is smoke in the air from other people smoking.) The National Cancer Institute has information on smoking cessation. Visit SmokeFree.gov and check out Clear Horizons, a quit smoking guide for adults 50+. You can also visit the website of the American Lung Association at www.lung.org, or call 1-800-QUIT NOW (1-800-784-8669). Other Lifestyle Changes If you have COPD, you may have trouble eating enough because of your symptoms, such as shortness of breath and fatigue. (This issue is more common with severe disease.) As a result, you may not get all of the calories and nutrients you need, which can worsen your symptoms and raise your risk for infections. Talk with your doctor about following an eating plan that will meet your nutritional needs. Your doctor may suggest eating smaller, more frequent meals; resting before eating; and taking vitamins or nutritional supplements. Also, talk with your doctor about what types of activity are safe for you. You may find it hard to be active with your symptoms. However, physical activity can strengthen the muscles that help you breathe and improve your overall wellness. Treatment Goals The goals of COPD treatment are to - relieve symptoms with no or minimal side effects of treatment - slow the progress of the disease - improve the ability to stay active and exercise - prevent and treat any complications from the disease - improve health overall. relieve symptoms with no or minimal side effects of treatment slow the progress of the disease improve the ability to stay active and exercise prevent and treat any complications from the disease improve health overall. Treatment for COPD can be different for each person and is based on whether symptoms are mild, moderate, or severe. Treatments include medication, pulmonary or lung rehabilitation, oxygen treatment, and surgery. There are also treatments to manage complications or a sudden onset of symptoms. COPD Medications - Bronchodilators are medications that work by relaxing the muscles around your airways. This helps open your airways and makes breathing easier. Depending on the severity of your COPD, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators last about 4–6 hours and should be used only when needed. Long-acting bronchodilators last about 12 hours or more and are used every day. Most bronchodilators are inhaled directly into the lungs with the use of an inhaler. This device allows the medicine to go straight to your lungs. Not all inhalers are used the same way. Ask your health care team to show you the correct way to use your inhaler. People with mild COPD may use inhalers only when needed. Those with moderate or severe COPD may need more regular bronchodilator treatment. Bronchodilators are medications that work by relaxing the muscles around your airways. This helps open your airways and makes breathing easier. Depending on the severity of your COPD, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators last about 4–6 hours and should be used only when needed. Long-acting bronchodilators last about 12 hours or more and are used every day. Most bronchodilators are inhaled directly into the lungs with the use of an inhaler. This device allows the medicine to go straight to your lungs. Not all inhalers are used the same way. Ask your health care team to show you the correct way to use your inhaler. People with mild COPD may use inhalers only when needed. Those with moderate or severe COPD may need more regular bronchodilator treatment. - Inhaled steroids are used for some people with moderate or severe COPD. They work to reduce the inflammation or swelling in the airways. Your doctor may ask you to try inhaled steroids for a trial period of 6 weeks to 3 months to see whether the medicine helps relieve your breathing problems. Inhaled steroids are used for some people with moderate or severe COPD. They work to reduce the inflammation or swelling in the airways. Your doctor may ask you to try inhaled steroids for a trial period of 6 weeks to 3 months to see whether the medicine helps relieve your breathing problems. Vaccines Doctors recommend that people with COPD get an annual flu shot to avoid any breathing complications from the flu and a pneumococcal vaccine to prevent pneumonia. - Flu Shot. The flu (influenza) can cause serious problems for people who have COPD. Flu shots can reduce your risk of getting the flu. Talk with your doctor about getting a yearly flu shot. Flu Shot. The flu (influenza) can cause serious problems for people who have COPD. Flu shots can reduce your risk of getting the flu. Talk with your doctor about getting a yearly flu shot. - Pneumococcal Vaccine.This vaccine lowers your risk for pneumococcal pneumonia (NU-mo-KOK-al nu-MO-ne-ah) and its complications. People who have COPD are at higher risk for pneumonia than people who don't have COPD. Talk with your doctor about whether you should get this vaccine. Pneumococcal Vaccine.This vaccine lowers your risk for pneumococcal pneumonia (NU-mo-KOK-al nu-MO-ne-ah) and its complications. People who have COPD are at higher risk for pneumonia than people who don't have COPD. Talk with your doctor about whether you should get this vaccine. Pulmonary Rehabilitation In addition to medications, doctors may recommend pulmonary or lung rehabilitation (rehab) to help people with COPD stay active. Pulmonary rehabilitation may include exercise training, nutritional counseling, and education about managing the disease. The program's goal is to help you stay active and carry out your daily activities. A program of pulmonary rehabilitation would be managed by doctors, nurses, respiratory therapists, exercise specialists, and dietitians, and would be customized for each patient. Oxygen Therapy For people with severe COPD and low levels of oxygen in the blood, doctors may recommend oxygen therapy to help with shortness of breath. For this treatment, you're given oxygen through nasal prongs or a mask. You may need extra oxygen all the time or only at certain times. For some people who have severe COPD, using extra oxygen for most of the day can help them - do tasks or activities, while having fewer symptoms - protect their hearts and other organs from damage - sleep more during the night and improve alertness during the day - live longer. do tasks or activities, while having fewer symptoms protect their hearts and other organs from damage sleep more during the night and improve alertness during the day live longer. Surgery For some people with severe COPD, surgery may be recommended. Surgery is usually a last resort for patients who have severe symptoms that have not improved from taking medicines. Surgeries for people who have COPD that's mainly related to emphysema include bullectomy (bul-EK-toe-me) and lung volume reduction surgery (LVRS). A lung transplant might be an option for people who have very severe COPD. - Bullectomy. When the walls of the air sacs are destroyed, larger air spaces called bullae (BUL-e) form. These air spaces can become so large that they interfere with breathing. In a bullectomy, doctors remove one or more very large bullae from the lungs. Bullectomy. When the walls of the air sacs are destroyed, larger air spaces called bullae (BUL-e) form. These air spaces can become so large that they interfere with breathing. In a bullectomy, doctors remove one or more very large bullae from the lungs. - Lung Volume Reduction Surgery. In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In carefully selected patients, LVRS can improve breathing and quality of life. Lung Volume Reduction Surgery. In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In carefully selected patients, LVRS can improve breathing and quality of life. - Lung Transplant. During a lung transplant, your damaged lung is removed and replaced with a healthy lung from a deceased donor. A lung transplant can improve your lung function and quality of life. However, lung transplants have many risks, such as infections. The surgery can cause death if the body rejects the transplanted lung. If you have very severe COPD, talk with your doctor about whether a lung transplant is an option. Ask your doctor about the benefits and risks of this type of surgery. Lung Transplant. During a lung transplant, your damaged lung is removed and replaced with a healthy lung from a deceased donor. A lung transplant can improve your lung function and quality of life. However, lung transplants have many risks, such as infections. The surgery can cause death if the body rejects the transplanted lung. If you have very severe COPD, talk with your doctor about whether a lung transplant is an option. Ask your doctor about the benefits and risks of this type of surgery. If COPD Suddenly Gets Worse People with COPD usually have symptoms that worsen slowly over time. However, they can have symptoms that suddenly get worse. Call your doctor right away if your symptoms worsen suddenly. A cold, the flu, or a lung infection may cause your symptoms to quickly worsen. When this happens, you have a much harder time catching your breath. You should call your doctor right away if you have sudden chest tightness, more coughing, a change in your sputum (mucus), or fever. Your doctor will look at things that may be causing these sudden symptoms. Your doctor might recommend antibiotics to fight the infection, or bronchodilators or inhaled steroids to help you breathe. Some severe symptoms may require treatment in a hospital. Frequently Asked Questions What is COPD? Chronic obstructive pulmonary disease, or COPD, is a progressive lung disease in which the airways of the lungs become damaged, making it harder to breathe. With COPD, airways become blocked, making it harder to get air in and out. Can COPD cause someone to die? COPD is a disease that slowly worsens over time, especially if you continue to smoke. If you have COPD, you are more likely to have lung infections, which can be fatal. If the lungs are severely damaged, the heart may be affected. A person with COPD dies when the lungs and heart are unable to function and get oxygen to the body's organs and tissues, or when a complication, such as a severe infection, occurs. Treatment for COPD may help prevent complications, prolong life, and improve a person's quality of life. What causes COPD? Cigarette smoking is the most common cause of COPD. Most people with COPD are smokers or have been smokers in the past. Breathing in other fumes and dusts over long periods of time can also lead to COPD. Pipe, cigar, and other types of tobacco smoking can cause COPD, especially if the smoke is inhaled. Exposure to secondhand smoke can play a role in causing COPD. Most people with COPD are at least 40 years old or around middle age when symptoms start. What are the symptoms of COPD? The most common symptoms of COPD are a cough that does not go away and coughing up a lot of sputum (mucus). These symptoms may occur years before lung damage has reduced the flow of air in and out of the lungs. Other symptoms of COPD include shortness of breath, especially with exercise; wheezing (a whistling sound when you breathe); and tightness in the chest. How is COPD diagnosed? To confirm a COPD diagnosis, a doctor will use a breathing test called spirometry. The test is easy and painless. It shows how well the lungs are working. The spirometer measures how much air the lungs can hold and how fast air is blown out of the lungs. Other tests, such as bronchodilator reversibility testing, a chest X-ray, and arterial blood gas test, may be ordered. What are the treatments for COPD? Treatment for COPD can be different for each person and is based on whether symptoms are mild, moderate or severe. Treatments include medication, pulmonary or lung rehabilitation, oxygen treatment, and surgery. There are also treatments to manage complications or a sudden onset of symptoms. If I am diagnosed with COPD, can I exercise? If you have not been exercising regularly, you should get the advice of your doctor before starting. The symptoms of COPD are different for each person. People with mild COPD may not have much difficulty walking or exercising. As the symptoms of COPD get worse over time, a person may have more difficulty with walking and exercising. You should talk to your doctor about exercising and whether you would benefit from a pulmonary or lung rehabilitation program. If my doctor sends me for pulmonary rehabilitation, what type of people will I be working with and what do they do? The pulmonary rehabilitation team is a group of health care professionals who work together with the patient and his/her own doctor to develop and monitor rehabilitation programs for patients with chronic lung diseases. Each member brings to the team expertise from his or her own area of specialty. Each team may have a different makeup and combination of staff depending on what is needed and who is available. Teams can include a doctor, a nurse, a respiratory therapist, a physical therapist, an occupational therapist, an exercise therapist, a sociologist, a social worker, and a dietitian. - A doctor with a special interest in working with patients with lung problems usually leads the team. - A nurse with special training in lung problems can help evaluate patients, develop the treatment plan, and make sure the program works for the patient and that the goals of the program are being met. - A respiratory therapist may help teach breathing techniques and proper use of equipment such as nebulizers and oxygen. - A physical therapist may help with physical training to improve strength, flexibility, and ability to exercise. - An occupational therapist can teach easier ways of doing everyday activities such as dressing, bathing, running errands, and doing chores. - An exercise therapist is someone with special training to help people with their physical activity and exercise. - A psychologist, social worker, or other therapist may help with the emotional adjustments to living with chronic lung disease. - A dietitian can work with persons with chronic lung diseases to make sure they are getting enough nutrition in their diets. A doctor with a special interest in working with patients with lung problems usually leads the team. A nurse with special training in lung problems can help evaluate patients, develop the treatment plan, and make sure the program works for the patient and that the goals of the program are being met. A respiratory therapist may help teach breathing techniques and proper use of equipment such as nebulizers and oxygen. A physical therapist may help with physical training to improve strength, flexibility, and ability to exercise. An occupational therapist can teach easier ways of doing everyday activities such as dressing, bathing, running errands, and doing chores. An exercise therapist is someone with special training to help people with their physical activity and exercise. A psychologist, social worker, or other therapist may help with the emotional adjustments to living with chronic lung disease. A dietitian can work with persons with chronic lung diseases to make sure they are getting enough nutrition in their diets. How can I prevent my COPD from getting worse? If you smoke, the most important thing you can do to prevent more lung damage is to stop smoking. It is also important to stay away from people who smoke and places where you know there will be smokers. Avoid exposure to pollutants like dust, fumes, and poor air quality, and take precautions to prevent flu and pneumonia. Following your doctor's instructions with medications and rehabilitative treatment can help alleviate COPD symptoms and control the disabling effects of the disease. What medications are used to treat COPD? Bronchodilators and inhaled steroids are two medications used to treat COPD. Bronchodilators work by relaxing the muscles around the airways, opening them and making it easier to breathe. People with mild COPD take bronchodilators using an inhaler only when needed. Those with moderate or severe COPD may need more regular treatment. Inhaled steroids also are used for people with moderate or severe COPD in order to reduce swelling in the airways. When is oxygen therapy used for COPD? For people with severe COPD and low levels of oxygen in the blood, doctors may recommend oxygen therapy to help with shortness of breath. Using extra oxygen more than 15 hours per day can help you perform tasks or activities with less shortness of breath, protect the heart and other organs from damage, help you sleep more, improve your alertness during the day, and help you live longer. When is surgery recommended for people with COPD? For some people with severe COPD, surgery may be recommended. Surgery is usually done for patients who have severe symptoms, have not gotten improvement from medications, and have a hard time breathing most of the time. There are two types of surgery that are considered in the case of severe COPD; a bullectomy, which removes a large air sac that may compress a good lung, or lung volume reduction surgery. A lung transplant may be done for some people with very severe COPD. What should I do if my COPD symptoms suddenly get worse? Call your doctor right away if your symptoms worsen suddenly. People with COPD may have symptoms that suddenly get worse. When this happens, you have a much harder time catching your breath. Symptoms that worsen suddenly can include sudden chest tightness, more coughing, a change in your sputum (mucus), or fever. Your doctor will look at things that may be causing these sudden symptoms. Sometimes the symptoms are caused by a lung infection. Where else can I find information on COPD? More information on COPD is available at: What is COPD? and at the Learn More, Breathe Better Campaign® For information on quitting smoking, visit http://www.surgeongeneral.gov/tobacco/ or Smokefree.gov. For information on the H1N1 flu and COPD, go to The Centers for Disease Control and Prevention.
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Pneumonia What Is... Pneumonia (nu-MO-ne-ah) is an infection in one or both of the lungs. Many germs—such as bacteria, viruses, and fungi—can cause pneumonia. The infection inflames your lungs' air sacs, which are called alveoli (al-VEE-uhl-eye). The air sacs may fill up with fluid or pus, causing symptoms such as a cough with phlegm (a slimy substance), fever, chills, and trouble breathing. Overview Pneumonia and its symptoms can vary from mild to severe. Many factors affect how serious pneumonia is, such as the type of germ causing the infection and your age and overall health. Pneumonia tends to be more serious for: Infants and young children. Older adults (people 65 years or older). People who have other health problems, such as heart failure, diabetes, or COPD (chronic obstructive pulmonary disease). People who have weak immune systems as a result of diseases or other factors. Examples of these diseases and factors include HIV/AIDS, chemotherapy (a treatment for cancer), and an organ transplant or blood and marrow stem cell transplant. Outlook Pneumonia is common in the United States. Treatment for pneumonia depends on its cause, how severe your symptoms are, and your age and overall health. Many people can be treated at home, often with oral antibiotics. Children usually start to feel better in 1 to 2 days. For adults, it usually takes 2 to 3 days. Anyone who has worsening symptoms should see a doctor. People who have severe symptoms or underlying health problems may need treatment in a hospital. It may take 3 weeks or more before they can go back to their normal routines. Fatigue (tiredness) from pneumonia can last for a month or more. Types Pneumonia is named for the way in which a person gets the infection or for the germ that causes it. Community-Acquired Pneumonia Community-acquired pneumonia (CAP) occurs outside of hospitals and other health care settings. Most people get CAP by breathing in germs (especially while sleeping) that live in the mouth, nose, or throat. CAP is the most common type of pneumonia. Most cases occur during the winter. About 4 million people get this form of pneumonia each year. About 1 out of every 5 people who has CAP needs to be treated in a hospital. Hospital-Acquired Pneumonia Some people catch pneumonia during a hospital stay for another illness. This is called hospital-acquired pneumonia (HAP). You're at higher risk of getting HAP if you're on a ventilator (a machine that helps you breathe). HAP tends to be more serious than CAP because you're already sick. Also, hospitals tend to have more germs that are resistant to antibiotics (medicines used to treat pneumonia). Health Care-Associated Pneumonia Patients also may get pneumonia in other health care settings, such as nursing homes, dialysis centers, and outpatient clinics. This type of pneumonia is called health care-associated pneumonia. Other Common Types of Pneumonia Aspiration Pneumonia This type of pneumonia can occur if you inhale food, drink, vomit, or saliva from your mouth into your lungs. This may happen if something disturbs your normal gag reflex, such as a brain injury, swallowing problem, or excessive use of alcohol or drugs. Aspiration pneumonia can cause pus to form in a cavity in the lung. When this happens, it's called a lung abscess (AB-ses). Atypical Pneumonia Several types of bacteria—Legionella pneumophila, mycoplasma pneumonia, and Chlamydophila pneumoniae—cause atypical pneumonia, a type of CAP. Atypical pneumonia is passed from person to person. Other Names Pneumonitis (nu-mo-NI-tis). Bronchopneumonia (BRONG-ko-nu-MO-ne-ah). Nosocomial (nos-o-KO-me-al) pneumonia. This is another name for hospital-acquired pneumonia. Walking pneumonia. This refers to pneumonia that's mild enough that you're not bedridden. Double pneumonia. This refers to pneumonia that affects both lobes of the lungs. Causes Many germs can cause pneumonia. Examples include different kinds of bacteria, viruses, and, less often, fungi. Most of the time, the body filters germs out of the air that we breathe to protect the lungs from infection. Your immune system, the shape of your nose and throat, your ability to cough, and fine, hair-like structures called cilia (SIL-e-ah) help stop the germs from reaching your lungs. (For more information, go to the Diseases and Conditions Index How the Lungs Work article.) Sometimes, though, germs manage to enter the lungs and cause infections. This is more likely to occur if: Your immune system is weak A germ is very strong Your body fails to filter germs out of the air that you breathe For example, if you can't cough because you've had a stroke or are sedated, germs may remain in your airways. ("Sedated" means you're given medicine to make you sleepy.) When germs reach your lungs, your immune system goes into action. It sends many kinds of cells to attack the germs. These cells cause the alveoli (air sacs) to become red and inflamed and to fill up with fluid and pus. This causes the symptoms of pneumonia. Germs That Can Cause Pneumonia Bacteria Bacteria are the most common cause of pneumonia in adults. Some people, especially the elderly and those who are disabled, may get bacterial pneumonia after having the flu or even a common cold. Many types of bacteria can cause pneumonia. Bacterial pneumonia can occur on its own or develop after you've had a cold or the flu. This type of pneumonia often affects one lobe, or area, of a lung. When this happens, the condition is called lobar pneumonia. The most common cause of pneumonia in the United States is the bacterium Streptococcus (strep-to-KOK-us) pneumoniae, or pneumococcus (nu-mo-KOK-us). Lobar Pneumonia Another type of bacterial pneumonia is called atypical pneumonia. Atypical pneumonia includes: Legionella pneumophila. This type of pneumonia sometimes is called Legionnaire's disease, and it has caused serious outbreaks. Outbreaks have been linked to exposure to cooling towers, whirlpool spas, and decorative fountains. Mycoplasma pneumonia. This is a common type of pneumonia that usually affects people younger than 40 years old. People who live or work in crowded places like schools, homeless shelters, and prisons are at higher risk for this type of pneumonia. It's usually mild and responds well to treatment with antibiotics. However, mycoplasma pneumonia can be very serious. It may be associated with a skin rash and hemolysis (the breakdown of red blood cells). Chlamydophila pneumoniae. This type of pneumonia can occur all year and often is mild. The infection is most common in people 65 to 79 years old. Viruses Respiratory viruses cause up to one-third of the pneumonia cases in the United States each year. These viruses are the most common cause of pneumonia in children younger than 5 years old. Most cases of viral pneumonia are mild. They get better in about 1 to 3 weeks without treatment. Some cases are more serious and may require treatment in a hospital. If you have viral pneumonia, you run the risk of getting bacterial pneumonia as well. The flu virus is the most common cause of viral pneumonia in adults. Other viruses that cause pneumonia include respiratory syncytial virus, rhinovirus, herpes simplex virus, severe acute respiratory syndrome (SARS), and more. Fungi Three types of fungi in the soil in some parts of the United States can cause pneumonia. These fungi are: Coccidioidomycosis (kok-sid-e-OY-do-mi-KO-sis). This fungus is found in Southern California and the desert Southwest. Histoplasmosis (HIS-to-plaz-MO-sis). This fungus is found in the Ohio and Mississippi River Valleys. Cryptococcus (krip-to-KOK-us). This fungus is found throughout the United States in bird droppings and soil contaminated with bird droppings. Most people exposed to these fungi don't get sick, but some do and require treatment. Serious fungal infections are most common in people who have weak immune systems due to the long-term use of medicines to suppress their immune systems or having HIV/AIDS. Pneumocystis jiroveci (nu-mo-SIS-tis ye-RO-VECH-e), formerly Pneumocystis carinii, sometimes is considered a fungal pneumonia. However, it's not treated with the usual antifungal medicines. This type of infection is most common in people who: Have HIV/AIDS or cancer Have had an organ transplant and/or blood and marrow stem cell transplant Take medicines that affect their immune systems Other kinds of fungal infections also can lead to pneumonia. Who Is at Risk Pneumonia can affect people of all ages. However, two age groups are at greater risk of developing pneumonia: Infants who are 2 years old or younger (because their immune systems are still developing during the first few years of life) People who are 65 years old or older Other conditions and factors also raise your risk for pneumonia. You're more likely to get pneumonia if you have a lung disease or other serious disease. Examples include cystic fibrosis, asthma, COPD (chronic obstructive pulmonary disease), bronchiectasis, diabetes, heart failure, and sickle cell anemia. You're at greater risk for pneumonia if you're in a hospital intensive-care unit, especially if you're on a ventilator (a machine that helps you breathe). Having a weak or suppressed immune system also raises your risk for pneumonia. A weak immune system may be the result of a disease such as HIV/AIDS. A suppressed immune system may be due to an organ transplant or blood and marrow stem cell transplant, chemotherapy (a treatment for cancer), or long-term steroid use. Your risk for pneumonia also increases if you have trouble coughing because of a stroke or problems swallowing. You're also at higher risk if you can't move around much or are sedated (given medicine to make you relaxed or sleepy). Smoking cigarettes, abusing alcohol, or being undernourished also raises your risk for pneumonia. Your risk also goes up if you've recently had a cold or the flu, or if you're exposed to certain chemicals, pollutants, or toxic fumes. Signs & Symptoms The signs and symptoms of pneumonia vary from mild to severe. Many factors affect how serious pneumonia is, including the type of germ causing the infection and your age and overall health. (For more information, go to "Who Is at Risk for Pneumonia?") See your doctor promptly if you: Have a high fever Have shaking chills Have a cough with phlegm (a slimy substance), which doesn't improve or worsens Develop shortness of breath with normal daily activities Have chest pain when you breathe or cough Feel suddenly worse after a cold or the flu People who have pneumonia may have other symptoms, including nausea (feeling sick to the stomach), vomiting, and diarrhea. Symptoms may vary in certain populations. Newborns and infants may not show any signs of the infection. Or, they may vomit, have a fever and cough, or appear restless, sick, or tired and without energy. Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. If they already have a lung disease, it may get worse. Older adults who have pneumonia sometimes have sudden changes in mental awareness. Complications of Pneumonia Often, people who have pneumonia can be successfully treated and not have complications. But some people, especially those in high-risk groups, may have complications such as: Bacteremia (bak-ter-E-me-ah). This serious complication occurs if the infection moves into your bloodstream. From there, it can quickly spread to other organs, including your brain. Lung abscesses. An abscess occurs if pus forms in a cavity in the lung. An abscess usually is treated with antibiotics. Sometimes surgery or drainage with a needle is needed to remove the pus. Pleural effusion. Pneumonia may cause fluid to build up in the pleural space. This is a very thin space between two layers of tissue that line the lungs and the chest cavity. Pneumonia can cause the fluid to become infected—a condition called empyema (em-pi-E-ma). If this happens, you may need to have the fluid drained through a chest tube or removed with surgery. Diagnosis Pneumonia can be hard to diagnose because it may seem like a cold or the flu. You may not realize it's more serious until it lasts longer than these other conditions. Your doctor will diagnose pneumonia based on your medical history, a physical exam, and test results. Medical History Your doctor will ask about your signs and symptoms and how and when they began. To find out what type of germ is causing the pneumonia, he or she also may ask about: Any recent traveling you've done Your hobbies Your exposure to animals Your exposure to sick people at home, school, or work Your past and current medical conditions, and whether any have gotten worse recently Any medicines you take Whether you smoke Whether you've had flu or pneumonia vaccinations Physical Exam Your doctor will listen to your lungs with a stethoscope. If you have pneumonia, your lungs may make crackling, bubbling, and rumbling sounds when you inhale. Your doctor also may hear wheezing. Your doctor may find it hard to hear sounds of breathing in some areas of your chest. Diagnostic Tests If your doctor thinks you have pneumonia, he or she may recommend one or more of the following tests. Chest X Ray A chest x ray is a painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. A chest x ray is the best test for diagnosing pneumonia. However, this test won't tell your doctor what kind of germ is causing the pneumonia. Blood Tests Blood tests involve taking a sample of blood from a vein in your body. A complete blood count (CBC) measures many parts of your blood, including the number of white blood cells in the blood sample. The number of white blood cells can show whether you have a bacterial infection. Your doctor also may recommend a blood culture to find out whether the infection has spread to your bloodstream. This test is used to detect germs in the bloodstream. A blood culture may show which germ caused the infection. If so, your doctor can decide how to treat the infection. Other Tests Your doctor may recommend other tests if you're in the hospital, have serious symptoms, are older, or have other health problems. Sputum test. Your doctor may look at a sample of sputum (spit) collected from you after a deep cough. This may help your doctor find out what germ is causing your pneumonia. Then, he or she can plan treatment. Chest computed tomography (CT) scan. A chest CT scan is a painless test that creates precise pictures of the structures in your chest, such as your lungs. A chest CT scan is a type of x ray, but its pictures show more detail than those of a standard chest x ray. Pleural fluid culture. For this test, a fluid sample is taken from the pleural space (a thin space between two layers of tissue that line the lungs and chest cavity). Doctors use a procedure called thoracentesis (THOR-ah-sen-TE-sis) to collect the fluid sample. The fluid is studied for germs that may cause pneumonia. Pulse oximetry. For this test, a small sensor is attached to your finger or ear. The sensor uses light to estimate how much oxygen is in your blood. Pneumonia can keep your lungs from moving enough oxygen into your bloodstream. If you're very sick, your doctor may need to measure the level of oxygen in your blood using a blood sample. The sample is taken from an artery, usually in your wrist. This test is called an arterial blood gas test. Bronchoscopy. Bronchoscopy (bron-KOS-ko-pee) is a procedure used to look inside the lungs' airways. If you're in the hospital and treatment with antibiotics isn't working well, your doctor may use this procedure. Your doctor passes a thin, flexible tube through your nose or mouth, down your throat, and into the airways. The tube has a light and small camera that allow your doctor to see your windpipe and airways and take pictures. Your doctor can see whether something is blocking your airways or whether another factor is contributing to your pneumonia. Treatments Treatment for pneumonia depends on the type of pneumonia you have and how severe it is. Most people who have community-acquired pneumonia—the most common type of pneumonia—are treated at home. The goals of treatment are to cure the infection and prevent complications. General Treatment If you have pneumonia, follow your treatment plan, take all medicines as prescribed, and get ongoing medical care. Ask your doctor when you should schedule followup care. Your doctor may want you to have a chest x ray to make sure the pneumonia is gone. Although you may start feeling better after a few days or weeks, fatigue (tiredness) can persist for up to a month or more. People who are treated in the hospital may need at least 3 weeks before they can go back to their normal routines. Bacterial Pneumonia Bacterial pneumonia is treated with medicines called antibiotics. You should take antibiotics as your doctor prescribes. You may start to feel better before you finish the medicine, but you should continue taking it as prescribed. If you stop too soon, the pneumonia may come back. Most people begin to improve after 1 to 3 days of antibiotic treatment. This means that they should feel better and have fewer symptoms, such as cough and fever. Viral Pneumonia Antibiotics don't work when the cause of pneumonia is a virus. If you have viral pneumonia, your doctor may prescribe an antiviral medicine to treat it. Viral pneumonia usually improves in 1 to 3 weeks. Treating Severe Symptoms You may need to be treated in a hospital if: Your symptoms are severe You're at risk for complications because of other health problems If the level of oxygen in your bloodstream is low, you may receive oxygen therapy. If you have bacterial pneumonia, your doctor may give you antibiotics through an intravenous (IV) line inserted into a vein. Prevention Pneumonia can be very serious and even life threatening. When possible, take steps to prevent the infection, especially if you're in a high-risk group. Vaccines Vaccines are available to prevent pneumococcal pneumonia and the flu. Vaccines can't prevent all cases of infection. However, compared to people who don't get vaccinated, those who do and still get pneumonia tend to have: Milder cases of the infection Pneumonia that doesn't last as long Fewer serious complications Pneumococcal Pneumonia Vaccine A vaccine is available to prevent pneumococcal pneumonia. In most adults, one shot is good for at least 5 years of protection. This vaccine often is recommended for: People who are 65 years old or older. People who have chronic (ongoing) diseases, serious long-term health problems, or weak immune systems. For example, this may include people who have cancer, HIV/AIDS, asthma, or damaged or removed spleens. People who smoke. Children who are younger than 5 years old. Children who are 5–18 years of age with certain medical conditions, such as heart or lung diseases or cancer. For more information, talk with your child's doctor. For more information about the pneumococcal pneumonia vaccine, go to the Centers for Disease Control and Prevention's (CDC's) Vaccines and Preventable Diseases: Pneumococcal Vaccination Web page. Influenza Vaccine The vaccine that helps prevent the flu is good for 1 year. It's usually given in October or November, before peak flu season. Because many people get pneumonia after having the flu, this vaccine also helps prevent pneumonia. For more information about the influenza vaccine, go to the CDC's Vaccines and Preventable Diseases: Seasonal Influenza (Flu) Vaccination Web page. Hib Vaccine Haemophilus influenzae type b (Hib) is a type of bacteria that can cause pneumonia and meningitis (men-in-JI-tis). (Meningitis is an infection of the covering of the brain and spinal cord.) The Hib vaccine is given to children to help prevent these infections. The vaccine is recommended for all children in the United States who are younger than 5 years old. The vaccine often is given to infants starting at 2 months of age. For more information about the Hib vaccine, go to the CDC's Vaccines and Preventable Diseases: Hib Vaccination Web page. Other Ways To Help Prevent Pneumonia You also can take the following steps to help prevent pneumonia: Wash your hands with soap and water or alcohol-based rubs to kill germs. Don't smoke. Smoking damages your lungs' ability to filter out and defend against germs. For information about how to quit smoking, go to the Health Topics Smoking and Your Heart article. Although this resource focuses on heart health, it includes general information about how to quit smoking. Keep your immune system strong. Get plenty of rest and physical activity and follow a healthy diet. If you have pneumonia, limit contact with family and friends. Cover your nose and mouth while coughing or sneezing, and get rid of used tissues right away. These actions help keep the infection from spreading. Living With If you have pneumonia, you can take steps to recover from the infection and prevent complications. Get plenty of rest. Follow your treatment plan as your doctor advises. Take all medicines as your doctor prescribes. If you're using antibiotics, continue to take the medicine until it's all gone. You may start to feel better before you finish the medicine, but you should continue to take it. If you stop too soon, the pneumonia may come back. Ask your doctor when you should schedule followup care. Your doctor may recommend a chest x ray to make sure the infection is gone. It may take time to recover from pneumonia. Some people feel better and are able to return to their normal routines within a week. For other people, it can take a month or more. Most people continue to feel tired for about a month. Talk with your doctor about when you can go back to your normal routine.
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Colon cancer Overview Colon cancer is cancer of the large intestine (colon), which is the final part of your digestive tract. Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps can become colon cancers. Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying and removing polyps before they turn into cancer. Symptoms Signs and symptoms of colon cancer include: - A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool, that lasts longer than four weeks - Rectal bleeding or blood in your stool - Persistent abdominal discomfort, such as cramps, gas or pain - A feeling that your bowel doesn't empty completely - Weakness or fatigue - Unexplained weight loss Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they'll likely vary, depending on the cancer's size and location in your large intestine. When to see a doctor If you notice any symptoms of colon cancer, such as blood in your stool or an ongoing change in bowel habits, do not hesitate to make an appointment with your doctor. Talk to your doctor about when you should begin screening for colon cancer. Guidelines generally recommend that colon cancer screenings begin at age 50. Your doctor may recommend more frequent or earlier screening if you have other risk factors, such as a family history of the disease. Causes In most cases, it's not clear what causes colon cancer. Doctors know that colon cancer occurs when healthy cells in the colon develop errors in their genetic blueprint, the DNA. Healthy cells grow and divide in an orderly way to keep your body functioning normally. But when a cell's DNA is damaged and becomes cancerous, cells continue to divide - even when new cells aren't needed. As the cells accumulate, they form a tumor. With time, the cancer cells can grow to invade and destroy normal tissue nearby. And cancerous cells can travel to other parts of the body to form deposits there (metastasis). Inherited gene mutations that increase the risk of colon cancer Inherited gene mutations that increase the risk of colon cancer can be passed through families, but these inherited genes are linked to only a small percentage of colon cancers. Inherited gene mutations don't make cancer inevitable, but they can increase an individual's risk of cancer significantly. The most common forms of inherited colon cancer syndromes are: - Hereditary nonpolyposis colorectal cancer (HNPCC). HNPCC, also called Lynch syndrome, increases the risk of colon cancer and other cancers. People with HNPCC tend to develop colon cancer before age 50. - Familial adenomatous polyposis (FAP). FAP is a rare disorder that causes you to develop thousands of polyps in the lining of your colon and rectum. People with untreated FAP have a greatly increased risk of developing colon cancer before age 40. FAP, HNPCC and other, rarer inherited colon cancer syndromes can be detected through genetic testing. If you're concerned about your family's history of colon cancer, talk to your doctor about whether your family history suggests you have a risk of these conditions. Association between diet and increased colon cancer risk Studies of large groups of people have shown an association between a typical Western diet and an increased risk of colon cancer. A typical Western diet is high in fat and low in fiber. When people move from areas where the typical diet is low in fat and high in fiber to areas where the typical Western diet is most common, the risk of colon cancer in these people increases significantly. It's not clear why this occurs, but researchers are studying whether a high-fat, low-fiber diet affects the microbes that live in the colon or causes underlying inflammation that may contribute to cancer risk. This is an area of active investigation and research is ongoing. Risk factors Factors that may increase your risk of colon cancer include: - Older age. The great majority of people diagnosed with colon cancer are older than 50. Colon cancer can occur in younger people, but it occurs much less frequently. - African-American race. African-Americans have a greater risk of colon cancer than do people of other races. - A personal history of colorectal cancer or polyps. If you've already had colon cancer or adenomatous polyps, you have a greater risk of colon cancer in the future. - Inflammatory intestinal conditions. Chronic inflammatory diseases of the colon, such as ulcerative colitis and Crohn's disease, can increase your risk of colon cancer. - Inherited syndromes that increase colon cancer risk. Genetic syndromes passed through generations of your family can increase your risk of colon cancer. These syndromes include familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, which is also known as Lynch syndrome. - Family history of colon cancer. You're more likely to develop colon cancer if you have a parent, sibling or child with the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater. - Low-fiber, high-fat diet. Colon cancer and rectal cancer may be associated with a diet low in fiber and high in fat and calories. Research in this area has had mixed results. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meat. - A sedentary lifestyle. If you're inactive, you're more likely to develop colon cancer. Getting regular physical activity may reduce your risk of colon cancer. - Diabetes. People with diabetes and insulin resistance have an increased risk of colon cancer. - Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight. - Smoking. People who smoke may have an increased risk of colon cancer. - Alcohol. Heavy use of alcohol increases your risk of colon cancer. - Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous cancers increases the risk of colon and rectal cancer. Diagnosis Screening for colon cancer Doctors recommend certain screening tests for healthy people with no signs or symptoms in order to look for early colon cancer. Finding colon cancer at its earliest stage provides the greatest chance for a cure. Screening has been shown to reduce your risk of dying of colon cancer. People with an average risk of colon cancer can consider screening beginning at age 50. But people with an increased risk, such as those with a family history of colon cancer, should consider screening sooner. African-Americans and American Indians may consider beginning colon cancer screening at age 45. Several screening options exist - each with its own benefits and drawbacks. Talk about your options with your doctor, and together you can decide which tests are appropriate for you. If a colonoscopy is used for screening, polyps can be removed during the procedure before they turn into cancer. Diagnosing colon cancer If your signs and symptoms indicate that you could have colon cancer, your doctor may recommend one or more tests and procedures, including: - Using a scope to examine the inside of your colon. Colonoscopy uses a long, flexible and slender tube attached to a video camera and monitor to view your entire colon and rectum. If any suspicious areas are found, your doctor can pass surgical tools through the tube to take tissue samples (biopsies) for analysis and remove polyps. - Blood tests. No blood test can tell you if you have colon cancer. But your doctor may test your blood for clues about your overall health, such as kidney and liver function tests. Your doctor may also test your blood for a chemical sometimes produced by colon cancers (carcinoembryonic antigen or CEA). Tracked over time, the level of CEA in your blood may help your doctor understand your prognosis and whether your cancer is responding to treatment. Staging colon cancer Once you've been diagnosed with colon cancer, your doctor will order tests to determine the extent (stage) of your cancer. Staging helps determine what treatments are most appropriate for you. Staging tests may include imaging procedures such as abdominal, pelvic and chest CT scans. In many cases, the stage of your cancer may not be determined until after colon cancer surgery. The stages of colon cancer are: - Stage I. The cancer has grown through the superficial lining (mucosa) of the colon or rectum but hasn't spread beyond the colon wall or rectum. - Stage II. The cancer has grown into or through the wall of the colon or rectum but hasn't spread to nearby lymph nodes. - Stage III. The cancer has invaded nearby lymph nodes but isn't affecting other parts of your body yet. - Stage IV. The cancer has spread to distant sites, such as other organs - for instance, to your liver or lung. Treatment The type of treatment your doctor recommends will depend largely on the stage of your cancer. The three primary treatment options are surgery, chemotherapy and radiation. Surgery for early-stage colon cancer If your colon cancer is very small, your doctor may recommend a minimally invasive approach to surgery, such as: - Removing polyps during a colonoscopy. If your cancer is small, localized and completely contained within a polyp and in a very early stage, your doctor may be able to remove it completely during a colonoscopy. - Endoscopic mucosal resection. Removing larger polyps may require also taking a small amount of the lining of the colon or rectum in a procedure called an endoscopic mucosal resection. - Minimally invasive surgery. Polyps that can't be removed during a colonoscopy may be removed using laparoscopic surgery. In this procedure, your surgeon performs the operation through several small incisions in your abdominal wall, inserting instruments with attached cameras that display your colon on a video monitor. The surgeon may also take samples from lymph nodes in the area where the cancer is located. Surgery for invasive colon cancer If the cancer has grown into or through your colon, your surgeon may recommend: - Partial colectomy. During this procedure, the surgeon removes the part of your colon that contains the cancer, along with a margin of normal tissue on either side of the cancer. Your surgeon is often able to reconnect the healthy portions of your colon or rectum. This procedure can commonly be done by a minimally invasive approach (laparoscopy). - Surgery to create a way for waste to leave your body. When it's not possible to reconnect the healthy portions of your colon or rectum, you may need an ostomy. This involves creating an opening in the wall of your abdomen from a portion of the remaining bowel for the elimination of stool into a bag that fits securely over the opening. Sometimes the ostomy is only temporary, allowing your colon or rectum time to heal after surgery. In some cases, however, the colostomy may be permanent. - Lymph node removal. Nearby lymph nodes are usually also removed during colon cancer surgery and tested for cancer. Surgery for advanced cancer If your cancer is very advanced or your overall health very poor, your surgeon may recommend an operation to relieve a blockage of your colon or other conditions in order to improve your symptoms. This surgery isn't done to cure cancer, but instead to relieve signs and symptoms, such as bleeding and pain. In specific cases where the cancer has spread only to the liver but your overall health is otherwise good, your doctor may recommend surgery to remove the cancerous lesion from your liver. Chemotherapy may be used before or after this type of surgery. This approach provides a chance to be free of cancer over the long term. Chemotherapy Chemotherapy uses drugs to destroy cancer cells. Chemotherapy for colon cancer is usually given after surgery if the cancer has spread to lymph nodes. In this way, chemotherapy may help reduce the risk of cancer recurrence and death from cancer. Sometimes chemotherapy may be used before surgery as well, with the goal of shrinking the cancer before an operation. Chemotherapy before surgery is more common in rectal cancer than in colon cancer. Chemotherapy can also be given to relieve symptoms of colon cancer that has spread to other areas of the body. Radiation therapy Radiation therapy uses powerful energy sources, such as X-rays, to kill cancer cells, to shrink large tumors before an operation so that they can be removed more easily, or to relieve symptoms of colon cancer and rectal cancer. Radiation therapy either alone or combined with chemotherapy is one of the standard treatment options for the initial management of rectal cancer followed by surgery. Targeted drug therapy Drugs that target specific malfunctions that allow cancer cells to grow are available to people with advanced colon cancer, including: - Bevacizumab (Avastin) - Cetuximab (Erbitux) - Panitumumab (Vectibix) - Ramucirumab (Cyramza) - Regorafenib (Stivarga) - Ziv-aflibercept (Zaltrap) Targeted drugs can be given along with chemotherapy or alone. Targeted drugs are typically reserved for people with advanced colon cancer. Some people are helped by targeted drugs, while others are not. Researchers have recently made progress in determining who is most likely to benefit from specific targeted drugs. Until more is known, doctors carefully weigh the possible benefit of targeted drugs against the risk of side effects and the cost when deciding whether to use these treatments. Immunotherapy Some patients with advanced colon cancer have a chance to benefit from immunotherapy with antibodies such as pembrolizumab (Keytruda) and nivolumab (Opdivo). Whether a colon cancer has the chance to respond to these immunotherapies can be determined by a specific test of the tumor tissue. 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. 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.
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Pulmonary hypertension: Pulmonary hypertension is a type of high blood pressure that affects the arteries in your lungs and the right side of your heart. In one form of pulmonary hypertension, tiny arteries in your lungs, called pulmonary arterioles, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through your lungs, and raises pressure within your lungs' arteries. As the pressure builds, your heart's lower right chamber (right ventricle) must work harder to pump blood through your lungs, eventually causing your heart muscle to weaken and fail. Some forms of pulmonary hypertension are serious conditions that become progressively worse and are sometimes fatal. Although some forms of pulmonary hypertension aren't curable, treatment can help lessen symptoms and improve your quality of life. The signs and symptoms of pulmonary hypertension in its early stages might not be noticeable for months or even years. As the disease progresses, symptoms become worse. Pulmonary hypertension symptoms include: - Shortness of breath (dyspnea), initially while exercising and eventually while at rest - Fatigue - Dizziness or fainting spells (syncope) - Chest pressure or pain - Swelling (edema) in your ankles, legs and eventually in your abdomen (ascites) - Bluish color to your lips and skin (cyanosis) - Racing pulse or heart palpitations Your heart has two upper chambers (atria) and two lower chambers (ventricles). Each time blood passes through your heart, the lower right chamber (right ventricle) pumps blood to your lungs through a large blood vessel (pulmonary artery). In your lungs, the blood releases carbon dioxide and picks up oxygen. The oxygen-rich blood then flows through blood vessels in your lungs (pulmonary arteries, capillaries and veins) to the left side of your heart. Ordinarily, the blood flows easily through the vessels in your lungs, so blood pressure is usually much lower in your lungs. With pulmonary hypertension, the rise in blood pressure is caused by changes in the cells that line your pulmonary arteries. These changes can cause the walls of the arteries to become stiff and thick, and extra tissue may form. The blood vessels may also become inflamed and tight. These changes in the pulmonary arteries can reduce or block blood flow through the blood vessels. This makes it harder for blood to flow, raising the blood pressure in the pulmonary arteries. Pulmonary hypertension is classified into five groups, depending on the cause. Group 1: Pulmonary arterial hypertension - Cause unknown, known as idiopathic pulmonary arterial hypertension - A specific gene mutation that can cause pulmonary hypertension to develop in families, also called heritable pulmonary arterial hypertension - Certain drugs - such as certain prescription diet drugs or illegal drugs such as methamphetamines - or certain toxins - Heart abnormalities present at birth (congenital heart disease) - Other conditions, such as connective tissue disorders (scleroderma, lupus, others), HIV infection or chronic liver disease (cirrhosis) Group 2: Pulmonary hypertension caused by left-sided heart disease - Left-sided valvular heart disease, such as mitral valve or aortic valve disease - Failure of the lower left heart chamber (left ventricle) Group 3: Pulmonary hypertension caused by lung disease - Chronic obstructive pulmonary disease, such as emphysema - Lung disease such as pulmonary fibrosis, a condition that causes scarring in the tissue between the lungs' air sacs (interstitium) - Sleep apnea and other sleep disorders - Long-term exposure to high altitudes in people who may be at higher risk of pulmonary hypertension Group 4: Pulmonary hypertension caused by chronic blood clots - Chronic blood clots in the lungs (pulmonary emboli) Group 5: Pulmonary hypertension associated with other conditions that have unclear reasons why the pulmonary hypertension occurs - Blood disorders - Disorders that affect several organs in the body, such as sarcoidosis - Metabolic disorders, such as glycogen storage disease - Tumors pressing against pulmonary arteries Eisenmenger syndrome and pulmonary hypertension Eisenmenger syndrome, a type of congenital heart disease, causes pulmonary hypertension. It's most commonly caused by a large hole in your heart between the two lower heart chambers (ventricles), called a ventricular septal defect. This hole in your heart causes blood to circulate abnormally in your heart. Oxygen-carrying blood (red blood) mixes with oxygen-poor blood (blue blood). The blood then returns to your lungs instead of going to the rest of your body, increasing the pressure in the pulmonary arteries and causing pulmonary hypertension. Your risk of developing pulmonary hypertension may be greater if: - You're a young adult, as idiopathic pulmonary arterial hypertension is more common in younger adults - You're overweight - You have a family history of the disease - You have one of various conditions that can increase your risk of developing pulmonary hypertension - You use illegal drugs, such as cocaine - You take certain appetite-suppressant medications - You have an existing risk of developing pulmonary hypertension, such as a family history of the condition, and you live at a high altitude Pulmonary hypertension is hard to diagnose early because it's not often detected in a routine physical exam. Even when the condition is more advanced, its signs and symptoms are similar to those of other heart and lung conditions. To diagnose your condition, your doctor may review your medical and family history, discuss your signs and symptoms, and conduct a physical examination. Doctors may order several tests to diagnose pulmonary hypertension, determine the severity of your condition and find out the cause of your condition. Tests may include: - Echocardiogram. Sound waves can create moving images of the beating heart. An echocardiogram can help your doctor to check the size and functioning of the right ventricle, and the thickness of the right ventricle's wall. An echocardiogram can also show how well your heart chambers and valves are working. Doctors may also use this to measure the pressure in your pulmonary arteries. In some cases, your doctor will recommend an exercise echocardiogram to help determine how well your heart and lungs work under stress. In this test, you'll have an echocardiogram before exercising on a stationary bike or treadmill and another test immediately afterward. This could be done as an oxygen consumption test, in which you may have to wear a mask that assesses the ability of your heart and lungs to deal with oxygen and carbon dioxide. Other exercise tests may also be done. These tests can help determine the severity and cause of your condition. They may also be done at follow-up appointments to check that your treatments are working. - Chest X-ray. A chest X-ray can show images of your heart, lungs and chest. This test can show enlargement of the right ventricle of the heart or the pulmonary arteries, which can occur in pulmonary hypertension. This test can also be used to identify other conditions that may be causing pulmonary hypertension. - Electrocardiogram (ECG). This noninvasive test shows your heart's electrical patterns and can detect abnormal rhythms. Doctors may also be able to see signs of right ventricle enlargement or strain. - Right heart catheterization. After you've had an echocardiogram, if your doctor thinks you have pulmonary hypertension, you'll likely have a right heart catheterization. This test can often help confirm that you have pulmonary hypertension and determine the severity of your condition. During the procedure, a cardiologist places a thin, flexible tube (catheter) into a vein in your neck or groin. The catheter is then threaded into your right ventricle and pulmonary artery. Right heart catheterization allows your doctor to directly measure the pressure in the main pulmonary arteries and right ventricle. It's also used to see what effect different medications may have on your pulmonary hypertension. - Blood tests. Your doctor might order blood tests to check for certain substances in your blood that might show you have pulmonary hypertension or its complications. Blood tests can also test for certain conditions that may be causing your condition. Your doctor might order additional tests to check the condition of your lungs and pulmonary arteries and to determine the cause of your condition, including: - Computerized tomography (CT) scan. During a CT scan, you lie on a table inside a doughnut-shaped machine. CT scanning generates X-rays to produce cross-sectional images of your body. Doctors may inject a dye into your blood vessels that helps your arteries to be more visible on the CT pictures (CT angiography). Doctors may use this test to look at the heart's size and function and to check for blood clots in the lungs' arteries. - Magnetic resonance imaging (MRI). This test may be used to check the right ventricle's function and the blood flow in the lung's arteries. In this test, you lie on a movable table that slides into the tunnel. An MRI uses a magnetic field and pulses of radio wave energy to make pictures of the body. - Pulmonary function test. This noninvasive test measures how much air your lungs can hold, and the airflow in and out of your lungs. During the test, you'll blow into a simple instrument called a spirometer. - Polysomnogram. This test detects your brain activity, heart rate, blood pressure, oxygen levels and other factors while you sleep. It can help diagnose a sleep disorder such as obstructive sleep apnea. - Ventilation/perfusion (V/Q) scan. In this test, a tracer is injected into a vein in your arm. The tracer maps blood flow and air to your lungs. This test can be used to determine whether blood clots are causing symptoms of pulmonary hypertension. - Open-lung biopsy. Rarely, a doctor might recommend an open-lung biopsy. An open-lung biopsy is a type of surgery in which a small sample of tissue is removed from your lungs under general anesthesia to check for a possible secondary cause of pulmonary hypertension. Genetic tests If a family member has had pulmonary hypertension, your doctor might screen you for genes that are linked with pulmonary hypertension. If you test positive, your doctor might recommend that other family members be screened for the same genetic mutation. Pulmonary hypertension classifications Once you've been diagnosed with pulmonary hypertension, your doctor might classify the severity of your disease into one of several classes, including: - Class I. Although you've been diagnosed with pulmonary hypertension, you have no symptoms with normal activity. - Class II. You don't have symptoms at rest, but you experience symptoms such as fatigue, shortness of breath or chest pain with normal activity. - Class III. You're comfortable at rest, but have symptoms when you're physically active. - Class IV. You have symptoms with physical activity and while at rest. Pulmonary hypertension can't be cured, but doctors can help you manage your condition. Treatment may help improve your symptoms and slow the progress of pulmonary hypertension. It often takes some time to find the most appropriate treatment for pulmonary hypertension. The treatments are often complex and require extensive follow-up care. Your doctor might also need to change your treatment if it's no longer effective. When pulmonary hypertension is caused by another condition, your doctor will treat the underlying cause whenever possible. Medications - Blood vessel dilators (vasodilators). Vasodilators open narrowed blood vessels. One of the most commonly prescribed vasodilators for pulmonary hypertension is epoprostenol (Flolan, Veletri). The drawback to epoprostenol is that its effects last only a few minutes. This drug is continuously injected through an intravenous (IV) catheter via a small pump that you wear in a pack on your belt or shoulder. Potential side effects of epoprostenol include jaw pain, nausea, diarrhea and leg cramps, as well as pain and infection at the IV site. Another form of the drug, iloprost (Ventavis), can be inhaled six to nine times a day through a nebulizer, a machine that vaporizes your medication. Because it's inhaled, it goes directly to the lungs. Side effects associated with iloprost include chest pain - often accompanied by a headache and nausea - and breathlessness. Treprostinil (Tyvaso, Remodulin, Orenitram), another form of the drug, can be given four times a day. It can be inhaled, taken as oral medication or administered by injection. It can cause side effects such as a headache, nausea and diarrhea. - Endothelin receptor antagonists. These medications reverse the effect of endothelin, a substance in the walls of blood vessels that causes them to narrow. These drugs may improve your energy level and symptoms. However, these drugs shouldn't be taken if you're pregnant. Also, these drugs can damage your liver and you may need monthly liver monitoring. These medications include bosentan (Tracleer), macitentan (Opsumit), and ambrisentan (Letairis). - Sildenafil and tadalafil. Sildenafil (Revatio, Viagra) and tadalafil (Cialis, Adcirca) are sometimes used to treat pulmonary hypertension. These drugs work by opening the blood vessels in the lungs to allow blood to flow through more easily. Side effects can include an upset stomach, headache and vision problems. - High-dose calcium channel blockers. These drugs help relax the muscles in the walls of your blood vessels. They include medications such as amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and nifedipine (Procardia, others). Although calcium channel blockers can be effective, only a small number of people with pulmonary hypertension respond to them. - Soluble guanylate cyclase (SGC) stimulator. Soluble guanylate cyclase (SGC) stimulators (Adempas) interact with nitric oxide and help relax the pulmonary arteries and lower the pressure within the arteries. These medications should not be taken if you're pregnant. They can sometimes cause dizziness or nausea. - Anticoagulants. Your doctor is likely to prescribe the anticoagulant warfarin (Coumadin, Jantoven) to help prevent the formation of blood clots within the small pulmonary arteries. Because anticoagulants prevent normal blood coagulation, they increase your risk of bleeding complications. Take warfarin exactly as prescribed, because warfarin can cause severe side effects if taken incorrectly. If you're taking warfarin, your doctor will ask you to have periodic blood tests to check how well the drug is working. Many other drugs, herbal supplements and foods can interact with warfarin, so be sure your doctor knows all of the medications you're taking. - Digoxin. Digoxin (Lanoxin) can help the heart beat stronger and pump more blood. It can help control the heart rate if you experience arrhythmias. - Diuretics. Commonly known as water pills, these medications help eliminate excess fluid from your body. This reduces the amount of work your heart has to do. They may also be used to limit fluid buildup in your lungs. - Oxygen. Your doctor might suggest that you sometimes breathe pure oxygen, a treatment known as oxygen therapy, to help treat pulmonary hypertension, especially if you live at a high altitude or have sleep apnea. Some people who have pulmonary hypertension eventually require continuous oxygen therapy. Surgeries - Atrial septostomy. If medications don't control your pulmonary hypertension, this open-heart surgery might be an option. In an atrial septostomy, a surgeon will create an opening between the upper left and right chambers of your heart (atria) to relieve the pressure on the right side of your heart. Atrial septostomy can have serious complications, including heart rhythm abnormalities (arrhythmias). - Transplantation. In some cases, a lung or heart-lung transplant might be an option, especially for younger people who have idiopathic pulmonary arterial hypertension. Major risks of any type of transplantation include rejection of the transplanted organ and serious infection, and you must take immunosuppressant drugs for life to help reduce the chance of rejection. Although medical treatment can't cure pulmonary hypertension, it can lessen symptoms. Lifestyle changes also can help improve your condition. Consider these tips: - Get plenty of rest. Resting can reduce the fatigue that might come from having pulmonary hypertension. - Stay as active as possible. Even the mildest forms of activity might be too exhausting for some people who have pulmonary hypertension. For others, moderate exercise such as walking might be beneficial - especially when done with oxygen. But first, talk to your doctor about specific exercise restrictions. In most cases, it's recommended that you not lift heavy weights. Your doctor can help you plan an appropriate exercise program. - Don't smoke. If you smoke, the most important thing you can do for your heart and lungs is to stop. If you can't stop smoking by yourself, ask your doctor to prescribe a treatment plan to help you quit. Also, avoid secondhand smoke if possible. - Avoid pregnancy and birth control pills. If you're a woman of childbearing age, avoid pregnancy. Pregnancy can be life-threatening for both you and your baby. Also avoid using birth control pills, which can increase your risk of blood clots. Talk to your doctor about alternative forms of birth control. If you do become pregnant, it's important to consult with your doctor as pulmonary hypertension can cause serious complications to both you and the fetus. - Avoid traveling to or living at high altitudes. High altitudes can worsen the symptoms of pulmonary hypertension. If you live at an altitude of 8,000 feet (2,438 meters) or higher, your doctor might recommend that you move to a lower altitude. - Avoid situations that can excessively lower blood pressure. These include sitting in a hot tub or sauna or taking long hot baths or showers. These activities lower your blood pressure and can cause fainting or even death. Also avoid activities that cause prolonged straining, such as lifting heavy objects or weights. - Follow a nutritious diet and stay at a healthy weight. Aim to eat a healthy diet of whole grains, a variety of fruits and vegetables, lean meats and low-fat dairy products. Avoid saturated fat, trans fat and cholesterol. It's likely your doctor will recommend limiting the amount of salt in your diet. Aim to maintain a healthy weight. - Ask your doctor about medications. Take all your medications as prescribed. Ask your doctor about any other medications before taking them, as some can interfere with your medication or worsen your condition. - See your doctor at follow-up appointments. Your doctor may recommend regular follow-up appointments. Let your doctor know if you have any questions about your condition or medications you're taking, or if you have any symptoms or side effects from your medications. If pulmonary hypertension is affecting your quality of life, ask your doctor about options that could improve your quality of life. - Get vaccines. Your doctor may recommend getting an influenza and pneumonia vaccine, as these conditions can cause serious issues for people with pulmonary hypertension. - Get support. If you're feeling stressed or worried due to your condition, get support from family or friends. Or, consider joining a support group with others who have pulmonary hypertension.
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Systemic Lupus Erythematosus (Lupus): - Lupus can affect many body parts, including the joints, skin, kidneys, heart, lungs, blood vessels, or brain. - You will have periods of illness (flares) and wellness. - Anyone can get lupus, but it most often affects women. Lupus is also more common among African American, Hispanic, Asian, and Native American women. - Genes play an important role in lupus, but other factors are also involved. - Most people will see a rheumatologist for their lupus treatment. Treatment generally consists of a team approach. - Learning to recognize the warning signs of a flare can help with reducing or preventing the flares. Systemic lupus erythematosus (lupus) happens when the body’s defense system attacks healthy cells and tissues, instead of viruses and bacteria. This can damage many parts of the body such as the: - Joints. - Skin. - Kidneys. - Heart. - Lungs. - Blood vessels. - Brain. You can’t catch lupus from another person. If you have lupus you will have periods of illness (flares) and wellness. - Lupus can affect many body parts, including the joints, skin, kidneys, heart, lungs, blood vessels, or brain. - You will have periods of illness (flares) and wellness. - Anyone can get lupus, but it most often affects women. Lupus is also more common among African American, Hispanic, Asian, and Native American women. - Genes play an important role in lupus, but other factors are also involved. - Most people will see a rheumatologist for their lupus treatment. Treatment generally consists of a team approach. - Learning to recognize the warning signs of a flare can help with reducing or preventing the flares. - Lupus can affect many body parts, including the joints, skin, kidneys, heart, lungs, blood vessels, or brain. - You will have periods of illness (flares) and wellness. - Anyone can get lupus, but it most often affects women. Lupus is also more common among African American, Hispanic, Asian, and Native American women. - Genes play an important role in lupus, but other factors are also involved. - Most people will see a rheumatologist for their lupus treatment. Treatment generally consists of a team approach. - Learning to recognize the warning signs of a flare can help with reducing or preventing the flares. Systemic lupus erythematosus (lupus) happens when the body’s defense system attacks healthy cells and tissues, instead of viruses and bacteria. This can damage many parts of the body such as the: - Joints. - Skin. - Kidneys. - Heart. - Lungs. - Blood vessels. - Brain. You can’t catch lupus from another person. If you have lupus you will have periods of illness (flares) and wellness. Anyone can get systemic lupus erythematosus (lupus), but it most often affects women. Lupus is also more common in African American, Hispanic, Asian, and Native American women than in Caucasian women. Anyone can get systemic lupus erythematosus (lupus), but it most often affects women. Lupus is also more common in African American, Hispanic, Asian, and Native American women than in Caucasian women. No one knows what causes systemic lupus erythematosus (lupus). Research suggests that genes play an important role, but genes alone do not determine who gets lupus. It is likely that many factors trigger the disease. No one knows what causes systemic lupus erythematosus (lupus). Research suggests that genes play an important role, but genes alone do not determine who gets lupus. It is likely that many factors trigger the disease. No one knows what causes systemic lupus erythematosus (lupus). Research suggests that genes play an important role, but genes alone do not determine who gets lupus. It is likely that many factors trigger the disease. There is no single test to diagnose systemic lupus erythematosus (lupus). It may take months or years for your doctor to diagnose the disease. Your doctor may use many tools to make a diagnosis: - Medical history. - Complete physical exam. - Samples from the blood, skin, or kidneys for laboratory tests. There is no single test to diagnose systemic lupus erythematosus (lupus). It may take months or years for your doctor to diagnose the disease. Your doctor may use many tools to make a diagnosis: - Medical history. - Complete physical exam. - Samples from the blood, skin, or kidneys for laboratory tests. There is no single test to diagnose systemic lupus erythematosus (lupus). It may take months or years for your doctor to diagnose the disease. Your doctor may use many tools to make a diagnosis: - Medical history. - Complete physical exam. - Samples from the blood, skin, or kidneys for laboratory tests. Your doctor will develop a treatment plan to fit your needs. You and your doctor should review the plan often to be sure it’s working. You should report new symptoms to your doctor right away so that treatment can be changed if needed. Treatments may include: - Medicines to: - Reduce swelling and pain. - Prevent or reduce flares. - Help the immune system. - Reduce or prevent damage to joints. - Balance the hormones. - Treat problems related to lupus, such as high cholesterol, high blood pressure, or infection. - Alternative treatments may improve symptoms. No research shows that this kind of treatment works for people with lupus. You should talk to your doctor about alternative treatments. Your doctor will develop a treatment plan to fit your needs. You and your doctor should review the plan often to be sure it’s working. You should report new symptoms to your doctor right away so that treatment can be changed if needed. Treatments may include: - Medicines to: - Reduce swelling and pain. - Prevent or reduce flares. - Help the immune system. - Reduce or prevent damage to joints. - Balance the hormones. - Treat problems related to lupus, such as high cholesterol, high blood pressure, or infection. - Alternative treatments may improve symptoms. No research shows that this kind of treatment works for people with lupus. You should talk to your doctor about alternative treatments. Your doctor will develop a treatment plan to fit your needs. You and your doctor should review the plan often to be sure it’s working. You should report new symptoms to your doctor right away so that treatment can be changed if needed. Treatments may include: - Medicines to: - Reduce swelling and pain. - Prevent or reduce flares. - Help the immune system. - Reduce or prevent damage to joints. - Balance the hormones. - Treat problems related to lupus, such as high cholesterol, high blood pressure, or infection. - Alternative treatments may improve symptoms. No research shows that this kind of treatment works for people with lupus. You should talk to your doctor about alternative treatments. Most people will see a rheumatologist for their systemic lupus erythematosus (lupus) treatment. Treatment generally consists of a team approach and may include: - Family doctors, who can work with your other doctors to coordinate your care. - Clinical immunologists, who treat problems with the immune system. - Nephrologists, who treat kidney disease. - Hematologists, who treat blood disorders. - Dermatologists, who treat skin problems. - Neurologists, who treat problems of the brain and spinal cord. - Cardiologists, who treat problems with your heart and blood vessels. - Endocrinologists, who treat problems related to the glands and hormones. - Nurses. - Psychologists. - Social workers. Most people will see a rheumatologist for their systemic lupus erythematosus (lupus) treatment. Treatment generally consists of a team approach and may include: - Family doctors, who can work with your other doctors to coordinate your care. - Clinical immunologists, who treat problems with the immune system. - Nephrologists, who treat kidney disease. - Hematologists, who treat blood disorders. - Dermatologists, who treat skin problems. - Neurologists, who treat problems of the brain and spinal cord. - Cardiologists, who treat problems with your heart and blood vessels. - Endocrinologists, who treat problems related to the glands and hormones. - Nurses. - Psychologists. - Social workers. Most people will see a rheumatologist for their systemic lupus erythematosus (lupus) treatment. Treatment generally consists of a team approach and may include: - Family doctors, who can work with your other doctors to coordinate your care. - Clinical immunologists, who treat problems with the immune system. - Nephrologists, who treat kidney disease. - Hematologists, who treat blood disorders. - Dermatologists, who treat skin problems. - Neurologists, who treat problems of the brain and spinal cord. - Cardiologists, who treat problems with your heart and blood vessels. - Endocrinologists, who treat problems related to the glands and hormones. - Nurses. - Psychologists. - Social workers. Dealing with a long-lasting disease like systemic lupus erythematosus (lupus) can be hard on the emotions. You might think that your friends, family, and coworkers do not understand how you feel. Sadness and anger are common reactions. Besides working with your doctor to determine a treatment plan, there are a few things you can do to help you live with lupus: - Learn to recognize the warning signs of a flare so that you and your doctor might reduce or prevent them. These warning signs include: - Feeling more tired. - Pain. - Rash. - Fever. - Stomachache. - Headache. - Dizziness. - Eat a proper diet, exercise, and learn relaxation techniques to help cope with stress. A healthy lifestyle, as well as quitting smoking, will also reduce your risk for heart disease associated with lupus. Talk to your doctor before starting an exercise program. - Develop and maintain a good support system of family, friends, medical professionals, community organizations, and support groups. Pregnancy and Contraception for Women With Lupus Pregnancy in women with lupus is considered high risk, but most women with lupus carry their babies safely. There are a few things to keep in mind: - Talk to your doctor if you plan to become pregnant. - See your doctor often once you are pregnant. - Good nutrition during pregnancy is important. - Lupus can flare during pregnancy. Recent studies have shown that birth control pills are safe for women with lupus. Dealing with a long-lasting disease like systemic lupus erythematosus (lupus) can be hard on the emotions. You might think that your friends, family, and coworkers do not understand how you feel. Sadness and anger are common reactions. Besides working with your doctor to determine a treatment plan, there are a few things you can do to help you live with lupus: - Learn to recognize the warning signs of a flare so that you and your doctor might reduce or prevent them. These warning signs include: - Feeling more tired. - Pain. - Rash. - Fever. - Stomachache. - Headache. - Dizziness. - Eat a proper diet, exercise, and learn relaxation techniques to help cope with stress. A healthy lifestyle, as well as quitting smoking, will also reduce your risk for heart disease associated with lupus. Talk to your doctor before starting an exercise program. - Develop and maintain a good support system of family, friends, medical professionals, community organizations, and support groups. Pregnancy and Contraception for Women With Lupus Pregnancy in women with lupus is considered high risk, but most women with lupus carry their babies safely. There are a few things to keep in mind: - Talk to your doctor if you plan to become pregnant. - See your doctor often once you are pregnant. - Good nutrition during pregnancy is important. - Lupus can flare during pregnancy. Recent studies have shown that birth control pills are safe for women with lupus.
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Fibromyalgia Overview Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals. Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event. Women are more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression. While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help. Symptoms Symptoms of fibromyalgia include: - Widespread pain. The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist. - Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea. - Cognitive difficulties. A symptom commonly referred to as "fibro fog" impairs the ability to focus, pay attention and concentrate on mental tasks. Fibromyalgia often co-exists with other painful conditions, such as: - Irritable bowel syndrome - Migraine and other types of headaches - Interstitial cystitis or painful bladder syndrome - Temporomandibular joint disorders Causes Doctors don't know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include: - Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder. - Infections. Some illnesses appear to trigger or aggravate fibromyalgia. - Physical or emotional trauma. Fibromyalgia can sometimes be triggered by a physical trauma, such as a car accident. Psychological stress may also trigger the condition. Why does it hurt? Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals. Risk factors Risk factors for fibromyalgia include: - Your sex. Fibromyalgia is diagnosed more often in women than in men. - Family history. You may be more likely to develop fibromyalgia if a relative also has the condition. - Other disorders. If you have osteoarthritis, rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia. Diagnosis In the past, doctors would check 18 specific points on a person's body to see how many of them were painful when pressed firmly. Newer guidelines don't require a tender point exam. Instead, a fibromyalgia diagnosis can be made if a person has had widespread pain for more than three months - with no underlying medical condition that could cause the pain. Blood tests While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include: - Complete blood count - Erythrocyte sedimentation rate - Cyclic citrullinated peptide test - Rheumatoid factor - Thyroid function tests Treatment In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms. Medications Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include: - Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Your doctor might suggest a prescription pain reliever such as tramadol (Ultram). Narcotics are not advised, because they can lead to dependence and may even worsen the pain over time. - Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep. - Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia. Therapy A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your life. Examples include: - Physical therapy. A physical therapist can teach you exercises that will improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful. - Occupational therapy. An occupational therapist can help you make adjustments to your work area or the way you perform certain tasks that will cause less stress on your body. - Counseling. Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations. Lifestyle and home remedies Self-care is critical in the management of fibromyalgia. - Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation. - Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping. - Exercise regularly. At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful. - Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not overdoing it on your good days, but likewise it means not self-limiting or doing too little on the days when symptoms flare. - Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day. Alternative medicine Complementary and alternative therapies for pain and stress management aren't new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia. Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven't been adequately studied. - Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit. - Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety. - Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.
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Hair loss Overview Hair loss can affect just your scalp or your entire body. It can be the result of heredity, hormonal changes, medical conditions or medications. Anyone - men, women and children - can experience hair loss. Baldness typically refers to excessive hair loss from your scalp. Hereditary hair loss with age is the most common cause of baldness. Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the treatments available to prevent further hair loss and to restore growth. Before pursuing hair loss treatment, talk with your doctor about the cause of the hair loss and the best treatment options. Symptoms Hair loss can appear in many different ways, depending on what's causing it. It can come on suddenly or gradually and affect just your scalp or your whole body. Some types of hair loss are temporary, and others are permanent. Signs and symptoms of hair loss may include: - Gradual thinning on top of head. This is the most common type of hair loss, affecting both men and women as they age. In men, hair often begins to recede from the forehead in a line that resembles the letter M. Women typically retain the hairline on the forehead but have a broadening of the part in their hair. - Circular or patchy bald spots. Some people experience smooth, coin-sized bald spots. This type of hair loss usually affects just the scalp, but it sometimes also occurs in beards or eyebrows. In some cases, your skin may become itchy or painful before the hair falls out. - Sudden loosening of hair. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing your hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches. - Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back. - Patches of scaling that spread over the scalp. This is a sign of ringworm. It may be accompanied by broken hair, redness, swelling and, at times, oozing. When to see a doctor See your doctor if your child or you are distressed by hair loss and want to pursue treatment. Also talk to your doctor if you notice sudden or patchy hair loss or more than usual hair loss when combing or washing your or your child's hair. Sudden hair loss can signal an underlying medical condition that requires treatment. Causes Most people normally shed 50 to 100 hairs a day. This usually doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair loss occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue. The exact cause of hair loss may not be fully understood, but it's usually related to one or more of the following factors: - Family history (heredity) - Hormonal changes - Medical conditions - Medications Family history (heredity) The most common cause of hair loss is a hereditary condition called male-pattern baldness or female-pattern baldness. It usually occurs gradually and in predictable patterns - a receding hairline and bald spots in men and thinning hair in women. Heredity also affects the age at which you begin to lose hair, the rate of hair loss and the extent of baldness. Pattern baldness is most common in men and can begin as early as puberty. This type of hair loss may involve both hair thinning and miniaturization (hair becomes soft, fine and short). Hormonal changes and medical conditions A variety of conditions can cause hair loss, including: - Hormonal changes. Hormonal changes and imbalances can cause temporary hair loss. This could be due to pregnancy, childbirth or the onset of menopause. Hormone levels are also affected by the thyroid gland, so thyroid problems may cause hair loss. - Patchy hair loss. This type of nonscarring hair loss is called alopecia areata (al-o-PEE-she-uh ar-e-A-tuh). It occurs when the body's immune system attacks hair follicles - causing sudden hair loss that leaves smooth, roundish bald patches on the skin. - Scalp infections. Infections, such as ringworm, can invade the hair and skin of your scalp, leading to scaly patches and hair loss. Once infections are treated, hair generally grows back. - Other skin disorders. Diseases that cause scarring alopecia may result in permanent loss at the scarred areas. These conditions include lichen planus, some types of lupus and sarcoidosis. - Hair-pulling disorder. This condition, also called trichotillomania (trik-o-til-o-MAY-nee-uh), causes people to have an irresistible urge to pull out their hair, whether it's from the scalp, the eyebrows or other areas of the body. Medications Hair loss can be caused by drugs used for cancer, arthritis, depression, heart problems, high blood pressure and birth control. Intake of too much vitamin A may cause hair loss as well. Other causes of hair loss Hair loss can also result from: - Radiation therapy to the head. The hair may not grow back the same as it was before. - A trigger event. Many people experience a general thinning of hair several months after a physical or emotional shock. This type of hair loss is temporary. Examples of trigger events include sudden or excessive weight loss, a high fever, surgery, or a death in the family. - Certain hairstyles and treatments. Excessive hairstyling or hairstyles that pull your hair tight, such as pigtails or cornrows, can cause traction alopecia. Hot oil hair treatments and permanents can cause inflammation of hair follicles that leads to hair loss. If scarring occurs, hair loss could be permanent. Risk factors A number of factors can increase your risk of hair loss, including: - Family history - Age - Poor nutrition - Certain medical conditions, such as diabetes and lupus - Stress Diagnosis Before making a diagnosis, your doctor will likely give you a physical exam and ask about your medical history and family history. He or she may also perform tests, such as the following: - Blood test. This may help uncover medical conditions related to hair loss, such as thyroid disease. - Pull test. Your doctor gently pulls several dozen hairs to see how many come out. This helps determine the stage of the shedding process. - Scalp biopsy. Your doctor scrapes samples from the skin or from a few hairs plucked from the scalp to examine the hair roots. This can help determine whether an infection is causing hair loss. - Light microscopy. Your doctor uses a special instrument to examine hairs trimmed at their bases. Microscopy helps uncover possible disorders of the hair shaft. Treatment Effective treatments for some types of hair loss are available. But some hair loss is permanent. With some conditions, such as patchy alopecia, hair may regrow without treatment within a year. Treatments for hair loss include medications, surgery, laser therapy, and wigs or hairpieces. Your doctor may suggest a combination of these approaches in order to get the best results. The goals of treatment are to promote hair growth, slow hair loss or hide hair loss. Medication If your hair loss is caused by an underlying disease, treatment for that disease will be necessary. This may include drugs to reduce inflammation and suppress your immune system, such as prednisone. If a certain medication is causing the hair loss, your doctor may advise you to stop using it for at least three months. Medications are available to treat pattern baldness. Two medications approved by the Food and Drug Administration (FDA) to treat hair loss are: - Minoxidil (Rogaine). Minoxidil is an over-the-counter liquid or foam that you rub into your scalp twice a day to grow hair and to prevent further hair loss. It may be used by men and women. With this treatment, some people experience hair regrowth, a slower rate of hair loss or both. The effect peaks at 16 weeks and you need to keep applying the medication to retain benefits. Possible side effects include scalp irritation, unwanted hair growth on the adjacent skin of the face and hands, and rapid heart rate (tachycardia). - Finasteride (Propecia). This prescription drug is available only to men. It's taken daily in pill form. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. You need to keep taking it to retain benefits. Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer. Women who are or may be pregnant need to avoid touching crushed or broken tablets. Surgery In the most common type of permanent hair loss, only the top of the head is affected. Hair transplant or restoration surgery can make the most of the hair you have left. During this procedure, your surgeon removes tiny plugs of skin, each containing a few hairs, from the back or sides of your scalp. He or she then implants the plugs into the bald sections of your scalp. You may be asked to take a hair loss medication before and after surgery to improve results. Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring. Wigs and hairpieces You may want to try a wig or a hairpiece as an alternative to medical treatment or if you don't respond to treatment. It can be used to cover either permanent or temporary hair loss. Quality, natural-looking wigs and hairpieces are available. If your hair loss is due to a medical condition, the cost of a wig may be covered by insurance. You'll need a prescription for the wig from your doctor. Alternative medicine If you are otherwise well-nourished, taking nutritional supplements has not been shown to be helpful. Some studies report that the patchy hair loss caused by alopecia areata may be helped by lavender oil combined with oils from thyme, rosemary and cedar wood. Further study is needed.
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Bipolar disorder Overview Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly. Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any. Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy). Bipolar disorder care at Mayo Clinic Symptoms There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life. - Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis). - Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode. - Cyclothymic disorder. You've had at least two years - or one year in children and teenagers - of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression). - Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke. Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment. Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time. Mania and hypomania Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization. Both a manic and a hypomanic episode include three or more of these symptoms: - Abnormally upbeat, jumpy or wired - Increased activity, energy or agitation - Exaggerated sense of well-being and self-confidence (euphoria) - Decreased need for sleep - Unusual talkativeness - Racing thoughts - Distractibility - Poor decision-making - for example, going on buying sprees, taking sexual risks or making foolish investments Major depressive episode A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms: - Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability) - Marked loss of interest or feeling no pleasure in all - or almost all - activities - Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression) - Either insomnia or sleeping too much - Either restlessness or slowed behavior - Fatigue or loss of energy - Feelings of worthlessness or excessive or inappropriate guilt - Decreased ability to think or concentrate, or indecisiveness - Thinking about, planning or attempting suicide Other features of bipolar disorder Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons. Symptoms in children and teens Symptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder. Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes. The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings. When to see a doctor Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don't get the treatment they need. And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out - and perhaps in financial, legal or relationship trouble. If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control. When to get emergency help Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or call a suicide hotline number - in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room. Causes The exact cause of bipolar disorder is unknown, but several factors may be involved, such as: - Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes. - Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder. Risk factors Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include: - Having a first-degree relative, such as a parent or sibling, with bipolar disorder - Periods of high stress, such as the death of a loved one or other traumatic event - Drug or alcohol abuse Complications Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as: - Problems related to drug and alcohol use - Suicide or suicide attempts - Legal or financial problems - Damaged relationships - Poor work or school performance Co-occurring conditions If you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include: - Anxiety disorders - Eating disorders - Attention-deficit/hyperactivity disorder (ADHD) - Alcohol or drug problems - Physical health problems, such as heart disease, thyroid problems, headaches or obesity Diagnosis To determine if you have bipolar disorder, your evaluation may include: - Physical exam. Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms. - Psychiatric assessment. Your doctor may refer you to a psychiatrist, who will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms. - Mood charting. You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment. - Criteria for bipolar disorder. Your psychiatrist may compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Diagnosis in children Although diagnosis of children and teenagers with bipolar disorder includes the same criteria that are used for adults, symptoms in children and teens often have different patterns and may not fit neatly into the diagnostic categories. Also, children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems, which can make diagnosis more complicated. Referral to a child psychiatrist with experience in bipolar disorder is recommended. Treatment Treatment is best guided by a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist) who is skilled in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, social worker and psychiatric nurse. Bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms. Depending on your needs, treatment may include: - Medications. Often, you'll need to start taking medications to balance your moods right away. - Continued treatment. Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression. - Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control. - Substance abuse treatment. If you have problems with alcohol or drugs, you'll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder. - Hospitalization. Your doctor may recommend hospitalization if you're behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic or major depressive episode. The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms, and also may include education and support groups. Medications A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your particular symptoms. Medications may include: - Mood stabilizers. You'll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal). - Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic drug such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer. - Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it's usually prescribed along with a mood stabilizer or antipsychotic. - Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. - Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep, but are usually used on a short-term basis. Finding the right medication Finding the right medication or medications for you will likely take some trial and error. If one doesn't work well for you, there are several others to try. This process requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so that your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. Medications also may need to be adjusted as your symptoms change. Side effects Mild side effects often improve as you find the right medications and doses that work for you, and your body adjusts to the medications. Talk to your doctor or mental health professional if you have bothersome side effects. Don't make changes or stop taking your medications. If you stop your medication, you may experience withdrawal effects or your symptoms may worsen or return. You may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor. Medications and pregnancy A number of medications for bipolar disorder can be associated with birth defects and can pass through breast milk to your baby. Certain medications, such as valproic acid and divalproex sodium, should not be used during pregnancy. Also, birth control medications may lose effectiveness when taken along with certain bipolar disorder medications. Discuss treatment options with your doctor before you become pregnant, if possible. If you're taking medication to treat your bipolar disorder and think you may be pregnant, talk to your doctor right away. Psychotherapy Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Several types of therapy may be helpful. These include: - Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleeping, waking and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise. - Cognitive behavioral therapy (CBT). The focus is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations. - Psychoeducation. Learning about bipolar disorder (psychoeducation) can help you and your loved ones understand the condition. Knowing what's going on can help you get the best support, identify issues, make a plan to prevent relapse and stick with treatment. - Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings. Other treatment options Depending on your needs, other treatments may be added to your depression therapy. During electroconvulsive therapy (ECT), electrical currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can reverse symptoms of certain mental illnesses. ECT may be an option for bipolar treatment if you don't get better with medications, can't take antidepressants for health reasons such as pregnancy or are at high risk of suicide. Transcranial magnetic stimulation (TMS) is being investigated as an option for those who haven't responded to antidepressants. Treatment in children and teenagers Treatments for children and teenagers are generally decided on a case-by-case basis, depending on symptoms, medication side effects and other factors. Generally, treatment includes: - Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There's less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research. - Psychotherapy. Initial and long-term therapy can help keep symptoms from returning. Psychotherapy can help children and teens manage their routines, develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems common in older children and teens with bipolar disorder. - Psychoeducation. Psychoeducation can include learning the symptoms of bipolar disorder and how they differ from behavior related to your child's developmental age, the situation and appropriate cultural behavior. Understanding about bipolar disorder can also help you support your child. - Support. Working with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success. Lifestyle and home remedies You'll probably need to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder. Here are some steps to take: - Quit drinking or using recreational drugs. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behavior and drug or alcohol abuse. Get help if you have trouble quitting on your own. - Form healthy relationships. Surround yourself with people who are a positive influence. Friends and family members can provide support and help you watch for warning signs of mood shifts. - Create a healthy routine. Having a regular routine for sleeping, eating and physical activity can help balance your moods. Check with your doctor before starting any exercise program. Eat a healthy diet. If you take lithium, talk with your doctor about appropriate fluid and salt intake. If you have trouble sleeping, talk to your doctor or mental health professional about what you can do. - Check first before taking other medications. Call the doctor who's treating you for bipolar disorder before you take medications prescribed by another doctor or any over-the-counter supplements or medications. Sometimes other medications trigger episodes of depression or mania or may interfere with medications you're taking for bipolar disorder. - Consider keeping a mood chart. Keeping a record of your daily moods, treatments, sleep, activities and feelings may help identify triggers, effective treatment options and when treatment needs to be adjusted. Alternative medicine There isn't much research on alternative or complementary medicine - sometimes called integrative medicine - and bipolar disorder. Most of the studies are on major depression, so it isn't clear how these nontraditional approaches work for bipolar disorder. If you choose to use alternative or complementary medicine in addition to your physician-recommended treatment, take some precautions first: - Don't stop taking your prescribed medications or skip therapy sessions. Alternative or complementary medicine is not a substitute for regular medical care when it comes to treating bipolar disorder. - Be honest with your doctors and mental health professionals. Tell them exactly which alternative or complementary treatments you use or would like to try. - Be aware of potential dangers. Alternative and complementary products aren't regulated the way prescription drugs are. Just because it's natural doesn't mean it's safe. Before using alternative or complementary medicine, talk to your doctor about the risks, including possible serious interactions with medications.
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Atherosclerosis What Is... Español Atherosclerosis is a disease in which plaque builds up inside your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body. Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death. Atherosclerosis Atherosclerosis-Related Diseases Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, pelvis, and kidneys. As a result, different diseases may develop based on which arteries are affected. Coronary Heart Disease Coronary heart disease (CHD), also called coronary artery disease, occurs when plaque builds up in the coronary arteries. These arteries supply oxygen-rich blood to your heart. Plaque narrows the coronary arteries and reduces blood flow to your heart muscle. Plaque buildup also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow. If blood flow to your heart muscle is reduced or blocked, you may have angina (chest pain or discomfort) or a heart attack. Plaque also can form in the heart's smallest arteries. This disease is called coronary microvascular disease (MVD). In coronary MVD, plaque doesn't cause blockages in the arteries as it does in CHD. Carotid Artery Disease Carotid (ka-ROT-id) artery disease occurs if plaque builds up in the arteries on each side of your neck (the carotid arteries). These arteries supply oxygen-rich blood to your brain. If blood flow to your brain is reduced or blocked, you may have a stroke. Peripheral Artery Disease Peripheral artery disease (P.A.D.) occurs if plaque builds up in the major arteries that supply oxygen-rich blood to your legs, arms, and pelvis. If blood flow to these parts of your body is reduced or blocked, you may have numbness, pain, and, sometimes, dangerous infections. Chronic Kidney Disease Chronic kidney disease can occur if plaque builds up in the renal arteries. These arteries supply oxygen-rich blood to your kidneys. Over time, chronic kidney disease causes a slow loss of kidney function. The main function of the kidneys is to remove waste and extra water from the body. Overview The cause of atherosclerosis isn't known. However, certain traits, conditions, or habits may raise your risk for the disease. These conditions are known as risk factors. You can control some risk factors, such as lack of physical activity, smoking, and an unhealthy diet. Others you can't control, such as age and a family history of heart disease. Some people who have atherosclerosis have no signs or symptoms. They may not be diagnosed until after a heart attack or stroke. The main treatment for atherosclerosis is lifestyle changes. You also may need medicines and medical procedures. These treatments, along with ongoing medical care, can help you live a healthier life. Outlook Improved treatments have reduced the number of deaths from atherosclerosis-related diseases. These treatments also have improved the quality of life for people who have these diseases. However, atherosclerosis remains a common health problem. You may be able to prevent or delay atherosclerosis and the diseases it can cause. Making lifestyle changes and getting ongoing care can help you avoid the problems of atherosclerosis and live a long, healthy life. OTHER NAMES Arteriosclerosis Hardening of the arteries CAUSES The exact cause of atherosclerosis isn't known. However, studies show that atherosclerosis is a slow, complex disease that may start in childhood. It develops faster as you age. Atherosclerosis may start when certain factors damage the inner layers of the arteries. These factors include: Smoking High amounts of certain fats and cholesterol in the blood High blood pressure High amounts of sugar in the blood due to insulin resistance or diabetes Plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries. Eventually, an area of plaque can rupture (break open). When this happens, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots. Clots narrow the arteries even more, limiting the flow of oxygen-rich blood to your body. Depending on which arteries are affected, blood clots can worsen angina (chest pain) or cause a heart attack or stroke. Researchers continue to look for the causes of atherosclerosis. They hope to find answers to questions such as: Why and how do the arteries become damaged? How does plaque develop and change over time? Why does plaque rupture and lead to blood clots? WHO IS AT RISK The exact cause of atherosclerosis isn't known. However, certain traits, conditions, or habits may raise your risk for the disease. These conditions are known as risk factors. The more risk factors you have, the more likely it is that you'll develop atherosclerosis. You can control most risk factors and help prevent or delay atherosclerosis. Other risk factors can't be controlled. Major Risk Factors Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called "bad" cholesterol) and low HDL cholesterol (sometimes called "good" cholesterol). High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. (The mmHg is millimeters of mercury—the units used to measure blood pressure.) Smoking. Smoking can damage and tighten blood vessels, raise cholesterol levels, and raise blood pressure. Smoking also doesn't allow enough oxygen to reach the body's tissues. Insulin resistance. This condition occurs if the body can't use its insulin properly. Insulin is a hormone that helps move blood sugar into cells where it's used as an energy source. Insulin resistance may lead to diabetes. Diabetes. With this disease, the body's blood sugar level is too high because the body doesn't make enough insulin or doesn't use its insulin properly. Overweight or obesity. The terms "overweight" and "obesity" refer to body weight that's greater than what is considered healthy for a certain height. Lack of physical activity. A lack of physical activity can worsen other risk factors for atherosclerosis, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight and obesity. Unhealthy diet. An unhealthy diet can raise your risk for atherosclerosis. Foods that are high in saturated and trans fats, cholesterol, sodium (salt), and sugar can worsen other atherosclerosis risk factors. Older age. As you get older, your risk for atherosclerosis increases. Genetic or lifestyle factors cause plaque to build up in your arteries as you age. By the time you're middle-aged or older, enough plaque has built up to cause signs or symptoms. In men, the risk increases after age 45. In women, the risk increases after age 55. Family history of early heart disease. Your risk for atherosclerosis increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age. Although age and a family history of early heart disease are risk factors, it doesn't mean that you'll develop atherosclerosis if you have one or both. Controlling other risk factors often can lessen genetic influences and prevent atherosclerosis, even in older adults. Studies show that an increasing number of children and youth are at risk for atherosclerosis. This is due to a number of causes, including rising childhood obesity rates. Emerging Risk Factors Scientists continue to study other possible risk factors for atherosclerosis. High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk for atherosclerosis and heart attack. High levels of CRP are a sign of inflammation in the body. Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls seems to trigger inflammation and help plaque grow. People who have low CRP levels may develop atherosclerosis at a slower rate than people who have high CRP levels. Research is under way to find out whether reducing inflammation and lowering CRP levels also can reduce the risk for atherosclerosis. High levels of triglycerides (tri-GLIH-seh-rides) in the blood also may raise the risk for atherosclerosis, especially in women. Triglycerides are a type of fat. Studies are under way to find out whether genetics may play a role in atherosclerosis risk. Other Factors That Affect Atherosclerosis Other factors also may raise your risk for atherosclerosis, such as: Sleep apnea. Sleep apnea is a disorder that causes one or more pauses in breathing or shallow breaths while you sleep. Untreated sleep apnea can raise your risk for high blood pressure, diabetes, and even a heart attack or stroke. Stress. Research shows that the most commonly reported "trigger" for a heart attack is an emotionally upsetting event, especially one involving anger. Alcohol. Heavy drinking can damage the heart muscle and worsen other risk factors for atherosclerosis. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. SIGNS & SYMPTOMS Atherosclerosis usually doesn't cause signs and symptoms until it severely narrows or totally blocks an artery. Many people don't know they have the disease until they have a medical emergency, such as a heart attack or stroke. Some people may have signs and symptoms of the disease. Signs and symptoms will depend on which arteries are affected. Coronary Arteries The coronary arteries supply oxygen-rich blood to your heart. If plaque narrows or blocks these arteries (a disease called coronary heart disease, or CHD), a common symptom is angina. Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood. Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain. Other symptoms of CHD are shortness of breath and arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat. Plaque also can form in the heart's smallest arteries. This disease is called coronary microvascular disease (MVD). Symptoms of coronary MVD include angina, shortness of breath, sleep problems, fatigue (tiredness), and lack of energy. Carotid Arteries The carotid arteries supply oxygen-rich blood to your brain. If plaque narrows or blocks these arteries (a disease called carotid artery disease), you may have symptoms of a stroke. These symptoms may include: Sudden weakness Paralysis (an inability to move) or numbness of the face, arms, or legs, especially on one side of the body Confusion Trouble speaking or understanding speech Trouble seeing in one or both eyes Problems breathing Dizziness, trouble walking, loss of balance or coordination, and unexplained falls Loss of consciousness Sudden and severe headache Peripheral Arteries Plaque also can build up in the major arteries that supply oxygen-rich blood to the legs, arms, and pelvis (a disease called peripheral artery disease). If these major arteries are narrowed or blocked, you may have numbness, pain, and, sometimes, dangerous infections. Renal Arteries The renal arteries supply oxygen-rich blood to your kidneys. If plaque builds up in these arteries, you may develop chronic kidney disease. Over time, chronic kidney disease causes a slow loss of kidney function. Early kidney disease often has no signs or symptoms. As the disease gets worse it can cause tiredness, changes in how you urinate (more often or less often), loss of appetite, nausea (feeling sick to the stomach), swelling in the hands or feet, itchiness or numbness, and trouble concentrating. DIAGNOSIS Your doctor will diagnose atherosclerosis based on your medical and family histories, a physical exam, and test results. Specialists Involved If you have atherosclerosis, a primary care doctor, such as an internist or family practitioner, may handle your care. Your doctor may recommend other health care specialists if you need expert care, such as: A cardiologist. This is a doctor who specializes in diagnosing and treating heart diseases and conditions. You may go to a cardiologist if you have peripheral artery disease (P.A.D.) or coronary microvascular disease (MVD). A vascular specialist. This is a doctor who specializes in diagnosing and treating blood vessel problems. You may go to a vascular specialist if you have P.A.D. A neurologist. This is a doctor who specializes in diagnosing and treating nervous system disorders. You may see a neurologist if you've had a stroke due to carotid artery disease. A nephrologist. This is a doctor who specializes in diagnosing and treating kidney diseases and conditions. You may go to a nephrologist if you have chronic kidney disease. Physical Exam During the physical exam, your doctor may listen to your arteries for an abnormal whooshing sound called a bruit (broo-E). Your doctor can hear a bruit when placing a stethoscope over an affected artery. A bruit may indicate poor blood flow due to plaque buildup. Your doctor also may check to see whether any of your pulses (for example, in the leg or foot) are weak or absent. A weak or absent pulse can be a sign of a blocked artery. Diagnostic Tests Your doctor may recommend one or more tests to diagnose atherosclerosis. These tests also can help your doctor learn the extent of your disease and plan the best treatment. Blood Tests Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may be a sign that you're at risk for atherosclerosis. EKG (Electrocardiogram) An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart. An EKG can show signs of heart damage caused by CHD. The test also can show signs of a previous or current heart attack. Chest X Ray A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure. Ankle/Brachial Index This test compares the blood pressure in your ankle with the blood pressure in your arm to see how well your blood is flowing. This test can help diagnose P.A.D. Echocardiography Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart and how well your heart chambers and valves are working. Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow. Computed Tomography Scan A computed tomography (CT) scan creates computer-generated pictures of the heart, brain, or other areas of the body. The test can show hardening and narrowing of large arteries. A cardiac CT scan also can show whether calcium has built up in the walls of the coronary (heart) arteries. This may be an early sign of CHD. Stress Testing During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to make your heart work hard and beat fast. When your heart is working hard, it needs more blood and oxygen. Plaque-narrowed arteries can't supply enough oxygen-rich blood to meet your heart's needs. A stress test can show possible signs and symptoms of CHD, such as: Abnormal changes in your heart rate or blood pressure Shortness of breath or chest pain Abnormal changes in your heart rhythm or your heart's electrical activity As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in various parts of your heart. They also can show how well your heart pumps blood when it beats. Angiography Angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the inside of your arteries. This test can show whether plaque is blocking your arteries and how severe the blockage is. A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. Dye that can be seen on an x-ray picture is injected through the catheter into the arteries. By looking at the x-ray picture, your doctor can see the flow of blood through your arteries. Other Tests Other tests are being studied to see whether they can give a better view of plaque buildup in the arteries. Examples of these tests include magnetic resonance imaging (MRI) and positron emission tomography (PET). TREATMENTS Treatments for atherosclerosis may include heart-healthy lifestyle changes, medicines, and medical procedures or surgery. The goals of treatment include: Lowering the risk of blood clots forming Preventing atherosclerosis-related diseases Reducing risk factors in an effort to slow or stop the buildup of plaque Relieving symptoms Widening or bypassing plaque-clogged arteries Heart-Healthy Lifestyle Changes Your doctor may recommend heart-healthy lifestyle changes if you have atherosclerosis. Heart-healthy lifestyle changes include heart-healthy eating, maintaining a healthy weight, managing stress, physical activity and quitting smoking. Heart-Healthy Eating Your doctor may recommend heart-healthy eating, which should include: Fat-free or low-fat dairy products, such as skim milk Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week Fruits, such as apples, bananas, oranges, pears, and prunes Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans Vegetables, such as broccoli, cabbage, and carrots Whole grains, such as oatmeal, brown rice, and corn tortillas When following a heart-healthy diet, you should avoid eating: A lot of red meat Palm and coconut oils Sugary foods and beverages Two nutrients in your diet make blood cholesterol levels rise: Saturated fat—found mostly in foods that come from animals Trans fat (trans fatty acids)—found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats. Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5 percent to 6 percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples: 1,200 calories a day 8 grams of saturated fat a day 1,500 calories a day 10 grams of saturated fat a day 1,800 calories a day 12 grams of saturated fat a day 2,000 calories a day 13 grams of saturated fat a day 2,500 calories a day 17 grams of saturated fat a day Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. Some sources of monounsaturated and polyunsaturated fats are: Avocados Corn, sunflower, and soybean oils Nuts and seeds, such as walnuts Olive, canola, peanut, safflower, and sesame oils Peanut butter Salmon and trout Tofu Sodium You should try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and “no added salt” foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more. Dietary Approaches to Stop Hypertension Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt. The DASH eating plan is a good heart-healthy eating plan, even for those who don’t have high blood pressure. Read more about DASH. Alcohol Try to limit alcohol intake. Too much alcohol will raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is: 12 ounces of beer 5 ounces of wine 1½ ounces of liquor Maintaining a Healthy Weight Maintaining a healthy weight is important for overall health and can lower your risk for coronary heart disease. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active. Knowing your body mass index (BMI) helps you find out if you’re a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institute’s online BMI calculator or talk to your doctor. A BMI: Below 18.5 is a sign that you are underweight. Between 18.5 and 24.9 is in the normal range. Between 25.0 and 29.9 is considered overweight. A BMI of 30.0 or higher is considered obese. A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal. Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, you’re at a higher risk for heart disease and type 2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk. For more information about losing weight or maintaining your weight, visit Aim for a Healthy Weight. If you’re overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol. Managing Stress Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as: A stress management program Meditation Physical activity Relaxation therapy Talking things out with friends or family Physical Activity Regular physical activity can lower many atherosclerosis risk factors, including LDL or “bad” cholesterol, high blood pressure, and excess weight. Physical activity also can lower your risk for diabetes and raise your HDL or “good” cholesterol, which helps prevent atherosclerosis. Everyone should try to participate in moderate-intensity aerobic exercise at least 2 hours and 30 minutes per week or vigorous aerobic exercise for 1 hour and 15 minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10 minutes at a time spread throughout the week. Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you. Read more about physical activity at: Physical Activity and Your Heart U.S. Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans Quitting Smoking If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk for atherosclerosis. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. For more information about how to quit smoking, visit Smoking and Your Heart. Medicines Sometimes lifestyle changes alone aren’t enough to control your cholesterol levels. For example, you also may need statin medications to control or lower your cholesterol. By lowering your blood cholesterol level, you can decrease your chance of having a heart attack or stroke. Doctors usually prescribe statins for people who have: Coronary heart disease, peripheral artery disease, or had a prior stroke Diabetes High LDL cholesterol levels Doctors may discuss beginning statin treatment with people who have an elevated risk for developing heart disease or having a stroke. Your doctor also may prescribe other medications to: Lower your blood pressure Lower your blood sugar levels Prevent blood clots, which can lead to heart attack and stroke Prevent inflammation Take all medicines regularly, as your doctor prescribes. Don’t change the amount of your medicine or skip a dose unless your doctor tells you to. You should still follow a heart healthy lifestyle, even if you take medicines to treat your atherosclerosis. Medical Procedures and Surgery If you have severe atherosclerosis, your doctor may recommend a medical procedure or surgery. Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a procedure that’s used to open blocked or narrowed coronary (heart) arteries. PCI can improve blood flow to the heart and relieve chest pain. Sometimes a small mesh tube called a stent is placed in the artery to keep it open after the procedure. Coronary artery bypass grafting (CABG) is a type of surgery. In CABG, arteries or veins from other areas in your body are used to bypass or go around your narrowed coronary arteries. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Bypass grafting also can be used for leg arteries. For this surgery, a healthy blood vessel is used to bypass a narrowed or blocked artery in one of the legs. The healthy blood vessel redirects blood around the blocked artery, improving blood flow to the leg. Carotid endarterectomy is a type of surgery to remove plaque buildup from the carotid arteries in the neck. This procedure restores blood flow to the brain, which can help prevent a stroke. PREVENTION Taking action to control your risk factors can help prevent or delay atherosclerosis and its related diseases. Your risk for atherosclerosis increases with the number of risk factors you have. One step you can take is to adopt a healthy lifestyle, which can include: Heart-Healthy Eating. Adopt heart-healthy eating habits, which include eating different fruits and vegetables (including beans and peas), whole grains, lean meats, poultry without skin, seafood, and fat-free or low-fat milk and dairy products. A heart-healthy diet is low in sodium, added sugar, solid fats, and refined grains. Following a heart-healthy diet is an important part of a healthy lifestyle. Physical Activity. Be as physically active as you can. Physical activity can improve your fitness level and your health. Ask your doctor what types and amounts of activity are safe for you. Read more about Physical Activity and Your Heart. Quit Smoking. If you smoke, quit. Smoking can damage and tighten blood vessels and raise your risk for atherosclerosis. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. Read more about Smoking and Your Heart. Weight Control. If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control risk factors for atherosclerosis. Other steps that can prevent or delay atherosclerosis include knowing your family history of atherosclerosis. If you or someone in your family has an atherosclerosis-related disease, be sure to tell your doctor. If lifestyle changes aren’t enough, your doctor may prescribe medicines to control your atherosclerosis risk factors. Take all of your medicines as your doctor advises. LIVING WITH Improved treatments have reduced the number of deaths from atherosclerosis-related diseases. These treatments also have improved the quality of life for people who have these diseases. Adopting a healthy lifestyle may help you prevent or delay atherosclerosis and the problems it can cause. This, along with ongoing medical care, can help you avoid the problems of atherosclerosis and live a long, healthy life. Researchers continue to look for ways to improve the health of people who have atherosclerosis or may develop it. Ongoing Care If you have atherosclerosis, work closely with your doctor and other health care providers to avoid serious problems, such as heart attack and stroke. Follow your treatment plan and take all of your medicines as your doctor prescribes. Your doctor will let you know how often you should schedule office visits or blood tests. Be sure to let your doctor know if you have new or worsening symptoms. Emotional Issues and Support Having an atherosclerosis-related disease may cause fear, anxiety, depression, and stress. Talk about how you feel with your doctor. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life. Community resources are available to help you learn more about atherosclerosis. Contact your local public health departments, hospitals, and local chapters of national health organizations to learn more about available resources in your area. Talk about your lifestyle changes with your family and friends—whoever can provide support or needs to understand why you're changing your habits. Family and friends may be able to help you make lifestyle changes. For example, they can help you plan healthier meals. Because atherosclerosis tends to run in families, your lifestyle changes may help many of your family members too.
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Tetanus Overview Tetanus is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and can threaten your life. Tetanus is commonly known as "lockjaw." Thanks to the tetanus vaccine, cases of tetanus are rare in the United States and other parts of the developed world. However, the disease remains a threat to those who aren't up to date on their vaccinations, and is more common in developing countries. There's no cure for tetanus. Treatment focuses on managing complications until the effects of the tetanus toxin resolve. Symptoms Signs and symptoms of tetanus appear anytime from a few days to several weeks after tetanus bacteria enter your body through a wound. The average incubation period is seven to 10 days. Common signs and symptoms of tetanus include: - Spasms and stiffness in your jaw muscles (trismus) - Stiffness of your neck muscles - Difficulty swallowing - Stiffness of your abdominal muscles - Painful body spasms lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light Possible other signs and symptoms include: - Fever - Sweating - Elevated blood pressure - Rapid heart rate See your doctor for a tetanus booster shot if you have a deep or dirty wound and you haven't had a booster shot in five years. If you aren't sure of when your last booster was, get a booster. Or see your doctor about a tetanus booster for any wound - especially if it might have been contaminated with dirt, animal feces or manure - if you haven't had a booster shot within the past 10 years or aren't sure of when you were last vaccinated. Causes Spores of the bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. When they enter a deep flesh wound, spores grow into bacteria that can produce a powerful toxin, tetanospasmin, which impairs the nerves that control your muscles (motor neurons). The toxin can cause muscle stiffness and spasms - the major signs of tetanus. Nearly all cases of tetanus occur in people who have never been vaccinated or adults who haven't kept up with their 10-year booster shots. You can't catch tetanus from a person who has it. Risk factors The following increase your likelihood of getting tetanus: - Failure to get vaccinated or to keep up to date with booster shots against tetanus - An injury that lets tetanus spores into the wound - A foreign body, such as a nail or splinter Tetanus cases have developed from the following: - Puncture wounds - including from splinters, body piercings, tattoos, injection drugs - Gunshot wounds - Compound fractures - Burns - Surgical wounds - Injection drug use - Animal or insect bites - Infected foot ulcers - Dental infections - Infected umbilical stumps in newborns born of inadequately immunized mothers Complications Once tetanus toxin has bonded to your nerve endings it is impossible to remove. Complete recovery from a tetanus infection requires new nerve endings to grow, which can take up to several months. Complications of tetanus infection may include: - Broken bones. The severity of spasms may cause the spine and other bones to break. - Blockage of a lung artery (pulmonary embolism). A blood clot that has traveled from elsewhere in your body can block the main artery of the lung or one of its branches. - Death. Severe tetanus-induced (tetanic) muscle spasms can interfere with or stop your breathing. Respiratory failure is the most common cause of death. Lack of oxygen may also induce cardiac arrest and death. Pneumonia is another cause of death. Diagnosis Doctors diagnose tetanus based on a physical exam, medical and immunization history, and the signs and symptoms of muscle spasms, stiffness and pain. Laboratory tests generally aren't helpful for diagnosing tetanus. Treatment Since there's no cure for tetanus, treatment consists of wound care, medications to ease symptoms and supportive care. Wound care Cleaning the wound is essential to preventing growth of tetanus spores. This involves removing dirt, foreign objects and dead tissue from the wound. Medications - Antitoxin. Your doctor may give you a tetanus antitoxin, such as tetanus immune globulin. However, the antitoxin can neutralize only toxin that hasn't yet bonded to nerve tissue. - Antibiotics. Your doctor may also give you antibiotics, either orally or by injection, to fight tetanus bacteria. - Vaccine. All people with tetanus should receive the tetanus vaccine as soon as they're diagnosed with the condition. - Sedatives. Doctors generally use powerful sedatives to control muscle spasms. - Other drugs. Other medications, such as magnesium sulfate and certain beta blockers, might be used to regulate involuntary muscle activity, such as your heartbeat and breathing. Morphine might be used for this purpose as well as sedation. Supportive therapies Severe tetanus infection often requires a long stay in an intensive care setting. Since sedatives can inhibit breathing, you might temporarily need a ventilator. Lifestyle and home remedies Puncture wounds or other deep cuts, animal bites, or particularly dirty wounds put you at increased risk of tetanus infection. Get medical attention if the wound is deep and dirty, and particularly if you're unsure of when you were last vaccinated. Leave unclean wounds open to avoid trapping bacteria in the wound with a bandage. Your doctor may need to clean the wound, prescribe an antibiotic and give you a booster shot of the tetanus toxoid vaccine. If you've previously been immunized, your body should quickly make the needed antibodies to protect you against tetanus. If you have a minor wound, these steps will help prevent tetanus: - Control bleeding. Apply direct pressure to control bleeding. - Keep the wound clean. After the bleeding stops, rinse the wound thoroughly with clean running water. Clean the area around the wound with soap and a washcloth. If something is embedded in a wound, see your doctor. - Use an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment, such as the multi-ingredient antibiotics Neosporin and Polysporin. These antibiotics won't make the wound heal faster, but they can discourage bacterial growth and infection. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment. - Cover the wound. Exposure to the air might speed healing, but bandages can keep the wound clean and keep harmful bacteria out. Blisters that are draining are vulnerable. Keep them covered until a scab forms. - Change the dressing. Apply a new dressing at least once a day or whenever the dressing becomes wet or dirty to help prevent infection. If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and paper tape.
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Staph infections Overview Staph infections are caused by staphylococcus bacteria, types of germs commonly found on the skin or in the nose of even healthy individuals. Most of the time, these bacteria cause no problems or result in relatively minor skin infections. But staph infections can turn deadly if the bacteria invade deeper into your body, entering your bloodstream, joints, bones, lungs or heart. A growing number of otherwise healthy people are developing life-threatening staph infections. Treatment usually involves antibiotics and drainage of the infected area. However, some staph infections no longer respond to common antibiotics. Symptoms Staph infections can range from minor skin problems to endocarditis, a life-threatening infection of the inner lining of your heart (endocardium). As a result, signs and symptoms of staph infections vary widely, depending on the location and severity of the infection. Skin infections caused by staph bacteria include: - Boils. The most common type of staph infection is the boil, a pocket of pus that develops in a hair follicle or oil gland. The skin over the infected area usually becomes red and swollen. If a boil breaks open, it will probably drain pus. Boils occur most often under the arms or around the groin or buttocks. - Impetigo. This contagious, often painful rash can be caused by staph bacteria. Impetigo usually features large blisters that may ooze fluid and develop a honey-colored crust. - Cellulitis. Cellulitis - an infection of the deeper layers of skin - causes skin redness and swelling on the surface of your skin. Sores (ulcers) or areas of oozing discharge may develop, too. - Staphylococcal scalded skin syndrome. Toxins produced as a result of a staph infection may lead to staphylococcal scalded skin syndrome. Affecting mostly babies and children, this condition features fever, a rash and sometimes blisters. When the blisters break, the top layer of skin comes off - leaving a red, raw surface that looks like a burn. Staph bacteria are one of the most common causes of food poisoning. Symptoms come on quickly, usually within hours of eating a contaminated food. Symptoms usually disappear quickly, too, often lasting just half a day. A staph infection in food usually doesn't cause a fever. Signs and symptoms you can expect with this type of staph infection include: - Nausea and vomiting - Diarrhea - Dehydration - Low blood pressure Also known as blood poisoning, septicemia occurs when staph bacteria enter a person's bloodstream. A fever and low blood pressure are signs of septicemia. The bacteria can travel to locations deep within your body, to produce infections affecting: - Internal organs, such as your brain, heart or lungs - Bones and muscles - Surgically implanted devices, such as artificial joints or cardiac pacemakers This life-threatening condition results from toxins produced by some strains of staph bacteria and has been linked to certain types of tampons, skin wounds and surgery. It usually develops suddenly with: - A high fever - Nausea and vomiting - A rash on your palms and soles that resembles sunburn - Confusion - Muscle aches - Diarrhea - Abdominal pain Septic arthritis is often caused by a staph infection. The bacteria often target the knees, shoulders, hips, and fingers or toes. Signs and symptoms may include: - Joint swelling - Severe pain in the affected joint - Fever Go to the doctor if you or your child has: - An area of red, irritated or painful skin - Pus-filled blisters - Fever You may also want to consult your doctor if: - Skin infections are being passed from one family member to another - Two or more family members have skin infections at the same time Causes Many people carry staph bacteria and never develop staph infections. However, if you develop a staph infection, there's a good chance that it's from bacteria you've been carrying around for some time. These bacteria can also be transmitted from person to person. Because staph bacteria are so hardy, they can live on inanimate objects such as pillowcases or towels long enough to transfer to the next person who touches them. Staph bacteria are able to survive: - Drying - Extremes of temperature - Stomach acid - High levels of salt Risk factors A variety of factors - including the status of your immune system to the types of sports you play - can increase your risk of developing staph infections. Certain disorders or the medications used to treat them can make you more susceptible to staph infections. People who may be more likely to get a staph infection include those with: - Diabetes who use insulin - HIV/AIDS - Kidney failure requiring dialysis - Weakened immune systems - either from a disease or medications that suppress the immune system - Cancer, especially those who are undergoing chemotherapy or radiation - Skin damage from conditions such as eczema, insect bites or minor trauma that opens the skin - Respiratory illness, such as cystic fibrosis or emphysema Despite vigorous attempts to eradicate them, staph bacteria remain present in hospitals, where they attack the most vulnerable, including people with: - Weakened immune systems - Burns - Surgical wounds Staph bacteria can travel along the medical tubing that connects the outside world with your internal organs. Examples include: - Dialysis tubing - Urinary catheters - Feeding tubes - Breathing tubes - Intravascular catheters Staph bacteria can spread easily through cuts, abrasions and skin-to-skin contact. Staph infections may also spread in the locker room through shared razors, towels, uniforms or equipment. Food handlers who don't properly wash their hands can transfer staph from their skin to the food they're preparing. Foods that are contaminated with staph look and taste normal. Complications If staph bacteria invade your bloodstream, you may develop a type of infection that affects your entire body. Called sepsis, this infection can lead to septic shock - a life-threatening episode with extremely low blood pressure. Diagnosis To diagnose a staph infection, your doctor will: - Perform a physical exam. During the exam, your doctor will closely examine any skin lesions you may have. - Collect a sample for testing. Most often, doctors diagnose staph infections by checking a tissue sample or nasal secretions for signs of the bacteria. Treatment Treatment of a staph infection may include: - Antibiotics. Your doctor may perform tests to identify of the staph bacteria behind your infection, and to help choose the antibiotic that will work best. Antibiotics commonly prescribed to treat staph infections include certain cephalosporins, nafcillin or related antibiotics, sulfa drugs, or vancomycin. Vancomycin increasingly is required to treat serious staph infections because so many strains of staph bacteria have become resistant to other traditional medicines. But vancomycin and some other antibiotics have to be given intravenously. If you're given an oral antibiotic, be sure to take it as directed, and to finish all of the medication prescribed by your doctor. Ask your doctor what signs and symptoms you should watch for that might indicate your infection is worsening. - Wound drainage. If you have a skin infection, your doctor will likely make an incision into the sore to drain fluid that has collected there. - Device removal. If your infection involves a device or prosthetic, prompt removal of the device is needed. For some devices, removal might require surgery. Antibiotic resistance Staph bacteria are very adaptable, and many varieties have become resistant to one or more antibiotics. For example, only about 10 percent of today's staph infections can be cured with penicillin. The emergence of antibiotic-resistant strains of staph bacteria - often described as methicillin-resistant Staphylococcus aureus (MRSA) strains - has led to the use of IV antibiotics, such as vancomycin, with the potential for more side effects, such as vancomycin.
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CHAPTER 1: CHARACTERISING AUSTRALIA'S RURAL SPECIALIST PHYSICIAN WORKFORCE: THE PROFESSIONAL PROFILE AND PROFESSIONAL SATISFACTION OF JUNIOR DOCTORS AND CONSULTANTS: Objective: To assess differences in the demographic characteristics, professional profile and professional satisfaction of rural and metropolitan junior physicians and physician consultants in Australia. DESIGN, SETTING AND PARTICIPANTS Cross-sectional, population level national survey of the Medicine in Australia: Balancing Employment and Life longitudinal cohort study (collected 2008-2016). Participants were specialist physicians from four career stage groups: pre-registrars (physician intent); registrars; new consultants (< 5 years since Fellowship); and consultants. MAIN OUTCOME MEASURES Level of professional satisfaction across various job aspects, such as hours worked, working conditions, support networks and educational opportunities, comparing rural and metropolitan based physicians. RESULTS Participants included 1587 pre-registrars (15% rural), 1745 physician registrars (9% rural), 421 new consultants (20% rural) and 1143 consultants (13% rural). Rural physicians of all career stages demonstrated equivalent professional satisfaction across most job aspects, compared with metropolitan physician counterparts. Some examples of differences in satisfaction included rural pre-registrars being less likely to agree they had good access to support and supervision from qualified consultants (odds ratio [OR], 0.6; 95% CI, 0.3-0.9) and rural consultants being more likely to agree they had a poorer professional support network (OR, 1.9; 95% CI, 1.2-2.9). In terms of demographics, relatively more rural physicians had a rural background or were trained overseas. Although most junior physicians were women, female consultants were less likely to be working in a rural location (OR, 0.6; 95% CI, 0.4-0.8). CONCLUSION Junior physicians in metropolitan or rural settings have a similar professional experience, which is important in attracting future trainees. Increased opportunities for rural training should be prioritised, along with addressing concerns about the professional isolation and poorer support network of those in rural areas, not only among junior doctors but also consultants. Finally, making rural practice more attractive to female junior physicians could greatly improve the consultant physician distribution. CHAPTER 2: GENERAL PHYSICIANS AND PAEDIATRICIANS IN RURAL AUSTRALIA: THE SOCIAL CONSTRUCTION OF PROFESSIONAL IDENTITY: Objective: To explore the construction of professional identity among general physicians and paediatricians working in non-metropolitan areas. DESIGN, SETTING AND PARTICIPANTS In-depth qualitative interviews were conducted with general physicians and paediatricians, plus informants from specialist colleges, government agencies and academia who were involved in policy and programs for the training and recruitment of specialists in rural locations across three states and two territories. This research is part of the Training Pathways and Professional Support for Building a Rural Physician Workforce Study, 2018-19. MAIN OUTCOME MEASURES Individual and collective descriptors of professional identity. RESULTS We interviewed 36 key informants. Professional identity for general physicians and paediatricians working in regional, rural and remote Australia is grounded in the breadth of their training, but qualified by location - geographic location, population served or specific location, where social and cultural context specifically shapes practice. General physicians and paediatricians were deeply engaged with their local community and its economic vulnerability, and they described the population size and dynamics of local economies as determinants of viable practice. They often complemented their practice with formal or informal training in areas of special interest, but balanced their practice against subspecialist availability, also dependent on demographics. While valuing their professional roles, they showed limited inclination for industrial organisation. CONCLUSION Despite limited consensus on identity descriptors, rural general physicians and paediatricians highly value generalism and their rural engagement. The structural and geographic bias that preferences urban areas will need to be addressed to further develop coordinated strategies for advanced training in rural contexts, for which collective identity is integral. CHAPTER 3: SUSTAINABLE RURAL PHYSICIAN TRAINING: LEADERSHIP IN A FRAGILE ENVIRONMENT: Objectives: To understand Royal Australasian College of Physicians (RACP) training contexts, including supervisor and trainee perspectives, and to identify contributors to the sustainability of training sites, including training quality. DESIGN, SETTING AND PARTICIPANTS A cross-sectional mixed-methods design was used. A national sample of RACP trainees and Fellows completed online surveys. Survey respondents who indicated willingness to participate in interviews were purposively recruited to cover perspectives from a range of geographic, demographic and training context parameters. MAIN OUTCOME MEASURES Fellows' and trainees' work and life satisfaction, and their experiences of supervision and training, respectively, by geographic location. RESULTS Fellows and trainees reported high levels of satisfaction, with one exception - inner regional Fellows reported lower satisfaction regarding opportunities to use their abilities. Not having a good support network was associated with lower satisfaction. Our qualitative findings indicate that a culture of undermining rural practice is prevalent and that good leadership at all levels is important to reduce negative impacts on supervisor and trainee availability, site accreditation and viability. Trainees described challenges in navigating training pathways, ensuring career development, and having the flexibility to meet family needs. The small number of Fellows in some sites poses challenges for supervisors and trainees and results in a blurring of roles; accreditation is an obstacle to provision of training at rural sites; and the overlap between service and training roles can be difficult for supervisors. CONCLUSION Our qualitative findings emphasise the distinctive nature of regional specialist training, which can make it a fragile environment. Leadership at all levels is critical to sustaining accreditation and support for supervisors and trainees. CHAPTER 4: PRINCIPLES TO GUIDE TRAINING AND PROFESSIONAL SUPPORT FOR A SUSTAINABLE RURAL SPECIALIST PHYSICIAN WORKFORCE: Objective: To draw on research conducted in the Building a Rural Physician Workforce project, the first national study on rural specialist physicians, to define a set of principles applicable to guiding training and professional support action. DESIGN We used elements of the Delphi approach for systematic data collection and codesign, and applied a hybrid participatory action planning approach to achieve consensus on a set of principles. RESULTS Eight interconnected foundational principles built around rural regions and rural people were identified: FP1, grow your own "connected to" place; FP2, select trainees invested in rural practice; FP3, ground training in community need; FP4, rural immersion - not exposure; FP5, optimise and invest in general medicine; FP6, include service and academic learning components; FP7, join up the steps in rural training; and FP8, plan sustainable specialist roles. CONCLUSION These eight principles can guide training and professional support to build a sustainable rural physician workforce. Application of the principles, and coordinated action by stakeholders and the responsible organisations, are needed at national, state and local levels to achieve a sustainable rural physician workforce.
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Rasagiline Why is this medication prescribed? Rasagiline is used alone or in combination with another medication to treat the symptoms of Parkinson's disease (a slowly progressing disease of the nervous system causing a fixed face without expression, tremor at rest, slowing of movements, walking with shuffling steps, stooped posture and muscle weakness). Rasagiline is in a class of medications called monoamine oxidase (MAO) type B inhibitors. It works by increasing the amounts of certain natural substances in the brain. How should this medicine be used? Rasagiline comes as a tablet to take by mouth. It is usually taken once a day with or without food. Take rasagiline at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take rasagiline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor may start you on a low dose of rasagiline and may increase your dose based upon your body's response to this medication. Do not stop taking rasagiline without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop taking rasagiline, you may experience withdrawal symptoms such as a fever; muscle stiffness; unsteadiness, wobbliness, or lack of coordination; or changes in consciousness. Tell your doctor if you experience any of these symptoms when your dose of rasagiline is decreased. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? <h3>Before taking rasagiline,</h3> /h3> tell your doctor and pharmacist if you are allergic to rasagiline, any other medications, or any of the ingredients in rasagiline tablets. Ask your pharmacist for a list of the ingredients. tell your doctor if you are taking cough and cold products containing dextromethorphan (DM; Delsym, Hold, Robitussin CoughGels, Vicks 44 Cough Relief, in Robitussin DM, others), cyclobenzaprine (Flexeril), meperidine (Demerol), methadone (Dolophine, Methadose), propoxyphene (Darvon, in Darvocet-N, others), St. John's wort, or tramadol (Ultram, in Ultracet). Also tell your doctor if you are taking MAO inhibitors such as phenelzine (Nardil), selegiline (Eldepryl), or tranylcypromine (Parnate) or have stopped taking them within the past two weeks. Your doctor may tell you not to take rasagiline if you are taking one or more of these medications. tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amphetamines (Adderall, Dexedrine, DextroStat); antidepressants; cimetidine (Tagamet); decongestants placed in the eye or nose; diet or weight-control products containing ephedrine; fluoroquinolone antibiotics including ciprofloxacin (Cipro), gatifloxacin (Tequin), levofloxacin (Levaquin), norfloxacin (Noroxin), and ofloxacin (Floxin); fluvoxamine (Luvox); medications to treat asthma; medications to treat high blood pressure; medications to treat mental illness; medications to treat pain; phenylpropanolamine (not available in the U.S.); pseudoephedrine (PediaCare, Sudafed, Suphedrine, others); and ticlopidine (Ticlid). Tell your doctor if you are taking fluoxetine (Prozac, Sarafem) or have stopped taking it within the past 5 weeks. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have or have ever had high blood pressure, mental illness or psychosis;kidney, or liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking rasagiline, call your doctor. you should know that rasagiline may cause dizziness, lightheadedness, nausea, sweating, and fainting when you get up too quickly from a lying position. This is more common during the first 2 months of taking rasagiline. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up. you should know that rasagiline may cause serious, life-threatening high blood pressure when taken with certain medications or foods. Carefully follow your doctor's instructions about medications and foods to be avoided. Call your doctor right away if you have a severe headache, blurred vision, or any of the other symptoms listed below as serious side effects. you should know that people who have Parkinson's disease have a higher risk of melanoma (a type of skin cancer) than people who do not have Parkinson's disease. It is not known whether this increased risk is caused by Parkinson's disease, medications used for Parkinson's disease such as rasagiline, or other factors. You should have regular visits with a dermatologist to examine your skin for melanoma. you should know that some people who took rasagiline or similar medications to treat Parkinson's disease experienced intense urges to gamble, increased sexual urges, and other urges that they were unable to control. Tell your doctor if you experience new or increased gambling urges, increased sexual urges, or other intense urges while taking rasagiline. What special dietary instructions should I follow? You will need to avoid eating foods that contain very high amounts of tyramine, such as aged cheeses (e.g., Stilton or blue cheese) during your treatment with rasagiline. Talk to your doctor or dietitian about which foods you should avoid during your treatment or if you do not feel well after eating or drinking certain foods while taking rasagiline. What should I do if I forget a dose? Do not take a double dose to make up for a missed one. Skip the missed dose and take your next dose at the usual time the next day. What side effects can this medication cause? <h3>Rasagiline may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: </h3> /h3> mild headache joint or neck pain heartburn nausea vomiting stomach pain constipation diarrhea loss of appetite weight loss flu-like symptoms fever sweating red, swollen, and/or itchy eyes dry mouth swollen gums unsteadiness, wobbliness, or lack of coordination involuntary, repeated body movements lack of energy sleepiness abnormal dreams depression pain, burning, numbness, or tingling in the hands or feet rash bruising or purple discoloration on skin <h3>Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately: </h3> /h3> severe headache blurred vision seizures chest pain shortness of breath or difficulty breathing confusion unconsciousness slow or difficult speech dizziness or faintness weakness or numbness of an arm or leg hallucinating (seeing things or hearing voices that do not exist) extreme restlessness difficulty thinking clearly or understanding reality Rasagiline may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. What should I know about storage and disposal of this medication? Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location - one that is up and away and out of their sight and reach. http://www.upandaway.org In case of emergency/overdose In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911. <h3>Symptoms of rasagiline overdose may occur as late as 1 to 2 days after the overdose. Symptoms of overdose may include the following: </h3> /h3> drowsiness dizziness faintness irritability hyperactivity agitation or restlessness severe headache hallucinating confusion loss of coordination difficulty opening the mouth rigid body spasm that may include an arched back twitching muscles seizures loss of consciousness fast or irregular heart beat pain in the area between the stomach and chest difficulty breathing or slowed breathing diarrhea fever sweating cool, clammy skin shivering increase in pupil size (black circle in middle of eye) What other information should I know? Keep all appointments with your doctor. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. Brand names Azilect
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Hardening of the arteries Atherosclerosis Arteriosclerosis Plaque buildup - arteries Hyperlipidemia - atherosclerosis Cholesterol - atherosclerosis Summary Hardening of the arteries, also called atherosclerosis, occurs when fat, cholesterol, and other substances build up in the walls of arteries. These deposits are called plaques. Over time, these plaques can narrow or completely block the arteries and cause problems throughout the body. Hardening of the arteries is a common disorder. Causes Watch this video about: Atherosclerosis </div> </div> Hardening of the arteries often occurs with aging. As you grow older, plaque buildup narrows your arteries and makes them stiffer. These changes make it harder for blood to flow through them. Clots may form in these narrowed arteries and block blood flow. Pieces of plaque can also break off and move to smaller blood vessels, blocking them. These blockages starve tissues of blood and oxygen. This can result in damage or tissue death. It is a common cause of heart attack and stroke. High blood cholesterol levels can cause hardening of the arteries at a younger age. For many people, high cholesterol levels are due to a diet that is too high in saturated fats and trans fats. Other factors that can contribute to hardening of the arteries include: Diabetes Family history of hardening of the arteries High blood pressure Lack of exercise Being overweight or obese Smoking Symptoms Hardening of the arteries does not cause symptoms until blood flow to part of the body becomes slowed or blocked. If the arteries supplying the heart become narrow, blood flow can slow down or stop. This can cause chest pain (stable angina), shortness of breath, and other symptoms. Narrowed or blocked arteries may also cause problems in the intestines, kidneys, legs, and brain. Exams and Tests A health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Hardening of the arteries can create a whooshing or blowing sound ("bruit") over an artery. All adults over the age of 18 should have their blood pressure checked every year . More frequent measurement may be needed for those with a history of high blood pressure readings or those with risk factors for high blood pressure. Cholesterol testing is recommended in all adults. The major national guidelines differ on the suggested age to start testing. Screening should begin between ages 20 to 35 for men and ages 20 to 45 for women. Repeat testing is not needed for five years for most adults with normal cholesterol levels. Repeat testing may be needed if lifestyle changes occur, such as large increase in weight or a change in diet. More frequent testing is needed for adults with a history of high cholesterol, diabetes, kidney problems, heart disease, stroke, and other conditions A number of imaging tests may be used to see how well blood moves through your arteries. Doppler tests that use ultrasound or sound waves Magnetic resonance arteriography (MRA), a special type of MRI scan Special CT scans called CT angiography Arteriograms or angiography that use x-rays and contrast material (sometimes called "dye") to see the path of blood flow inside the arteries Treatment Lifestyle changes will reduce your risk of hardening of the arteries. Things you can do include: Quit smoking: This is the single most important change you can make to reduce your risk of heart disease and stroke. Avoid fatty foods: Eat well-balanced meals that are low in fat and cholesterol. Include several daily servings of fruits and vegetables. Adding fish to your diet at least twice a week may be helpful. However, do not eat fried fish. Limit how much alcohol you drink: Recommended limits are one drink a day for women, two a day for men. Get regular physical activity: Exercise with moderate intensity (such as brisk walking) 5 days a week for 30 minutes a day if you are at a healthy weight. For weight loss, exercise for 60 to 90 minutes a day. Talk to your provider before starting a new exercise plan, especially if you have been diagnosed with heart disease or you have ever had a heart attack. If your blood pressure is high, it is important for you to lower it and keep it under control. The goal of treatment is to reduce your blood pressure so that you have a lower risk of health problems caused by high blood pressure. You and your provider should set a blood pressure goal for you. Do not stop or change high blood pressure medicines without talking to your provider. Your provider may want you to take medicine for abnormal cholesterol levels or for high blood pressure if lifestyle changes do not work. This will depend on: Your age The medicines you take Your risk of side effects from possible medicines Whether you have heart disease or other blood flow problems Whether you smoke or are overweight Whether you have diabetes or other heart disease risk factors Whether you have any other medical problems, such as kidney disease Your provider may suggest taking aspirin or another medicine to help prevent blood clots from forming in your arteries. These medicines are called antiplatelet drugs. DO NOT take aspirin without first talking to your provider. Losing weight if you are overweight and reducing blood sugar if you have diabetes or pre-diabetes can help reduce the risk of developing atherosclerosis. Outlook (Prognosis) Hardening of the arteries cannot be reversed once it has occurred. However, lifestyle changes and treating high cholesterol levels can prevent or slow the process from becoming worse. This can help reduce the chances of having a heart attack and stroke as a result of atherosclerosis. Possible Complications In some cases, the plaque is part of a process that causes a weakening of the wall of an artery. This can lead to a bulge in an artery called an aneurysm. Aneurysms can break open (rupture). This causes bleeding that can be life threatening. Review Date 2/22/2018 Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Prescription Medications to Treat Overweight and Obesity What are overweight and obesity? Health care providers use the Body Mass Index (BMI), which is a measure of your weight in relation to your height, to define overweight and obesity. People who have a BMI between 25 and 30 are considered overweight. Obesity is defined as having a BMI of 30 or greater. You can calculate your BMI to learn if you are overweight or obese. Being overweight or obese may increase the risk of health problems. Your health care provider can assess your individual risk due to your weight.Obesity is a chronic condition that affects more than one in three adults in the United States. Another one in three adults is overweight. If you are struggling with your weight, you may find that a healthy eating plan and regular physical activity help you lose weight and keep it off over the long term. If these lifestyle changes are not enough to help you lose weight or maintain your weight loss, your doctor may prescribe medications as part of your weight-control program. How do weight-loss medications work? Prescription medications to treat overweight and obesity work in different ways. For example, some medications may help you feel less hungry or full sooner. Other medications may make it harder for your body to absorb fat from the foods you eat. Who might benefit from weight-loss medications? Weight-loss medications are meant to help people who may have health problems related to overweight or obesity. Before prescribing a weight-loss medication, your doctor also will considerthe likely benefits of weight loss the medication's possible side effects your current health issues and other medications your family's medical history costHealth care professionals often use BMI to help decide who might benefit from weight-loss medications. Your doctor may prescribe a medication to treat your overweight or obesity if you are an adult witha BMI of 30 or more or a BMI of 27 or more and you have weight-related health problems, such as high blood pressure or type 2 diabetes.Weight-loss medications aren't for everyone with a high BMI. Some people who are overweight or obese may lose weight with a lifestyle program that helps them change their behaviors and improve their eating and physical activity habits. A lifestyle program may also address other factors that affect weight gain, such as eating triggers and not getting enough sleep. Can children or teenagers take weight-loss medications? The U.S. Food and Drug Administration (FDA) has approved most weight-loss medications only for adults. The prescription medication orlistat (Xenical) is FDA-approved for children ages 12 and older. Can medications replace physical activity and healthy eating habits as a way to lose weight? Medications don't replace physical activity or healthy eating habits as a way to lose weight. Studies show that weight-loss medications work best when combined with a lifestyle program. Ask your doctor or other health care professional about lifestyle treatment programs for weight management that will work for you.Weight-loss medications don't replace physical activity and healthy eating habits. What are the benefits of using prescription medications to lose weight? When combined with changes to behavior, including eating and physical activity habits, prescription medications may help some people lose weight. On average, people who take prescription medications as part of a lifestyle program lose between 3 and 9 percent more of their starting body weight than people in a lifestyle program who do not take medication. Research shows that some people taking prescription weight-loss medications lose 10 percent or more of their starting weight.1 Results vary by medication and by person.Weight loss of 5 to 10 percent of your starting body weight may help improve your health by lowering blood sugar, blood pressure, and triglycerides. Losing weight also can improve some other health problems related to overweight and obesity, such as joint pain or sleep apnea. Most weight loss takes place within the first 6 months of starting the medication. What are the concerns with using prescription medications to lose weight? Experts are concerned that, in some cases, the side effects of prescription medications to treat overweight and obesity may outweigh the benefits. For this reason, you should never take a weight-loss medication only to improve the way you look. In the past, some weight-loss medications were linked to serious health problems. For example, the FDA recalled fenfluramine and dexfenfluramine (part of the "fen-phen" combination) in 1997 because of concerns related to heart valve problems.Possible side effects vary by medication and how it acts on your body. Most side effects are mild and most often improve if you continue to take the medication. Rarely, serious side effects can occur.Tips for Taking Weight-loss MedicationFollow your doctor's instructions about weight-loss medications. Buy your medication from a pharmacy or web distributor approved by your doctor. Take weight-loss medication to support your healthy eating and physical activity program. Know the side effects and warnings for taking any medication. Ask your doctor if you should stop taking your medication if you are not losing weight after 12 weeks. Discuss other medications, including supplements and vitamins, you are taking with your doctor when considering weight-loss medications. Avoid taking weight-loss medications during pregnancy or if you are planning a pregnancy. Which weight-loss medication might work for me? Choosing a medication to treat overweight or obesity is a decision between you and your doctor. Important factors to consider includethe likely benefits of weight loss the medication's possible side effects your current health issues and other medications your family's medical history costTalk with your doctor about which weight-loss medication might be right for you. How long will I need to take weight-loss medication? How long you will need to take weight-loss medication depends on whether the drug helps you lose and maintain weight and whether you have any side effects. If you have lost enough weight to improve your health and are not having serious side effects, your doctor may advise that you stay on the medication indefinitely. If you do not lose at least 5 percent of your starting weight after 12 weeks on the full dose of your medication, your doctor will probably advise you to stop taking it. He or she may change your treatment plan or consider using a different weight-loss medication. Your doctor also may have you try different lifestyle, physical activity, or eating programs; change your other medications that cause weight gain; or refer you to a bariatric surgeon to see if weight-loss surgery might be an option for you.Because obesity is a chronic condition, you may need to continue changes to your eating and physical activity habits and other behaviors for years-or even a lifetime-to improve your health and maintain a healthy weight. Will I regain some weight after I stop taking weight-loss medication? You will probably regain some weight after you stop taking weight-loss medication. Developing and maintaining healthy eating habits and increasing physical activity may help you regain less weight or keep it off. Federal physical activity guidelines recommend at least 150 minutes of physical activity per week for adults-that's about 30 minutes a day most days of the week. You may need to do more to reach or maintain your weight-loss goal. Will insurance cover the cost of weight-loss medication? Some, but not all, insurance plans cover medications that treat overweight and obesity. Contact your insurance provider to find out if your plan covers these medications. What medications are available to treat overweight and obesity? The table below lists FDA-approved prescription medications for weight loss. The FDA has approved five of these drugs-orlistat (Xenical, Alli), lorcaserin (Belviq), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), and liraglutide (Saxenda)-for long-term use. You can keep taking these drugs as long as you are benefiting from treatment and not having unpleasant side-effects.Some weight-loss medications that curb appetite are approved by the FDA only for short-term use, or up to 12 weeks. Although some doctors prescribe them for longer periods of time, not many research studies have looked at how safe and effective they are for long-term use.Pregnant women should never take weight-loss medications. Women who are planning to get pregnant also should avoid these medications, as some of them may harm a fetus.Prescription Medications Approved for Overweight and Obesity TreatmentWeight-loss medication Approved for How it works Common side effects Warnings Orlistat (Xenical) Available in lower dose without prescription (Alli) Adults and children ages 12 and older Works in your gut to reduce the amount of fat your body absorbs from the food you eat diarrhea gas leakage of oily stools stomach pain Rare cases of severe liver injury have been reported. Avoid taking with cyclosporine. Take a multivitamin pill daily to make sure you get enough of certain vitamins that your body may not absorb from the food you eat. Lorcaserin (Belviq) Adults Acts on the serotonin receptors in your brain. May help you feel full after eating smaller amounts of food. constipation cough dizziness dry mouth feeling tired headaches nausea Tell your doctor if you take antidepressants or migraine medications, since some of these can cause problems when taken together. Phentermine-topiramate (Qsymia) Adults A mix of two medications: phentermine, which lessens your appetite, and topiramate, which is used to treat seizures or migraine headaches. May make you less hungry or feel full sooner. constipation dizziness dry mouth taste changes, especially with carbonated beverages tingling of your hands and feet trouble sleeping Don't use if you have glaucoma or hyperthyroidism. Tell your doctor if you have had a heart attack or stroke, abnormal heart rhythm, kidney disease, or mood problems. MAY LEAD TO BIRTH DEFECTS. DO NOT TAKE QSYMIA IF YOU ARE PREGNANT OR PLANNING A PREGNANCY. Do not take if you are breastfeeding. Naltrexone-bupropion (Contrave) Adults A mix of two medications: naltrexone, which is used to treat alcohol and drug dependence, and bupropion, which is used to treat depression or help people quit smoking. May make you feel less hungry or full sooner. constipation diarrhea dizziness dry mouth headache increased blood pressure increased heart rate insomnia liver damage nausea vomiting Do not use if you have uncontrolled high blood pressure, seizures or a history of anorexia or bulimia nervosa. Do not use if you are dependent on opioid pain medications or withdrawing from drugs or alcohol. Do not use if you are taking bupropion (Wellbutrin, Zyban). MAY INCREASE SUICIDAL THOUGHTS OR ACTIONS. Liraglutide (Saxenda) Available by injection only Adults May make you feel less hungry or full sooner. At a lower dose under a different name, Victoza, FDA-approved to treat type 2 diabetes. nausea diarrhea constipation abdominal pain headache raised pulse May increase the chance of developing pancreatitis. Has been found to cause a rare type of thyroid tumor in animals. Other medications that curb your desire to eat include phentermine benzphetamine diethylpropion phendimetrazine Adults Increase chemicals in your brain to make you feel you are not hungry or that you are full. Note: FDA-approved only for short-term use-up to 12 weeks dry mouth constipation difficulty sleeping dizziness feeling nervous feeling restless headache raised blood pressure raised pulse Do not use if you have heart disease, uncontrolled high blood pressure, hyperthyroidism, or glaucoma. Tell your doctor if you have severe anxiety or other mental health problems. How do doctors use prescription medications “off-label” to treat overweight and obesity? Sometimes doctors use medications in a way that's different from what the FDA has approved, known as "off-label" use. By choosing an off-label medication to treat overweight and obesity, your doctor may prescribea drug approved for treating a different medical problem two or more drugs at the same time a drug for a longer period of time than approved by the FDAYou should feel comfortable asking your doctor if he or she is prescribing a medication that is not approved just for treating overweight and obesity. Before using a medication, learn all you need to know about it. What other medications for weight loss may be available in the future? Researchers are currently studying several new medications and combinations of medications in animals and people. Researchers are working to identify safer and more effective medications to help people who are overweight or obese lose weight and maintain a healthy weight for a long time.Future drugs may use new strategies, such as tocombine drugs that affect appetite and those that affect addiction (or craving) stimulate gut hormones that reduce appetite shrink the blood vessels that feed fat cells in the body, thereby preventing them from growing target genes that affect body weight change bacteria in the gut to control weight Prescription Medications to Treat Overweight and Obesity [1] Yanovski SZ, Yanovski JA. JAMA. Long-term drug treatment for obesity: A systematic and clinical review. 2014; 311(1):74-86.
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Headaches in children Overview Headaches in children are common and usually aren't serious. Like adults, children can develop different types of headaches, including migraine or stress-related (tension) headaches. Children can also have chronic daily headaches. In some cases, headaches in children are caused by an infection, high levels of stress or anxiety, or minor head trauma. It's important to pay attention to your child's headache symptoms and consult a doctor if the headache worsens or occurs frequently. Headaches in children usually can be treated with over-the-counter pain medications and other lifestyle measures. Symptoms Children get the same types of headaches adults do, but their symptoms may differ. For example, migraine pain in children may last less than four hours, whereas in adults, migraines last at least four hours. Differences in symptoms may make it difficult to pinpoint headache type in a child, especially in a younger child who can't describe symptoms. In general, though, certain symptoms tend to fall more frequently under certain categories. Migraines can cause: - Pulsating, throbbing or pounding head pain - Pain that worsens with exertion - Nausea - Vomiting - Abdominal pain - Extreme sensitivity to light and sound Even infants can have migraines. A child who's too young to tell you what's wrong may cry and hold his or her head to indicate severe pain. Tension-type headaches can cause: - A pressing tightness in the muscles of the head or neck - Mild to moderate, nonpulsating pain on both sides of the head - Pain that's not worsened by physical activity - Headache that's not accompanied by nausea or vomiting, as is often the case with migraine Younger children may withdraw from regular play and want to sleep more. Tension-type headaches can last from 30 minutes to several days. Cluster headaches are uncommon in children under 10 years of age. They usually: - Occur in groups of five or more episodes, ranging from one headache every other day to eight a day - Involve sharp, stabbing pain on one side of the head that lasts less than three hours - Are accompanied by teariness, congestion, runny nose, or restlessness or agitation Doctors use the phrase "chronic daily headache" (CDH) for migraine headaches and tension-type headaches that occur more than 15 days a month. CDH may be caused by an infection, minor head injury or taking pain medications - even nonprescription pain medications - too often. Most headaches aren't serious, but seek prompt medical care if your child's headaches: - Wake your child from sleep - Worsen or become more frequent - Change your child's personality - Follow an injury, such as a blow to the head - Feature persistent vomiting or visual changes - Are accompanied by fever and neck pain or stiffness Causes A number of factors can cause your child to develop headaches. Factors include: - Illness and infection. Common illnesses such as colds, flu, and ear and sinus infections are some of the most frequent causes of headaches in children. More-serious infections, such as meningitis or encephalitis, also can cause headaches, but are usually accompanied by other signs and symptoms, such as fever and neck stiffness. - Head trauma. Bumps and bruises can cause headaches. Although most head injuries are minor, seek prompt medical attention if your child falls hard on his or her head or gets hit hard in the head. Also, contact a doctor if your child's head pain steadily worsens after a head injury. - Emotional factors. Stress and anxiety - perhaps triggered by problems with peers, teachers or parents - can play a role in children's headaches. Children with depression may complain of headaches, particularly if they have trouble recognizing feelings of sadness and loneliness. - Genetic predisposition. Headaches, particularly migraines, tend to run in families. - Certain foods and beverages. Nitrates - a food preservative found in cured meats, such as bacon, bologna and hot dogs - can trigger headaches, as can the food additive MSG. Also, too much caffeine - contained in soda, chocolates, coffees and teas - can cause headaches. - Problems in the brain. Rarely, a brain tumor or abscess or bleeding in the brain can press on areas of the brain, causing a chronic, worsening headache. Typically in these cases, however, there are other symptoms, such as visual problems, dizziness and lack of coordination. Risk factors Any child can develop headaches, but they're more common in: - Girls after they reach puberty - Children who have a family history of headaches or migraines - Older teens Diagnosis To learn about the nature of your child's headache, your doctor will likely look to: - Headache history. Your doctor asks you and your child to describe the headaches in detail, to see if there's a pattern or a common trigger. Your doctor may also ask you to keep a headache diary for a time, so you can record more details about your child's headaches, such as frequency, severity of pain and possible triggers. - Physical exam. The doctor performs a physical exam, including measuring your child's height, weight, head circumference, blood pressure and pulse, and examining your child's eyes, neck, head, shoulders and spine. - Neurological exam. Your doctor checks for any problems with movement, coordination or sensation. If your child is otherwise healthy and headaches are the only symptom, no further testing usually is needed. In a few cases, however, imaging scans and other evaluations can help pinpoint a diagnosis or rule out other medical conditions that could be causing the headaches. These tests may include: - Computerized tomography (CT) scan. This imaging procedure uses a series of computer-directed X-rays that provide a cross-sectional view of your child's brain. This helps doctors diagnose tumors, infections and other medical problems that can cause headaches. - Magnetic resonance imaging (MRI). MRIs use a powerful magnet to produce detailed views of the brain. MRI scans help doctors diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain. - Spinal tap (lumbar puncture). If your doctor suspects that an underlying condition, such as bacterial or viral meningitis, is causing your child's headaches, he or she may recommend a spinal tap (lumbar puncture). In this procedure, a thin needle is inserted between two vertebrae in the lower back to extract a sample of cerebrospinal fluid for laboratory analysis. Treatment Usually you can treat your child's headache at home with rest, decreased noise, plenty of fluids, balanced meals and over-the-counter (OTC) pain relievers. If your child is older and has frequent headaches, learning to relax and manage stress through different forms of therapy may help, as well. Medications - OTC pain relievers. Acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) can typically relieve headaches for your child. They should be taken at the first sign of a headache. Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children. Talk to your doctor if you have concerns. - Prescription medications. Triptans, prescription drugs used to treat migraines, are effective and can be used safely in children older than 6 years of age. If your child experiences nausea and vomiting with migraines, your doctor may prescribe an anti-nausea drug. The medication strategy differs from child to child, however. Ask your doctor or pharmacist about nausea relief. Caution: Overuse of medications is itself a contributing factor to headaches (rebound headache). Over time, painkillers and other medications may lose their effectiveness. In addition, all medications have side effects. If your child takes medications regularly, including products you buy over-the-counter, discuss the risks and benefits with your doctor. Therapies While stress doesn't appear to cause headaches, it can act as a trigger for headaches or make a headache worse. Depression and other mental health disorders also can play a role. For these situations, your doctor may recommend one or more behavior therapies, such as: - Relaxation training. Relaxation techniques include deep breathing, yoga, meditation and progressive muscle relaxation, which is accomplished by tensing one muscle at a time, and then completely releasing the tension, until every muscle in the body is relaxed. An older child can learn relaxation techniques in classes or at home using books or tapes. - Biofeedback training. Biofeedback teaches your child to control certain body responses that help reduce pain. During a biofeedback session, your child is connected to devices that monitor and give feedback on body functions, such as muscle tension, heart rate and blood pressure. Your child then learns how to reduce muscle tension and slow his or her heart rate and breathing. The goal of biofeedback is to help your child enter a relaxed state to better cope with pain. - Cognitive behavioral therapy. This therapy can help your child learn to manage stress and reduce the frequency and severity of headaches. During this type of talk therapy, a counselor helps your child learn ways to view and cope with life events more positively. Lifestyle and home remedies OTC pain medications, such as acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others), are usually effective in reducing headache pain. Before giving your child pain medication, keep these points in mind: - Read labels carefully and use only the dosages recommended for your child. - Don't give doses more frequently than recommended. - Don't give your child OTC pain medication more than two or three days a week. Daily use can trigger a rebound headache, a type of headache caused by overuse of pain medications. - Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children. Talk to your doctor if you have concerns. In addition to OTC pain medications, the following can help ease your child's headache: - Rest and relaxation. Encourage your child to rest in a dark, quiet room. Sleeping often resolves headaches in children. - Use a cool, wet compress. While your child rests, place a cool, wet cloth on his or her forehead. - Offer a healthy snack. If your child hasn't eaten in a while, offer a piece of fruit, whole-wheat crackers or low-fat cheese. Not eating can make headaches worse. Alternative medicine Although they haven't been well-studied, a number of dietary supplements have been suggested to help children's headaches, including: - Magnesium - Coenzyme Q10 - Vitamin D - Melatonin Check with your child's doctor before trying any herbal products or dietary supplements to be sure they won't interact with your child's medicine or have harmful side effects. Several alternative treatments may also be helpful for headaches in children, including: - Acupuncture. Acupuncture practitioners use extremely thin, disposable needles that generally cause little pain or discomfort. Some research has suggested that this treatment may help relieve headache symptoms. - Massage. Massage can help reduce stress and relieve tension, and may help ease headaches.
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Chickenpox: Chickenpox (varicella) is a viral infection that causes an itchy rash with small, fluid-filled blisters. Chickenpox is highly contagious to people who haven't had the disease or been vaccinated against it. Before routine chickenpox vaccination, virtually all people had been infected by the time they reached adulthood, sometimes with serious complications. Today, the number of cases and hospitalizations is down dramatically. For most people, chickenpox is a mild disease. Still, it's better to get vaccinated. The chickenpox vaccine is a safe, effective way to prevent chickenpox and its possible complications. Chickenpox infection appears 10 to 21 days after exposure to the virus and usually lasts about five to 10 days. The rash is the telltale indication of chickenpox. Other signs and symptoms, which may appear one to two days before the rash, include: - Fever - Loss of appetite - Headache - Tiredness and a general feeling of being unwell (malaise) Once the chickenpox rash appears, it goes through three phases: - Raised pink or red bumps (papules), which break out over several days - Small fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking - Crusts and scabs, which cover the broken blisters and take several more days to heal New bumps continue to appear for several days. As a result, you may have all three stages of the rash - bumps, blisters and scabbed lesions - at the same time on the second day of the rash. Once infected, you can spread the virus for up to 48 hours before the rash appears, and you remain contagious until all spots crust over. The disease is generally mild in healthy children. In severe cases, the rash can spread to cover the entire body, and lesions may form in the throat, eyes and mucous membranes of the urethra, anus and vagina. New spots continue to appear for several days. When to see a doctor If you suspect that you or your child has chickenpox, consult your doctor. He or she usually can diagnose chickenpox by examining the rash and by noting the presence of accompanying symptoms. Your doctor can also prescribe medications to lessen the severity of chickenpox and treat complications, if necessary. Be sure to call ahead for an appointment and mention you think you or your child has chickenpox, to avoid waiting and possibly infecting others in a waiting room. Also, be sure to let your doctor know if any of these complications occur: - The rash spreads to one or both eyes. - The rash gets very red, warm or tender, indicating a possible secondary bacterial skin infection. - The rash is accompanied by dizziness, disorientation, rapid heartbeat, shortness of breath, tremors, loss of muscle coordination, worsening cough, vomiting, stiff neck or a fever higher than 102 F (38.9 C). - Anyone in the household is immune deficient or younger than 6 months old. Chickenpox, which is caused by the varicella-zoster virus, is highly contagious, and it can spread quickly. The virus is transmitted by direct contact with the rash or by droplets dispersed into the air by coughing or sneezing. Your risk of catching chickenpox is higher if you: - Haven't had chickenpox - Haven't been vaccinated for chickenpox - Work in or attend a school or child care facility - Live with children Most people who have had chickenpox or have been vaccinated against chickenpox are immune to chickenpox. If you've been vaccinated and still get chickenpox, symptoms are often milder, with fewer blisters and mild or no fever. A few people can get chickenpox more than once, but this is rare. Chickenpox is normally a mild disease. But it can be serious and can lead to complications or death, especially in high-risk people. Complications include: - Bacterial infections of the skin, soft tissues, bones, joints or bloodstream (sepsis) - Dehydration - Pneumonia - Inflammation of the brain (encephalitis) - Toxic shock syndrome - Reye's syndrome for people who take aspirin during chickenpox Who's at risk? Those at high risk of having complications from chickenpox include: - Newborns and infants whose mothers never had chickenpox or the vaccine - Adults - Pregnant women who haven't had chickenpox - People whose immune systems are impaired by medication, such as chemotherapy, or another disease, such as cancer or HIV - People who are taking steroid medications for another disease or condition, such as children with asthma - People taking drugs that suppress their immune systems Chickenpox and pregnancy Other complications of chickenpox affect pregnant women. Chickenpox early in pregnancy can result in a variety of problems in a newborn, including low birth weight and birth defects, such as limb abnormalities. A greater threat to a baby occurs when the mother develops chickenpox in the week before birth or within a couple of days after giving birth. Then it can cause a serious, life-threatening infection in a newborn. If you're pregnant and not immune to chickenpox, talk to your doctor about the risks to you and your unborn child. Chickenpox and shingles If you've had chickenpox, you're at risk of another disease caused by the varicella-zoster virus called shingles. After a chickenpox infection, some of the varicella-zoster virus may remain in your nerve cells. Many years later, the virus can reactivate and resurface as shingles - a painful band of short-lived blisters. The virus is more likely to reappear in older adults and people with weakened immune systems. Shingles can lead to its own complication - a condition in which the pain of shingles persists long after the blisters disappear. This complication, called postherpetic neuralgia, can be severe. A shingles vaccine (Zostavax) is available and is recommended for adults age 60 and older who have had chickenpox. Doctors generally diagnose chickenpox based on the telltale rash. If there's any doubt about the diagnosis, chickenpox can be confirmed with laboratory tests, including blood tests or a culture of lesion samples. In otherwise healthy children, chickenpox typically requires no medical treatment. Your doctor may prescribe an antihistamine to relieve itching. But for the most part, the disease is allowed to run its course. If you're at high risk of complications For people who have a high risk of complications from chickenpox, doctors sometimes prescribe medications to shorten the duration of the infection and to help reduce the risk of complications. If you or your child falls into a high-risk group, your doctor may suggest an antiviral drug such as acyclovir (Zovirax) or another drug called immune globulin intravenous (Privigen). These medications may lessen the severity of the disease when given within 24 hours after the rash first appears. Other antiviral drugs, such as valacyclovir (Valtrex) and famciclovir (Famvir), also may lessen the severity of the disease, but may not be approved or appropriate for all cases. In some instances, your doctor may recommend getting the chickenpox vaccine after exposure to the virus. This can prevent the disease or lessen its severity. Don't give anyone with chickenpox - child or adult - any medicine containing aspirin because this combination has been associated with a condition called Reye's syndrome. Treating complications If complications do develop, your doctor will determine the appropriate treatment. Treatment for skin infections and pneumonia may be with antibiotics. Treatment for encephalitis is usually with antiviral drugs. Hospitalization may be necessary. To help ease the symptoms of an uncomplicated case of chickenpox, follow these self-care measures. Don't scratch Scratching can cause scarring, slow healing and increase the risk that the sores will become infected. If your child can't stop scratching: - Put gloves on his or her hands, especially at night - Trim his or her fingernails Relieve the itch and other symptoms The chickenpox rash can be very itchy, and broken vesicles sometimes sting. These discomforts, along with fever, headache and fatigue, can make anyone miserable. For relief, try: - A cool bath with added baking soda, uncooked oatmeal or colloidal oatmeal - a finely ground oatmeal that is made for soaking. - Calamine lotion dabbed on the spots. - A soft, bland diet if chickenpox sores develop in the mouth. - Antihistamines such as diphenhydramine (Benadryl, others) for itching. Check with your doctor to make sure your child can safely take antihistamines. - Acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, Children's Motrin, others) for a mild fever. Don't give aspirin to anyone with chickenpox because it can lead to a serious condition called Reye's syndrome. And don't treat a high fever without consulting your doctor.
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Bipolar disorder: Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly. Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any. Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy). Bipolar disorder care at Mayo Clinic There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life. - Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis). - Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode. - Cyclothymic disorder. You've had at least two years - or one year in children and teenagers - of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression). - Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke. Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment. Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time. Mania and hypomania Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization. Both a manic and a hypomanic episode include three or more of these symptoms: - Abnormally upbeat, jumpy or wired - Increased activity, energy or agitation - Exaggerated sense of well-being and self-confidence (euphoria) - Decreased need for sleep - Unusual talkativeness - Racing thoughts - Distractibility - Poor decision-making - for example, going on buying sprees, taking sexual risks or making foolish investments Major depressive episode A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms: - Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability) - Marked loss of interest or feeling no pleasure in all - or almost all - activities - Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression) - Either insomnia or sleeping too much - Either restlessness or slowed behavior - Fatigue or loss of energy - Feelings of worthlessness or excessive or inappropriate guilt - Decreased ability to think or concentrate, or indecisiveness - Thinking about, planning or attempting suicide Other features of bipolar disorder Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons. Symptoms in children and teens Symptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder. Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes. The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings. When to see a doctor Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don't get the treatment they need. And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out - and perhaps in financial, legal or relationship trouble. If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control. When to get emergency help Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or call a suicide hotline number - in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room. The exact cause of bipolar disorder is unknown, but several factors may be involved, such as: - Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes. - Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder. Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include: - Having a first-degree relative, such as a parent or sibling, with bipolar disorder - Periods of high stress, such as the death of a loved one or other traumatic event - Drug or alcohol abuse Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as: - Problems related to drug and alcohol use - Suicide or suicide attempts - Legal or financial problems - Damaged relationships - Poor work or school performance Co-occurring conditions If you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include: - Anxiety disorders - Eating disorders - Attention-deficit/hyperactivity disorder (ADHD) - Alcohol or drug problems - Physical health problems, such as heart disease, thyroid problems, headaches or obesity To determine if you have bipolar disorder, your evaluation may include: - Physical exam. Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms. - Psychiatric assessment. Your doctor may refer you to a psychiatrist, who will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms. - Mood charting. You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment. - Criteria for bipolar disorder. Your psychiatrist may compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Diagnosis in children Although diagnosis of children and teenagers with bipolar disorder includes the same criteria that are used for adults, symptoms in children and teens often have different patterns and may not fit neatly into the diagnostic categories. Also, children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems, which can make diagnosis more complicated. Referral to a child psychiatrist with experience in bipolar disorder is recommended. Treatment is best guided by a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist) who is skilled in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, social worker and psychiatric nurse. Bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms. Depending on your needs, treatment may include: - Medications. Often, you'll need to start taking medications to balance your moods right away. - Continued treatment. Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression. - Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control. - Substance abuse treatment. If you have problems with alcohol or drugs, you'll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder. - Hospitalization. Your doctor may recommend hospitalization if you're behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic or major depressive episode. The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms, and also may include education and support groups. Medications A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your particular symptoms. Medications may include: - Mood stabilizers. You'll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal). - Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic drug such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer. - Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it's usually prescribed along with a mood stabilizer or antipsychotic. - Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. - Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep, but are usually used on a short-term basis. Finding the right medication Finding the right medication or medications for you will likely take some trial and error. If one doesn't work well for you, there are several others to try. This process requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so that your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. Medications also may need to be adjusted as your symptoms change. Side effects Mild side effects often improve as you find the right medications and doses that work for you, and your body adjusts to the medications. Talk to your doctor or mental health professional if you have bothersome side effects. Don't make changes or stop taking your medications. If you stop your medication, you may experience withdrawal effects or your symptoms may worsen or return. You may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor. Medications and pregnancy A number of medications for bipolar disorder can be associated with birth defects and can pass through breast milk to your baby. Certain medications, such as valproic acid and divalproex sodium, should not be used during pregnancy. Also, birth control medications may lose effectiveness when taken along with certain bipolar disorder medications. Discuss treatment options with your doctor before you become pregnant, if possible. If you're taking medication to treat your bipolar disorder and think you may be pregnant, talk to your doctor right away. Psychotherapy Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Several types of therapy may be helpful. These include: - Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleeping, waking and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise. - Cognitive behavioral therapy (CBT). The focus is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations. - Psychoeducation. Learning about bipolar disorder (psychoeducation) can help you and your loved ones understand the condition. Knowing what's going on can help you get the best support, identify issues, make a plan to prevent relapse and stick with treatment. - Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings. Other treatment options Depending on your needs, other treatments may be added to your depression therapy. During electroconvulsive therapy (ECT), electrical currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can reverse symptoms of certain mental illnesses. ECT may be an option for bipolar treatment if you don't get better with medications, can't take antidepressants for health reasons such as pregnancy or are at high risk of suicide. Transcranial magnetic stimulation (TMS) is being investigated as an option for those who haven't responded to antidepressants. Treatment in children and teenagers Treatments for children and teenagers are generally decided on a case-by-case basis, depending on symptoms, medication side effects and other factors. Generally, treatment includes: - Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There's less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research. - Psychotherapy. Initial and long-term therapy can help keep symptoms from returning. Psychotherapy can help children and teens manage their routines, develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems common in older children and teens with bipolar disorder. - Psychoeducation. Psychoeducation can include learning the symptoms of bipolar disorder and how they differ from behavior related to your child's developmental age, the situation and appropriate cultural behavior. Understanding about bipolar disorder can also help you support your child. - Support. Working with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success. You'll probably need to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder. Here are some steps to take: - Quit drinking or using recreational drugs. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behavior and drug or alcohol abuse. Get help if you have trouble quitting on your own. - Form healthy relationships. Surround yourself with people who are a positive influence. Friends and family members can provide support and help you watch for warning signs of mood shifts. - Create a healthy routine. Having a regular routine for sleeping, eating and physical activity can help balance your moods. Check with your doctor before starting any exercise program. Eat a healthy diet. If you take lithium, talk with your doctor about appropriate fluid and salt intake. If you have trouble sleeping, talk to your doctor or mental health professional about what you can do. - Check first before taking other medications. Call the doctor who's treating you for bipolar disorder before you take medications prescribed by another doctor or any over-the-counter supplements or medications. Sometimes other medications trigger episodes of depression or mania or may interfere with medications you're taking for bipolar disorder. - Consider keeping a mood chart. Keeping a record of your daily moods, treatments, sleep, activities and feelings may help identify triggers, effective treatment options and when treatment needs to be adjusted. There isn't much research on alternative or complementary medicine - sometimes called integrative medicine - and bipolar disorder. Most of the studies are on major depression, so it isn't clear how these nontraditional approaches work for bipolar disorder. If you choose to use alternative or complementary medicine in addition to your physician-recommended treatment, take some precautions first: - Don't stop taking your prescribed medications or skip therapy sessions. Alternative or complementary medicine is not a substitute for regular medical care when it comes to treating bipolar disorder. - Be honest with your doctors and mental health professionals. Tell them exactly which alternative or complementary treatments you use or would like to try. - Be aware of potential dangers. Alternative and complementary products aren't regulated the way prescription drugs are. Just because it's natural doesn't mean it's safe. Before using alternative or complementary medicine, talk to your doctor about the risks, including possible serious interactions with medications.
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Psoriasis What is it? Points To Remember About Psoriasis What is psoriasis? Psoriasis is an autoimmune disease that causes red, scaly skin.It is caused by genes, meaning it runs in families, but some outside factors can make it worse or trigger flares.Psoriasis can be hard to diagnose because it can look like other skin diseases.Your doctor may recommend creams, ultraviolet light therapy, prescription medications, shots, or some combination of these treatments.You may have to try a couple of different treatments before finding one that helps you.Joining a support group helps some people with psoriasis cope with the disease.Psoriasis is a skin disease that causes red, scaly skin that may feel painful, swollen or hot.If you have psoriasis, you are more likely to get some other conditions, including: Psoriatic arthritis, a condition that causes joint pain and swelling.Cardiovascular problems, which affect the heart and blood circulation system.Obesity.High blood pressure.Diabetes.Some treatments for psoriasis can have serious side effects, so be sure to talk about them with your doctor and keep all your appointments. Psoriasis is an autoimmune disease that causes red, scaly skin.It is caused by genes, meaning it runs in families, but some outside factors can make it worse or trigger flares.Psoriasis can be hard to diagnose because it can look like other skin diseases.Your doctor may recommend creams, ultraviolet light therapy, prescription medications, shots, or some combination of these treatments.You may have to try a couple of different treatments before finding one that helps you.Joining a support group helps some people with psoriasis cope with the disease. Psoriasis is an autoimmune disease that causes red, scaly skin.It is caused by genes, meaning it runs in families, but some outside factors can make it worse or trigger flares.Psoriasis can be hard to diagnose because it can look like other skin diseases.Your doctor may recommend creams, ultraviolet light therapy, prescription medications, shots, or some combination of these treatments.You may have to try a couple of different treatments before finding one that helps you.Joining a support group helps some people with psoriasis cope with the disease.Psoriasis is a skin disease that causes red, scaly skin that may feel painful, swollen or hot.If you have psoriasis, you are more likely to get some other conditions, including: Psoriatic arthritis, a condition that causes joint pain and swelling.Cardiovascular problems, which affect the heart and blood circulation system.Obesity.High blood pressure.Diabetes.Some treatments for psoriasis can have serious side effects, so be sure to talk about them with your doctor and keep all your appointments. Who gets it? Who gets psoriasis? Anyone can get psoriasis, but it is more common in adults. Certain genes have been linked to psoriasis, so you are more likely to get it if someone else in your family has it.Anyone can get psoriasis, but it is more common in adults. Certain genes have been linked to psoriasis, so you are more likely to get it if someone else in your family has it. What are the types? What are the types of psoriasis? There are several different types of psoriasis. Here are a few examples: Plaque psoriasis, which causes patches of skin that are red at the base and covered by silvery scales.Guttate psoriasis, which causes small, drop-shaped lesions on your trunk, limbs, and scalp. This type of psoriasis is most often triggered by upper respiratory infections, such as strep throat.Pustular psoriasis, which causes pus-filled blisters. Attacks or flares can be caused by medications, infections, stress, or certain chemicals.Inverse psoriasis, which causes smooth, red patches in folds of skin near the genitals, under the breasts or in the armpits. Rubbing and sweating can make this type of psoriasis worse.Erythrodermic psoriasis, which causes red and scaly skin over much of your body. This can be a reaction to a bad sunburn or taking certain medications, such as corticosteroids. It can also happen if you have a different type of psoriasis that is not well controlled. This type of psoriasis can be very serious, so if you have it, you should see a doctor immediately.There are several different types of psoriasis. Here are a few examples: Plaque psoriasis, which causes patches of skin that are red at the base and covered by silvery scales.Guttate psoriasis, which causes small, drop-shaped lesions on your trunk, limbs, and scalp. This type of psoriasis is most often triggered by upper respiratory infections, such as strep throat.Pustular psoriasis, which causes pus-filled blisters. Attacks or flares can be caused by medications, infections, stress, or certain chemicals.Inverse psoriasis, which causes smooth, red patches in folds of skin near the genitals, under the breasts or in the armpits. Rubbing and sweating can make this type of psoriasis worse.Erythrodermic psoriasis, which causes red and scaly skin over much of your body. This can be a reaction to a bad sunburn or taking certain medications, such as corticosteroids. It can also happen if you have a different type of psoriasis that is not well controlled. This type of psoriasis can be very serious, so if you have it, you should see a doctor immediately. What causes it? What causes psoriasis? Psoriasis is an autoimmune disease, which means that your body's immune system - which protects you from diseases - starts overacting and causing problems. If you have psoriasis, a type of white blood cells called the T cells become so active that they trigger other immune system responses, including swelling and fast turnover of skin cells.Your skin cells grow deep in the skin and rise slowly to the surface. This is called cell turnover, and it usually takes about a month. If you have psoriasis, though, cell turnover can take only a few days. Your skin cells rise too fast and pile up on the surface, causing your skin to look red and scaly.Some things may cause a flare, meaning your psoriasis becomes worse for a while, including: Infections.Stress.Changes in the weather that dry out your skin.Certain medicines.Cuts, scratches or sunburns.Certain genes have been linked to psoriasis, meaning it runs in families.Psoriasis is an autoimmune disease, which means that your body's immune system - which protects you from diseases - starts overacting and causing problems. If you have psoriasis, a type of white blood cells called the T cells become so active that they trigger other immune system responses, including swelling and fast turnover of skin cells.Your skin cells grow deep in the skin and rise slowly to the surface. This is called cell turnover, and it usually takes about a month. If you have psoriasis, though, cell turnover can take only a few days. Your skin cells rise too fast and pile up on the surface, causing your skin to look red and scaly.Some things may cause a flare, meaning your psoriasis becomes worse for a while, including: Infections.Stress.Changes in the weather that dry out your skin.Certain medicines.Cuts, scratches or sunburns.Certain genes have been linked to psoriasis, meaning it runs in families.Psoriasis is an autoimmune disease, which means that your body's immune system - which protects you from diseases - starts overacting and causing problems. If you have psoriasis, a type of white blood cells called the T cells become so active that they trigger other immune system responses, including swelling and fast turnover of skin cells.Your skin cells grow deep in the skin and rise slowly to the surface. This is called cell turnover, and it usually takes about a month. If you have psoriasis, though, cell turnover can take only a few days. Your skin cells rise too fast and pile up on the surface, causing your skin to look red and scaly.Some things may cause a flare, meaning your psoriasis becomes worse for a while, including: Infections.Stress.Changes in the weather that dry out your skin.Certain medicines.Cuts, scratches or sunburns.Certain genes have been linked to psoriasis, meaning it runs in families. Is there a test? Is there a test for psoriasis? Psoriasis can be hard to diagnose because it can look like other skin diseases. Your doctor may look at a small sample of your skin under a microscope to help them figure out if psoriasis is causing your skin condition.Psoriasis can be hard to diagnose because it can look like other skin diseases. Your doctor may look at a small sample of your skin under a microscope to help them figure out if psoriasis is causing your skin condition.Psoriasis can be hard to diagnose because it can look like other skin diseases. Your doctor may look at a small sample of your skin under a microscope to help them figure out if psoriasis is causing your skin condition. How is it treated? How is psoriasis treated? There are several different types of treatment for psoriasis. Your doctor may recommend that you try one of these or a combination of them: Topical treatment, which means putting creams on your skin.Light therapy, which involves a doctor shining an ultraviolet light on your skin or getting more sunlight. It's important that a doctor controls the amount of light you are getting from this therapy, because too much ultraviolet light may make your psoriasis worse.Systemic treatment, which can include taking prescription medicines or getting shots of medicine.There are several different types of treatment for psoriasis. Your doctor may recommend that you try one of these or a combination of them: Topical treatment, which means putting creams on your skin.Light therapy, which involves a doctor shining an ultraviolet light on your skin or getting more sunlight. It's important that a doctor controls the amount of light you are getting from this therapy, because too much ultraviolet light may make your psoriasis worse.Systemic treatment, which can include taking prescription medicines or getting shots of medicine.There are several different types of treatment for psoriasis. Your doctor may recommend that you try one of these or a combination of them: Topical treatment, which means putting creams on your skin.Light therapy, which involves a doctor shining an ultraviolet light on your skin or getting more sunlight. It's important that a doctor controls the amount of light you are getting from this therapy, because too much ultraviolet light may make your psoriasis worse.Systemic treatment, which can include taking prescription medicines or getting shots of medicine. Who treats it? Who treats psoriasis? Several types of health care professionals may treat you, including: Dermatologists, who treat skin problems.Internists, who diagnose and treat adults.Several types of health care professionals may treat you, including: Dermatologists, who treat skin problems.Internists, who diagnose and treat adults.Several types of health care professionals may treat you, including: Dermatologists, who treat skin problems.Internists, who diagnose and treat adults. Living With It Living with psoriasis Psoriasis is a chronic disease, which means it lasts a long time. You can take an active role in treating your psoriasis. Besides going to your doctor regularly, here are some things you can try to help manage your symptoms: Keeping your skin well moisturized.Staying healthy overall.Joining support groups or counseling to help you realize you are not alone in dealing with psoriasis and to share ideas for coping with the disease.Psoriasis is a chronic disease, which means it lasts a long time. You can take an active role in treating your psoriasis. Besides going to your doctor regularly, here are some things you can try to help manage your symptoms: Keeping your skin well moisturized.Staying healthy overall.Joining support groups or counseling to help you realize you are not alone in dealing with psoriasis and to share ideas for coping with the disease.
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Duchenne muscular dystrophy: Duchenne muscular dystrophy (DMD) is a progressive form of muscular dystrophy that occurs primarily in males, though in rare cases may affect females. DMD causes progressive weakness and loss (atrophy) of skeletal and heart muscles. [1] Early signs of DMD may include delayed ability to sit, stand, or walk and difficulties learning to speak. Muscle weakness is usually noticeable by 3 or 4 years of age and begins in the hips, pelvic area, upper legs, and shoulders. The calves may be enlarged. Children with DMD may have an unusual walk and difficulty running, climbing stairs, and getting up from the floor. [2] DMD may also affect learning and memory, as well as communication and certain social emotional skills. [3] Muscle weakness worsens with age and progresses to the arms, legs and trunk. Most children with DMD use a wheelchair full time by age 13. Heart and respiratory muscle problems begin in the teen years and lead to serious, life threatening complications. [2] DMD is caused by changes ( mutations ) in the DMD gene . The DMD gene codes for the protein dystrophin. [1] [2] Dystrophin is mainly made in skeletal and heart muscle cells , but a small amount is also made in nerve cells (neurons) in specific parts of the brain. [3] DMD is inherited in an X-linked recessive pattern; however, it may also occur in people who do not have a family history of DMD. [2] While there is no known cure for DMD, there are treatments that can help control symptoms. [4] Due to the advancement of medical treatment, boys with DMD may now live into young adulthood. [2] [3] Becker muscular dystrophy (BMD) is also caused by mutations in the DMD gene. People with BMD have less severe symptoms than DMD. In addition, symptoms start later in childhood or in adolescence and progress more slowly. [1] Symptoms of Duchenne muscular dystrophy (DMD) are usually noticed in boys between 1 to 6 years of age. There is a steady decline in muscle strength between the ages of 6 and 11 years. By age 10, braces may be required for walking, and by age 13, most boys with DMD are confined to a wheelchair. The signs and symptoms are as follows: [1] [2] [3] Taking longer to learn to sit, stand, or walk on own, which is known as delayed motor development. The mean age for walking in boys with DMD is 18 months. Having a waddling walk or gait, difficulty climbing stairs, and running due to progressive muscle weakness of the leg and pelvic muscles and progressive loss of muscle mass (wasting or atrophy). Difficulty getting up from the floor. Child may walk his hands up his legs to stand which is known as the Gower maneuver. Enlargement of calf muscles due to the calf muscle cells being Muscle weakness first affecting the muscles of the hips, pelvic area, thighs and shoulders, and later the skeletal (voluntary) muscles in the arms, legs and trunk. Tight or rigid joints (also known as contractures ) may develop as muscle loss progresses. If not treated, these will become severe, causing discomfort and restricting mobility and flexibility. Contractures can affect the knees, hips, feet, elbows, wrists and fingers. Scoliosis may develop within several years of being confined to a wheelchair. By the early teens, the respiratory and heart muscles are also affected. Breathing problems due to weakness of the diaphragm and the other muscles supporting the operation of the lungs. Skeletal changes, such as scoliosis, may also increase breathing problems. Breathing problems may become life threatening. Progressive enlargement of the heart ( cardiomyopathy ) develops. This stops the heart from pumping blood efficiently, and becomes life-threatening in many cases. Learning and memory issues (cognitive impairment) may occur in some cases, but do not worsen as the DMD progresses. Communication may be more difficult for some. Social behavior may be affected, as well as the ability to read facial cues. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Calf muscle hypertrophy Very frequent Cardiomyopathy Very frequent Cognitive impairment Very frequent Delayed speech and language development Very frequent Elevated serum creatine phosphokinase Very frequent Flexion contracture Very frequent Motor delay Very frequent Progressive muscle weakness Very frequent Proximal muscle weakness Very frequent Respiratory insufficiency Very frequent Scoliosis Very frequent Skeletal muscle atrophy Very frequent Specific learning disability Very frequent Waddling gait Very frequent Calf muscle pseudohypertrophy - Childhood onset - Congestive heart failure - Dilated cardiomyopathy - Generalized hypotonia - Gowers sign - Hyperlordosis - Hyporeflexia - Hypoventilation - Intellectual disability , mild - Muscular dystrophy - Respiratory failure - X-linked recessive inheritance - View complete list of signs and symptoms... Duchenne muscular dystrophy (DMD) is caused by mutations in the DMD gene . The DMD gene provides instructions for making a protein called dystrophin. Dystophin is primarily made in the muscle cells of the heart and skeletal muscle. The main job of dystrophin in muscle cells is to help stabilize and protect muscle fibers. [1] [2] [3] DMD is caused by genetic changes in the DMD gene that stop any functional dystrophin from being made. [2] When dystrophin is missing, the muscle cells become damaged more easily. In response to the damage, inflammation occurs, which only worsens the process. Over time, the muscle cells without dystrophin weaken and die, leading to the muscle weakness and heart problems seen in DMD. [2] [3] The non-progressive memory and learning problems, as well as social behavioral problems, in some boys with DMD are most likely linked to loss of dystrophin in the neurons of the hippocampus and other parts of the brain where dystrophin is normally produced in small amounts, but at this point it is not known why this occurs and why only some people with DMD have these problems. [3] Different genetic changes in the DMD gene can cause a spectrum of disorders known as dystrophinopathies. The dystrophinopathies can range from very mild symptoms to the more severe symptoms seen in people with DMD. Other dystrophinopathies include Becker muscular dystrophy (BMD) and DMD-associated dilated cardiomyopathy (DCM). [2] Genetic changes causing Duchenne muscular dystrophy (DMD) can be passed down in families. The DMD gene is located on the X chromosome , one of the two types of sex chromosomes . Males have an X and a Y chromosome ; whereas females have two X chromosomes . Since males only have one X chromosome, they also only have one copy of the DMD gene. If this copy has a genetic change that causes DMD, the male will have DMD. Males get their X chromosome from their mother and the Y chromosome from their father. [1] [2] Since females have two X chromosomes, they have two copies of the DMD gene. Having two changed copies of the DMD gene that can cause DMD is unlikely, but would cause DMD in females. A female with only one changed copy of the DMD gene is called a " carrier ". She can pass on the changed gene, but usually does not have symptoms of DMD. Carriers of changes in the DMD gene that can cause DMD are at an increased risk of developing heart problems, including cardiomyopathy . In addition, due to a process called X-inactivation , in rare cases, female carriers may have mild, moderate, or severe DMD. [2] If a man with DMD has children, all of his daughters will be carriers. Since boys inherit the Y chromosome from their father, sons will not inherit DMD from their fathers, even if the father has DMD. [1] [2] DMD DMD DMD DMD A child's doctor may suspect Duchenne muscular dystrophy (DMD) in young boys who have the signs and symptoms of DMD, including progressive muscle weakness. Family history is also important. Blood tests can be used to check for increased levels of certain special proteins called muscle enzymes in the blood which can leak from damaged muscles. Most commonly, the blood level of the enzyme creatine phosphokinase (CPK or CK) is checked, but a doctor may also check the blood levels of transaminases such as aspartate transaminase and alanine transaminase. Finding a change in the DMD gene that can cause DMD through genetic testing confirms the diagnosis of DMD. [2] [5] Testing for DMD may include: [2] [5] Blood test which measures the levels of serum creatine phosphokinase Molecular genetic testing Electromyography Muscle biopsy is rarely used to diagnose DMD due to the decreased cost and higher accuracy of genetic testing. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. There is no known cure for Duchenne muscular dystrophy (DMD) but research is ongoing. The goal of treatment is to control the symptoms of DMD and related complications caused by severe progressive muscle weakness and loss in order to maximize the quality of life. An enlarged, weakened heart (dilated cardiomyopathy ) may be treated with medications, but in severe cases a heart transplant may be necessary. Assistive devices for breathing difficulties may be needed, especially at night and as the disease progresses. [2] [6] Physical therapy Steroids ( corticosteroids ) may improve the strength and function of muscles in people with DMD, including lung function. Steroid options include: [2] [6] Prednisone is a steroid that has been shown to extend the ability to walk by 2 to 5 years. However, the possible side effects of prednisone include weight gain, high blood pressure , behavior changes, and delayed growth. Deflazacort (another form of prednisone), is used in Europe and believed to have fewer side effects and was recently approved in the United States by the FDA. Oxandrolone, a medication used in a research study, also has similar benefits to prednisone, but with fewer side effects. Management Guidelines Section on Cardiology and Cardiac Surgery. Cardiovascular health supervision for individuals affected by Duchenne or Becker Muscular Dystrophy. Pediatrics 2006; 116: 1569-1573. GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. Orphanet Emergency Guidelines is an article which is expert-authored and peer-reviewed that is intended to guide health care professionals in emergency situations involving this condition. Project OrphanAnesthesia is a project whose aim is to create peer-reviewed, readily accessible guidelines for patients with rare diseases and for the anesthesiologists caring for them. The project is a collaborative effort of the German Society of Anesthesiology and Intensive Care, Orphanet, the European Society of Pediatric Anesthesia, anesthetists and rare disease experts with the aim to contribute to patient safety. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal National Library of Medicine Drug Information Portal Medline Plus Health Information The following diseases are related to Duchenne muscular dystrophy. If you have a question about any of these diseases, you can contact GARD. Muscular dystrophy
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Absence seizure Overview Absence seizures involve brief, sudden lapses of consciousness. They're more common in children than in adults. Someone having an absence seizure may look like he or she is staring blankly into space for a few seconds. Then, there is a quick return to a normal level of alertness. This type of seizure usually doesn't lead to physical injury. Absence seizures usually can be controlled with anti-seizure medications. Some children who have them also develop other seizures. Many children outgrow absence seizures in their teens. Symptoms An indication of simple absence seizure is a vacant stare, which may be mistaken for a lapse in attention that lasts about 10 seconds, though it may last as long as 20 seconds, without any confusion, headache or drowsiness afterward. Signs and symptoms of absence seizures include: - Sudden stop in motion without falling - Lip smacking - Eyelid flutters - Chewing motions - Finger rubbing - Small movements of both hands Afterward, there's no memory of the incident. Some people have many episodes daily, which interfere with school or daily activities. A child may have absence seizures for some time before an adult notices the seizures, because they're so brief. A decline in a child's learning ability may be the first sign of this disorder. Teachers may comment about a child's inability to pay attention or that a child is often daydreaming. Contact your doctor: - The first time you notice a seizure - If this is a new type of seizure - If the seizures continue to occur despite taking anti-seizure medication Contact 911 or emergency services in your area: - If you observe prolonged automatic behaviors lasting minutes to hours - activities such as eating or moving without awareness - or prolonged confusion, possible symptoms of a condition called absence status epilepticus - After any seizure lasting more than five minutes Causes Many children appear to have a genetic predisposition to absence seizures. In general, seizures are caused by abnormal electrical impulses from nerve cells (neurons) in the brain. The brain's nerve cells normally send electrical and chemical signals across the synapses that connect them. In people who have seizures, the brain's usual electrical activity is altered. During an absence seizure, these electrical signals repeat themselves over and over in a three-second pattern. People who have seizures may also have altered levels of the chemical messengers that help the nerve cells communicate with one another (neurotransmitters). Risk factors Certain factors are common to children who have absence seizures, including: - Age. Absence seizures are more common in children between the ages of 4 and 14. - Sex. Absence seizures are more common in girls. - Family members who have seizures. Nearly half of children with absence seizures have a close relative who has seizures. Diagnosis Your doctor will ask for a detailed description of the seizures and conduct a physical exam. Tests may include: - Electroencephalography (EEG). This painless procedure measures waves of electrical activity in the brain. Brain waves are transmitted to the EEG machine via small electrodes attached to the scalp with paste or an elastic cap. Rapid breathing (hyperventilation) during an EEG study can trigger an absence seizure. During a seizure, the pattern on the EEG differs from the normal pattern. - Brain scans. In absence seizures, brain-imaging studies, such as magnetic resonance imaging (MRI), will be normal. But tests such as MRI can produce detailed images of the brain, which can help rule out other problems, such as a stroke or a brain tumor. Because your child will need to hold still for long periods, talk with your doctor about the possible use of sedation. Treatment Your doctor likely will start at the lowest dose of anti-seizure medication possible and increase the dosage as needed to control the seizures. Children may be able to taper off anti-seizure medications, under a doctor's supervision, after they've been seizure-free for two years. Drugs prescribed for absence seizure include: - Ethosuximide (Zarontin). This is the drug most doctors start with for absence seizures. In most cases, seizures respond well to this drug. Possible side effects include nausea, vomiting, sleepiness, trouble sleeping, hyperactivity. - Valproic acid (Depakene). Girls who continue to need medication into adulthood should discuss potential risks of valproic acid with their doctors. Valproic acid has been associated with higher risk of birth defects in babies, and doctors advise women against using it during pregnancy or while trying to conceive. Doctors may recommend the use of valproic acid in children who have both absence and grand mal (tonic-clonic) seizures. - Lamotrigine (Lamictal). Some studies show this drug to be less effective than ethosuximide or valproic acid, but it has fewer side effects. Side effects may include rash and nausea. Lifestyle and home remedies Dietary therapy Following a diet that's high in fat and low in carbohydrates, known as a ketogenic diet, can improve seizure control. This is used only if traditional medications fail to control the seizures. This diet isn't easy to maintain, but is successful at reducing seizures for some people. Variations on a high-fat, low-carbohydrate diet, such as the glycemic index and modified Atkins diets, though less effective, aren't as restrictive as the ketogenic diet and may also provide benefit. Additional options Here are other steps you might take to help with seizure control: - Take medication correctly. Don't adjust the dosage before talking to your doctor. If you feel your medication should be changed, discuss it with your doctor. - Get enough sleep. Lack of sleep can trigger seizures. Be sure to get adequate rest every night. - Wear a medical alert bracelet. This will help emergency personnel know how to treat you correctly if you have another seizure. - Ask your doctor about driving or recreation restrictions. Someone with a seizure disorder will have to be seizure-free for reasonable lengths of time (intervals vary from state to state) before being able to drive. Don't bathe or swim unless someone else is nearby to help if needed.
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Chickenpox Overview Chickenpox (varicella) is a viral infection that causes an itchy rash with small, fluid-filled blisters. Chickenpox is highly contagious to people who haven't had the disease or been vaccinated against it. Before routine chickenpox vaccination, virtually all people had been infected by the time they reached adulthood, sometimes with serious complications. Today, the number of cases and hospitalizations is down dramatically. For most people, chickenpox is a mild disease. Still, it's better to get vaccinated. The chickenpox vaccine is a safe, effective way to prevent chickenpox and its possible complications. Symptoms Chickenpox infection appears 10 to 21 days after exposure to the virus and usually lasts about five to 10 days. The rash is the telltale indication of chickenpox. Other signs and symptoms, which may appear one to two days before the rash, include: - Fever - Loss of appetite - Headache - Tiredness and a general feeling of being unwell (malaise) Once the chickenpox rash appears, it goes through three phases: - Raised pink or red bumps (papules), which break out over several days - Small fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking - Crusts and scabs, which cover the broken blisters and take several more days to heal New bumps continue to appear for several days. As a result, you may have all three stages of the rash - bumps, blisters and scabbed lesions - at the same time on the second day of the rash. Once infected, you can spread the virus for up to 48 hours before the rash appears, and you remain contagious until all spots crust over. The disease is generally mild in healthy children. In severe cases, the rash can spread to cover the entire body, and lesions may form in the throat, eyes and mucous membranes of the urethra, anus and vagina. New spots continue to appear for several days. When to see a doctor If you suspect that you or your child has chickenpox, consult your doctor. He or she usually can diagnose chickenpox by examining the rash and by noting the presence of accompanying symptoms. Your doctor can also prescribe medications to lessen the severity of chickenpox and treat complications, if necessary. Be sure to call ahead for an appointment and mention you think you or your child has chickenpox, to avoid waiting and possibly infecting others in a waiting room. Also, be sure to let your doctor know if any of these complications occur: - The rash spreads to one or both eyes. - The rash gets very red, warm or tender, indicating a possible secondary bacterial skin infection. - The rash is accompanied by dizziness, disorientation, rapid heartbeat, shortness of breath, tremors, loss of muscle coordination, worsening cough, vomiting, stiff neck or a fever higher than 102 F (38.9 C). - Anyone in the household is immune deficient or younger than 6 months old. Risk factors Chickenpox, which is caused by the varicella-zoster virus, is highly contagious, and it can spread quickly. The virus is transmitted by direct contact with the rash or by droplets dispersed into the air by coughing or sneezing. Your risk of catching chickenpox is higher if you: - Haven't had chickenpox - Haven't been vaccinated for chickenpox - Work in or attend a school or child care facility - Live with children Most people who have had chickenpox or have been vaccinated against chickenpox are immune to chickenpox. If you've been vaccinated and still get chickenpox, symptoms are often milder, with fewer blisters and mild or no fever. A few people can get chickenpox more than once, but this is rare. Complications Chickenpox is normally a mild disease. But it can be serious and can lead to complications or death, especially in high-risk people. Complications include: - Bacterial infections of the skin, soft tissues, bones, joints or bloodstream (sepsis) - Dehydration - Pneumonia - Inflammation of the brain (encephalitis) - Toxic shock syndrome - Reye's syndrome for people who take aspirin during chickenpox Who's at risk? Those at high risk of having complications from chickenpox include: - Newborns and infants whose mothers never had chickenpox or the vaccine - Adults - Pregnant women who haven't had chickenpox - People whose immune systems are impaired by medication, such as chemotherapy, or another disease, such as cancer or HIV - People who are taking steroid medications for another disease or condition, such as children with asthma - People taking drugs that suppress their immune systems Chickenpox and pregnancy Other complications of chickenpox affect pregnant women. Chickenpox early in pregnancy can result in a variety of problems in a newborn, including low birth weight and birth defects, such as limb abnormalities. A greater threat to a baby occurs when the mother develops chickenpox in the week before birth or within a couple of days after giving birth. Then it can cause a serious, life-threatening infection in a newborn. If you're pregnant and not immune to chickenpox, talk to your doctor about the risks to you and your unborn child. Chickenpox and shingles If you've had chickenpox, you're at risk of another disease caused by the varicella-zoster virus called shingles. After a chickenpox infection, some of the varicella-zoster virus may remain in your nerve cells. Many years later, the virus can reactivate and resurface as shingles - a painful band of short-lived blisters. The virus is more likely to reappear in older adults and people with weakened immune systems. Shingles can lead to its own complication - a condition in which the pain of shingles persists long after the blisters disappear. This complication, called postherpetic neuralgia, can be severe. A shingles vaccine (Zostavax) is available and is recommended for adults age 60 and older who have had chickenpox. Diagnosis Doctors generally diagnose chickenpox based on the telltale rash. If there's any doubt about the diagnosis, chickenpox can be confirmed with laboratory tests, including blood tests or a culture of lesion samples. Treatment In otherwise healthy children, chickenpox typically requires no medical treatment. Your doctor may prescribe an antihistamine to relieve itching. But for the most part, the disease is allowed to run its course. If you're at high risk of complications For people who have a high risk of complications from chickenpox, doctors sometimes prescribe medications to shorten the duration of the infection and to help reduce the risk of complications. If you or your child falls into a high-risk group, your doctor may suggest an antiviral drug such as acyclovir (Zovirax) or another drug called immune globulin intravenous (Privigen). These medications may lessen the severity of the disease when given within 24 hours after the rash first appears. Other antiviral drugs, such as valacyclovir (Valtrex) and famciclovir (Famvir), also may lessen the severity of the disease, but may not be approved or appropriate for all cases. In some instances, your doctor may recommend getting the chickenpox vaccine after exposure to the virus. This can prevent the disease or lessen its severity. Don't give anyone with chickenpox - child or adult - any medicine containing aspirin because this combination has been associated with a condition called Reye's syndrome. Treating complications If complications do develop, your doctor will determine the appropriate treatment. Treatment for skin infections and pneumonia may be with antibiotics. Treatment for encephalitis is usually with antiviral drugs. Hospitalization may be necessary. Lifestyle and home remedies To help ease the symptoms of an uncomplicated case of chickenpox, follow these self-care measures. Don't scratch Scratching can cause scarring, slow healing and increase the risk that the sores will become infected. If your child can't stop scratching: - Put gloves on his or her hands, especially at night - Trim his or her fingernails Relieve the itch and other symptoms The chickenpox rash can be very itchy, and broken vesicles sometimes sting. These discomforts, along with fever, headache and fatigue, can make anyone miserable. For relief, try: - A cool bath with added baking soda, uncooked oatmeal or colloidal oatmeal - a finely ground oatmeal that is made for soaking. - Calamine lotion dabbed on the spots. - A soft, bland diet if chickenpox sores develop in the mouth. - Antihistamines such as diphenhydramine (Benadryl, others) for itching. Check with your doctor to make sure your child can safely take antihistamines. - Acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, Children's Motrin, others) for a mild fever. Don't give aspirin to anyone with chickenpox because it can lead to a serious condition called Reye's syndrome. And don't treat a high fever without consulting your doctor.
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Klinefelter syndrome: Klinefelter syndrome (KS) is a condition that occurs in males when they have an extra X chromosome . Some males with KS have no obvious signs or symptoms while others may have varying degrees of cognitive, social, behavioral, and learning difficulties. Adults with Klinefelter syndrome may also experience primary hypogonadism (decreased testosterone production), small testes , enlarged breast tissue ( gynecomastia ), tall stature, and/or infertility. KS is not inherited , but usually occurs as a random event during the formation of reproductive cells (eggs and sperm). Treatment is based on the signs and symptoms present in each person. [1] [2] [3] The signs and symptoms of Klinefelter syndrome (KS) vary among affected people. Some men with KS have no symptoms of the condition or are only mildy affected. In these cases, they may not even know that they are affected by KS. When present, symptoms may include: [1] [2] [3] Small, firm testicles Delayed or incomplete puberty Breast growth ( gynecomastia ) Reduced facial and body hair Infertility Tall height Abnormal body proportions (long legs, short trunk, shoulder equal to hip size) Learning disablity Speech delay Whether or not a male with KS has visible symptoms depends on many factors, including how much testosterone his body makes, if he is mosaic (with both XY and XXY cells ), and his age when the condition is diagnosed and treated. [1] Klinefelter syndrome usually occurs as a random event during the formation of reproductive cells (eggs and sperm). An error in cell division called nondisjunction results in a reproductive cell with an abnormal number of chromosomes . For example, an egg or sperm cell may gain one or more extra copies of the X chromosome as a result of nondisjunction. If one of these atypical reproductive cells contributes to the genetic makeup of a child, the child will have one or more extra X chromosomes in each of the body's cells. [2] Most often, Klinefelter syndrome is caused by a single extra copy of the X chromosome, resulting in a total of 47 chromosomes per cell. Males normally have one X chromosome and one Y chromosome in each cell (46, XY), while females have two X chromosomes (46, XX). People with Klinefelter syndrome usually have two X chromosomes and one Y chromosome (47, XXY). Some people with Klinefelter syndrome have the extra X chromosome in only some of their cells; these people are said to have mosaic Klinefelter syndrome. [2] It is estimated that about half of the time, the cell division error occurs during development of the sperm, while the remainder are due to errors in egg development. Women who have pregnancies after age 35 have a slightly increased chance of having offspring with this syndrome. [4] The features of Klinefelter syndrome are due to the extra copies of genes on the extra X chromosome, which can alter male sexual development. [3] Klinefelter syndrome is not inherited , but usually occurs as a random event during the formation of reproductive cells (eggs and sperm). An error in cell division called nondisjunction can result in reproductive cells with an abnormal number of chromosomes . For example, an egg or sperm cell may gain one or more extra copies of the X chromosome as a result of nondisjunction. If one of these reproductive cells contributes to the genetic makeup of a child, the child will have one or several extra X chromosomes in each of the body's cells. [2] A diagnosis of Klinefelter syndrome is often suspected based on the presence of characteristic signs and symptoms. Additional testing can then be ordered to confirm the diagnosis. This generally includes a chromosomal analysis (called a karyotype ). [3] [5] It is also possible to diagnosis Klinefelter syndrome before birth through chorionic villous sampling or amniocentesis . [5] Because symptoms of Klinefelter syndrome (KS) can sometimes be very mild, many people are never diagnosed or treated. When a diagnosis is made, treatment is based on the signs and symptoms present in each person. This may include: [1] [3] [6] Educational interventions - As children, many people with Klinefelter syndrome qualify for special services to help them in school. Teachers can also help by using certain methods in the classroom, such as breaking bigger tasks into small steps. Therapeutic options - A variety of therapists, such as physical, speech, occupational, behavioral, mental health, and family therapists can often help reduce or eliminate some of the symptoms of Klinefelter syndrome such as poor muscle tone; speech and language problems; or low self-confidence. Medical management - About half of people with KS have low testosterone levels, which may be raised by taking supplemental testosterone. Having a more normal testosterone level can help affected people develop bigger muscles, a deeper voice, and facial and body hair. Many healthcare providers recommend testosterone therapy when a boy reaches puberty. However, not all males with KS benefit from testosterone therapy. Some affected people may opt to have breast removal or reduction surgery. The Eunice Kennedy Shriver National Institute of Child Health and Human Development's Web site offers more specific information on the treatment and management of Klinefelter syndrome. Please click on the link to access this resource. Babies with the 47, XXY form of Klinefelter differ little from healthy children. The results of one study on non- mosaic XXY infants younger than 2 years indicated that most XXY babies had normal external genitalia and facial features with height and weight in the normal range. Genetic testing had been performed due to a delay in walking and/or speech. Early detection of Klinefelter syndrome is shown to be important to monitor potential developmental problems. [6] Boys with the 47, XXY karyotype may struggle through adolescence with academics, various frustrations, and, in a few instances, serious emotional or behavioral difficulties. However, most move toward full independence from their families as they enter adulthood. Some have completed graduate education and have a normal level of functioning. Lifespan is not affected by Klinefelter syndrome. [6] It is estimated that 1 in every 500 to 1,000 newborn males has an extra X chromosome, making Klinefelter syndrome one of the most common chromosomal disorders seen among newborns. Variants of Klinefelter syndrome (such as 48,XXXY, 49,XXXXY) are much rarer, occurring in 1 in 50,000 to 1 in 85,000 or fewer newborns. [1] [7] It is suspected that Klinefelter syndrome is underdiagnosed because mild cases may not be identified. In addition, the features of this condition vary and can overlap significantly with those of other conditions. [7] The following diseases are related to Klinefelter syndrome. If you have a question about any of these diseases, you can contact GARD. 47, XXY
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Arteriosclerosis / atherosclerosis Overview Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff - sometimes restricting blood flow to your organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls in your arteries can harden, a condition commonly called hardening of the arteries. Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably. Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaques), which can restrict blood flow. These plaques can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body. Atherosclerosis may be preventable and is treatable. Symptoms Atherosclerosis develops gradually. Mild atherosclerosis usually doesn't have any symptoms. You usually won't have atherosclerosis symptoms until an artery is so narrowed or clogged that it can't supply adequate blood to your organs and tissues. Sometimes a blood clot completely blocks blood flow, or even breaks apart and can trigger a heart attack or stroke. Symptoms of moderate to severe atherosclerosis depend on which arteries are affected. For example: - If you have atherosclerosis in your heart arteries, you may have symptoms, such as chest pain or pressure (angina). - If you have atherosclerosis in the arteries leading to your brain, you may have signs and symptoms such as sudden numbness or weakness in your arms or legs, difficulty speaking or slurred speech, temporary loss of vision in one eye, or drooping muscles in your face. These signal a transient ischemic attack (TIA), which, if left untreated, may progress to a stroke. - If you have atherosclerosis in the arteries in your arms and legs, you may have symptoms of peripheral artery disease, such as leg pain when walking (claudication). - If you have atherosclerosis in the arteries leading to your kidneys, you develop high blood pressure or kidney failure. When to see a doctor If you think you have atherosclerosis, talk to your doctor. Also pay attention to early symptoms of inadequate blood flow, such as chest pain (angina), leg pain or numbness. Early diagnosis and treatment can stop atherosclerosis from worsening and prevent a heart attack, stroke or another medical emergency. Causes Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an artery. The damage may be caused by: - High blood pressure - High cholesterol - High triglycerides, a type of fat (lipid) in your blood - Smoking and other sources of tobacco - Insulin resistance, obesity or diabetes - Inflammation from diseases, such as arthritis, lupus or infections, or inflammation of unknown cause Once the inner wall of an artery is damaged, blood cells and other substances often clump at the injury site and build up in the inner lining of the artery. Over time, fatty deposits (plaques) made of cholesterol and other cellular products also build up at the injury site and harden, narrowing your arteries. The organs and tissues connected to the blocked arteries then don't receive enough blood to function properly. Eventually, pieces of the fatty deposits may break off and enter your bloodstream. In addition, the smooth lining of a plaque may rupture, spilling cholesterol and other substances into your bloodstream. This may cause a blood clot, which can block the blood flow to a specific part of your body, such as occurs when blocked blood flow to your heart causes a heart attack. A blood clot can also travel to other parts of your body, blocking flow to another organ. Risk factors Hardening of the arteries occurs over time. Besides aging, factors that increase the risk of atherosclerosis include: - High blood pressure - High cholesterol - Diabetes - Obesity - Smoking and other tobacco use - A family history of early heart disease - Lack of exercise - An unhealthy diet Complications The complications of atherosclerosis depend on which arteries are blocked. For example: - Coronary artery disease. When atherosclerosis narrows the arteries close to your heart, you may develop coronary artery disease, which can cause chest pain (angina), a heart attack or heart failure. - Carotid artery disease. When atherosclerosis narrows the arteries close to your brain, you may develop carotid artery disease, which can cause a transient ischemic attack (TIA) or stroke. - Peripheral artery disease. When atherosclerosis narrows the arteries in your arms or legs, you may develop circulation problems in your arms and legs called peripheral artery disease. This can make you less sensitive to heat and cold, increasing your risk of burns or frostbite. In rare cases, poor circulation in your arms or legs can cause tissue death (gangrene). - Aneurysms. Atherosclerosis can also cause aneurysms, a serious complication that can occur anywhere in your body. An aneurysm is a bulge in the wall of your artery. Most people with aneurysms have no symptoms. Pain and throbbing in the area of an aneurysm may occur and is a medical emergency. If an aneurysm bursts, you may face life-threatening internal bleeding. Although this is usually a sudden, catastrophic event, a slow leak is possible. If a blood clot within an aneurysm dislodges, it may block an artery at some distant point. - Chronic kidney disease. Atherosclerosis can cause the arteries leading to your kidneys to narrow, preventing oxygenated blood from reaching them. Over time, this can affect your kidney function, keeping waste from exiting your body. Diagnosis During a physical exam, your doctor may find signs of narrowed, enlarged or hardened arteries, including: - A weak or absent pulse below the narrowed area of your artery - Decreased blood pressure in an affected limb - Whooshing sounds (bruits) over your arteries, heard using a stethoscope Depending on the results of the physical exam, your doctor may suggest one or more diagnostic tests, including: - Blood tests. Lab tests can detect increased levels of cholesterol and blood sugar that may increase the risk of atherosclerosis. You'll need to go without eating or drinking anything but water for nine to 12 hours before your blood test. Your doctor should tell you ahead of time if this test will be performed during your visit. - Doppler ultrasound. Your doctor may use a special ultrasound device (Doppler ultrasound) to measure your blood pressure at various points along your arm or leg. These measurements can help your doctor gauge the degree of any blockages, as well as the speed of blood flow in your arteries. - Ankle-brachial index. This test can tell if you have atherosclerosis in the arteries in your legs and feet. Your doctor may compare the blood pressure in your ankle with the blood pressure in your arm. This is known as the ankle-brachial index. An abnormal difference may indicate peripheral vascular disease, which is usually caused by atherosclerosis. - Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. - Stress test. A stress test, also called an exercise stress test, is used to gather information about how well your heart works during physical activity. Because exercise makes your heart pump harder and faster than it does during most daily activities, an exercise stress test can reveal problems within your heart that might not be noticeable otherwise. An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored. In some types of stress tests, pictures will be taken of your heart, such as during a stress echocardiogram (ultrasound) or nuclear stress test. If you're unable to exercise, you may receive a medication that mimics the effect of exercise on your heart. - Cardiac catheterization and angiogram. This test can show if your coronary arteries are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage. - Other imaging tests. Your doctor may use ultrasound, a computerized tomography (CT) scan or magnetic resonance angiography (MRA) to study your arteries. These tests can often show hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls. Treatment Lifestyle changes, such as eating a healthy diet and exercising, are often the most appropriate treatment for atherosclerosis. Sometimes, medication or surgical procedures may be recommended as well. Medications Various drugs can slow - or even reverse - the effects of atherosclerosis. Here are some common choices: - Cholesterol medications. Aggressively lowering your low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, can slow, stop or even reverse the buildup of fatty deposits in your arteries. Boosting your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, may help, too. Your doctor can choose from a range of cholesterol medications, including drugs known as statins and fibrates. In addition to lowering cholesterol, statins have additional effects that help stabilize the lining of your heart arteries and prevent atherosclerosis. - Anti-platelet medications. Your doctor may prescribe anti-platelet medications, such as aspirin, to reduce the likelihood that platelets will clump in narrowed arteries, form a blood clot and cause further blockage. - Beta blocker medications. These medications are commonly used for coronary artery disease. They lower your heart rate and blood pressure, reducing the demand on your heart and often relieve symptoms of chest pain. Beta blockers reduce the risk of heart attacks and some heart rhythm problems. - Angiotensin-converting enzyme (ACE) inhibitors. These medications may help slow the progression of atherosclerosis by lowering blood pressure and producing other beneficial effects on the heart arteries. ACE inhibitors can also reduce the risk of recurrent heart attacks. - Calcium channel blockers. These medications lower blood pressure and are sometimes used to treat angina. - Water pills (diuretics). High blood pressure is a major risk factor for atherosclerosis. Diuretics lower blood pressure. - Other medications. Your doctor may suggest certain medications to control specific risk factors for atherosclerosis, such as diabetes. Sometimes specific medications to treat symptoms of atherosclerosis, such as leg pain during exercise, are prescribed. Surgical procedures Sometimes more aggressive treatment is needed to treat atherosclerosis. If you have severe symptoms or a blockage that threatens muscle or skin tissue survival, you may be a candidate for one of the following surgical procedures: - Angioplasty and stent placement. In this procedure, your doctor inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A second catheter with a deflated balloon on its tip is then passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open. - Endarterectomy. In some cases, fatty deposits must be surgically removed from the walls of a narrowed artery. When the procedure is done on arteries in the neck (the carotid arteries), it's called a carotid endarterectomy. - Fibrinolytic therapy. If you have an artery that's blocked by a blood clot, your doctor may use a clot-dissolving drug to break it apart. - Bypass surgery. Your doctor may create a graft bypass using a vessel from another part of your body or a tube made of synthetic fabric. This allows blood to flow around the blocked or narrowed artery. Lifestyle and home remedies Lifestyle changes can help you prevent or slow the progression of atherosclerosis. - Stop smoking. Smoking damages your arteries. If you smoke or use tobacco in any form, quitting is the best way to halt the progression of atherosclerosis and reduce your risk of complications. - Exercise most days of the week. Regular exercise can condition your muscles to use oxygen more efficiently. Physical activity can also improve circulation and promote development of new blood vessels that form a natural bypass around obstructions (collateral vessels). Exercise helps lower blood pressure and reduces your risk of diabetes. Aim to exercise at least 30 minutes most days of the week. If you can't fit it all into one session, try breaking it up into 10-minute intervals. You can take the stairs instead of the elevator, walk around the block during your lunch hour, or do some situps or pushups while watching television. - Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains - and low in refined carbohydrates, sugars, saturated fat and sodium - can help you control your weight, blood pressure, cholesterol and blood sugar. Try substituting whole-grain bread in place of white bread; grabbing an apple, a banana or carrot sticks as a snack; and reading nutrition labels as a guide to controlling the amount of salt and fat you eat. Use monounsaturated fats, such as olive oil, and reduce or eliminate sugar and sugar substitutes. - Lose extra pounds and maintain a healthy weight. If you're overweight, losing as few as 5 to 10 pounds (about 2.3 to 4.5 kilograms) can help reduce your risk of high blood pressure and high cholesterol, two of the major risk factors for developing atherosclerosis. Losing weight helps reduce your risk of diabetes or control your condition if you already have diabetes. - Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing. If you have high cholesterol, high blood pressure, diabetes or another chronic disease, work with your doctor to manage the condition and promote overall health. Alternative medicine It's thought that some foods and herbal supplements can help reduce your high cholesterol level and high blood pressure, two major risk factors for developing atherosclerosis. With your doctor's OK, you might consider these supplements and products: - Alpha-linolenic acid (ALA) - Barley - Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ) - Black tea - Blond psyllium (found in seed husk and products such as Metamucil) - Calcium - Cocoa - Cod liver oil - Coenzyme Q10 - Fish oil - Folic acid - Garlic - Green tea - Oat bran (found in oatmeal and whole oats) - Sitostanol (found in oral supplements and some margarines, such as Benecol) - Vitamin C Talk to your doctor before adding any of these supplements to your atherosclerosis treatment. Some supplements can interact with medications, causing harmful side effects. You can also practice relaxation techniques, such as yoga or deep breathing, to help you relax and reduce your stress level. These practices can temporarily reduce your blood pressure, reducing your risk of developing atherosclerosis.
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Preeclampsia and Eclampsia Overview Preeclampsia (pree-i-KLAMP-see-uh) and eclampsia (ih-KLAMP-see-uh) are pregnancy-related high blood pressure disorders. In preeclampsia, the mother’s high blood pressure reduces the blood supply to the fetus, which may get less oxygen and fewer nutrients. Eclampsia is when pregnant women with preeclampsia develop seizures or coma. NICHD and other agencies are working to understand what causes these conditions and how they can be prevented and better treated. About Preeclampsia and Eclampsia Preeclampsia and eclampsia are part of the spectrum of high blood pressure, or hypertensive, disorders that can occur during pregnancy.At the mild end of the spectrum is gestational hypertension, which occurs when a woman who previously had normal blood pressure develops high blood pressure when she is more than 20 weeks pregnant and her blood pressure returns to normal within 12 weeks after delivery. This problem usually occurs without other symptoms. In many cases, gestational hypertension does not harm the mother or fetus. Severe gestational hypertension, however, may be associated with preterm birth and infants who are small for their age at birth.1 And about 15% to 25% of women with gestational hypertension go on to develop preeclampsia.2Preeclampsia is similar to gestational hypertension, because it also describes high blood pressure at or after 20 weeks of pregnancy in a woman whose blood pressure was normal before pregnancy. But preeclampsia can also include blood pressure at or greater than 140/90 mmHg, increased swelling, and protein in the urine.3 The condition can be serious and is a leading cause of preterm birth (before 37 weeks of pregnancy).4 If it is severe enough to affect brain function, causing seizures or coma, it is called eclampsia.One of the serious complications of hypertensive disorders in pregnancy is HELLP syndrome, a situation in which a pregnant woman with preeclampsia or eclampsia suffers damage to the liver and blood cells. The letters in the name HELLP stand for the following problems:- H - Hemolysis, in which oxygen-carrying red blood cells break down - EL - Elevated Liver enzymes, showing damage to the liver - LP - Low Platelet count, meaning that the cells responsible for stopping bleeding are low What causes preeclampsia and eclampsia? The causes of preeclampsia and eclampsia are not known. These disorders previously were believed to be caused by a toxin, called “toxemia,” in the blood, but health care providers now know that is not true. Nevertheless, preeclampsia is sometimes still referred to as “toxemia.”To learn more about preeclampsia and eclampsia, scientists are investigating many factors that could contribute to the development and progression of these diseases, including:- Placental abnormalities, such as insufficient blood flow - Genetic factors - Environmental exposures - Nutritional factors - Maternal immunology and autoimmune disorders - Cardiovascular and inflammatory changes - Hormonal imbalances What are the risks of preeclampsia & eclampsia to the mother? - Risks During Pregnancy Preeclampsia during pregnancy is mild in 75% of cases.1 However, a woman can progress from mild to severe preeclampsia or to full eclampsia very quickly―even in a matter of days. Both preeclampsia and eclampsia can cause serious health problems for the mother and infant. Women with preeclampsia are at increased risk for damage to the kidneys, liver, brain, and other organ and blood systems. Preeclampsia may also affect the placenta. The condition could lead to a separation of the placenta from the uterus (referred to as placental abruption), preterm birth, and pregnancy loss or stillbirth. In some cases, preeclampsia can lead to organ failure or stroke. In severe cases, preeclampsia can develop into eclampsia, which includes seizures. Seizures in eclampsia may cause a woman to lose consciousness and twitch uncontrollably.2 If the fetus is not delivered, these conditions can cause the death of the mother and/or the fetus. Expecting mothers rarely die from preeclampsia in the developed world, but it is still a major cause of illness and death globally.3 According to the World Health Organization, preeclampsia and eclampsia cause 14% of maternal deaths each year, or about 50,000 to 75,000 women worldwide.4 - Risks After Pregnancy In “uncomplicated preeclampsia,” the mother’s high blood pressure and other symptoms usually go back to normal within 6 weeks of the infant’s birth. However, studies have shown that women who had preeclampsia are four times more likely to later develop hypertension (high blood pressure) and are twice as likely to later develop ischemic heart disease (reduced blood supply to the heart muscle, which can cause heart attacks), a blood clot in a vein, and stroke as are women who did not have preeclampsia.5 Less commonly, mothers who had preeclampsia could experience permanent damage to their organs, such as their kidneys and liver. They could also experience fluid in the lungs. In the days following birth, women with preeclampsia remain at increased risk for developing eclampsia and seizures.3,6 What are the risks of preeclampsia & eclampsia to the fetus? Preeclampsia may be related to problems with the placenta early in the pregnancy.1 Such problems pose risks to the fetus, including:- Lack of oxygen and nutrients, which can impair fetal growth - Preterm birth - Stillbirth if placental abruption (separation of the placenta from the uterine wall) leads to heavy bleeding in the mother - Death: According to the Preeclampsia Foundation , each year, about 10,500 infants in the United States and about half a million worldwide die due to preeclampsia.2 Stillbirths are more likely to occur when the mother has a more severe form of preeclampsia, including HELLP syndrome.Infants whose mothers had preeclampsia are also at increased risk for later problems, even if they were born at full term (39 weeks of pregnancy).3 Infants born preterm due to preeclampsia face a higher risk of some long-term health issues, mostly related to being born early, including learning disorders, cerebral palsy, epilepsy, deafness, and blindness. Infants born preterm may also have to be hospitalized for a long time after birth and may be smaller than infants born full term. Infants who experienced poor growth in the uterus may later be at higher risk of diabetes, congestive heart failure, and high blood pressure.4 How many women are affected by or at risk of preeclampsia? The exact number of women who develop preeclampsia is not known. Some estimates suggest that preeclampsia affects 2% to 8% of all pregnancies globally and about 3.4% in the United States.1,2The condition is estimated to account for 10% to 15% of maternal deaths worldwide.1 Disorders related to high blood pressure are the second leading cause of stillbirths and early neonatal deaths in developing nations.3In addition, HELLP syndrome occurs in about 10% to 20% of all women with severe preeclampsia or eclampsia.4Although preeclampsia occurs primarily in first pregnancies, a woman who had preeclampsia in a previous pregnancy is seven times more likely to develop preeclampsia in a later pregnancy.5Other factors that can increase a woman's risk include:5- Chronic high blood pressure or kidney disease before pregnancy - High blood pressure or preeclampsia in an earlier pregnancy - Obesity. Overweight or obese women are also more likely to have preeclampsia in more than one pregnancy.6 - Age. Women older than 40 are at higher risk. - Multiple gestation (being pregnant with more than one fetus) - African American ethnicity. Also, among women who have had preeclampsia before, non-white women are more likely than white women to develop preeclampsia again in a later pregnancy.6 - Family history of preeclampsia. According to the World Health Organization, among women who have had preeclampsia, about 20% to 40% of their daughters and 11% to 37% of their sisters also will get the disorder.7Preeclampsia is also more common among women who have histories of certain health conditions, such as migraines,8 diabetes,9 rheumatoid arthritis,10 lupus,11 scleroderma,12 urinary tract infections,13 gum disease,14 polycystic ovary syndrome,15 multiple sclerosis, gestational diabetes, and sickle cell disease.16Preeclampsia is also more common in pregnancies resulting from egg donation, donor insemination, or in vitro fertilization.The U.S. Preventative Services Task Force recommends that women who are at high risk for preeclampsia take low-dose aspirin starting after 12 weeks of pregnancy to prevent preeclampsia.17 Women who are pregnant or who are thinking about getting pregnant should talk with their health care provider about preeclampsia risk and ways to reduce the risk. What are the symptoms of preeclampsia, eclampsia, & HELLP syndrome? - Preeclampsia Possible symptoms of preeclampsia include: - High blood pressure - Too much protein in the urine - Swelling in a woman's face and hands (a woman's feet might swell too, but swollen feet are common during pregnancy and may not signal a problem) - Systemic problems, such as headache, blurred vision, and right upper quadrant abdominal pain - High blood pressure - Too much protein in the urine - Swelling in a woman's face and hands (a woman's feet might swell too, but swollen feet are common during pregnancy and may not signal a problem) - Systemic problems, such as headache, blurred vision, and right upper quadrant abdominal pain - Eclampsia The following symptoms are cause for immediate concern:1 - Seizures - Severe headache - Vision problems, such as temporary blindness - Abdominal pain, especially in the upper right area of the belly - Nausea and vomiting - Smaller urine output or not urinating very often - Seizures - Severe headache - Vision problems, such as temporary blindness - Abdominal pain, especially in the upper right area of the belly - Nausea and vomiting - Smaller urine output or not urinating very often - HELLP Syndrome HELLP syndrome can lead to serious complications, including liver failure and death.1 A pregnant woman with HELLP syndrome might bleed or bruise easily and/or experience abdominal pain, nausea or vomiting, headache, or extreme fatigue. Although most women who develop HELLP syndrome already have high blood pressure and preeclampsia, sometimes the syndrome is the first sign. In addition, HELLP syndrome can occur without a woman having either high blood pressure or protein in her urine. How do health care providers diagnose preeclampsia, eclampsia, and HELLP syndrome? A health care provider will check a pregnant woman’s blood pressure and urine during each prenatal visit. If the blood pressure reading is considered high (140/90 or higher), especially after the 20th week of pregnancy, the health care provider will likely perform blood tests and more extensive lab tests to look for extra protein in the urine (called proteinuria) as well as other symptoms.The American College of Obstetricians and Gynecologists provides the following criteria for a diagnosis of gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome.Gestational hypertension is diagnosed if a pregnant woman has high blood pressure but no protein in the urine. Gestational hypertension occurs when women whose blood pressure levels were normal before pregnancy develop high blood pressure after 20 weeks of pregnancy. Gestational hypertension can progress into preeclampsia.1Mild preeclampsia is diagnosed when a pregnant woman has:2- Systolic blood pressure (top number) of 140 mmHg or higher or diastolic blood pressure (bottom number) of 90 mmHg or higher and either - Urine with 0.3 or more grams of protein in a 24-hour specimen (a collection of every drop of urine within 24 hours) or a protein-to-creatinine ratio greater than 0.3 or - Blood tests that show kidney or liver dysfunction - Fluid in the lungs and difficulty breathing - Visual impairmentsSevere preeclampsia occurs when a pregnant woman has any of the following:- Systolic blood pressure of 160 mmHg or higher or diastolic blood pressure of 110 mmHg or higher on two occasions at least 4 hours apart while the patient is on bed rest - Urine with 5 or more grams of protein in a 24-hour specimen or 3 or more grams of protein on 2 random urine samples collected at least 4 hours apart - Test results suggesting kidney or liver damage—for example, blood tests that reveal low numbers of platelets or high liver enzymes - Severe, unexplained stomach pain that does not respond to medication - Symptoms that include visual disturbances, difficulty breathing, or fluid buildup3Eclampsia occurs when women with preeclampsia develop seizures. The seizures can happen before or during labor or after the baby is delivered. HELLP syndrome is diagnosed when laboratory tests show hemolysis (burst red blood cells release hemoglobin into the blood plasma), elevated liver enzymes, and low platelets. There also may or may not be extra protein in the urine.4Some women may also be diagnosed with superimposed preeclampsia—a situation in which the woman develops preeclampsia on top of high blood pressure that was present before she got pregnant. Health care providers look for an increase in blood pressure and either protein in the urine, fluid buildup, or both for a diagnosis of superimposed preeclampsia.In addition to tests that might diagnose preeclampsia or similar problems, health care providers may do other tests to assess the health of the mother and fetus, including:- Blood tests to see how well the mother's liver and kidneys are working - Blood tests to check blood platelet levels to see how well the mother’s blood is clotting - Blood tests to count the total number of red blood cells in the mother’s blood - A maternal weight check - An ultrasound to assess the fetus’s size - A check of the fetus's heart rate - A physical exam to look for swelling in the mother’s face, hands, or legs as well as abdominal tenderness or an enlarged liver What are the treatments for preeclampsia, eclampsia, & HELLP syndrome? - Preeclampsia Treatment If the pregnancy is at 37 weeks or later, the health care provider will usually want to deliver the fetus to treat preeclampsia and avoid further complications. If the pregnancy is at less than 37 weeks, however, the woman and her health care provider may consider treatment options that give the fetus more time to develop, depending on how severe the condition is. A health care provider may consider the following options: - If the preeclampsia is mild, it may be possible to wait to deliver. To help prevent further complications, the health care provider may ask the woman to go on bed rest to try to lower blood pressure and increase the blood flow to the placenta. - Close monitoring of the woman and her fetus will be needed. Tests for the mother might include blood and urine tests to see if the preeclampsia is progressing, such as tests to assess platelet counts, liver enzymes, kidney function, and urinary protein levels. Tests for the fetus might include ultrasound, heart rate monitoring, assessment of fetal growth, and amniotic fluid assessment. - Anticonvulsive medication, such as magnesium sulfate, might be used to prevent a seizure. - In some cases, such as with severe preeclampsia, the woman will be admitted to the hospital so she can be monitored closely and continuously. Treatment in the hospital might include intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus's lungs. When a woman has severe preeclampsia and is at 34 weeks of pregnancy or later, the American College of Obstetricians and Gynecologists recommends delivery as soon as medically possible. If the pregnancy is at less than 34 weeks, health care providers will probably prescribe corticosteroids to help speed up the maturation of the fetal lungs before attempting delivery.2 Preterm delivery may be necessary, even if that means likely complications for the infant, because of the risk of severe maternal complications. The symptoms of preeclampsia usually go away within 6 weeks of delivery.3 - If the preeclampsia is mild, it may be possible to wait to deliver. To help prevent further complications, the health care provider may ask the woman to go on bed rest to try to lower blood pressure and increase the blood flow to the placenta. - Close monitoring of the woman and her fetus will be needed. Tests for the mother might include blood and urine tests to see if the preeclampsia is progressing, such as tests to assess platelet counts, liver enzymes, kidney function, and urinary protein levels. Tests for the fetus might include ultrasound, heart rate monitoring, assessment of fetal growth, and amniotic fluid assessment. - Anticonvulsive medication, such as magnesium sulfate, might be used to prevent a seizure. - In some cases, such as with severe preeclampsia, the woman will be admitted to the hospital so she can be monitored closely and continuously. Treatment in the hospital might include intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus's lungs. - Eclampsia Treatment Eclampsia—the onset of seizures in a woman with preeclampsia—is considered a medical emergency. Immediate treatment, usually in a hospital, is needed to stop the mother's seizures, treat blood pressure levels that are too high, and deliver the fetus. Magnesium sulfate (a type of mineral) may be given to treat active seizures and prevent future seizures. Antihypertensive medications may be given to lower the blood pressure. - HELLP Syndrome Treatment HELLP syndrome, a severe complication of preeclampsia and eclampsia, can lead to serious complications for the mother, including liver failure and death, as well as the fetus. The health care provider may consider the following treatments after a diagnosis of HELLP syndrome: - Delivery of the fetus - Hospitalization to provide intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus's lungs.4 - Delivery of the fetus - Hospitalization to provide intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus's lungs.4 Other FAQs - If I have high blood pressure, can I take steps to prevent problems like preeclampsia during pregnancy? If you currently have chronic hypertension (high blood pressure not due to pregnancy), you may be at higher-than-average risk for getting preeclampsia during pregnancy. Your risk is also higher if you had gestational hypertension (high blood pressure that occurs only during pregnancy) or preeclampsia with a previous pregnancy, if you are obese, or if you have other risk factors.1 Talk with your health care provider about how hypertension might affect your pregnancy and what you can do to lower your risk. Before You Get Pregnant - Visit your health care provider for a preconception visit to discuss what you can do to lower your risk. Your health care provider may recommend ways to control your blood pressure, if needed, by limiting your salt intake, exercising regularly, and losing weight if you are overweight. - If you take medication to control your blood pressure, ask your health care provider if you should change it. Some medications should not be used during pregnancy. Your health care provider may be able to recommend safer alternatives. While You Are Pregnant - Get regular prenatal care, including regular blood pressure checks, urine tests for protein, as well as regular weight checks. - Avoid alcohol and tobacco. - Talk with your health care provider about any drugs or supplements that you take or are thinking of taking, including vitamins and herbs. Follow your provider's recommendations about prescription and other medications. - If you are at very high risk of preeclampsia, your doctor may recommend that you start taking low-dose aspirin after at least 12 weeks of pregnancy.2 [top] - Visit your health care provider for a preconception visit to discuss what you can do to lower your risk. Your health care provider may recommend ways to control your blood pressure, if needed, by limiting your salt intake, exercising regularly, and losing weight if you are overweight. - If you take medication to control your blood pressure, ask your health care provider if you should change it. Some medications should not be used during pregnancy. Your health care provider may be able to recommend safer alternatives. - Get regular prenatal care, including regular blood pressure checks, urine tests for protein, as well as regular weight checks. - Avoid alcohol and tobacco. - Talk with your health care provider about any drugs or supplements that you take or are thinking of taking, including vitamins and herbs. Follow your provider's recommendations about prescription and other medications. - If you are at very high risk of preeclampsia, your doctor may recommend that you start taking low-dose aspirin after at least 12 weeks of pregnancy.2 - If I had preeclampsia with a previous pregnancy, will I have it again in later pregnancies? If you had preeclampsia during your first pregnancy, your risk of developing preeclampsia again is about 15%.3 Your risk is even higher if you delivered your first child before 28 weeks of pregnancy or if you are overweight or obese.3 Your risk of having preeclampsia again is also higher if you developed preeclampsia early in your previous pregnancy, if you developed chronic hypertension or diabetes after the first pregnancy, if you had in vitro fertilization, or if you are carrying more than one fetus. Having severe preeclampsia or HELLP syndrome during the first pregnancy also raises your risk. If you had HELLP syndrome during a pregnancy, you have about a 20% chance of getting some form of gestational hypertension again.4 [top]
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Cavities/tooth decay Overview Cavities are permanently damaged areas in the hard surface of your teeth that develop into tiny openings or holes. Cavities, also called tooth decay or caries, are caused by a combination of factors, including bacteria in your mouth, frequent snacking, sipping sugary drinks and not cleaning your teeth well. Cavities and tooth decay are among the world's most common health problems. They're especially common in children, teenagers and older adults. But anyone who has teeth can get cavities, including infants. If cavities aren't treated, they get larger and affect deeper layers of your teeth. They can lead to a severe toothache, infection and tooth loss. Regular dental visits and good brushing and flossing habits are your best protection against cavities and tooth decay. Symptoms The signs and symptoms of cavities vary, depending on their extent and location. When a cavity is just beginning, you may not have any symptoms at all. As the decay gets larger, it may cause signs and symptoms such as: - Toothache, spontaneous pain or pain that occurs without any apparent cause - Tooth sensitivity - Mild to sharp pain when eating or drinking something sweet, hot or cold - Visible holes or pits in your teeth - Brown, black or white staining on any surface of a tooth - Pain when you bite down When to see a dentist You may not be aware that a cavity is forming. That's why it's important to have regular dental checkups and cleanings, even when your mouth feels fine. However, if you experience a toothache or mouth pain, see your dentist as soon as possible. Causes Cavities are caused by tooth decay - a process that occurs over time. Here's how tooth decay develops: - Plaque forms. Dental plaque is a clear sticky film that coats your teeth. It's due to eating a lot of sugars and starches and not cleaning your teeth well. When sugars and starches aren't cleaned off your teeth, bacteria quickly begin feeding on them and form plaque. Plaque that stays on your teeth can harden under or above your gum line into tartar (calculus). Tartar makes plaque more difficult to remove and creates a shield for bacteria. - Plaque attacks. The acids in plaque remove minerals in your tooth's hard, outer enamel. This erosion causes tiny openings or holes in the enamel - the first stage of cavities. Once areas of enamel are worn away, the bacteria and acid can reach the next layer of your teeth, called dentin. This layer is softer than enamel and less resistant to acid. Dentin has tiny tubes that directly communicate with the nerve of the tooth causing sensitivity. - Destruction continues. As tooth decay develops, the bacteria and acid continue their march through your teeth, moving next to the inner tooth material (pulp) that contains nerves and blood vessels. The pulp becomes swollen and irritated from the bacteria. Because there is no place for the swelling to expand inside of a tooth, the nerve becomes pressed, causing pain. Discomfort can even extend outside of the tooth root to the bone. Risk factors Everyone who has teeth is at risk of getting cavities, but the following factors can increase risk: - Tooth location. Decay most often occurs in your back teeth (molars and premolars). These teeth have lots of grooves, pits and crannies, and multiple roots that can collect food particles. As a result, they're harder to keep clean than your smoother, easy-to-reach front teeth. - Certain foods and drinks. Foods that cling to your teeth for a long time - such as milk, ice cream, honey, sugar, soda, dried fruit, cake, cookies, hard candy and mints, dry cereal, and chips - are more likely to cause decay than foods that are easily washed away by saliva. - Frequent snacking or sipping. When you steadily snack or sip sugary drinks, you give mouth bacteria more fuel to produce acids that attack your teeth and wear them down. And sipping soda or other acidic drinks throughout the day helps create a continual acid bath over your teeth. - Bedtime infant feeding. When babies are given bedtime bottles filled with milk, formula, juice or other sugar-containing liquids, these beverages remain on their teeth for hours while they sleep, feeding decay-causing bacteria. This damage is often called baby bottle tooth decay. Similar damage can occur when toddlers wander around drinking from a sippy cup filled with these beverages. - Inadequate brushing. If you don't clean your teeth soon after eating and drinking, plaque forms quickly and the first stages of decay can begin. - Not getting enough fluoride. Fluoride, a naturally occurring mineral, helps prevent cavities and can even reverse the earliest stages of tooth damage. Because of its benefits for teeth, fluoride is added to many public water supplies. It's also a common ingredient in toothpaste and mouth rinses. But bottled water usually does not contain fluoride. - Younger or older age. In the United States, cavities are common in very young children and teenagers. Older adults also are at higher risk. Over time, teeth can wear down and gums may recede, making teeth more vulnerable to root decay. Older adults also may use more medications that reduce saliva flow, increasing the risk of tooth decay. - Dry mouth. Dry mouth is caused by a lack of saliva, which helps prevent tooth decay by washing away food and plaque from your teeth. Substances found in saliva also help counter the acid produced by bacteria. Certain medications, some medical conditions, radiation to your head or neck, or certain chemotherapy drugs can increase your risk of cavities by reducing saliva production. - Worn fillings or dental devices. Over the years, dental fillings can weaken, begin to break down or develop rough edges. This allows plaque to build up more easily and makes it harder to remove. Dental devices can stop fitting well, allowing decay to begin underneath them. - Heartburn. Heartburn or gastroesophageal reflux disease (GERD) can cause stomach acid to flow into your mouth (reflux), wearing away the enamel of your teeth and causing significant tooth damage. This exposes more of the dentin to attack by bacteria, creating tooth decay. Your dentist may recommend that you consult your doctor to see if gastric reflux is the cause of your enamel loss. - Eating disorders. Anorexia and bulimia can lead to significant tooth erosion and cavities. Stomach acid from repeated vomiting (purging) washes over the teeth and begins dissolving the enamel. Eating disorders also can interfere with saliva production. Complications Cavities and tooth decay are so common that you may not take them seriously. And you may think that it doesn't matter if children get cavities in their baby teeth. However, cavities and tooth decay can have serious and lasting complications, even for children who don't have their permanent teeth yet. Complications of cavities may include: - Pain - Tooth abscess - Swelling or pus around a tooth - Damage or broken teeth - Chewing problems - Positioning shifts of teeth after tooth loss When cavities and decay become severe, you may have: - Pain that interferes with daily living - Weight loss or nutrition problems from painful or difficult eating or chewing - Tooth loss, which may affect your appearance, as well as your confidence and self-esteem - In rare cases, a tooth abscess - a pocket of pus that's caused by bacterial infection - which can lead to more serious or even life-threatening infections Diagnosis Your dentist can usually detect tooth decay by: - Asking about tooth pain and sensitivity - Examining your mouth and teeth - Probing your teeth with dental instruments to check for soft areas - Looking at dental X-rays, which can show the extent of cavities and decay Your dentist will also be able to tell you which of the three types of cavities you have - smooth surface, pit and fissure, or root. Treatment Regular checkups can identify cavities and other dental conditions before they cause troubling symptoms and lead to more-serious problems. The sooner you seek care, the better your chances of reversing the earliest stages of tooth decay and preventing its progression. If a cavity is treated before it starts causing pain, you probably won't need extensive treatment. Treatment of cavities depends on how severe they are and your particular situation. Treatment options include: - Fluoride treatments. If your cavity just started, a fluoride treatment may help restore your tooth's enamel and can sometimes reverse a cavity in the very early stages. Professional fluoride treatments contain more fluoride than the amount found in tap water, toothpaste and mouth rinses. Fluoride treatments may be liquid, gel, foam or varnish that's brushed onto your teeth or placed in a small tray that fits over your teeth. - Fillings. Fillings, also called restorations, are the main treatment option when decay has progressed beyond the earliest stage. Fillings are made of various materials, such as tooth-colored composite resins, porcelain or dental amalgam that is a combination of several materials. - Crowns. For extensive decay or weakened teeth, you may need a crown - a custom-fitted covering that replaces your tooth's entire natural crown. Your dentist drills away all the decayed area and enough of the rest of your tooth to ensure a good fit. Crowns may be made of gold, high strength porcelain, resin, porcelain fused to metal or other materials. - Root canals. When decay reaches the inner material of your tooth (pulp), you may need a root canal. This is a treatment to repair and save a badly damaged or infected tooth instead of removing it. The diseased tooth pulp is removed. Medication is sometimes put into the root canal to clear any infection. Then the pulp is replaced with a filling. - Tooth extractions. Some teeth become so severely decayed that they can't be restored and must be removed. Having a tooth pulled can leave a gap that allows your other teeth to shift. If possible, consider getting a bridge or a dental implant to replace the missing tooth.
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Multiple sclerosis Overview Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system). In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged. Signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others may experience long periods of remission without any new symptoms. There's no cure for multiple sclerosis. However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms. Find out why Mayo Clinic is the best place for your care. Symptoms Multiple sclerosis signs and symptoms may differ greatly from person to person and over the course of the disease depending on the location of affected nerve fibers. They may include: - Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time, or the legs and trunk - Partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement - Prolonged double vision - Tingling or pain in parts of your body - Electric-shock sensations that occur with certain neck movements, especially bending the neck forward (Lhermitte sign) - Tremor, lack of coordination or unsteady gait - Slurred speech - Fatigue - Dizziness - Problems with bowel and bladder function When to see a doctor See a doctor if you experience any of the above symptoms for unknown reasons. Disease course Most people with MS have a relapsing-remitting disease course. They experience periods of new symptoms or relapses that develop over days or weeks and usually improve partially or completely. These relapses are followed by quiet periods of disease remission that can last months or even years. Small increases in body temperature can temporarily worsen signs and symptoms of MS, but these aren't considered disease relapses. About 60 to 70 percent of people with relapsing-remitting MS eventually develop a steady progression of symptoms, with or without periods of remission, known as secondary-progressive MS. The worsening of symptoms usually includes problems with mobility and gait. The rate of disease progression varies greatly among people with secondary-progressive MS. Some people with MS experience a gradual onset and steady progression of signs and symptoms without any relapses. This is known as primary-progressive MS. Causes The cause of multiple sclerosis is unknown. It's considered an autoimmune disease in which the body's immune system attacks its own tissues. In the case of MS, this immune system malfunction destroys myelin (the fatty substance that coats and protects nerve fibers in the brain and spinal cord). Myelin can be compared to the insulation coating on electrical wires. When the protective myelin is damaged and nerve fiber is exposed, the messages that travel along that nerve may be slowed or blocked. The nerve may also become damaged itself. It isn't clear why MS develops in some people and not others. A combination of genetics and environmental factors appears to be responsible. Risk factors These factors may increase your risk of developing multiple sclerosis: - Age. MS can occur at any age, but most commonly affects people between the ages of 15 and 60. - Sex. Women are about twice as likely as men are to develop MS. - Family history. If one of your parents or siblings has had MS, you are at higher risk of developing the disease. - Certain infections. A variety of viruses have been linked to MS, including Epstein-Barr, the virus that causes infectious mononucleosis. - Race. White people, particularly those of Northern European descent, are at highest risk of developing MS. People of Asian, African or Native American descent have the lowest risk. - Climate. MS is far more common in countries with temperate climates, including Canada, the northern United States, New Zealand, southeastern Australia and Europe. - Certain autoimmune diseases. You have a slightly higher risk of developing MS if you have thyroid disease, type 1 diabetes or inflammatory bowel disease. - Smoking. Smokers who experience an initial event of symptoms that may signal MS are more likely than nonsmokers to develop a second event that confirms relapsing-remitting MS. Diagnosis There are no specific tests for MS. Instead, a diagnosis of multiple sclerosis often relies on ruling out other conditions that might produce similar signs and symptoms, known as a differential diagnosis. Your doctor is likely to start with a thorough medical history and examination. Your doctor may then recommend: - Blood tests, to help rule out other diseases with symptoms similar to MS. Tests to check for specific biomarkers associated with MS are currently under development and may also aid in diagnosing the disease. - Lumbar puncture (spinal tap), in which a small sample of fluid is removed from your spinal canal for laboratory analysis. This sample can show abnormalities in antibodies that are associated with MS. Spinal tap can also help rule out infections and other conditions with symptoms similar to MS. - MRI, which can reveal areas of MS (lesions) on your brain and spinal cord. You may receive an intravenous injection of a contrast material to highlight lesions that indicate your disease is in an active phase. - Evoked potential tests, which record the electrical signals produced by your nervous system in response to stimuli. An evoked potential test may use visual stimuli or electrical stimuli, in which you watch a moving visual pattern, or short electrical impulses are applied to nerves in your legs or arms. Electrodes measure how quickly the information travels down your nerve pathways. In most people with relapsing-remitting MS, the diagnosis is fairly straightforward and based on a pattern of symptoms consistent with the disease and confirmed by brain imaging scans, such as MRI. Diagnosing MS can be more difficult in persons with unusual symptoms or progressive disease. In these cases, further testing with spinal fluid analysis, evoked potentials and additional imaging may be needed. Treatment There is no cure for multiple sclerosis. Treatment typically focuses on speeding recovery from attacks, slowing the progression of the disease and managing MS symptoms. Some people have such mild symptoms that no treatment is necessary. Treatments for MS attacks - Corticosteroids, such as oral prednisone and intravenous methylprednisolone, are prescribed to reduce nerve inflammation. Side effects may include insomnia, increased blood pressure, mood swings and fluid retention. - Plasma exchange (plasmapheresis). The liquid portion of part of your blood (plasma) is removed and separated from your blood cells. The blood cells are then mixed with a protein solution (albumin) and put back into your body. Plasma exchange may be used if your symptoms are new, severe and haven't responded to steroids. Treatments to modify progression For primary-progressive MS, ocrelizumab (Ocrevus) is the only FDA-approved disease-modifying therapy. It slows worsening of disability in people with this type of MS. For relapsing-remitting MS, several disease-modifying therapies are available. Much of the immune response associated with MS occurs in the early stages of the disease. Aggressive treatment with these medications as early as possible can lower the relapse rate and slow the formation of new lesions. Many of the disease-modifying therapies used to treat MS carry significant health risks. Selecting the right therapy for you will depend on careful consideration of many factors, including duration and severity of disease, effectiveness of previous MS treatments, other health issues, cost, and child-bearing status. Treatment options for relapsing-remitting MS include: - Beta interferons. These medications are among the most commonly prescribed medications to treat MS. They are injected under the skin or into muscle and can reduce the frequency and severity of relapses. Side effects of beta interferons may include flu-like symptoms and injection-site reactions. You'll need blood tests to monitor your liver enzymes because liver damage is a possible side effect of interferon use. People taking interferons may develop neutralizing antibodies that can reduce drug effectiveness. - Ocrelizumab (Ocrevus). This humanized immunoglobulin antibody medication is the only DMT approved by the FDA to treat both the relapse-remitting and primary progressive forms of MS. Clinical trials showed it reduced relapse rate in relapsing disease and slowed worsening of disability in both forms of the disease. Ocrevus is given via an intravenous infusion by a medical professional. Side effects may infusion-related reactions including irritation at the injection site, low blood pressure, fever, and nausea among others. Ocrevus may also increase the risk of some types of cancer, particularly breast cancer. - Glatiramer acetate (Copaxone). This medication may help block your immune system's attack on myelin and must be injected beneath the skin. Side effects may include skin irritation at the injection site. - Dimethyl fumarate (Tecfidera). This twice-daily oral medication can reduce relapses. Side effects may include flushing, diarrhea, nausea and lowered white blood cell count. - Fingolimod (Gilenya). This once-daily oral medication reduces relapse rate. You'll need to have your heart rate monitored for six hours after the first dose because your heartbeat may be slowed. Other side effects include headache, high blood pressure and blurred vision. - Teriflunomide (Aubagio). This once-daily medication can reduce relapse rate. Teriflunomide can cause liver damage, hair loss and other side effects. It is harmful to a developing fetus and should not be used by women who may become pregnant and are not using appropriate contraception, or their male partner. - Natalizumab (Tysabri). This medication is designed to block the movement of potentially damaging immune cells from your bloodstream to your brain and spinal cord. It may be considered a first line treatment for some people with severe MS or as a second line treatment in others. This medication increases the risk of a viral infection of the brain called progressive multifocal leukoencephalopathy in some people. - Alemtuzumab (Lemtrada). This drug helps reduce relapses of MS by targeting a protein on the surface of immune cells and depleting white blood cells. This effect can limit potential nerve damage caused by the white blood cells, but it also increases the risk of infections and autoimmune disorders. Treatment with alemtuzumab involves five consecutive days of drug infusions followed by another three days of infusions a year later. Infusion reactions are common with alemtuzumab. The drug is only available from registered providers, and people treated with the drug must be registered in a special drug safety monitoring program. - Mitoxantrone. This immunosuppressant drug can be harmful to the heart and is associated with development of blood cancers. As a result, its use in treating MS is extremely limited. Mitoxantrone is usually used only to treat severe, advanced MS. Treatments for MS signs and symptoms - Physical therapy. A physical or occupational therapist can teach you stretching and strengthening exercises and show you how to use devices to make it easier to perform daily tasks. Physical therapy along with the use of a mobility aid when necessary can also help manage leg weakness and other gait problems often associated with MS. - Muscle relaxants. You may experience painful or uncontrollable muscle stiffness or spasms, particularly in your legs. Muscle relaxants such as baclofen (Lioresal) and tizanidine (Zanaflex) may help. - Medications to reduce fatigue. - Other medications. Medications also may be prescribed for depression, pain, sexual dysfunction, and bladder or bowel control problems that are associated with MS. Lifestyle and home remedies To help relieve the signs and symptoms of MS, try to: - Get plenty of rest. - Exercise. If you have mild to moderate MS, regular exercise can help improve your strength, muscle tone, balance and coordination. Swimming or other water exercises are good options if you're bothered by heat. Other types of mild to moderate exercise recommended for people with MS include walking, stretching, low-impact aerobics, stationary bicycling, yoga and tai chi. - Cool down. MS symptoms often worsen when your body temperature rises. Avoiding exposure to heat and using devices such as cooling scarves or vests can be helpful. - Eat a balanced diet. Results of small studies suggest that a diet low in saturated fat but high in omega-3 fatty acids, such as those found in olive and fish oils, may be beneficial. But further research is needed. Studies also suggest that vitamin D may have potential benefit for people with MS. - Relieve stress. Stress may trigger or worsen your signs and symptoms. Yoga, tai chi, massage, meditation or deep breathing may help. Alternative medicine Many people with MS use a variety of alternative or complementary treatments or both to help manage their symptoms, such as fatigue and muscle pain. Activities such as exercise, meditation, yoga, massage, eating a healthier diet, acupuncture and relaxation techniques may help boost overall mental and physical well-being, but there are few studies to back up their use in managing symptoms of MS. Guidelines from the American Academy of Neurology recommend the use of oral cannabis extract for muscle spasticity and pain, but do not recommend cannabis in any other form for other MS symptoms due to a lack of evidence. The guidelines also do not recommend the use of herbal supplements such as Ginkgo biloba and bee venom or magnetic therapy for MS symptoms.
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Pneumonia Overview Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia. Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems. Symptoms The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type of germ causing the infection, and your age and overall health. Mild signs and symptoms often are similar to those of a cold or flu, but they last longer. Signs and symptoms of pneumonia may include: - Chest pain when you breathe or cough - Confusion or changes in mental awareness (in adults age 65 and older) - Cough, which may produce phlegm - Fatigue - Fever, sweating and shaking chills - Lower than normal body temperature (in adults older than age 65 and people with weak immune systems) - Nausea, vomiting or diarrhea - Shortness of breath Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and cough, appear restless or tired and without energy, or have difficulty breathing and eating. See your doctor if you have difficulty breathing, chest pain, persistent fever of 102 F (39 C) or higher, or persistent cough, especially if you're coughing up pus. It's especially important that people in these high-risk groups see a doctor: - Adults older than age 65 - Children younger than age 2 with signs and symptoms - People with an underlying health condition or weakened immune system - People receiving chemotherapy or taking medication that suppresses the immune system For some older adults and people with heart failure or chronic lung problems, pneumonia can quickly become a life-threatening condition. Causes Many germs can cause pneumonia. The most common are bacteria and viruses in the air we breathe. Your body usually prevents these germs from infecting your lungs. But sometimes these germs can overpower your immune system, even if your health is generally good. Pneumonia is classified according to the types of germs that cause it and where you got the infection. Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals or other health care facilities. It may be caused by: - Bacteria. The most common cause of bacterial pneumonia in the U.S. is Streptococcus pneumoniae. This type of pneumonia can occur on its own or after you've had a cold or the flu. It may affect one part (lobe) of the lung, a condition called lobar pneumonia. - Bacteria-like organisms. Mycoplasma pneumoniae also can cause pneumonia. It typically produces milder symptoms than do other types of pneumonia. Walking pneumonia is an informal name given to this type of pneumonia, which typically isn't severe enough to require bed rest. - Fungi. This type of pneumonia is most common in people with chronic health problems or weakened immune systems, and in people who have inhaled large doses of the organisms. The fungi that cause it can be found in soil or bird droppings and vary depending upon geographic location. - Viruses. Some of the viruses that cause colds and the flu can cause pneumonia. Viruses are the most common cause of pneumonia in children younger than 5 years. Viral pneumonia is usually mild. But in some cases it can become very serious. Some people catch pneumonia during a hospital stay for another illness. Hospital-acquired pneumonia can be serious because the bacteria causing it may be more resistant to antibiotics and because the people who get it are already sick. People who are on breathing machines (ventilators), often used in intensive care units, are at higher risk of this type of pneumonia. Health care-acquired pneumonia is a bacterial infection that occurs in people who live in long-term care facilities or who receive care in outpatient clinics, including kidney dialysis centers. Like hospital-acquired pneumonia, health care-acquired pneumonia can be caused by bacteria that are more resistant to antibiotics. Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs. Aspiration is more likely if something disturbs your normal gag reflex, such as a brain injury or swallowing problem, or excessive use of alcohol or drugs. Risk factors Pneumonia can affect anyone. But the two age groups at highest risk are: - Children who are 2 years old or younger - People who are age 65 or older Other risk factors include: - Being hospitalized. You're at greater risk of pneumonia if you're in a hospital intensive care unit, especially if you're on a machine that helps you breathe (a ventilator). - Chronic disease. You're more likely to get pneumonia if you have asthma, chronic obstructive pulmonary disease (COPD) or heart disease. - Smoking. Smoking damages your body's natural defenses against the bacteria and viruses that cause pneumonia. - Weakened or suppressed immune system. People who have HIV/AIDS, who've had an organ transplant, or who receive chemotherapy or long-term steroids are at risk. Complications Even with treatment, some people with pneumonia, especially those in high-risk groups, may experience complications, including: - Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from your lungs can spread the infection to other organs, potentially causing organ failure. - Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung diseases, you may have trouble breathing in enough oxygen. You may need to be hospitalized and use a breathing machine (ventilator) while your lung heals. - Fluid accumulation around the lungs (pleural effusion). Pneumonia may cause fluid to build up in the thin space between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes infected, you may need to have it drained through a chest tube or removed with surgery. - Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated with antibiotics. Sometimes, surgery or drainage with a long needle or tube placed into the abscess is needed to remove the pus. Diagnosis Your doctor will start by asking about your medical history and doing a physical exam, including listening to your lungs with a stethoscope to check for abnormal bubbling or crackling sounds that suggest pneumonia. If pneumonia is suspected, your doctor may recommend the following tests: - Blood tests. Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection. However, precise identification isn't always possible. - Chest X-ray. This helps your doctor diagnose pneumonia and determine the extent and location of the infection. However, it can't tell your doctor what kind of germ is causing the pneumonia. - Pulse oximetry. This measures the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream. - Sputum test. A sample of fluid from your lungs (sputum) is taken after a deep cough and analyzed to help pinpoint the cause of the infection. Your doctor might order additional tests if you're older than age 65, are in the hospital, or have serious symptoms or health conditions. These may include: - CT scan. If your pneumonia isn't clearing as quickly as expected, your doctor may recommend a chest CT scan to obtain a more detailed image of your lungs. - Pleural fluid culture. A fluid sample is taken by putting a needle between your ribs from the pleural area and analyzed to help determine the type of infection. Treatment Treatment for pneumonia involves curing the infection and preventing complications. People who have community-acquired pneumonia usually can be treated at home with medication. Although most symptoms ease in a few days or weeks, the feeling of tiredness can persist for a month or more. Specific treatments depend on the type and severity of your pneumonia, your age and your overall health. The options include: - Antibiotics. These medicines are used to treat bacterial pneumonia. It may take time to identify the type of bacteria causing your pneumonia and to choose the best antibiotic to treat it. If your symptoms don't improve, your doctor may recommend a different antibiotic. - Cough medicine. This medicine may be used to calm your cough so that you can rest. Because coughing helps loosen and move fluid from your lungs, it's a good idea not to eliminate your cough completely. In addition, you should know that very few studies have looked at whether over-the-counter cough medicines lessen coughing caused by pneumonia. If you want to try a cough suppressant, use the lowest dose that helps you rest. - Fever reducers/pain relievers. You may take these as needed for fever and discomfort. These include drugs such as aspirin, ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others). Hospitalization You may need to be hospitalized if: - You are older than age 65 - You are confused about time, people or places - Your kidney function has declined - Your systolic blood pressure is below 90 millimeters of mercury (mm Hg) or your diastolic blood pressure is 60 mm Hg or below - Your breathing is rapid (30 breaths or more a minute) - You need breathing assistance - Your temperature is below normal - Your heart rate is below 50 or above 100 You may be admitted to the intensive care unit if you need to be placed on a breathing machine (ventilator) or if your symptoms are severe. Children may be hospitalized if: - They are younger than age 2 months - They are lethargic or excessively sleepy - They have trouble breathing - They have low blood oxygen levels - They appear dehydrated Lifestyle and home remedies These tips can help you recover more quickly and decrease your risk of complications: - Get plenty of rest. Don't go back to school or work until after your temperature returns to normal and you stop coughing up mucus. Even when you start to feel better, be careful not to overdo it. Because pneumonia can recur, it's better not to jump back into your routine until you are fully recovered. Ask your doctor if you're not sure. - Stay hydrated. Drink plenty of fluids, especially water, to help loosen mucus in your lungs. - Take your medicine as prescribed. Take the entire course of any medications your doctor prescribed for you. If you stop taking medication too soon, your lungs may continue to harbor bacteria that can multiply and cause your pneumonia to recur.
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Cervical cancer: Cervical cancer is cancer that starts in the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina. Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of the routine use of Pap smears. Cervical cancer starts in the cells on the surface of the cervix. There are 2 types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers are from squamous cells. Cervical cancer usually develops slowly. It starts as a precancerous condition called dysplasia. This condition can be detected by a Pap smear and is 100% treatable. It can take years for dysplasia to develop into cervical cancer. Most women who are diagnosed with cervical cancer today have not had regular Pap smears, or they have not followed up on abnormal Pap smear results. Almost all cervical cancers are caused by HPV (human papillomavirus). HPV is a common virus that is spread through sexual intercourse. There are many different types (strains) of HPV. Some strains lead to cervical cancer. Other strains can cause genital warts. Others do not cause any problems at all. A woman's sexual habits and patterns can increase her risk of developing cervical cancer. Risky sexual practices include: - Having sex at an early age - Having multiple sexual partners - Having a partner or many partners who take part in high-risk sexual activities Other risk factors for cervical cancer include: - Not getting the HPV vaccine - Being economically disadvantaged - Having a mother who took the drug diethylstilbestrol (DES) during pregnancy in the early 1960s to prevent miscarriage - Having a weakened immune system Most of the time, early cervical cancer has no symptoms. Symptoms that may occur include: - Abnormal vaginal bleeding between periods, after intercourse, or after menopause - Vaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smelling - Periods that become heavier and last longer than usual Cervical cancer may spread to the bladder, intestines, lungs, and liver. Often, there are no problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include: - Back pain - Bone pain or fractures - Fatigue - Leaking of urine or feces from the vagina - Leg pain - Loss of appetite - Pelvic pain - Single swollen leg - Weight loss Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions: - A Pap smear screens for precancers and cancer, but does not make a final diagnosis. - The human papillomavirus (HPV) DNA test may be done along with a Pap test. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as the first test. - If abnormal changes are found, the cervix is usually examined under magnification. This procedure is called colposcopy. Pieces of tissue are removed (biopsied) during this procedure. This tissue is then sent to a lab for examination. - A procedure called a cone biopsy may also be done. If cervical cancer is diagnosed, the health care provider will order more tests. These help determine how far the cancer has spread. This is called staging. Tests may include: - Chest x-ray - CT scan of the pelvis - Cystoscopy - Intravenous pyelogram (IVP) - MRI of the pelvis Treatment of cervical cancer depends on: - The stage of the cancer - The size and shape of the tumor - The woman's age and general health - Her desire to have children in the future Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. This is why routine Pap smears are so important to prevent cervical cancer. There are surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future. Types of surgery for early cervical cancer include: - Loop electrosurgical excision procedure (LEEP): Uses electricity to remove abnormal tissue - Cryotherapy: Freezes abnormal cells - Laser therapy: Uses light to burn abnormal tissue A hysterectomy (surgery to remove the uterus but not the ovaries) is not often done for cervical cancer that has not spread. It may be done in women who have had repeated LEEP procedures. Treatment for more advanced cervical cancer may include: - Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina. - Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed. Radiation may be used to treat cancer that has spread beyond the cervix or cancer that has returned. Chemotherapy uses drugs to kill cancer. It may be given alone or with surgery or radiation. You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone. How well the person does depends on many things, including: - Type of cervical cancer - Stage of cancer (how far it has spread) - Age and general health - If the cancer comes back after treatment Precancerous conditions can be completely cured when followed up and treated properly. Most women are alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area. The 5-year survival rate falls as the cancer spreads outside the walls of the cervix into other areas. Complications can include: - Risk of the cancer coming back in women who have treatment to save the uterus - Problems with sexual, bowel, and bladder function after surgery or radiation Call your provider if you: - Have not had regular Pap smears - Have abnormal vaginal bleeding or discharge Cervical cancer can be prevented by doing the following: - Get the HPV vaccine. The vaccine prevents most types of HPV infection that cause cervical cancer. Your provider can tell you if the vaccine is right for you. - Practice safer sex. Using condoms during sex reduces the risk for HPV and other sexually transmitted infections (STIs). - Limit the number of sexual partners you have. Avoid partners who are active in high-risk sexual behaviors. - Get Pap smears as often as your provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer. - Get the HPV test if recommended by your provider. It can be used along with the Pap test to screen for cervical cancer in women 30 years and older. - If you smoke, quit. Smoking increases your chance of getting cervical cancer. Updated by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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Gastroparesis: Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. Normally, the muscles of the stomach, which are controlled by the vagus nerve, contract to break up food and move it through the gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether.Gastroparesis slows or stops the movement of food from the stomach to the small intestine.Gastroparesis slows or stops the movement of food from the stomach to the small intestine. Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. Other identifiable causes of gastroparesis include intestinal surgery and nervous system diseases such as Parkinson’s disease or multiple sclerosis. For reasons that are still unclear, gastroparesis is more commonly found in women than in men. The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food—sometimes several hours after a meal. Other symptoms of gastroparesis includegastroesophageal reflux (GER), also called acid reflux or acid regurgitation—a condition in which stomach contents flow back up into the esophagus, the organ that connects the mouth to the stomach pain in the stomach area abdominal bloating lack of appetitegastroesophageal reflux (GER), also called acid reflux or acid regurgitation—a condition in which stomach contents flow back up into the esophagus, the organ that connects the mouth to the stomachpain in the stomach areaabdominal bloatinglack of appetiteSymptoms may be aggravated by eating greasy or rich foods, large quantities of foods with fiber—such as raw fruits and vegetables—or drinking beverages high in fat or carbonation. Symptoms may be mild or severe, and they can occur frequently in some people and less often in others. The symptoms of gastroparesis may also vary in intensity over time in the same individual. Sometimes gastroparesis is difficult to diagnose because people experience a range of symptoms similar to those of other diseases. Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the GI tract, and gastric emptying tests. Tests may also identify a nutritional disorder or underlying disease. To rule out any blockage or other structural problems, the health care provider may perform one or more of the following tests:Upper gastrointestinal (GI) endoscopy. This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract, which includes the esophagus, stomach, and duodenum—the first part of the small intestine. The test is performed at a hospital or outpatient center by a gastroenterologist—a doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. An intravenous (IV) needle is placed in a vein in the arm if general anesthesia is given. The test may show blockage or large bezoars—solid collections of food, mucus, vegetable fiber, hair, or other material that cannot be digested in the stomach—that are sometimes softened, dissolved, or broken up during an upper GI endoscopy. Upper GI series. An upper GI series may be done to look at the small intestine. The test is performed at a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging. Anesthesia is not needed. No eating or drinking is allowed for 8 hours before the procedure, if possible. If the person has diabetes, a health care provider may give different instructions about fasting before the test. During the procedure, the person will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the small intestine, making signs of gastroparesis show up more clearly on x rays. Gastroparesis is likely if the x ray shows food in the stomach after fasting. A person may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes stools to be white or light colored. A health care provider will give the person specific instructions about eating and drinking after the test. Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care provider’s office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. The images can show whether gallbladder disease and pancreatitis could be the cause of a person’s digestive symptoms, rather than gastroparesis. Gastric emptying scintigraphy. The test involves eating a bland meal—such as eggs or an egg substitute—that contains a small amount of radioactive material. The test is performed in a radiology center or hospital by a specially trained technician and interpreted by a radiologist; anesthesia is not needed. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. If more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed. SmartPill. The SmartPill is a small electronic device in capsule form. The SmartPill test is available at specialized outpatient centers. The images are interpreted by a radiologist. The device is swallowed and moves through the entire digestive tract, sending information to a cell-phone-sized receiver worn around the person’s waist or neck. The recorded information provides a detailed record of how quickly food travels through each part of the digestive tract. Gastric emptying breath test. With this test, the person eats a special test meal that includes a natural material with a special type of carbon in it. Then, breath samples are taken over a period of several hours to measure the amount of the material in the exhaled breath. The results allow the health care provider to calculate how fast the stomach is emptying.Upper gastrointestinal (GI) endoscopy. This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract, which includes the esophagus, stomach, and duodenum—the first part of the small intestine. The test is performed at a hospital or outpatient center by a gastroenterologist—a doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. An intravenous (IV) needle is placed in a vein in the arm if general anesthesia is given. The test may show blockage or large bezoars—solid collections of food, mucus, vegetable fiber, hair, or other material that cannot be digested in the stomach—that are sometimes softened, dissolved, or broken up during an upper GI endoscopy.Upper gastrointestinal (GI) endoscopy.Upper GI series. An upper GI series may be done to look at the small intestine. The test is performed at a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging. Anesthesia is not needed. No eating or drinking is allowed for 8 hours before the procedure, if possible. If the person has diabetes, a health care provider may give different instructions about fasting before the test. During the procedure, the person will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the small intestine, making signs of gastroparesis show up more clearly on x rays. Gastroparesis is likely if the x ray shows food in the stomach after fasting. A person may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes stools to be white or light colored. A health care provider will give the person specific instructions about eating and drinking after the test.Upper GI series.Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care provider’s office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. The images can show whether gallbladder disease and pancreatitis could be the cause of a person’s digestive symptoms, rather than gastroparesis.Ultrasound.Gastric emptying scintigraphy. The test involves eating a bland meal—such as eggs or an egg substitute—that contains a small amount of radioactive material. The test is performed in a radiology center or hospital by a specially trained technician and interpreted by a radiologist; anesthesia is not needed. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. If more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed.Gastric emptying scintigraphy.SmartPill. The SmartPill is a small electronic device in capsule form. The SmartPill test is available at specialized outpatient centers. The images are interpreted by a radiologist. The device is swallowed and moves through the entire digestive tract, sending information to a cell-phone-sized receiver worn around the person’s waist or neck. The recorded information provides a detailed record of how quickly food travels through each part of the digestive tract.SmartPill.Gastric emptying breath test. With this test, the person eats a special test meal that includes a natural material with a special type of carbon in it. Then, breath samples are taken over a period of several hours to measure the amount of the material in the exhaled breath. The results allow the health care provider to calculate how fast the stomach is emptying.Gastric emptying breath test. Treatment of gastroparesis depends on the severity of the person’s symptoms. In most cases, treatment does not cure gastroparesis, which is usually a chronic, or long-lasting, condition. Gastroparesis is also a relapsing condition—the symptoms can come and go for periods of time. Treatment helps people manage the condition so they can be as comfortable and active as possible. Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. If less food enters the stomach each time a person eats, the stomach may not become overly full, allowing it to empty more easily. Chewing food well, drinking noncarbonated liquids with a meal, and walking or sitting for 2 hours after a meal—instead of lying down—may assist with gastric emptying.A health care provider may also recommend avoiding high-fat and fibrous foods. Fat naturally slows digestion and some raw vegetables and fruits are more difficult to digest than other foods. Some foods, such as oranges and broccoli, contain fibrous parts that do not digest well. People with gastroparesis should minimize their intake of large portions of these foods because the undigested parts may remain in the stomach too long. Sometimes, the undigested parts form bezoars.When a person has severe symptoms, a liquid or puréed diet may be prescribed. As liquids tend to empty more quickly from the stomach, some people may find a puréed diet helps improve symptoms. Puréed fresh or cooked fruits and vegetables can be incorporated into shakes and soups. A health care provider may recommend a dietitian to help a person plan meals that minimize symptoms and ensure all nutritional needs are met.When the most extreme cases of gastroparesis lead to severe nausea, vomiting, and dehydration, urgent care may be required at a medical facility where IV fluids can be given.MedicationsSeveral prescription medications are available to treat gastroparesis. A combination of medications may be used to find the most effective treatment.Metoclopramide (Reglan). This medication stimulates stomach muscle contractions to help with gastric emptying. Metoclopramide also helps reduce nausea and vomiting. The medication is taken 20 to 30 minutes before meals and at bedtime. Possible side effects of metoclopramide include fatigue, sleepiness, and depression. Currently, this is the only medication approved by the FDA for treatment of gastroparesis. However, the FDA has placed a black box warning on this medication because of rare reports of it causing an irreversible neurologic side effect called tardive dyskinesia—a disorder that affects movement.Metoclopramide (Reglan).Erythromycin. This antibiotic, prescribed at low doses, may improve gastric emptying. Like metaclopramide, erythromycin works by increasing the contractions that move food through the stomach. Possible side effects of erythromycin include nausea, vomiting, and abdominal cramps.Erythromycin.Other medications. Other medications may be used to treat symptoms and problems related to gastroparesis. For example, medications known as antiemetics are used to help control nausea and vomiting.Other medications.Botulinum ToxinBotulinum toxin is a nerve blocking agent also known as Botox. After passing an endoscope into the stomach, a health care provider injects the Botox into the pylorus, the opening from the stomach into the duodenum. Botox is supposed to help keep the pylorus open for longer periods of time and improve symptoms of gastroparesis. Although some initial research trials showed modest improvement in gastroparesis symptoms and the rate of gastric emptying following the injections, other studies have failed to show the same degree of effectiveness of the Botox injections.11Gastric Electrical StimulationThis treatment alternative may be effective for some people whose nausea and vomiting do not improve with dietary changes or medications. A gastric neurostimulator is a surgically implanted battery-operated device that sends mild electrical pulses to the stomach muscles to help control nausea and vomiting. The procedure may be performed at a hospital or outpatient center by a gastroenterologist. General anesthesia may be required. The gastroenterologist makes several tiny incisions in the abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached. The camera sends a magnified image from inside the stomach to a video monitor, giving the gastroenterologist a close-up view of the tissues. Once implanted, the settings on the battery-operated device can be adjusted to determine the settings that best control symptoms.JejunostomyIf medications and dietary changes don’t work, and the person is losing weight or requires frequent hospitalization for dehydration, a health care provider may recommend surgically placing a feeding tube through the abdominal wall directly into a part of the small intestine called the jejunum. The surgical procedure is known as a jejunostomy. The procedure is performed by a surgeon at a hospital or outpatient center. Anesthesia is needed. The feeding tube bypasses the stomach and delivers a special liquid food with nutrients directly into the jejunum. The jejunostomy is used only when gastroparesis is extremely severe.Parenteral NutritionWhen gastroparesis is so severe that dietary measures and other treatments are not helping, a health care provider may recommend parenteral nutrition—an IV liquid food mixture supplied through a special tube in the chest. The procedure is performed by a surgeon at a hospital or outpatient center; anesthesia is needed. The surgeon inserts a thin, flexible tube called a catheter into a chest vein, with the catheter opening outside the skin. A bag containing liquid nutrients is attached to the catheter, and the nutrients are transported through the catheter into the chest vein and into the bloodstream. This approach is a less preferable alternative to a jejunostomy and is usually a temporary treatment to get through a difficult period of gastroparesis. An elevated blood glucose level directly interferes with normal stomach emptying, so good blood glucose control in people with diabetes is important. However, gastroparesis can make blood glucose control difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Gastric emptying is unpredictable with gastroparesis, causing a person’s blood glucose levels to be erratic and difficult to control.The primary treatment goals for gastroparesis related to diabetes are to improve gastric emptying and regain control of blood glucose levels. In addition to the dietary changes and treatments already described, a health care provider will likely adjust the person’s insulin regimen.To better control blood glucose, people with diabetes and gastroparesis may need totake insulin more often or change the type of insulin they take take insulin after meals, instead of before check blood glucose levels frequently after eating and administer insulin when necessarytake insulin more often or change the type of insulin they taketake insulin after meals, instead of beforecheck blood glucose levels frequently after eating and administer insulin when necessaryA health care provider will give specific instructions for taking insulin based on the individual’s needs and the severity of gastroparesis.In some cases, the dietitian may suggest eating several liquid or puréed meals a day until gastroparesis symptoms improve and blood glucose levels are more stable. The problems of gastroparesis can includesevere dehydration due to persistent vomiting gastroesophageal reflux disease (GERD), which is GER that occurs more than twice a week for a few weeks; GERD can lead to esophagitis— irritation of the esophagus bezoars, which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill form difficulty managing blood glucose levels in people with diabetes malnutrition due to poor absorption of nutrients or a low calorie intake decreased quality of life, including work absences due to severe symptomssevere dehydration due to persistent vomitinggastroesophageal reflux disease (GERD), which is GER that occurs more than twice a week for a few weeks; GERD can lead to esophagitis— irritation of the esophagusbezoars, which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill formdifficulty managing blood glucose levels in people with diabetesmalnutrition due to poor absorption of nutrients or a low calorie intakedecreased quality of life, including work absences due to severe symptoms Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether. Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food— sometimes several hours after a meal. Other common symptoms include gastroesophageal reflux (GER), pain in the stomach area, abdominal bloating, and lack of appetite. Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal (GI) tract, and gastric emptying tests. Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. When a person has severe symptoms, a liquid or puréed diet may be prescribed. Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition. For people with gastroparesis and diabetes, a health care provider will likely adjust the person’s insulin regimen.Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine.Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether.Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests.Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve.The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food— sometimes several hours after a meal. Other common symptoms include gastroesophageal reflux (GER), pain in the stomach area, abdominal bloating, and lack of appetite.Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal (GI) tract, and gastric emptying tests.Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. When a person has severe symptoms, a liquid or puréed diet may be prescribed.Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition.For people with gastroparesis and diabetes, a health care provider will likely adjust the person’s insulin regimen. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.What are clinical trials, and are they right for you?Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.Find out if clinical trials are right for youWhat clinical trials are open?Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.www.ClinicalTrials.govThis information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information.This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information.www.fda.govThe U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.What is gastroparesis? Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. Normally, the muscles of the stomach, which are controlled by the vagus nerve, contract to break up food and move it through the gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether. Gastroparesis slows or stops the movement of food from the stomach to the small intestine. What causes gastroparesis? Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. Other identifiable causes of gastroparesis include intestinal surgery and nervous system diseases such as Parkinson’s disease or multiple sclerosis. For reasons that are still unclear, gastroparesis is more commonly found in women than in men. What are the symptoms of gastroparesis? The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food—sometimes several hours after a meal. Other symptoms of gastroparesis include gastroesophageal reflux (GER), also called acid reflux or acid regurgitation—a condition in which stomach contents flow back up into the esophagus, the organ that connects the mouth to the stomach pain in the stomach area abdominal bloating lack of appetite Symptoms may be aggravated by eating greasy or rich foods, large quantities of foods with fiber—such as raw fruits and vegetables—or drinking beverages high in fat or carbonation. Symptoms may be mild or severe, and they can occur frequently in some people and less often in others. The symptoms of gastroparesis may also vary in intensity over time in the same individual. Sometimes gastroparesis is difficult to diagnose because people experience a range of symptoms similar to those of other diseases. How is gastroparesis diagnosed? Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the GI tract, and gastric emptying tests. Tests may also identify a nutritional disorder or underlying disease. To rule out any blockage or other structural problems, the health care provider may perform one or more of the following tests: Upper gastrointestinal (GI) endoscopy. This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract, which includes the esophagus, stomach, and duodenum—the first part of the small intestine. The test is performed at a hospital or outpatient center by a gastroenterologist—a doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. An intravenous (IV) needle is placed in a vein in the arm if general anesthesia is given. The test may show blockage or large bezoars—solid collections of food, mucus, vegetable fiber, hair, or other material that cannot be digested in the stomach—that are sometimes softened, dissolved, or broken up during an upper GI endoscopy. Upper GI series. An upper GI series may be done to look at the small intestine. The test is performed at a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging. Anesthesia is not needed. No eating or drinking is allowed for 8 hours before the procedure, if possible. If the person has diabetes, a health care provider may give different instructions about fasting before the test. During the procedure, the person will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the small intestine, making signs of gastroparesis show up more clearly on x rays. Gastroparesis is likely if the x ray shows food in the stomach after fasting. A person may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes stools to be white or light colored. A health care provider will give the person specific instructions about eating and drinking after the test. Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care provider’s office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. The images can show whether gallbladder disease and pancreatitis could be the cause of a person’s digestive symptoms, rather than gastroparesis. Gastric emptying scintigraphy. The test involves eating a bland meal—such as eggs or an egg substitute—that contains a small amount of radioactive material. The test is performed in a radiology center or hospital by a specially trained technician and interpreted by a radiologist; anesthesia is not needed. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. If more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed. SmartPill. The SmartPill is a small electronic device in capsule form. The SmartPill test is available at specialized outpatient centers. The images are interpreted by a radiologist. The device is swallowed and moves through the entire digestive tract, sending information to a cell-phone-sized receiver worn around the person’s waist or neck. The recorded information provides a detailed record of how quickly food travels through each part of the digestive tract. Gastric emptying breath test. With this test, the person eats a special test meal that includes a natural material with a special type of carbon in it. Then, breath samples are taken over a period of several hours to measure the amount of the material in the exhaled breath. The results allow the health care provider to calculate how fast the stomach is emptying. How is gastroparesis treated? Treatment of gastroparesis depends on the severity of the person’s symptoms. In most cases, treatment does not cure gastroparesis, which is usually a chronic, or long-lasting, condition. Gastroparesis is also a relapsing condition—the symptoms can come and go for periods of time. Treatment helps people manage the condition so they can be as comfortable and active as possible. Eating, Diet, and Nutrition Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. If less food enters the stomach each time a person eats, the stomach may not become overly full, allowing it to empty more easily. Chewing food well, drinking noncarbonated liquids with a meal, and walking or sitting for 2 hours after a meal—instead of lying down—may assist with gastric emptying. A health care provider may also recommend avoiding high-fat and fibrous foods. Fat naturally slows digestion and some raw vegetables and fruits are more difficult to digest than other foods. Some foods, such as oranges and broccoli, contain fibrous parts that do not digest well. People with gastroparesis should minimize their intake of large portions of these foods because the undigested parts may remain in the stomach too long. Sometimes, the undigested parts form bezoars. When a person has severe symptoms, a liquid or puréed diet may be prescribed. As liquids tend to empty more quickly from the stomach, some people may find a puréed diet helps improve symptoms. Puréed fresh or cooked fruits and vegetables can be incorporated into shakes and soups. A health care provider may recommend a dietitian to help a person plan meals that minimize symptoms and ensure all nutritional needs are met. When the most extreme cases of gastroparesis lead to severe nausea, vomiting, and dehydration, urgent care may be required at a medical facility where IV fluids can be given. Medications Several prescription medications are available to treat gastroparesis. A combination of medications may be used to find the most effective treatment. Metoclopramide (Reglan). This medication stimulates stomach muscle contractions to help with gastric emptying. Metoclopramide also helps reduce nausea and vomiting. The medication is taken 20 to 30 minutes before meals and at bedtime. Possible side effects of metoclopramide include fatigue, sleepiness, and depression. Currently, this is the only medication approved by the FDA for treatment of gastroparesis. However, the FDA has placed a black box warning on this medication because of rare reports of it causing an irreversible neurologic side effect called tardive dyskinesia—a disorder that affects movement. Erythromycin. This antibiotic, prescribed at low doses, may improve gastric emptying. Like metaclopramide, erythromycin works by increasing the contractions that move food through the stomach. Possible side effects of erythromycin include nausea, vomiting, and abdominal cramps. Other medications. Other medications may be used to treat symptoms and problems related to gastroparesis. For example, medications known as antiemetics are used to help control nausea and vomiting. Botulinum Toxin Botulinum toxin is a nerve blocking agent also known as Botox. After passing an endoscope into the stomach, a health care provider injects the Botox into the pylorus, the opening from the stomach into the duodenum. Botox is supposed to help keep the pylorus open for longer periods of time and improve symptoms of gastroparesis. Although some initial research trials showed modest improvement in gastroparesis symptoms and the rate of gastric emptying following the injections, other studies have failed to show the same degree of effectiveness of the Botox injections.1 Gastric Electrical Stimulation This treatment alternative may be effective for some people whose nausea and vomiting do not improve with dietary changes or medications. A gastric neurostimulator is a surgically implanted battery-operated device that sends mild electrical pulses to the stomach muscles to help control nausea and vomiting. The procedure may be performed at a hospital or outpatient center by a gastroenterologist. General anesthesia may be required. The gastroenterologist makes several tiny incisions in the abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached. The camera sends a magnified image from inside the stomach to a video monitor, giving the gastroenterologist a close-up view of the tissues. Once implanted, the settings on the battery-operated device can be adjusted to determine the settings that best control symptoms. Jejunostomy If medications and dietary changes don’t work, and the person is losing weight or requires frequent hospitalization for dehydration, a health care provider may recommend surgically placing a feeding tube through the abdominal wall directly into a part of the small intestine called the jejunum. The surgical procedure is known as a jejunostomy. The procedure is performed by a surgeon at a hospital or outpatient center. Anesthesia is needed. The feeding tube bypasses the stomach and delivers a special liquid food with nutrients directly into the jejunum. The jejunostomy is used only when gastroparesis is extremely severe. Parenteral Nutrition When gastroparesis is so severe that dietary measures and other treatments are not helping, a health care provider may recommend parenteral nutrition—an IV liquid food mixture supplied through a special tube in the chest. The procedure is performed by a surgeon at a hospital or outpatient center; anesthesia is needed. The surgeon inserts a thin, flexible tube called a catheter into a chest vein, with the catheter opening outside the skin. A bag containing liquid nutrients is attached to the catheter, and the nutrients are transported through the catheter into the chest vein and into the bloodstream. This approach is a less preferable alternative to a jejunostomy and is usually a temporary treatment to get through a difficult period of gastroparesis. How is gastroparesis treated if a person has diabetes? An elevated blood glucose level directly interferes with normal stomach emptying, so good blood glucose control in people with diabetes is important. However, gastroparesis can make blood glucose control difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Gastric emptying is unpredictable with gastroparesis, causing a person’s blood glucose levels to be erratic and difficult to control. The primary treatment goals for gastroparesis related to diabetes are to improve gastric emptying and regain control of blood glucose levels. In addition to the dietary changes and treatments already described, a health care provider will likely adjust the person’s insulin regimen. To better control blood glucose, people with diabetes and gastroparesis may need to take insulin more often or change the type of insulin they take take insulin after meals, instead of before check blood glucose levels frequently after eating and administer insulin when necessary A health care provider will give specific instructions for taking insulin based on the individual’s needs and the severity of gastroparesis. In some cases, the dietitian may suggest eating several liquid or puréed meals a day until gastroparesis symptoms improve and blood glucose levels are more stable. What are the problems of gastroparesis? The problems of gastroparesis can include severe dehydration due to persistent vomiting gastroesophageal reflux disease (GERD), which is GER that occurs more than twice a week for a few weeks; GERD can lead to esophagitis— irritation of the esophagus bezoars, which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill form difficulty managing blood glucose levels in people with diabetes malnutrition due to poor absorption of nutrients or a low calorie intake decreased quality of life, including work absences due to severe symptoms Points to Remember Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether. Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food— sometimes several hours after a meal. Other common symptoms include gastroesophageal reflux (GER), pain in the stomach area, abdominal bloating, and lack of appetite. Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal (GI) tract, and gastric emptying tests. Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. When a person has severe symptoms, a liquid or puréed diet may be prescribed. Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition. For people with gastroparesis and diabetes, a health care provider will likely adjust the person’s insulin regimen. References [1] Bai Y, Xu MJ, Yang X, et al. A systematic review on intrapyloric botulinum toxin injection for gastroparesis. Digestion. 2010;81(1):27–34. Clinical Trials The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. What are clinical trials, and are they right for you? Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you. What clinical trials are open? Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov. This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.
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Arteriosclerosis / atherosclerosis: Arteriosclerosis occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff - sometimes restricting blood flow to your organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls in your arteries can harden, a condition commonly called hardening of the arteries. Atherosclerosis is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably. Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaques), which can restrict blood flow. These plaques can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body. Atherosclerosis may be preventable and is treatable. Atherosclerosis develops gradually. Mild atherosclerosis usually doesn't have any symptoms. You usually won't have atherosclerosis symptoms until an artery is so narrowed or clogged that it can't supply adequate blood to your organs and tissues. Sometimes a blood clot completely blocks blood flow, or even breaks apart and can trigger a heart attack or stroke. Symptoms of moderate to severe atherosclerosis depend on which arteries are affected. For example: - If you have atherosclerosis in your heart arteries, you may have symptoms, such as chest pain or pressure (angina). - If you have atherosclerosis in the arteries leading to your brain, you may have signs and symptoms such as sudden numbness or weakness in your arms or legs, difficulty speaking or slurred speech, temporary loss of vision in one eye, or drooping muscles in your face. These signal a transient ischemic attack (TIA), which, if left untreated, may progress to a stroke. - If you have atherosclerosis in the arteries in your arms and legs, you may have symptoms of peripheral artery disease, such as leg pain when walking (claudication). - If you have atherosclerosis in the arteries leading to your kidneys, you develop high blood pressure or kidney failure. When to see a doctor If you think you have atherosclerosis, talk to your doctor. Also pay attention to early symptoms of inadequate blood flow, such as chest pain (angina), leg pain or numbness. Early diagnosis and treatment can stop atherosclerosis from worsening and prevent a heart attack, stroke or another medical emergency. Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an artery. The damage may be caused by: - High blood pressure - High cholesterol - High triglycerides, a type of fat (lipid) in your blood - Smoking and other sources of tobacco - Insulin resistance, obesity or diabetes - Inflammation from diseases, such as arthritis, lupus or infections, or inflammation of unknown cause Once the inner wall of an artery is damaged, blood cells and other substances often clump at the injury site and build up in the inner lining of the artery. Over time, fatty deposits (plaques) made of cholesterol and other cellular products also build up at the injury site and harden, narrowing your arteries. The organs and tissues connected to the blocked arteries then don't receive enough blood to function properly. Eventually, pieces of the fatty deposits may break off and enter your bloodstream. In addition, the smooth lining of a plaque may rupture, spilling cholesterol and other substances into your bloodstream. This may cause a blood clot, which can block the blood flow to a specific part of your body, such as occurs when blocked blood flow to your heart causes a heart attack. A blood clot can also travel to other parts of your body, blocking flow to another organ. Hardening of the arteries occurs over time. Besides aging, factors that increase the risk of atherosclerosis include: - High blood pressure - High cholesterol - Diabetes - Obesity - Smoking and other tobacco use - A family history of early heart disease - Lack of exercise - An unhealthy diet The complications of atherosclerosis depend on which arteries are blocked. For example: - Coronary artery disease. When atherosclerosis narrows the arteries close to your heart, you may develop coronary artery disease, which can cause chest pain (angina), a heart attack or heart failure. - Carotid artery disease. When atherosclerosis narrows the arteries close to your brain, you may develop carotid artery disease, which can cause a transient ischemic attack (TIA) or stroke. - Peripheral artery disease. When atherosclerosis narrows the arteries in your arms or legs, you may develop circulation problems in your arms and legs called peripheral artery disease. This can make you less sensitive to heat and cold, increasing your risk of burns or frostbite. In rare cases, poor circulation in your arms or legs can cause tissue death (gangrene). - Aneurysms. Atherosclerosis can also cause aneurysms, a serious complication that can occur anywhere in your body. An aneurysm is a bulge in the wall of your artery. Most people with aneurysms have no symptoms. Pain and throbbing in the area of an aneurysm may occur and is a medical emergency. If an aneurysm bursts, you may face life-threatening internal bleeding. Although this is usually a sudden, catastrophic event, a slow leak is possible. If a blood clot within an aneurysm dislodges, it may block an artery at some distant point. - Chronic kidney disease. Atherosclerosis can cause the arteries leading to your kidneys to narrow, preventing oxygenated blood from reaching them. Over time, this can affect your kidney function, keeping waste from exiting your body. During a physical exam, your doctor may find signs of narrowed, enlarged or hardened arteries, including: - A weak or absent pulse below the narrowed area of your artery - Decreased blood pressure in an affected limb - Whooshing sounds (bruits) over your arteries, heard using a stethoscope Depending on the results of the physical exam, your doctor may suggest one or more diagnostic tests, including: - Blood tests. Lab tests can detect increased levels of cholesterol and blood sugar that may increase the risk of atherosclerosis. You'll need to go without eating or drinking anything but water for nine to 12 hours before your blood test. Your doctor should tell you ahead of time if this test will be performed during your visit. - Doppler ultrasound. Your doctor may use a special ultrasound device (Doppler ultrasound) to measure your blood pressure at various points along your arm or leg. These measurements can help your doctor gauge the degree of any blockages, as well as the speed of blood flow in your arteries. - Ankle-brachial index. This test can tell if you have atherosclerosis in the arteries in your legs and feet. Your doctor may compare the blood pressure in your ankle with the blood pressure in your arm. This is known as the ankle-brachial index. An abnormal difference may indicate peripheral vascular disease, which is usually caused by atherosclerosis. - Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. - Stress test. A stress test, also called an exercise stress test, is used to gather information about how well your heart works during physical activity. Because exercise makes your heart pump harder and faster than it does during most daily activities, an exercise stress test can reveal problems within your heart that might not be noticeable otherwise. An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored. In some types of stress tests, pictures will be taken of your heart, such as during a stress echocardiogram (ultrasound) or nuclear stress test. If you're unable to exercise, you may receive a medication that mimics the effect of exercise on your heart. - Cardiac catheterization and angiogram. This test can show if your coronary arteries are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage. - Other imaging tests. Your doctor may use ultrasound, a computerized tomography (CT) scan or magnetic resonance angiography (MRA) to study your arteries. These tests can often show hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls. Lifestyle changes, such as eating a healthy diet and exercising, are often the most appropriate treatment for atherosclerosis. Sometimes, medication or surgical procedures may be recommended as well. Medications Various drugs can slow - or even reverse - the effects of atherosclerosis. Here are some common choices: - Cholesterol medications. Aggressively lowering your low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, can slow, stop or even reverse the buildup of fatty deposits in your arteries. Boosting your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, may help, too. Your doctor can choose from a range of cholesterol medications, including drugs known as statins and fibrates. In addition to lowering cholesterol, statins have additional effects that help stabilize the lining of your heart arteries and prevent atherosclerosis. - Anti-platelet medications. Your doctor may prescribe anti-platelet medications, such as aspirin, to reduce the likelihood that platelets will clump in narrowed arteries, form a blood clot and cause further blockage. - Beta blocker medications. These medications are commonly used for coronary artery disease. They lower your heart rate and blood pressure, reducing the demand on your heart and often relieve symptoms of chest pain. Beta blockers reduce the risk of heart attacks and some heart rhythm problems. - Angiotensin-converting enzyme (ACE) inhibitors. These medications may help slow the progression of atherosclerosis by lowering blood pressure and producing other beneficial effects on the heart arteries. ACE inhibitors can also reduce the risk of recurrent heart attacks. - Calcium channel blockers. These medications lower blood pressure and are sometimes used to treat angina. - Water pills (diuretics). High blood pressure is a major risk factor for atherosclerosis. Diuretics lower blood pressure. - Other medications. Your doctor may suggest certain medications to control specific risk factors for atherosclerosis, such as diabetes. Sometimes specific medications to treat symptoms of atherosclerosis, such as leg pain during exercise, are prescribed. Surgical procedures Sometimes more aggressive treatment is needed to treat atherosclerosis. If you have severe symptoms or a blockage that threatens muscle or skin tissue survival, you may be a candidate for one of the following surgical procedures: - Angioplasty and stent placement. In this procedure, your doctor inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A second catheter with a deflated balloon on its tip is then passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open. - Endarterectomy. In some cases, fatty deposits must be surgically removed from the walls of a narrowed artery. When the procedure is done on arteries in the neck (the carotid arteries), it's called a carotid endarterectomy. - Fibrinolytic therapy. If you have an artery that's blocked by a blood clot, your doctor may use a clot-dissolving drug to break it apart. - Bypass surgery. Your doctor may create a graft bypass using a vessel from another part of your body or a tube made of synthetic fabric. This allows blood to flow around the blocked or narrowed artery. Lifestyle changes can help you prevent or slow the progression of atherosclerosis. - Stop smoking. Smoking damages your arteries. If you smoke or use tobacco in any form, quitting is the best way to halt the progression of atherosclerosis and reduce your risk of complications. - Exercise most days of the week. Regular exercise can condition your muscles to use oxygen more efficiently. Physical activity can also improve circulation and promote development of new blood vessels that form a natural bypass around obstructions (collateral vessels). Exercise helps lower blood pressure and reduces your risk of diabetes. Aim to exercise at least 30 minutes most days of the week. If you can't fit it all into one session, try breaking it up into 10-minute intervals. You can take the stairs instead of the elevator, walk around the block during your lunch hour, or do some situps or pushups while watching television. - Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains - and low in refined carbohydrates, sugars, saturated fat and sodium - can help you control your weight, blood pressure, cholesterol and blood sugar. Try substituting whole-grain bread in place of white bread; grabbing an apple, a banana or carrot sticks as a snack; and reading nutrition labels as a guide to controlling the amount of salt and fat you eat. Use monounsaturated fats, such as olive oil, and reduce or eliminate sugar and sugar substitutes. - Lose extra pounds and maintain a healthy weight. If you're overweight, losing as few as 5 to 10 pounds (about 2.3 to 4.5 kilograms) can help reduce your risk of high blood pressure and high cholesterol, two of the major risk factors for developing atherosclerosis. Losing weight helps reduce your risk of diabetes or control your condition if you already have diabetes. - Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing. If you have high cholesterol, high blood pressure, diabetes or another chronic disease, work with your doctor to manage the condition and promote overall health. It's thought that some foods and herbal supplements can help reduce your high cholesterol level and high blood pressure, two major risk factors for developing atherosclerosis. With your doctor's OK, you might consider these supplements and products: - Alpha-linolenic acid (ALA) - Barley - Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ) - Black tea - Blond psyllium (found in seed husk and products such as Metamucil) - Calcium - Cocoa - Cod liver oil - Coenzyme Q10 - Fish oil - Folic acid - Garlic - Green tea - Oat bran (found in oatmeal and whole oats) - Sitostanol (found in oral supplements and some margarines, such as Benecol) - Vitamin C Talk to your doctor before adding any of these supplements to your atherosclerosis treatment. Some supplements can interact with medications, causing harmful side effects. You can also practice relaxation techniques, such as yoga or deep breathing, to help you relax and reduce your stress level. These practices can temporarily reduce your blood pressure, reducing your risk of developing atherosclerosis.
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Duchenne muscular dystrophy Muscular dystrophy, Duchenne DMD Muscular dystrophy, pseudohypertrophic progressive, Duchenne type Summary Duchenne muscular dystrophy (DMD) is a progressive form of muscular dystrophy that occurs primarily in males, though in rare cases may affect females. DMD causes progressive weakness and loss (atrophy) of skeletal and heart muscles. [1] Early signs of DMD may include delayed ability to sit, stand, or walk and difficulties learning to speak. Muscle weakness is usually noticeable by 3 or 4 years of age and begins in the hips, pelvic area, upper legs, and shoulders. The calves may be enlarged. Children with DMD may have an unusual walk and difficulty running, climbing stairs, and getting up from the floor. [2] DMD may also affect learning and memory, as well as communication and certain social emotional skills. [3] Muscle weakness worsens with age and progresses to the arms, legs and trunk. Most children with DMD use a wheelchair full time by age 13. Heart and respiratory muscle problems begin in the teen years and lead to serious, life threatening complications. [2] DMD is caused by changes ( mutations ) in the DMD gene . The DMD gene codes for the protein dystrophin. [1] [2] Dystrophin is mainly made in skeletal and heart muscle cells , but a small amount is also made in nerve cells (neurons) in specific parts of the brain. [3] DMD is inherited in an X-linked recessive pattern; however, it may also occur in people who do not have a family history of DMD. [2] While there is no known cure for DMD, there are treatments that can help control symptoms. [4] Due to the advancement of medical treatment, boys with DMD may now live into young adulthood. [2] [3] Becker muscular dystrophy (BMD) is also caused by mutations in the DMD gene. People with BMD have less severe symptoms than DMD. In addition, symptoms start later in childhood or in adolescence and progress more slowly. [1] Symptoms Symptoms of Duchenne muscular dystrophy (DMD) are usually noticed in boys between 1 to 6 years of age. There is a steady decline in muscle strength between the ages of 6 and 11 years. By age 10, braces may be needed for walking. By age 13, most boys with DMD are using a wheelchair full-time. The signs and symptoms include: [1] [2] [3] Taking longer to learn to sit, stand, or walk on own, which is known as delayed motor development. The average age for walking in boys with DMD is 18 months. Having a waddling walk and difficulty climbing stairs or running. Difficulty getting up from the floor. Children may walk their hands up their legs to stand which is known as the Gower maneuver. Enlarged calf muscles due to the calf muscle cells being Muscle weakness first affecting the muscles of the hips, pelvic area, thighs and shoulders, and later the skeletal (voluntary) muscles in the arms, legs and trunk. Tight or rigid joints (also known as contractures ) may develop as muscle loss progresses. If not treated, these will become severe, causing discomfort and restricting mobility and flexibility. Contractures can affect the knees, hips, feet, elbows, wrists and fingers. Scoliosis may develop within several years of full-time wheelchair use. By the early teens, the respiratory and heart muscles are also affected. Breathing problems due to weakness of the diaphragm and the other muscles around the lungs. Skeletal changes, such as scoliosis, may also increase breathing problems. Breathing problems may become life-threatening. Progressive enlargement of the heart ( cardiomyopathy ) that stops the heart from pumping blood efficiently, and becomes life-threatening in many cases. Learning and memory issues (cognitive impairment) may occur in some cases, but do not worsen as DMD progresses. Communication may be more difficult for some. Social behavior may be affected, as well as the ability to read facial cues. This table lists symptoms that people with this disease may have. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. This information comes from a database called the Human Phenotype Ontology (HPO) . The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly. Use the HPO ID to access more in-depth information about a symptom. Showing of Medical Terms Other Names Learn More: HPO ID 80%-99% of people have these symptoms Calf muscle hypertrophy Increased size of calf muscles 0008981 Cardiomyopathy Disease of the heart muscle 0001638 Cognitive impairment Abnormality of cognition Cognitive abnormality Cognitive defects Cognitive deficits Intellectual impairment Mental impairment 0100543 Delayed speech and language development Deficiency of speech development Delayed language development Delayed speech Delayed speech acquisition Delayed speech development Impaired speech and language development Impaired speech development Language delay Language delayed Language development deficit Late-onset speech development Poor language development Speech and language delay Speech and language difficulties Speech delay 0000750 Elevated serum creatine phosphokinase Elevated blood creatine phosphokinase Elevated circulating creatine phosphokinase Elevated creatine kinase Elevated serum CPK Elevated serum creatine kinase High serum creatine kinase Increased CPK Increased creatine kinase Increased creatine phosphokinase Increased serum CK Increased serum creatine kinase Increased serum creatine phosphokinase 0003236 Flexion contracture 0001371 Global developmental delay 0001263 Motor delay 0001270 Progressive muscle weakness 0003323 Proximal muscle weakness Weakness in muscles of upper arms and upper legs 0003701 Respiratory insufficiency Respiratory impairment 0002093 Scoliosis Abnormal curving of the spine 0002650 Skeletal muscle atrophy Muscle degeneration Muscle wasting 0003202 Specific learning disability 0001328 Waddling gait 'Waddling' gait Waddling walk 0002515 Percent of people who have these symptoms is not available through HPO Abnormal EKG Abnormal ECG 0003115 Arrhythmia Abnormal heart rate Heart rhythm disorders Irregular heart beat Irregular heartbeat 0011675 Calf muscle pseudohypertrophy 0003707 Childhood onset Symptoms begin in childhood 0011463 Congestive heart failure Cardiac failure Cardiac failures Heart failure 0001635 Dilated cardiomyopathy Stretched and thinned heart muscle 0001644 Generalized hypotonia Decreased muscle tone Low muscle tone 0001290 Gowers sign 0003391 Hyperlordosis Prominent swayback 0003307 Hyporeflexia Decreased reflex response Decreased reflexes 0001265 Hypoventilation Slow breathing Under breathing 0002791 Intellectual disability , mild Mental retardation, borderline-mild Mild and nonprogressive mental retardation Mild mental retardation 0001256 Muscular dystrophy 0003560 Muscular hypotonia Low or weak muscle tone 0001252 Respiratory failure 0002878 X-linked recessive inheritance 0001419 Showing of Cause Duchenne muscular dystrophy (DMD) is caused by mutations in the DMD gene . The DMD gene provides instructions for making a protein called dystrophin. Dystophin is primarily made in the muscle cells of the heart and skeletal muscle. The main job of dystrophin in muscle cells is to help stabilize and protect muscle fibers. [1] [2] [3] DMD is caused by genetic changes in the DMD gene that stop any functional dystrophin from being made. [2] When dystrophin is missing, the muscle cells become damaged more easily. In response to the damage, inflammation occurs, which only worsens the process. Over time, the muscle cells without dystrophin weaken and die, leading to the muscle weakness and heart problems seen in DMD. [2] [3] The non-progressive memory and learning problems, as well as social behavioral problems, in some boys with DMD are most likely linked to loss of dystrophin in the neurons of the hippocampus and other parts of the brain where dystrophin is normally produced in small amounts, but at this point it is not known why this occurs and why only some people with DMD have these problems. [3] Different genetic changes in the DMD gene can cause a spectrum of disorders known as dystrophinopathies. The dystrophinopathies can range from very mild symptoms to the more severe symptoms seen in people with DMD. Other dystrophinopathies include Becker muscular dystrophy (BMD) and DMD-associated dilated cardiomyopathy (DCM). [2] Inheritance Genetic changes causing Duchenne muscular dystrophy (DMD) can be passed down in families. The DMD gene is located on the X chromosome , one of the two types of sex chromosomes . Males have an X and a Y chromosome ; whereas females have two X chromosomes . Since males only have one X chromosome, they also only have one copy of the DMD gene. If this copy has a genetic change that causes DMD, the male will have DMD. Males get their X chromosome from their mother and the Y chromosome from their father. [1] [2] Since females have two X chromosomes, they have two copies of the DMD gene. Having two changed copies of the DMD gene that can cause DMD is unlikely, but would cause DMD in females. A female with only one changed copy of the DMD gene is called a " carrier ". She can pass on the changed gene, but usually does not have symptoms of DMD. Carriers of changes in the DMD gene that can cause DMD are at an increased risk of developing heart problems, including cardiomyopathy . In addition, due to a process called X-inactivation , in rare cases, female carriers may have mild, moderate, or severe DMD. [2] If a man with DMD has children, all of his daughters will be carriers. Since boys inherit the Y chromosome from their father, sons will not inherit DMD from their fathers, even if the father has DMD. [1] [2] DMD DMD DMD DMD Diagnosis A child's doctor may suspect Duchenne muscular dystrophy (DMD) in young boys who have the signs and symptoms of DMD, including progressive muscle weakness. Family history is also important. Blood tests can be used to check for increased levels of certain special proteins called muscle enzymes in the blood which can leak from damaged muscles. Most commonly, the blood level of the enzyme creatine phosphokinase (CPK or CK) is checked, but a doctor may also check the blood levels of transaminases such as aspartate transaminase and alanine transaminase. Finding a change in the DMD gene that can cause DMD through genetic testing confirms the diagnosis of DMD. [2] [5] Testing for DMD may include: [2] [5] Blood test which measures the levels of serum creatine phosphokinase Molecular genetic testing Electromyography Muscle biopsy is rarely used to diagnose DMD due to the decreased cost and higher accuracy of genetic testing. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. Treatment There is no known cure for Duchenne muscular dystrophy (DMD) but research is ongoing. The goal of treatment is to control the symptoms of DMD and related complications caused by severe progressive muscle weakness and loss in order to maximize the quality of life. An enlarged, weakened heart (dilated cardiomyopathy ) may be treated with medications, but in severe cases a heart transplant may be necessary. Assistive devices for breathing difficulties may be needed, especially at night and as the disease progresses. [2] [6] Physical therapy Steroids ( corticosteroids ) may improve the strength and function of muscles in people with DMD, including lung function. Steroid options include: [2] [6] Prednisone is a steroid that has been shown to extend the ability to walk by 2 to 5 years. However, the possible side effects of prednisone include weight gain, high blood pressure , behavior changes, and delayed growth. Deflazacort (another form of prednisone), is used in Europe and believed to have fewer side effects and was recently approved in the United States by the FDA. Oxandrolone, a medication used in a research study, also has similar benefits to prednisone, but with fewer side effects. Management Guidelines Section on Cardiology and Cardiac Surgery. Cardiovascular health supervision for individuals affected by Duchenne or Becker Muscular Dystrophy. Pediatrics 2006; 116: 1569-1573. Orphanet Emergency Guidelines is an article which is expert-authored and peer-reviewed that is intended to guide health care professionals in emergency situations involving this condition. Project OrphanAnesthesia is a project whose aim is to create peer-reviewed, readily accessible guidelines for patients with rare diseases and for the anesthesiologists caring for them. The project is a collaborative effort of the German Society of Anesthesiology and Intensive Care, Orphanet, the European Society of Pediatric Anesthesia, anesthetists and rare disease experts with the aim to contribute to patient safety. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information National Library of Medicine Drug Information Portal Find a Specialist If you need medical advice, you can look for doctors or other healthcare professionals who have experience with this disease. You may find these specialists through advocacy organizations, clinical trials, or articles published in medical journals. You may also want to contact a university or tertiary medical center in your area, because these centers tend to see more complex cases and have the latest technology and treatments. If you can't find a specialist in your local area, try contacting national or international specialists. They may be able to refer you to someone they know through conferences or research efforts. Some specialists may be willing to consult with you or your local doctors over the phone or by email if you can't travel to them for care. You can find more tips in our guide, How to Find a Disease Specialist. We also encourage you to explore the rest of this page to find resources that can help you find specialists. Healthcare Resources To find a medical professional who specializes in genetics, you can ask your doctor for a referral or you can search for one yourself. Online directories are provided by the American College of Medical Genetics and the National Society of Genetic Counselors. If you need additional help, contact a GARD Information Specialist. You can also learn more about genetic consultations from Genetics Home Reference. Related Diseases Related diseases are conditions that have similar signs and symptoms. A health care provider may consider these conditions in the table below when making a diagnosis. Please note that the table may not include all the possible conditions related to this disease. Conditions with similar signs and symptoms from Orphanet Differential diagnoses include severe Becker muscular dystrophy and the limb girdle muscular dystrophies (see these terms). Antenatal diagnosis is possible for families in which the diagnosis has been confirmed by molecular testing. Visit the Orphanet disease page for more information.
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Binge eating disorder Overview Binge eating disorder is the most common type of eating disorder in the United States. People with binge eating disorder often feel out of control and eat a large amount of food at one time (called a binge). Unlike other eating disorders, people who have binge eating disorder do not throw up the food or exercise too much. Binge eating disorder is a serious health problem, but people with binge eating disorder can get better with treatment. What is binge eating disorder? Binge eating disorder is a type of eating disorder. Eating disorders are mental health problems that cause extreme and dangerous eating behaviors. These extreme eating behaviors cause other serious health problems and sometimes death. Some eating disorders also involve extreme exercise. According to the American Psychiatric Association, women with binge eating disorder feel out of control and eat too much (binge), at least once a week for at least three months. During binges women with binge eating disorder usually eat faster than normal, eat until they are uncomfortable, eat when they are not physically hungry, and feel embarrassed, disgusted, or depressed because of the binges. Women with this type of eating disorder may be overweight or obese. What is the difference between binge eating disorder and other eating disorders? Women with eating disorders, such as binge eating disorder, bulimia, and anorexia, have a mental health condition that affects how they eat, and sometimes how they exercise. These eating disorders threaten their health. Unlike people with anorexia or bulimia, people with binge eating disorder do not throw up their food, exercise a lot, or starve themselves. People with binge eating disorder are often overweight or obese. But not all people with binge eating disorder are overweight, and being overweight does not always mean you have binge eating disorder. It is possible to have more than one eating disorder in your lifetime. Regardless of what type of eating disorder you may have, you can get better with treatment. Who is at risk for binge eating disorder? Binge eating disorder affects more than 3% of women in the United States. More than half of people with binge eating disorder are women.1 Binge eating disorder affects women of all races and ethnicities. It is the most common eating disorder among Hispanic, Asian-American, and African-American women.2,3,4 Some women may be more at risk for binge eating disorder. What are the symptoms of binge eating disorder? It can be difficult to tell whether someone has binge eating disorder. Many women with binge eating disorder hide their behavior because they are embarrassed. You may have binge eating disorder if, for at least once a week over the past three months, you have binged. Binge eating disorder means you have at least three of these symptoms while binging:8 People with binge eating disorder may also have other mental health problems, such as depression, anxiety, or substance abuse. What causes binge eating disorder? Researchers are not sure exactly what causes binge eating disorder and other eating disorders. Researchers think that eating disorders might happen because of a combination of a person's biology and life events. This combination includes having specific genes, a person's biology, body image and self-esteem, social experiences, family health history, and sometimes other mental health illnesses. Studies suggest that people with binge eating disorder may use overeating as a way to deal with anger, sadness, boredom, anxiety, or stress.9,10 Researchers are studying how changing levels of brain chemicals may affect eating habits. Neuroimaging, or pictures of the brain, may lead to a better understanding of binge eating disorder.11 Learn more about current research on binge eating disorder. How does binge eating disorder affect a woman's health? Many, but not all, women with binge eating disorder are overweight or obese. Obesity raises your risk for many serious health problems:12 People with binge eating disorder often have other serious mental health illnesses such as depression, anxiety, or substance abuse. These problems can seriously affect a woman's everyday life and can be treated. How is binge eating disorder diagnosed? Your doctor or nurse will ask you questions about your symptoms and medical history. It may be difficult to talk to a doctor or nurse about secret eating behaviors. But doctors and nurses want to help you be healthy. Being honest about your eating behaviors with a doctor or nurse is a good way to ask for help. Your doctor may also do blood, urine, or other tests for other health problems, such as heart problems or gallbladder disease, that can be caused by binge eating disorder. How is binge eating disorder treated? Your doctor may refer you to a team of doctors, nutritionists, and therapists who will work to help you get better. Treatment plans may include one or more of the following: Most girls and women do get better with treatment and are able to eat in healthy ways again.14 Some may get better after the first treatment. Others get well but may relapse and need treatment again. How does binge eating disorder affect pregnancy? Binge eating disorder can cause problems getting pregnant and during pregnancy. Pregnancy can also trigger binge eating disorder. Obesity raises the level of the hormone estrogen in your body. Higher levels of estrogen can stop you from ovulating, or releasing an egg from the ovary. This can make it more difficult to get pregnant. However, if you do not want to have children right now and have sex, you should use birth control. Overweight or obesity may also cause problems during pregnancy. Overweight and obesity raises your risk for: Pregnancy can raise the risk for binge eating disorder in women who are at higher risk for eating disorders. In one study, almost half of the women with binge eating disorder got the condition during pregnancy. The research suggests that binge eating during pregnancy may be caused by:16 After pregnancy, postpartum depression and weight from pregnancy can trigger binge eating disorder in women with a history of binge eating. Women with binge eating disorder before pregnancy often gain more weight during pregnancy than women without an eating disorder. Researchers think that weight gain during pregnancy may cause some women who had binge eating disorder before pregnancy to binge eat during pregnancy.17 If I had an eating disorder in the past, can I still get pregnant? Yes. Women who have recovered from binge eating disorder, are at a healthy weight, and have normal menstrual cycles have a better chance of getting pregnant and having a safe and healthy pregnancy. Tell your doctor if you had an eating disorder in the past and are trying to become pregnant. If I take medicine to treat binge eating disorder, can I breastfeed my baby? Maybe. Some medicines used to treat binge eating disorder can pass through breastmilk. Certain antidepressants can be used safely during breastfeeding. Talk to your doctor to find out what medicine works best for you. Learn more about medicines and breastfeeding in our Breastfeeding. You can also enter a medicine into the LactMed database to find out if the medicine passes through breastmilk and about any possible side effects for your nursing baby. Did we answer your question about binge eating disorder? For more information about binge eating disorder, call the OWH Helpline at 1-800-994-9662 or contact the following organizations: Sources
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Prostate Cancer Overview The prostate gland makes fluid that forms part of semen. The prostate lies just below the bladder in front of the rectum. It surrounds the urethra (the tube that carries urine and semen through the penis and out of the body). Prostate cancer is the most common cancer in men in the United States, after skin cancer. It is the second leading cause of death from cancer in men. Prostate cancer occurs more often in African-American men than in white men. African-American men with prostate cancer are more likely to die from the disease than white men with prostate cancer. Almost all prostate cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). Prostate cancer often has no early symptoms. Advanced prostate cancer can cause men to urinate more often or have a weaker flow of urine, but these symptoms can also be caused by benign prostate conditions. Prostate cancer usually grows very slowly. Most men with prostate cancer are older than 65 years and do not die from the disease. Finding and treating prostate cancer before symptoms occur may not improve health or help you live longer. Talk to your doctor about your risk of prostate cancer and whether you need screening tests. General Information About Prostate Cancer Key Points - Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate. - Signs of prostate cancer include a weak flow of urine or frequent urination. - Tests that examine the prostate and blood are used to detect (find) and diagnose prostate cancer. - Certain factors affect prognosis (chance of recovery) and treatment options. Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate. The prostate is a gland in the male reproductive system. It lies just below the bladder (the organ that collects and empties urine) and in front of the rectum (the lower part of the intestine). It is about the size of a walnut and surrounds part of the urethra (the tube that empties urine from the bladder). The prostate gland makes fluid that is part of the semen. Enlarge Anatomy of the male reproductive and urinary systems, showing the prostate, testicles, bladder, and other organs. Prostate cancer is most common in older men. In the U.S., about 1 out of 5 men will be diagnosed with prostate cancer. Signs of prostate cancer include a weak flow of urine or frequent urination. These and other signs and symptoms may be caused by prostate cancer or by other conditions. Check with your doctor if you have any of the following: - Weak or interrupted ("stop-and-go") flow of urine. - Sudden urge to urinate. - Frequent urination (especially at night). - Trouble starting the flow of urine. - Trouble emptying the bladder completely. - Pain or burning while urinating. - Blood in the urine or semen. - A pain in the back, hips, or pelvis that doesn't go away. - Shortness of breath, feeling very tired, fast heartbeat, dizziness, or pale skin caused by anemia. Other conditions may cause the same symptoms. As men age, the prostate may get bigger and block the urethra or bladder. This may cause trouble urinating or sexual problems. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be like symptoms of prostate cancer. Enlarge Normal prostate and benign prostatic hyperplasia (BPH). A normal prostate does not block the flow of urine from the bladder. An enlarged prostate presses on the bladder and urethra and blocks the flow of urine. Tests that examine the prostate and blood are used to detect (find) and diagnose prostate cancer. The following tests and procedures may be used: - Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken. - Digital rectal exam (DRE): An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall for lumps or abnormal areas. Enlarge Digital rectal exam (DRE). The doctor inserts a gloved, lubricated finger into the rectum and feels the prostate to check for anything abnormal. - Prostate-specific antigen (PSA) test : A test that measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate or BPH (an enlarged, but noncancerous, prostate). - Transrectal ultrasound : A procedure in which a probe that is about the size of a finger is inserted into the rectum to check the prostate. The probe is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. Transrectal ultrasound may be used during a biopsy procedure. Enlarge Transrectal ultrasound. An ultrasound probe is inserted into the rectum to check the prostate. The probe bounces sound waves off body tissues to make echoes that form a sonogram (computer picture) of the prostate. - Transrectal magnetic resonance imaging (MRI): A procedure that uses a strong magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A probe that gives off radio waves is inserted into the rectum near the prostate. This helps the MRI machine make clearer pictures of the prostate and nearby tissue. A transrectal MRI is done to find out if the cancer has spread outside the prostate into nearby tissues. This procedure is also called nuclear magnetic resonance imaging (NMRI). - Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist. The pathologist will check the tissue sample to see if there are cancer cells and find out the Gleason score. The Gleason score ranges from 2-10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is to spread. A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure is usually done using transrectal ultrasound to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells. Enlarge Transrectal biopsy. An ultrasound probe is inserted into the rectum to show where the tumor is. Then a needle is inserted through the rectum into the prostate to remove tissue from the prostate. Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: - The stage of the cancer (level of PSA, Gleason score, grade of the tumor, how much of the prostate is affected by the cancer, and whether the cancer has spread to other places in the body). - The patient's age. - Whether the cancer has just been diagnosed or has recurred (come back). Treatment options also may depend on the following: - Whether the patient has other health problems. - The expected side effects of treatment. - Past treatment for prostate cancer. - The wishes of the patient. Most men diagnosed with prostate cancer do not die of it. Stages of Prostate Cancer Key Points - After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for prostate cancer: - Stage I - Stage II - Stage III - Stage IV After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body. The process used to find out if cancer has spread within the prostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose prostate cancer are often also used to stage the disease. (See the General Information section.) In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score. The following tests and procedures also may be used in the staging process: - Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner. Enlarge Bone scan. A small amount of radioactive material is injected into the patient's bloodstream and collects in abnormal cells in the bones. As the patient lies on a table that slides under the scanner, the radioactive material is detected and images are made on a computer screen or film. - MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). - CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. - Pelvic lymphadenectomy : A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells. - Seminal vesicle biopsy : The removal of fluid from the seminal vesicles (glands that make semen) using a needle. A pathologist views the fluid under a microscope to look for cancer cells. - ProstaScint scan : A procedure to check for cancer that has spread from the prostate to other parts of the body, such as the lymph nodes. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material attaches to prostate cancer cells and is detected by a scanner. The radioactive material shows up as a bright spot on the picture in areas where there are a lot of prostate cancer cells. The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen (PSA) test and the Gleason score. The tissue samples removed during the biopsy are used to find out the Gleason score. The Gleason score ranges from 2-10 and describes how different the cancer cells look from normal cells and how likely it is that the tumor will spread. The lower the number, the less likely the tumor is to spread. There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood: - Tissue. The cancer spreads from where it began by growing into nearby areas. - Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. - Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood. - Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body. - Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. Denosumab, a monoclonal antibody, may be used to prevent bone metastases. The following stages are used for prostate cancer: Enlarge As prostate cancer progresses from Stage I to Stage IV, the cancer cells grow within the prostate, through the outer layer of the prostate into nearby tissue, and then to lymph nodes or other parts of the body. Stage I In stage I, cancer is found in the prostate only. The cancer: - is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 10 and the Gleason score is 6 or lower; or - is found in one-half or less of one lobe of the prostate. The PSA level is lower than 10 and the Gleason score is 6 or lower; or - cannot be felt during a digital rectal exam and cannot be seen in imaging tests. Cancer is found in one-half or less of one lobe of the prostate. The PSA level and the Gleason score are not known. Stage II In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. Stage II is divided into stages IIA and IIB. In stage IIA, cancer: - is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 20 and the Gleason score is 7; or - is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is at least 10 but lower than 20 and the Gleason score is 6 or lower; or - is found in one-half or less of one lobe of the prostate. The PSA level is at least 10 but lower than 20 and the Gleason score is 6 or lower; or - is found in one-half or less of one lobe of the prostate. The PSA level is lower than 20 and the Gleason score is 7; or - is found in more than one-half of one lobe of the prostate. In stage IIB, cancer: - is found in opposite sides of the prostate. The PSA can be any level and the Gleason score can range from 2 to 10; or - cannot be felt during a digital rectal exam and cannot be seen in imaging tests. The PSA level is 20 or higher and the Gleason score can range from 2 to 10; or - cannot be felt during a digital rectal exam and cannot be seen in imaging tests. The PSA can be any level and the Gleason score is 8 or higher. Stage III In stage III, cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles. The PSA can be any level and the Gleason score can range from 2 to 10. Stage IV In stage IV, the PSA can be any level and the Gleason score can range from 2 to 10. Also, cancer: - has spread beyond the seminal vesicles to nearby tissue or organs, such as the rectum, bladder, or pelvic wall; or - may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. Cancer has spread to nearby lymph nodes; or - has spread to distant parts of the body, which may include lymph nodes or bones. Prostate cancer often spreads to the bones. Stage I In stage I, cancer is found in the prostate only. The cancer: - is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 10 and the Gleason score is 6 or lower; or - is found in one-half or less of one lobe of the prostate. The PSA level is lower than 10 and the Gleason score is 6 or lower; or - cannot be felt during a digital rectal exam and cannot be seen in imaging tests. Cancer is found in one-half or less of one lobe of the prostate. The PSA level and the Gleason score are not known. Stage II In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. Stage II is divided into stages IIA and IIB. In stage IIA, cancer: - is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 20 and the Gleason score is 7; or - is found by needle biopsy (done for a high PSA level) or in a small amount of tissue during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is at least 10 but lower than 20 and the Gleason score is 6 or lower; or - is found in one-half or less of one lobe of the prostate. The PSA level is at least 10 but lower than 20 and the Gleason score is 6 or lower; or - is found in one-half or less of one lobe of the prostate. The PSA level is lower than 20 and the Gleason score is 7; or - is found in more than one-half of one lobe of the prostate. In stage IIB, cancer: - is found in opposite sides of the prostate. The PSA can be any level and the Gleason score can range from 2 to 10; or - cannot be felt during a digital rectal exam and cannot be seen in imaging tests. The PSA level is 20 or higher and the Gleason score can range from 2 to 10; or - cannot be felt during a digital rectal exam and cannot be seen in imaging tests. The PSA can be any level and the Gleason score is 8 or higher. Stage III In stage III, cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles. The PSA can be any level and the Gleason score can range from 2 to 10. Stage IV In stage IV, the PSA can be any level and the Gleason score can range from 2 to 10. Also, cancer: - has spread beyond the seminal vesicles to nearby tissue or organs, such as the rectum, bladder, or pelvic wall; or - may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. Cancer has spread to nearby lymph nodes; or - has spread to distant parts of the body, which may include lymph nodes or bones. Prostate cancer often spreads to the bones. Recurrent Prostate Cancer Treatment Option Overview Key Points - There are different types of treatment for patients with prostate cancer. - Seven types of standard treatment are used: - Watchful waiting or active surveillance - Surgery - Radiation therapy and radiopharmaceutical therapy - Hormone therapy - Chemotherapy - Biologic therapy - Bisphosphonate therapy - There are treatments for bone pain caused by bone metastases or hormone therapy. - New types of treatment are being tested in clinical trials. - Cryosurgery - High-intensity-focused ultrasound therapy - Proton beam radiation therapy - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed. There are different types of treatment for patients with prostate cancer. Different types of treatment are available for patients with prostate cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Seven types of standard treatment are used: Watchful waiting or active surveillance Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test. Watchful waiting is closely monitoring a patient's condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life. Active surveillance is closely following a patient's condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer. Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management. Surgery Patients in good health whose tumor is in the prostate gland only may be treated with surgery to remove the tumor. The following types of surgery are used: - Radical prostatectomy: A surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. There are two types of radical prostatectomy: - Retropubic prostatectomy: A surgical procedure to remove the prostate through an incision (cut) in the abdominal wall. Removal of nearby lymph nodes may be done at the same time. - Perineal prostatectomy: A surgical procedure to remove the prostate through an incision (cut) made in the perineum (area between the scrotum and anus). Nearby lymph nodes may also be removed through a separate incision in the abdomen. Enlarge Two types of radical prostatectomy. In a retropubic prostatectomy, the prostate is removed through an incision in the wall of the abdomen. In a perineal prostatectomy, the prostate is removed through an incision in the area between the scrotum and the anus. - Pelvic lymphadenectomy: A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment. - Transurethral resection of the prostate (TURP): A surgical procedure to remove tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This procedure is done to treat benign prostatic hypertrophy and it is sometimes done to relieve symptoms caused by a tumor before other cancer treatment is given. TURP may also be done in men whose tumor is in the prostate only and who cannot have a radical prostatectomy. Enlarge Transurethral resection of the prostate (TURP). Tissue is removed from the prostate using a resectoscope (a thin, lighted tube with a cutting tool at the end) inserted through the urethra. Prostate tissue that is blocking the urethra is cut away and removed through the resectoscope. In some cases, nerve-sparing surgery can be done. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery. Possible problems after prostate cancer surgery include the following: - Impotence. - Leakage of urine from the bladder or stool from the rectum. - Shortening of the penis (1 to 2 centimeters). The exact reason for this is not known. - Inguinal hernia (bulging of fat or part of the small intestine through weak muscles into the groin). Inguinal hernia may occur more often in men treated with radical prostatectomy than in men who have some other types of prostate surgery, radiation therapy, or prostate biopsy alone. It is most likely to occur within the first 2 years after radical prostatectomy. Radiation therapy and radiopharmaceutical therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are different types of radiation therapy: - External radiation therapy uses a machine outside the body to send radiation toward the cancer. Conformal radiation is a type of external radiation therapy that uses a computer to make a 3-dimensional (3-D) picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high dose of radiation to reach the tumor and causes less damage to nearby healthy tissue. Hypofractionated radiation therapy may be given because it has a more convenient treatment schedule. Hypofractionated radiation therapy is radiation treatment in which a larger than usual total dose of radiation is given once a day over a shorter period of time (fewer days) compared to standard radiation therapy. Hypofractionated radiation therapy may have worse side effects than standard radiation therapy, depending on the schedules used. - Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. In early-stage prostate cancer, the radioactive seeds are placed in the prostate using needles that are inserted through the skin between the scrotum and rectum. The placement of the radioactive seeds in the prostate is guided by images from transrectal ultrasound or computed tomography (CT). The needles are removed after the radioactive seeds are placed in the prostate. - Radiopharmaceutical therapy uses a radioactive substance to treat cancer. Radiopharmaceutical therapy includes the following: - Alpha emitter radiation therapy uses a radioactive substance to treat prostate cancer that has spread to the bone. A radioactive substance called radium-223 is injected into a vein and travels through the bloodstream. The radium-223 collects in areas of bone with cancer and kills the cancer cells. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy, internal radiation therapy, and radiopharmaceutical therapy are used to treat prostate cancer. Men treated with radiation therapy for prostate cancer have an increased risk of having bladder and/or gastrointestinal cancer. Radiation therapy can cause impotence and urinary problems that may get worse with age. Hormone therapy Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. In prostate cancer, male sex hormones can cause prostate cancer to grow. Drugs, surgery, or other hormones are used to reduce the amount of male hormones or block them from working. Hormone therapy for prostate cancer may include the following: - Abiraterone acetate can prevent prostate cancer cells from making androgens. It is used in men with advanced prostate cancer that has not gotten better with other hormone therapy. - Orchiectomy is a surgical procedure to remove one or both testicles, the main source of male hormones, such as testosterone, to decrease the amount of hormone being made. - Estrogens (hormones that promote female sex characteristics) can prevent the testicles from making testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects. - Luteinizing hormone-releasing hormone agonists can stop the testicles from making testosterone. Examples are leuprolide, goserelin, and buserelin. - Antiandrogens can block the action of androgens (hormones that promote male sex characteristics), such as testosterone. Examples are flutamide, bicalutamide, enzalutamide, and nilutamide. - Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide. Hot flashes, impaired sexual function, loss of desire for sex, and weakened bones may occur in men treated with hormone therapy. Other side effects include diarrhea, nausea, and itching. See Drugs Approved for Prostate Cancer for more information. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. See Drugs Approved for Prostate Cancer for more information. Biologic therapy Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. Sipuleucel-T is a type of biologic therapy used to treat prostate cancer that has metastasized (spread to other parts of the body). See Drugs Approved for Prostate Cancer for more information. Bisphosphonate therapy Bisphosphonate drugs, such as clodronate or zoledronate, reduce bone disease when cancer has spread to the bone. Men who are treated with antiandrogen therapy or orchiectomy are at an increased risk of bone loss. In these men, bisphosphonate drugs lessen the risk of bone fracture (breaks). The use of bisphosphonate drugs to prevent or slow the growth of bone metastases is being studied in clinical trials. Watchful waiting or active surveillance Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test. Watchful waiting is closely monitoring a patient's condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life. Active surveillance is closely following a patient's condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer. Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management. Surgery Patients in good health whose tumor is in the prostate gland only may be treated with surgery to remove the tumor. The following types of surgery are used: - Radical prostatectomy: A surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. There are two types of radical prostatectomy: - Retropubic prostatectomy: A surgical procedure to remove the prostate through an incision (cut) in the abdominal wall. Removal of nearby lymph nodes may be done at the same time. - Perineal prostatectomy: A surgical procedure to remove the prostate through an incision (cut) made in the perineum (area between the scrotum and anus). Nearby lymph nodes may also be removed through a separate incision in the abdomen. Enlarge Two types of radical prostatectomy. In a retropubic prostatectomy, the prostate is removed through an incision in the wall of the abdomen. In a perineal prostatectomy, the prostate is removed through an incision in the area between the scrotum and the anus. - Pelvic lymphadenectomy: A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend other treatment. - Transurethral resection of the prostate (TURP): A surgical procedure to remove tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This procedure is done to treat benign prostatic hypertrophy and it is sometimes done to relieve symptoms caused by a tumor before other cancer treatment is given. TURP may also be done in men whose tumor is in the prostate only and who cannot have a radical prostatectomy. Enlarge Transurethral resection of the prostate (TURP). Tissue is removed from the prostate using a resectoscope (a thin, lighted tube with a cutting tool at the end) inserted through the urethra. Prostate tissue that is blocking the urethra is cut away and removed through the resectoscope. In some cases, nerve-sparing surgery can be done. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery. Possible problems after prostate cancer surgery include the following: - Impotence. - Leakage of urine from the bladder or stool from the rectum. - Shortening of the penis (1 to 2 centimeters). The exact reason for this is not known. - Inguinal hernia (bulging of fat or part of the small intestine through weak muscles into the groin). Inguinal hernia may occur more often in men treated with radical prostatectomy than in men who have some other types of prostate surgery, radiation therapy, or prostate biopsy alone. It is most likely to occur within the first 2 years after radical prostatectomy. Radiation therapy and radiopharmaceutical therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are different types of radiation therapy: - External radiation therapy uses a machine outside the body to send radiation toward the cancer. Conformal radiation is a type of external radiation therapy that uses a computer to make a 3-dimensional (3-D) picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high dose of radiation to reach the tumor and causes less damage to nearby healthy tissue. Hypofractionated radiation therapy may be given because it has a more convenient treatment schedule. Hypofractionated radiation therapy is radiation treatment in which a larger than usual total dose of radiation is given once a day over a shorter period of time (fewer days) compared to standard radiation therapy. Hypofractionated radiation therapy may have worse side effects than standard radiation therapy, depending on the schedules used. - Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. In early-stage prostate cancer, the radioactive seeds are placed in the prostate using needles that are inserted through the skin between the scrotum and rectum. The placement of the radioactive seeds in the prostate is guided by images from transrectal ultrasound or computed tomography (CT). The needles are removed after the radioactive seeds are placed in the prostate. - Radiopharmaceutical therapy uses a radioactive substance to treat cancer. Radiopharmaceutical therapy includes the following: - Alpha emitter radiation therapy uses a radioactive substance to treat prostate cancer that has spread to the bone. A radioactive substance called radium-223 is injected into a vein and travels through the bloodstream. The radium-223 collects in areas of bone with cancer and kills the cancer cells. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy, internal radiation therapy, and radiopharmaceutical therapy are used to treat prostate cancer. Men treated with radiation therapy for prostate cancer have an increased risk of having bladder and/or gastrointestinal cancer. Radiation therapy can cause impotence and urinary problems that may get worse with age. Hormone therapy Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. In prostate cancer, male sex hormones can cause prostate cancer to grow. Drugs, surgery, or other hormones are used to reduce the amount of male hormones or block them from working. Hormone therapy for prostate cancer may include the following: - Abiraterone acetate can prevent prostate cancer cells from making androgens. It is used in men with advanced prostate cancer that has not gotten better with other hormone therapy. - Orchiectomy is a surgical procedure to remove one or both testicles, the main source of male hormones, such as testosterone, to decrease the amount of hormone being made. - Estrogens (hormones that promote female sex characteristics) can prevent the testicles from making testosterone. However, estrogens are seldom used today in the treatment of prostate cancer because of the risk of serious side effects. - Luteinizing hormone-releasing hormone agonists can stop the testicles from making testosterone. Examples are leuprolide, goserelin, and buserelin. - Antiandrogens can block the action of androgens (hormones that promote male sex characteristics), such as testosterone. Examples are flutamide, bicalutamide, enzalutamide, and nilutamide. - Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide. Hot flashes, impaired sexual function, loss of desire for sex, and weakened bones may occur in men treated with hormone therapy. Other side effects include diarrhea, nausea, and itching. See Drugs Approved for Prostate Cancer for more information. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. See Drugs Approved for Prostate Cancer for more information. Biologic therapy Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. Sipuleucel-T is a type of biologic therapy used to treat prostate cancer that has metastasized (spread to other parts of the body). See Drugs Approved for Prostate Cancer for more information. Bisphosphonate therapy Bisphosphonate drugs, such as clodronate or zoledronate, reduce bone disease when cancer has spread to the bone. Men who are treated with antiandrogen therapy or orchiectomy are at an increased risk of bone loss. In these men, bisphosphonate drugs lessen the risk of bone fracture (breaks). The use of bisphosphonate drugs to prevent or slow the growth of bone metastases is being studied in clinical trials. There are treatments for bone pain caused by bone metastases or hormone therapy. Prostate cancer that has spread to the bone and certain types of hormone therapy can weaken bones and lead to bone pain. Treatments for bone pain include the following: - Pain medicine. - External radiation therapy. - Strontium-89 (a radioisotope). - Targeted therapy with a monoclonal antibody, such as denosumab. - Bisphosphonate therapy. - Corticosteroids. See the PDQ summary on Pain for more information. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Cryosurgery Cryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells. Ultrasound is used to find the area that will be treated. This type of treatment is also called cryotherapy. Cryosurgery can cause impotence and leakage of urine from the bladder or stool from the rectum. High-intensity-focused ultrasound therapy High-intensity-focused ultrasound therapy is a treatment that uses ultrasound (high-energy sound waves) to destroy cancer cells. To treat prostate cancer, an endorectal probe is used to make the sound waves. Proton beam radiation therapy Proton beam radiation therapy is a type of high-energy, external radiation therapy that targets tumors with streams of protons (small, positively charged particles). This type of radiation therapy is being studied in the treatment of prostate cancer. Cryosurgery Cryosurgery is a treatment that uses an instrument to freeze and destroy prostate cancer cells. Ultrasound is used to find the area that will be treated. This type of treatment is also called cryotherapy. Cryosurgery can cause impotence and leakage of urine from the bladder or stool from the rectum. High-intensity-focused ultrasound therapy High-intensity-focused ultrasound therapy is a treatment that uses ultrasound (high-energy sound waves) to destroy cancer cells. To treat prostate cancer, an endorectal probe is used to make the sound waves. Proton beam radiation therapy Proton beam radiation therapy is a type of high-energy, external radiation therapy that targets tumors with streams of protons (small, positively charged particles). This type of radiation therapy is being studied in the treatment of prostate cancer. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI's clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website. Follow-up tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups. Treatment Options by Stage Stage I Prostate Cancer Standard treatment of stage I prostate cancer may include the following: - Watchful waiting. - Active surveillance. If the cancer begins to grow, hormone therapy may be given. - Radical prostatectomy, usually with pelvic lymphadenectomy. Radiation therapy may be given after surgery. - External radiation therapy. Hormone therapy may be given after radiation therapy. - Internal radiation therapy with radioactive seeds. - A clinical trial of high-intensity-focused ultrasound therapy. - A clinical trial of cryosurgery. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage II Prostate Cancer Standard treatment of stage II prostate cancer may include the following: - Watchful waiting. - Active surveillance. If the cancer begins to grow, hormone therapy may be given. - Radical prostatectomy, usually with pelvic lymphadenectomy. Radiation therapy may be given after surgery. - External radiation therapy. Hormone therapy may be given after radiation therapy. - Internal radiation therapy with radioactive seeds. - A clinical trial of cryosurgery. - A clinical trial of high-intensity-focused ultrasound therapy. - A clinical trial of proton beam radiation therapy. - Clinical trials of new types of treatment, such as hormone therapy followed by radical prostatectomy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage III Prostate Cancer Standard treatment of stage III prostate cancer may include the following: - External radiation therapy. Hormone therapy may be given after radiation therapy. - Hormone therapy. Radiation therapy may be given after hormone therapy. - Radical prostatectomy. Radiation therapy may be given after surgery. - Watchful waiting. - Active surveillance. If the cancer begins to grow, hormone therapy may be given. Treatment to control cancer that is in the prostate and lessen urinary symptoms may include the following: - External radiation therapy. - Internal radiation therapy with radioactive seeds. - Hormone therapy. - Transurethral resection of the prostate (TURP). - A clinical trial of new types of radiation therapy. - A clinical trial of cryosurgery. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage IV Prostate Cancer Standard treatment of stage IV prostate cancer may include the following: - Hormone therapy. - Hormone therapy combined with chemotherapy. - Bisphosphonate therapy. - External radiation therapy. Hormone therapy may be given after radiation therapy. - Alpha emitter radiation therapy. - Watchful waiting. - Active surveillance. If the cancer begins to grow, hormone therapy may be given. - A clinical trial of radical prostatectomy with orchiectomy. Treatment to control cancer that is in the prostate and lessen urinary symptoms may include the following: - Transurethral resection of the prostate (TURP). - Radiation therapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Treatment Options for Recurrent Prostate Cancer
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Psoriasis Overview Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful. Psoriasis is a chronic disease that often comes and goes. The main goal of treatment is to stop the skin cells from growing so quickly. There is no cure for psoriasis, but you can manage symptoms. Lifestyle measures, such as moisturizing, quitting smoking and managing stress, may help. Psoriasis care at Mayo Clinic Symptoms Psoriasis signs and symptoms are different for everyone. Common signs and symptoms include: - Red patches of skin covered with thick, silvery scales - Small scaling spots (commonly seen in children) - Dry, cracked skin that may bleed - Itching, burning or soreness - Thickened, pitted or ridged nails - Swollen and stiff joints Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission. There are several types of psoriasis. These include: - Plaque psoriasis. The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques might be itchy or painful and there may be few or many. They can occur anywhere on your body, including your genitals and the soft tissue inside your mouth. - Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble. - Guttate psoriasis. This type primarily affects young adults and children. It's usually triggered by a bacterial infection such as strep throat. It's marked by small, water-drop-shaped, scaling lesions on your trunk, arms, legs and scalp. The lesions are covered by a fine scale and aren't as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes. - Inverse psoriasis. This mainly affects the skin in the armpits, in the groin, under the breasts and around the genitals. Inverse psoriasis causes smooth patches of red, inflamed skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis. - Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips. It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea. - Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely. - Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes swollen, painful joints that are typical of arthritis. Sometimes the joint symptoms are the first or only manifestation of psoriasis or at times only nail changes are seen. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint. Although the disease usually isn't as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity. If you suspect that you may have psoriasis, see your doctor for an examination. Also, talk to your doctor if your psoriasis: - Causes you discomfort and pain - Makes performing routine tasks difficult - Causes you concern about the appearance of your skin - Leads to joint problems, such as pain, swelling or inability to perform daily tasks Seek medical advice if your signs and symptoms worsen or don't improve with treatment. You may need a different medication or a combination of treatments to manage the psoriasis. Causes The cause of psoriasis isn't fully understood, but it's thought to be related to an immune system problem with T cells and other white blood cells, called neutrophils, in your body. T cells normally travel through the body to defend against foreign substances, such as viruses or bacteria. But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection. Overactive T cells also trigger increased production of healthy skin cells, more T cells and other white blood cells, especially neutrophils. These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create warmth and redness in the skin lesions. The process becomes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly - in days rather than weeks. Skin cells build up in thick, scaly patches on the skin's surface, continuing until treatment stops the cycle. Just what causes T cells to malfunction in people with psoriasis isn't entirely clear. Researchers believe both genetics and environmental factors play a role. Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include: - Infections, such as strep throat or skin infections - Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn - Stress - Smoking - Heavy alcohol consumption - Vitamin D deficiency - Certain medications - including lithium, which is prescribed for bipolar disorder, high blood pressure medications such as beta blockers, antimalarial drugs, and iodides Risk factors Anyone can develop psoriasis, but these factors can increase your risk of developing the disease: - Family history. This is one of the most significant risk factors. Having one parent with psoriasis increases your risk of getting the disease, and having two parents with psoriasis increases your risk even more. - Viral and bacterial infections. People with HIV are more likely to develop psoriasis than people with healthy immune systems are. Children and young adults with recurring infections, particularly strep throat, also may be at increased risk. - Stress. Because stress can impact your immune system, high stress levels may increase your risk of psoriasis. - Obesity. Excess weight increases the risk of psoriasis. Lesions (plaques) associated with all types of psoriasis often develop in skin creases and folds. - Smoking. Smoking tobacco not only increases your risk of psoriasis but also may increase the severity of the disease. Smoking may also play a role in the initial development of the disease. Diagnosis In most cases, diagnosis of psoriasis is fairly straightforward. - Physical exam and medical history. Your doctor usually can diagnose psoriasis by taking your medical history and examining your skin, scalp and nails. - Skin biopsy. Rarely, your doctor may take a small sample of skin (biopsy). He or she will likely first apply a local anesthetic. The sample is examined under a microscope to determine the exact type of psoriasis and to rule out other disorders. Treatment Psoriasis treatments reduce inflammation and clear the skin. Treatments can be divided into three main types: topical treatments, light therapy and systemic medications. Topical treatments Used alone, creams and ointments that you apply to your skin can effectively treat mild to moderate psoriasis. When the disease is more severe, creams are likely to be combined with oral medications or light therapy. Topical psoriasis treatments include: - Topical corticosteroids. These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They reduce inflammation and relieve itching and may be used with other treatments. Mild corticosteroid ointments are usually recommended for sensitive areas, such as your face or skin folds, and for treating widespread patches of damaged skin. Your doctor may prescribe stronger corticosteroid ointment for smaller, less sensitive or tougher-to-treat areas. Long-term use or overuse of strong corticosteroids can cause thinning of the skin. Topical corticosteroids may stop working over time. It's usually best to use topical corticosteroids as a short-term treatment during flares. - Vitamin D analogues. These synthetic forms of vitamin D slow skin cell growth. Calcipotriene (Dovonex) is a prescription cream or solution containing a vitamin D analogue that treats mild to moderate psoriasis along with other treatments. Calcipotriene might irritate your skin. Calcitriol (Vectical) is expensive but may be equally effective and possibly less irritating than calcipotriene. - Anthralin. This medication helps slow skin cell growth. Anthralin (Dritho-Scalp) can also remove scales and make skin smoother. But anthralin can irritate skin, and it stains almost anything it touches. It's usually applied for a short time and then washed off. - Topical retinoids. These are vitamin A derivatives that may decrease inflammation. The most common side effect is skin irritation. These medications may also increase sensitivity to sunlight, so while using the medication apply sunscreen before going outdoors. The risk of birth defects is far lower for topical retinoids than for oral retinoids. But tazarotene (Tazorac, Avage) isn't recommended when you're pregnant or breast-feeding or if you intend to become pregnant. - Calcineurin inhibitors. Calcineurin inhibitors - tacrolimus (Prograf) and pimecrolimus (Elidel) - reduce inflammation and plaque buildup. Calcineurin inhibitors are not recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma. They may be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects. - Salicylic acid. Available over-the-counter (nonprescription) and by prescription, salicylic acid promotes sloughing of dead skin cells and reduces scaling. Sometimes it's combined with other medications, such as topical corticosteroids or coal tar, to increase its effectiveness. Salicylic acid is available in medicated shampoos and scalp solutions to treat scalp psoriasis. - Coal tar. Derived from coal, coal tar reduces scaling, itching and inflammation. Coal tar can irritate the skin. It's also messy, stains clothing and bedding, and has a strong odor. Coal tar is available in over-the-counter shampoos, creams and oils. It's also available in higher concentrations by prescription. This treatment isn't recommended for women who are pregnant or breast-feeding. - Moisturizers. Moisturizing creams alone won't heal psoriasis, but they can reduce itching, scaling and dryness. Moisturizers in an ointment base are usually more effective than are lighter creams and lotions. Apply immediately after a bath or shower to lock in moisture. Light therapy (phototherapy) This treatment uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications. - Sunlight. Exposure to ultraviolet (UV) rays in sunlight or artificial light slows skin cell turnover and reduces scaling and inflammation. Brief, daily exposures to small amounts of sunlight may improve psoriasis, but intense sun exposure can worsen symptoms and cause skin damage. Before beginning a sunlight regimen, ask your doctor about the safest way to use natural sunlight for psoriasis treatment. - UVB phototherapy. Controlled doses of UVB light from an artificial light source may improve mild to moderate psoriasis symptoms. UVB phototherapy, also called broadband UVB, can be used to treat single patches, widespread psoriasis and psoriasis that resists topical treatments. Short-term side effects may include redness, itching and dry skin. Using a moisturizer may help decrease these side effects. - Narrow band UVB phototherapy. A newer type of psoriasis treatment, narrow band UVB phototherapy may be more effective than broadband UVB treatment. It's usually administered two or three times a week until the skin improves, and then maintenance may require only weekly sessions. Narrow band UVB phototherapy may cause more-severe and longer lasting burns, however. - Goeckerman therapy. Some doctors combine UVB treatment and coal tar treatment, which is known as Goeckerman treatment. The two therapies together are more effective than either alone because coal tar makes skin more receptive to UVB light. - Psoralen plus ultraviolet A (PUVA). This form of photochemotherapy involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure. This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma. - Excimer laser. This form of light therapy, used for mild to moderate psoriasis, treats only the involved skin without harming healthy skin. A controlled beam of UVB light is directed to the psoriasis plaques to control scaling and inflammation. Excimer laser therapy requires fewer sessions than does traditional phototherapy because more powerful UVB light is used. Side effects can include redness and blistering. Oral or injected medications If you have severe psoriasis or it's resistant to other types of treatment, your doctor may prescribe oral or injected drugs. This is known as systemic treatment. Because of severe side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment. - Retinoids. Related to vitamin A, this group of drugs may help if you have severe psoriasis that doesn't respond to other therapies. Side effects may include lip inflammation and hair loss. And because retinoids such as acitretin (Soriatane) can cause severe birth defects, women must avoid pregnancy for at least three years after taking the medication. - Methotrexate. Taken orally, methotrexate (Rheumatrex) helps psoriasis by decreasing the production of skin cells and suppressing inflammation. It may also slow the progression of psoriatic arthritis in some people. Methotrexate is generally well-tolerated in low doses but may cause upset stomach, loss of appetite and fatigue. When used for long periods, it can cause a number of serious side effects, including severe liver damage and decreased production of red and white blood cells and platelets. - Cyclosporine. Cyclosporine (Gengraf, Neoral) suppresses the immune system and is similar to methotrexate in effectiveness, but can only be taken short-term. Like other immunosuppressant drugs, cyclosporine increases your risk of infection and other health problems, including cancer. Cyclosporine also makes you more susceptible to kidney problems and high blood pressure - the risk increases with higher dosages and long-term therapy. - Drugs that alter the immune system (biologics). Several of these drugs are approved for the treatment of moderate to severe psoriasis. They include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab (Stelara), golimumab (Simponi), apremilast (Otezla), secukinumab (Cosentyx) and ixekizumab (Taltz). Most of these drugs are given by injection (apremilast is oral) and are usually used for people who have failed to respond to traditional therapy or who have associated psoriatic arthritis. Biologics must be used with caution because they have strong effects on the immune system and may permit life-threatening infections. In particular, people taking these treatments must be screened for tuberculosis. - Other medications. Thioguanine (Tabloid) and hydroxyurea (Droxia, Hydrea) are medications that can be used when other drugs can't be given. Treatment considerations Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments - topical creams and ultraviolet light therapy (phototherapy) - in those patients with typical skin lesions (plaques) and then progress to stronger ones only if necessary. Patients with pustular or erythrodermic psoriasis or associated arthritis usually need systemic therapy from the beginning of treatment. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects. Potential future treatments There are a number of new medications currently being researched that have the potential to improve psoriasis treatment. These treatments target different proteins that work with the immune system. Alternative medicine A number of alternative therapies claim to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs. None have definitively been proved effective. But some alternative therapies are deemed generally safe, and they may be helpful to some people in reducing signs and symptoms, such as itching and scaling. These treatments would be most appropriate for those with milder, plaque disease and not for those with pustules, erythroderma or arthritis. - Aloe vera. Taken from the leaves of the aloe vera plant, aloe extract cream may reduce redness, scaling, itching and inflammation. You may need to use the cream several times a day for a month or more to see any improvements in your skin. - Fish oil. Omega-3 fatty acids found in fish oil supplements may reduce inflammation associated with psoriasis, although results from studies are mixed. Taking 3 grams or less of fish oil daily is generally recognized as safe, and you may find it beneficial. - Oregon grape. Also known as barberry, topical applications of Oregon grape may reduce inflammation and ease psoriasis symptoms. If you're considering dietary supplements or other alternative therapy to ease the symptoms of psoriasis, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies. Lifestyle and home remedies Although self-help measures won't cure psoriasis, they may help improve the appearance and feel of damaged skin. These measures may benefit you: - Take daily baths. Bathing daily helps remove scales and calm inflamed skin. Add bath oil, colloidal oatmeal, Epsom salts or Dead Sea salts to the water and soak. Avoid hot water and harsh soaps, which can worsen symptoms; use lukewarm water and mild soaps that have added oils and fats. Soak about 10 minutes then gently pat dry skin. - Use moisturizer. After bathing, apply a heavy, ointment-based moisturizer while your skin is still moist. For very dry skin, oils may be preferable - they have more staying power than creams or lotions do and are more effective at preventing water from evaporating from your skin. During cold, dry weather, you may need to apply a moisturizer several times a day. - Expose your skin to small amounts of sunlight. A controlled amount of sunlight can improve psoriasis, but too much sun can trigger or worsen outbreaks and increase the risk of skin cancer. First ask your doctor about the best way to use natural sunlight to treat your skin. Log your time in the sun, and protect skin that isn't affected by psoriasis with sunscreen. - Avoid psoriasis triggers, if possible. Find out what triggers, if any, worsen your psoriasis and take steps to prevent or avoid them. Infections, injuries to your skin, stress, smoking and intense sun exposure can all worsen psoriasis. - Avoid drinking alcohol. Alcohol consumption may decrease the effectiveness of some psoriasis treatments. If you have psoriasis, avoid alcohol. If you do drink, keep it moderate.
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Childhood obesity Overview Childhood obesity is a serious medical condition that affects children and adolescents. Children who are obese are above the normal weight for their age and height. Childhood obesity is particularly troubling because the extra pounds often start children on the path to health problems that were once considered adult problems - diabetes, high blood pressure and high cholesterol. Many obese children become obese adults, especially if one or both parents are obese. Childhood obesity can also lead to poor self-esteem and depression. One of the best strategies to reduce childhood obesity is to improve the eating and exercise habits of your entire family. Treating and preventing childhood obesity helps protect your child's health now and in the future. Symptoms Not all children carrying extra pounds are overweight or obese. Some children have larger than average body frames. And children normally carry different amounts of body fat at the various stages of development. So you might not know just by looking at your child if weight is a health concern. The body mass index (BMI), which provides a guideline of weight in relation to height, is the accepted measure of overweight and obesity. Your child's doctor can help you figure out if your child's weight could pose health problems by using growth charts, the BMI and, if necessary, other tests. When to see a doctor If you're worried that your child is putting on too much weight, talk to his or her doctor. Your child's doctor will consider your child's history of growth and development, your family's weight-for-height history, and where your child lands on the growth charts. This can help determine if your child's weight is in an unhealthy range. Causes Lifestyle issues - too little activity and too many calories from food and drinks - are the main contributors to childhood obesity. But genetic and hormonal factors might play a role as well. For example, recent research has found that changes in digestive hormones can affect the signals that let you know you're full. Risk factors Many factors - usually working in combination - increase your child's risk of becoming overweight: - Diet. Regularly eating high-calorie foods, such as fast foods, baked goods and vending machine snacks, can easily cause your child to gain weight. Candy and desserts also can cause weight gain, and more and more evidence points to sugary drinks, including fruit juices, as culprits in obesity in some people. - Lack of exercise. Children who don't exercise much are more likely to gain weight because they don't burn as many calories. Too much time spent in sedentary activities, such as watching television or playing video games, also contributes to the problem. - Family factors. If your child comes from a family of overweight people, he or she may be more likely to put on weight. This is especially true in an environment where high-calorie foods are always available and physical activity isn't encouraged. - Psychological factors. Personal, parental and family stress can increase a child's risk of obesity. Some children overeat to cope with problems or to deal with emotions, such as stress, or to fight boredom. Their parents may have similar tendencies. - Socioeconomic factors. People in some communities have limited resources and limited access to supermarkets. As a result, they may opt for convenience foods that don't spoil quickly, such as frozen meals, crackers and cookies. In addition, people who live in lower income neighborhoods might not have access to a safe place to exercise. Complications Childhood obesity can have complications for your child's physical, social and emotional well-being. Physical complications - Type 2 diabetes. This chronic condition affects the way your child's body uses sugar (glucose). Obesity and a sedentary lifestyle increase the risk of type 2 diabetes. - Metabolic syndrome. This cluster of conditions can put your child at risk of heart disease, diabetes or other health problems. Conditions include high blood pressure, high blood sugar, high triglycerides, low HDL ("good") cholesterol and excess abdominal fat. - High cholesterol and high blood pressure. A poor diet can cause your child to develop one or both of these conditions. These factors can contribute to the buildup of plaques in the arteries. These plaques can cause arteries to narrow and harden, which can lead to a heart attack or stroke later in life. - Asthma. Children who are overweight or obese might be more likely to have asthma. - Sleep disorders. Obstructive sleep apnea is a potentially serious disorder in which a child's breathing repeatedly stops and starts during sleep. - Nonalcoholic fatty liver disease (NAFLD). This disorder, which usually causes no symptoms, causes fatty deposits to build up in the liver. NAFLD can lead to scarring and liver damage. Social and emotional complications - Low self-esteem and being bullied. Children often tease or bully their overweight peers, who suffer a loss of self-esteem and an increased risk of depression as a result. - Behavior and learning problems. Overweight children tend to have more anxiety and poorer social skills than normal-weight children do. These problems might lead children who are overweight to act out and disrupt their classrooms at one extreme, or to withdraw socially at the other. - Depression. Low self-esteem can create overwhelming feelings of hopelessness, which can lead to depression in some children who are overweight. Diagnosis As part of regular well-child care, the doctor calculates your child's BMI and determines where it falls on the BMI-for-age growth chart. The BMI helps indicate if your child is overweight for his or her age and height. Using the growth chart, your doctor determines your child's percentile, meaning how your child compares with other children of the same sex and age. For example, if your child is in the 80th percentile, it means that compared with other children of the same sex and age, 80 percent have a lower weight or BMI. Cutoff points on these growth charts, established by the Centers for Disease Control and Prevention, help identify children who are overweight and obese: - BMI between 85th and 94th percentiles - overweight - BMI 95th percentile or above - obesity Because BMI doesn't consider things such as being muscular or having a larger than average body frame and because growth patterns vary greatly among children, your doctor also factors in your child's growth and development. This helps determine whether your child's weight is a health concern. In addition to BMI and charting weight on the growth charts, the doctor evaluates: - Your family's history of obesity and weight-related health problems, such as diabetes - Your child's eating habits - Your child's activity level - Other health conditions your child may have - Psychosocial history, including incidences of depression and sleep disturbances and sadness and whether your child has friends or is the target of bullying Blood tests Your child's doctor might order blood tests if he or she finds that your child is obese. These tests might include: - A cholesterol test - A blood sugar test - Other blood tests to check for hormone imbalances, vitamin D deficiency or other conditions associated with obesity Some of these tests require that your child not eat or drink anything before the test. Ask if your child needs to fast before a blood test and for how long. Treatment Treatment for childhood obesity is based on your child's age and if he or she has other medical conditions. Treatment usually includes changes in your child's eating habits and physical activity level. In certain circumstances, treatment might include medications or weight-loss surgery. Treatment for children who are overweight The American Academy of Pediatrics recommends that children older than 2 and adolescents whose weight falls in the overweight category be put on a weight-maintenance program to slow the progress of weight gain. This strategy allows the child to add inches in height but not pounds, causing BMI to drop over time into a healthier range. Treatment for children who are obese Children ages 6 to 11 who are obese might be encouraged to modify their eating habits for gradual weight loss of no more than 1 pound (or about 0.5 kilogram) a month. Older children and adolescents who are obese or severely obese might be encouraged to modify their eating habits to aim for weight loss of up to 2 pounds (or about 1 kilogram) a week. The methods for maintaining your child's current weight or losing weight are the same: Your child needs to eat a healthy diet - both in terms of type and amount of food - and increase physical activity. Success depends largely on your commitment to helping your child make these changes. Healthy eating Parents are the ones who buy groceries, cook meals and decide where the food is eaten. Even small changes can make a big difference in your child's health. - When food shopping, choose fruits and vegetables. Cut back on convenience foods - such as cookies, crackers and prepared meals - which are often high in sugar, fat and calories. Always have healthy snacks available. - Limit sweetened beverages. This includes those that contain fruit juice. These drinks provide little nutritional value in exchange for their high calories. They also can make your child feel too full to eat healthier foods. - Limit fast food. Many of the menu options are high in fat and calories. - Sit down together for family meals. Make it an event - a time to share news and tell stories. Discourage eating in front of a TV, computer or video game screen, which can lead to fast eating and lowered awareness of amount eaten. - Serve appropriate portion sizes. Children don't need as much food as adults do. Allow your child to eat until he or she is full, even if that means leaving food on the plate. And remember, when you eat out, restaurant portion sizes are often significantly oversized. Physical activity A critical part of achieving and maintaining a healthy weight, especially for children, is physical activity. It burns calories, strengthens bones and muscles, and helps children sleep well at night and stay alert during the day. Good habits established in childhood help adolescents maintain healthy weights despite the hormonal changes, rapid growth and social influences that often lead to overeating. And active children are more likely to become fit adults. To increase your child's activity level: - Limit TV and recreational computer time. Time spent watching television or using computers, smartphones or tablets is known as screen time. Children younger than 18 months should avoid all screen time, except for video-chatting with family and friends. For older preschooolers, limit screen use to 1 hour per day of high-quality programming. - Emphasize activity, not exercise. Children should be moderately to vigorously active for at least an hour a day. Your child's activity doesn't have to be a structured exercise program - the object is to get him or her moving. Free-play activities - such as playing hide-and-seek, tag or jump-rope - can be great for burning calories and improving fitness. - Find activities your child likes. For instance, if your child is artistically inclined, go on a nature hike to collect leaves and rocks that your child can use to make a collage. If your child likes to climb, head for the nearest neighborhood jungle gym or climbing wall. If your child likes to read, then walk or bike to the neighborhood library for a book. Medications Medication might be prescribed for some adolescents as part of an overall weight-loss plan. The risks of taking a prescription medication over the long term are unknown, and the medication's effect on weight loss and weight maintenance for adolescents is still in question. Weight-loss surgery Weight-loss surgery may be an option for severely obese adolescents who have been unable to lose weight through lifestyle changes. However, as with any type of surgery, there are potential risks and long-term complications. Also, the long-term effects of weight-loss surgery on future growth and development are largely unknown. Weight-loss surgery in adolescents is uncommon. But your doctor might recommend this surgery if your child's weight poses a greater health threat than do the potential risks of surgery. It's important that a child being considered for weight-loss surgery meet with a team of pediatric specialists, including a pediatric endocrinologist, psychologist and dietitian. Weight-loss surgery isn't a miracle cure. It doesn't guarantee that an adolescent will lose all of his or her excess weight or be able to keep it off long term. And surgery doesn't replace the need for a healthy diet and regular physical activity. Lifestyle and home remedies Addressing a woman's health and weight before she conceives could lead to improvements in childhood obesity. If you're overweight and thinking of becoming pregnant, losing weight and eating well might affect your child's future. Eating well throughout pregnancy might also have a positive impact on your baby's later food choices. To give your infant a healthy start, the World Health Organization recommends exclusively breast-feeding for 6 months. If your child is overweight or obese, his or her best chance to achieve and maintain a healthy weight is to start eating a healthy diet and exercising more. Here are some steps you can take at home to help your child succeed: - Be a role model. Choose healthy foods and active pastimes for yourself. If you need to lose weight, doing so will motivate your child to do likewise. - Involve the whole family. Make healthy eating a priority and emphasize how important it is for everyone to be physically active. This avoids singling out the child who is overweight.
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Endometriosis Pelvic pain - endometriosis Endometrioma Summary Endometriosis occurs when cells from the lining of your womb (uterus) grow in other areas of your body. This can cause pain, heavy bleeding, bleeding between periods, and problems getting pregnant (infertility). Causes Every month, a woman's ovaries produce hormones that tell the cells lining the uterus to swell and get thicker. Your uterus sheds these cells along with blood and tissue through your vagina when you have your period. Endometriosis occurs when these cells grow outside the uterus in other parts of your body. This tissue may attach on your: Ovaries Bowel Rectum Bladder Lining of your pelvic area It can grow in other areas of the body, too. These growths stay in your body, and like the cells in the lining of your uterus, these growths react to the hormones from your ovaries. They grow and bleed when you get your period. Over time, the growths may add more tissue and blood. The buildup of blood and tissue in your body leads to pain and other symptoms. No one knows what causes endometriosis. One idea is that when you get your period, the cells may travel backwards through the fallopian tubes into the pelvis. Once there, the cells attach and grow. However, this backward period flow occurs in many women. Researchers think that the immune system plays a role in causing endometriosis in women the condition. Endometriosis is common. Sometimes, it may run in families. Endometriosis probably starts when a woman begins having periods. However, it usually is not diagnosed until ages 25 to 35. You are more likely to develop endometriosis if you: Have a mother or sister with endometriosis Started your period at a young age Never had children Have frequent periods, or they last 7 or more days Have a closed hymen, which blocks the flow of menstrual blood during the period Symptoms Pain is the main symptom of endometriosis. You may have: Painful periods. Pain in your lower belly before and during your period. Cramps for a week or 2 before and during your period. Cramps may be steady and range from dull to severe. Pain during or following sexual intercourse. Pain with bowel movements. Pelvic or low back pain that may occur at any time. You may not have any symptoms. Some women with a lot of tissue in their pelvis have no pain at all, while some women with milder disease have severe pain. Exams and Tests Your health care provider will perform a physical exam, including a pelvic exam. You may have one of these tests to help diagnose the disease: Transvaginal ultrasound Pelvic laparoscopy Treatment Learning how to manage your symptoms can make it easier to live with endometriosis. What type of treatment you have depends on: Your age Severity of your symptoms Severity of the disease Whether you want children in the future There are different treatment options. PAIN RELIEVERS If you have mild symptoms, you may be able to manage cramping and pain with: Exercise and relaxation techniques. Over-the-counter pain relievers -- These include ibuprofen (Advil), naproxen (Aleve), and acetaminophen (Tylenol). Prescription painkillers, if needed, for more severe pain. Regular exams every 6 to 12 months so your doctor can assess the disease. HORMONE THERAPY These medicines can stop endometriosis from getting worse. They may be given as pills, nasal spray, or shots. Only women who are not trying get pregnant should have this therapy. Hormone therapy will prevent you from getting pregnant. Once you stop therapy, you can get pregnant again. Birth control pills<strong> --</strong> With this therapy, you take the hormone pills (not the inactive or placebo pills) for 6 to 9 months continuously. Taking these pills relieves most symptoms. However, it does not treat any damage that has already occurred. Progesterone pills or injections <strong>--</strong> This treatment helps shrink growths. Side effects may include weight gain and depression. <strong> </strong> Gonadotropin-agonist medicines <strong>-- </strong>These medicines stop your ovaries from producing the hormone estrogen. This causes a menopause-like state. Side effects include hot flashes, vaginal dryness, and mood changes. Treatment is often limited to 6 months because it can weaken your bones. Your provider may give you small doses of hormone to relieve symptoms during this treatment. This is known as 'add-back' therapy. It may also help protect against bone loss, while not triggering growth of the endometriosis. SURGERY Your provider may recommend surgery if you have severe pain that does not get better with other treatments. Laparoscopy helps diagnose the disease and can also remove growths and scar tissue. Because only a small cut is made in your belly, you will heal faster than other types of surgery. Laparotomy involves making a large incision (cut) in your belly to remove growths and scar tissue. This is major surgery, so healing takes longer. Laparoscopy or laparotomy may be a good option if you want to become pregnant, because they treat the disease and leave your organs in place. Hysterectomy is surgery to remove your uterus, fallopian tubes, and ovaries. If your ovaries are not removed, symptoms may return. You would only have this surgery if you have severe symptoms and do not want to have children in the future. Outlook (Prognosis) Hormone therapy and laparoscopy can't cure endometriosis. However, in some women, these treatments may help relieve symptoms for years. Removal of the uterus, fallopian tubes, and both ovaries (a hysterectomy) gives you the best chance for a cure. Once you enter menopause, endometriosis is unlikely to cause problems. Possible Complications Endometriosis can lead to problems getting pregnant. However, most women with mild symptoms can still get pregnant. Laparoscopy to remove growths and scar tissue may help improve your chances of becoming pregnant. If it does not, you may want to consider fertility treatments. Other complications of endometriosis include: Long-term pelvic pain that interferes with social and work activities Large cysts in the pelvis that may break open (rupture) In rare cases, endometriosis tissue may block the intestines or urinary tract. Very rarely, cancer may develop in the areas of tissue growth after menopause. When to Contact a Medical Professional Call your provider if: You have symptoms of endometriosis Back pain or other symptoms reoccurring after endometriosis is treated You may want to get screened for endometriosis if: Your mother or sister has the disease You are unable to become pregnant after trying for 1 year Prevention Birth control pills may help to prevent or slow down the development of the endometriosis. Birth control pills used as treatment for endometriosis work best when taken continuously and not stopped to allow a menstrual period. They may be used for young women in late adolescence or early 20s with painful periods that may be due to endometriosis. Review Date 2/13/2018 Updated by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Overweight and Obesity What Are... Español The terms "overweight" and "obesity" refer to body weight that’s greater than what is considered healthy for a certain height. The most useful measure of overweight and obesity is body mass index (BMI). BMI is calculated from your height and weight. For more information about BMI, go to "How Are Overweight and Obesity Diagnosed?" Overview Millions of Americans and people worldwide are overweight or obese. Being overweight or obese puts you at risk for many health problems. The more body fat that you have and the more you weigh, the more likely you are to develop: Coronary heart disease High blood pressure Type 2 diabetes Gallstones Breathing problems Certain cancers Your weight is the result of many factors. These factors include environment, family history and genetics, metabolism (the way your body changes food and oxygen into energy), behavior or habits, and more. You can't change some factors, such as family history. However, you can change other factors, such as your lifestyle habits. For example, follow a healthy eating plan and keep your calorie needs in mind. Be physically active and try to limit the amount of time that you're inactive. Weight-loss medicines and surgery also are options for some people if lifestyle changes aren't enough. Outlook Reaching and staying at a healthy weight is a long-term challenge for people who are overweight or obese. But it also is a chance to lower your risk for other serious health problems. With the right treatment and motivation, it's possible to lose weight and lower your long-term disease risk. Causes Lack of Energy Balance A lack of energy balance most often causes overweight and obesity. Energy balance means that your energy IN equals your energy OUT. Energy IN is the amount of energy or calories you get from food and drinks. Energy OUT is the amount of energy your body uses for things like breathing, digesting, and being physically active. To maintain a healthy weight, your energy IN and OUT don't have to balance exactly every day. It's the balance over time that helps you maintain a healthy weight. The same amount of energy IN and energy OUT over time = weight stays the same More energy IN than energy OUT over time = weight gain More energy OUT than energy IN over time = weight loss Overweight and obesity happen over time when you take in more calories than you use. Other Causes An Inactive Lifestyle Many Americans aren't very physically active. One reason for this is that many people spend hours in front of TVs and computers doing work, schoolwork, and leisure activities. In fact, more than 2 hours a day of regular TV viewing time has been linked to overweight and obesity. Other reasons for not being active include: relying on cars instead of walking, fewer physical demands at work or at home because of modern technology and conveniences, and lack of physical education classes in schools. People who are inactive are more likely to gain weight because they don't burn the calories that they take in from food and drinks. An inactive lifestyle also raises your risk for coronary heart disease, high blood pressure, diabetes, colon cancer, and other health problems. Environment Our environment doesn't support healthy lifestyle habits; in fact, it encourages obesity. Some reasons include: Lack of neighborhood sidewalks and safe places for recreation. Not having area parks, trails, sidewalks, and affordable gyms makes it hard for people to be physically active. Work schedules. People often say that they don't have time to be physically active because of long work hours and time spent commuting. Oversized food portions. Americans are exposed to huge food portions in restaurants, fast food places, gas stations, movie theaters, supermarkets, and even at home. Some of these meals and snacks can feed two or more people. Eating large portions means too much energy IN. Over time, this will cause weight gain if it isn't balanced with physical activity. Lack of access to healthy foods. Some people don't live in neighborhoods that have supermarkets that sell healthy foods, such as fresh fruits and vegetables. Or, for some people, these healthy foods are too costly. Food advertising. Americans are surrounded by ads from food companies. Often children are the targets of advertising for high-calorie, high-fat snacks and sugary drinks. The goal of these ads is to sway people to buy these high-calorie foods, and often they do. Genes and Family History Studies of identical twins who have been raised apart show that genes have a strong influence on a person's weight. Overweight and obesity tend to run in families. Your chances of being overweight are greater if one or both of your parents are overweight or obese. Your genes also may affect the amount of fat you store in your body and where on your body you carry the extra fat. Because families also share food and physical activity habits, a link exists between genes and the environment. Children adopt the habits of their parents. A child who has overweight parents who eat high-calorie foods and are inactive will likely become overweight too. However, if the family adopts healthy food and physical activity habits, the child's chance of being overweight or obese is reduced. Health Conditions Some hormone problems may cause overweight and obesity, such as underactive thyroid (hypothyroidism), Cushing's syndrome, and polycystic ovarian syndrome (PCOS). Underactive thyroid is a condition in which the thyroid gland doesn't make enough thyroid hormone. Lack of thyroid hormone will slow down your metabolism and cause weight gain. You'll also feel tired and weak. Cushing's syndrome is a condition in which the body's adrenal glands make too much of the hormone cortisol. Cushing's syndrome also can develop if a person takes high doses of certain medicines, such as prednisone, for long periods. People who have Cushing's syndrome gain weight, have upper-body obesity, a rounded face, fat around the neck, and thin arms and legs. PCOS is a condition that affects about 5–10 percent of women of childbearing age. Women who have PCOS often are obese, have excess hair growth, and have reproductive problems and other health issues. These problems are caused by high levels of hormones called androgens. Medicines Certain medicines may cause you to gain weight. These medicines include some corticosteroids, antidepressants, and seizure medicines. These medicines can slow the rate at which your body burns calories, increase your appetite, or cause your body to hold on to extra water. All of these factors can lead to weight gain. Emotional Factors Some people eat more than usual when they're bored, angry, or stressed. Over time, overeating will lead to weight gain and may cause overweight or obesity. Smoking Some people gain weight when they stop smoking. One reason is that food often tastes and smells better after quitting smoking. Another reason is because nicotine raises the rate at which your body burns calories, so you burn fewer calories when you stop smoking. However, smoking is a serious health risk, and quitting is more important than possible weight gain. Age As you get older, you tend to lose muscle, especially if you're less active. Muscle loss can slow down the rate at which your body burns calories. If you don't reduce your calorie intake as you get older, you may gain weight. Midlife weight gain in women is mainly due to aging and lifestyle, but menopause also plays a role. Many women gain about 5 pounds during menopause and have more fat around the waist than they did before. Pregnancy During pregnancy, women gain weight to support their babies’ growth and development. After giving birth, some women find it hard to lose the weight. This may lead to overweight or obesity, especially after a few pregnancies. Lack of Sleep Research shows that lack of sleep increases the risk of obesity. For example, one study of teenagers showed that with each hour of sleep lost, the odds of becoming obese went up. Lack of sleep increases the risk of obesity in other age groups as well. People who sleep fewer hours also seem to prefer eating foods that are higher in calories and carbohydrates, which can lead to overeating, weight gain, and obesity. Sleep helps maintain a healthy balance of the hormones that make you feel hungry (ghrelin) or full (leptin). When you don't get enough sleep, your level of ghrelin goes up and your level of leptin goes down. This makes you feel hungrier than when you're well-rested. Sleep also affects how your body reacts to insulin, the hormone that controls your blood glucose (sugar) level. Lack of sleep results in a higher than normal blood sugar level, which may increase your risk for diabetes. For more information, go to the Health Topics Sleep Deprivation and Deficiency article. Risks Being overweight or obese isn't a cosmetic problem. These conditions greatly raise your risk for other health problems. Overweight and Obesity-Related Health Problems in Adults Coronary Heart Disease As your body mass index rises, so does your risk for coronary heart disease (CHD). CHD is a condition in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. Plaque can narrow or block the coronary arteries and reduce blood flow to the heart muscle. This can cause angina (an-JI-nuh or AN-juh-nuh) or a heart attack. (Angina is chest pain or discomfort.) Obesity also can lead to heart failure. This is a serious condition in which your heart can't pump enough blood to meet your body's needs. High Blood Pressure Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and stays high over time, it can damage the body in many ways. Your chances of having high blood pressure are greater if you're overweight or obese. Stroke Being overweight or obese can lead to a buildup of plaque in your arteries. Eventually, an area of plaque can rupture, causing a blood clot to form. If the clot is close to your brain, it can block the flow of blood and oxygen to your brain and cause a stroke. The risk of having a stroke rises as BMI increases. Type 2 Diabetes Diabetes is a disease in which the body's blood glucose, or blood sugar, level is too high. Normally, the body breaks down food into glucose and then carries it to cells throughout the body. The cells use a hormone called insulin to turn the glucose into energy. In type 2 diabetes, the body's cells don't use insulin properly. At first, the body reacts by making more insulin. Over time, however, the body can't make enough insulin to control its blood sugar level. Diabetes is a leading cause of early death, CHD, stroke, kidney disease, and blindness. Most people who have type 2 diabetes are overweight. Abnormal Blood Fats If you're overweight or obese, you're at increased risk of having abnormal levels of blood fats. These include high levels of triglycerides and LDL ("bad") cholesterol and low levels of HDL ("good") cholesterol. Abnormal levels of these blood fats are a risk factor for CHD. For more information about triglycerides and LDL and HDL cholesterol, go to the Health Topics High Blood Cholesterol article. Metabolic Syndrome Metabolic syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke. You can develop any one of these risk factors by itself, but they tend to occur together. A diagnosis of metabolic syndrome is made if you have at least three of the following risk factors: A large waistline. This is called abdominal obesity or "having an apple shape." Having extra fat in the waist area is a greater risk factor for CHD than having extra fat in other parts of the body, such as on the hips. A higher than normal triglyceride level (or you're on medicine to treat high triglycerides). A lower than normal HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). Higher than normal blood pressure (or you're on medicine to treat high blood pressure). Higher than normal fasting blood sugar (or you're on medicine to treat diabetes). Cancer Being overweight or obese raises your risk for colon, breast, endometrial, and gallbladder cancers. Osteoarthritis Osteoarthritis is a common joint problem of the knees, hips, and lower back. The condition occurs if the tissue that protects the joints wears away. Extra weight can put more pressure and wear on joints, causing pain. Sleep Apnea Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. A person who has sleep apnea may have more fat stored around the neck. This can narrow the airway, making it hard to breathe. Obesity Hypoventilation Syndrome Obesity hypoventilation syndrome (OHS) is a breathing disorder that affects some obese people. In OHS, poor breathing results in too much carbon dioxide (hypoventilation) and too little oxygen in the blood (hypoxemia). OHS can lead to serious health problems and may even cause death. Reproductive Problems Obesity can cause menstrual issues and infertility in women. Gallstones Gallstones are hard pieces of stone-like material that form in the gallbladder. They're mostly made of cholesterol. Gallstones can cause stomach or back pain. People who are overweight or obese are at increased risk of having gallstones. Also, being overweight may result in an enlarged gallbladder that doesn't work well. Overweight and Obesity-Related Health Problems in Children and Teens Overweight and obesity also increase the health risks for children and teens. Type 2 diabetes once was rare in American children, but an increasing number of children are developing the disease. Also, overweight children are more likely to become overweight or obese as adults, with the same disease risks. Who Is at Risk Overweight and obesity affect Americans of all ages, sexes, and racial/ethnic groups. This serious health problem has been growing over the last 30 years. Adults According to the National Health and Nutrition Examination Survey (NHANES) 2009–2010, almost 70 percent of Americans are overweight or obese. The survey also shows differences in overweight and obesity among racial/ethnic groups. In women, overweight and obesity are highest among non-Hispanic Black women (about 82 percent), compared with about 76 percent for Hispanic women and 64 percent for non-Hispanic White women. In men, overweight and obesity are highest among Hispanic men (about 82 percent), compared with about 74 percent for non-Hispanic White men and about 70 percent for non-Hispanic Black men. Children and Teens Children also have become heavier. In the past 30 years, obesity has tripled among school-aged children and teens. According to NHANES 2009–2010, about 1 in 6 American children ages 2–19 are obese. The survey also suggests that overweight and obesity are having a greater effect on minority groups, including Blacks and Hispanics. Signs & Symptoms Weight gain usually happens over time. Most people know when they've gained weight. Some of the signs of overweight or obesity include: Clothes feeling tight and needing a larger size. The scale showing that you've gained weight. Having extra fat around the waist. A higher than normal body mass index and waist circumference. (For more information, go to "How Are Overweight and Obesity Diagnosed?") Diagnosis The most common way to find out whether you're overweight or obese is to figure out your body mass index (BMI). BMI is an estimate of body fat, and it's a good gauge of your risk for diseases that occur with more body fat. BMI is calculated from your height and weight. You can use the chart below or the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI. Or, you health care provider can measure your BMI. Body Mass Index for Adults Use this table to learn your BMI. First, find your height on the far left column. Next, move across the row to find your weight. Weight is measured with underwear but no shoes. Once you've found your weight, move to the very top of that column. This number is your BMI. This table offers a sample of BMI measurements. If you don't see your height and/or weight listed on this table, go the NHLBI's complete Body Mass Index Table. What Does Body Mass Index Mean? Although BMI can be used for most men and women, it does have some limits. It may overestimate body fat in athletes and others who have a muscular build. BMI also may underestimate body fat in older people and others who have lost muscle. Body Mass Index for Children and Teens Overweight are obesity are defined differently for children and teens than for adults. Children are still growing, and boys and girls mature at different rates. BMIs for children and teens compare their heights and weights against growth charts that take age and sex into account. This is called BMI-for-age percentile. A child or teen's BMI-for-age percentile shows how his or her BMI compares with other boys and girls of the same age. For more information about BMI-for-age and growth charts for children, go to the Centers for Disease Control and Prevention's BMI-for-age calculator. What Does the BMI-for-Age Percentile Mean? Waist Circumference Health care professionals also may take your waist measurement. This helps screen for the possible health risks related to overweight and obesity in adults. If you have abdominal obesity and most of your fat is around your waist rather than at your hips, you're at increased risk for coronary heart disease and type 2 diabetes. The risk goes up with a waist size that's greater than 35 inches for women or greater than 40 inches for men. You also can measure your waist size. To do so correctly, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out. Specialists Involved A primary care doctor (or pediatrician for children and teens) will assess your BMI, waist measurement, and overall health risk. If you're overweight or obese, or if you have a large waist size, your doctor should explain the health risks and find out whether you're interested and willing to lose weight. If you are, you and your doctor can work together to create a treatment plan. The plan may include weight-loss goals and treatment options that are realistic for you. Your doctor may send you to other health care specialists if you need expert care. These specialists may include: An endocrinologist if you need to be treated for type 2 diabetes or a hormone problem, such as an underactive thyroid. A registered dietitian or nutritionist to work with you on ways to change your eating habits. An exercise physiologist or trainer to figure out your level of fitness and show you how to do physical activities suitable for you. A bariatric surgeon if weight-loss surgery is an option for you. A psychiatrist, psychologist, or clinical social worker to help treat depression or stress. Treatments Successful weight-loss treatments include setting goals and making lifestyle changes, such as eating fewer calories and being physically active. Medicines and weight-loss surgery also are options for some people if lifestyle changes aren't enough. Set Realistic Goals Setting realistic weight-loss goals is an important first step to losing weight. For Adults Try to lose 5 to 10 percent of your current weight over 6 months. This will lower your risk for coronary heart disease (CHD) and other conditions. The best way to lose weight is slowly. A weight loss of 1 to 2 pounds a week is do-able, safe, and will help you keep off the weight. It also will give you the time to make new, healthy lifestyle changes. If you've lost 10 percent of your body weight, have kept it off for 6 months, and are still overweight or obese, you may want to consider further weight loss. For Children and Teens If your child is overweight or at risk for overweight or obesity, the goal is to maintain his or her current weight and to focus on eating healthy and being physically active. This should be part of a family effort to make lifestyle changes. If your child is overweight or obese and has a health condition related to overweight or obesity, your doctor may refer you to a pediatric obesity treatment center. Lifestyle Changes Lifestyle changes can help you and your family achieve long-term weight-loss success. Example of lifestyle changes include: Focusing on balancing energy IN (calories from food and drinks) with energy OUT (physical activity) Following a healthy eating plan Learning how to adopt healthy lifestyle habits Over time, these changes will become part of your everyday life. Calories Cutting back on calories (energy IN) will help you lose weight. To lose 1 to 2 pounds a week, adults should cut back their calorie intake by 500 to 1,000 calories a day. In general, having 1,000 to 1,200 calories a day will help most women lose weight safely. In general, having 1,200 to 1,600 calories a day will help most men lose weight safely. This calorie range also is suitable for women who weigh 165 pounds or more or who exercise routinely. These calorie levels are a guide and may need to be adjusted. If you eat 1,600 calories a day but don't lose weight, then you may want to cut back to 1,200 calories. If you're hungry on either diet, then you may want to add 100 to 200 calories a day. Very low-calorie diets with fewer than 800 calories a day shouldn't be used unless your doctor is monitoring you. For overweight children and teens, it's important to slow the rate of weight gain. However, reduced-calorie diets aren't advised unless you talk with a health care provider. Healthy Eating Plan A healthy eating plan gives your body the nutrients it needs every day. It has enough calories for good health, but not so many that you gain weight. A healthy eating plan is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar. Following a healthy eating plan will lower your risk for heart disease and other conditions. Healthy foods include: Fat-free and low-fat dairy products, such as low-fat yogurt, cheese, and milk. Protein foods, such as lean meat, fish, poultry without skin, beans, and peas. Whole-grain foods, such as whole-wheat bread, oatmeal, and brown rice. Other grain foods include pasta, cereal, bagels, bread, tortillas, couscous, and crackers. Fruits, which can be fresh, canned, frozen, or dried. Vegetables, which can be fresh, canned (without salt), frozen, or dried. Canola and olive oils, and soft margarines made from these oils, are heart healthy. However, you should use them in small amounts because they're high in calories. You also can include unsalted nuts, like walnuts and almonds, in your diet as long as you limit the amount you eat (nuts also are high in calories). The National Heart, Lung, and Blood Institute's "Aim for a Healthy Weight" patient booklet provides more information about following a healthy eating plan. Foods to limit. Foods that are high in saturated and trans fats and cholesterol raise blood cholesterol levels and also might be high in calories. Fats and cholesterol raise your risk for heart disease, so they should be limited. Saturated fat is found mainly in: Fatty cuts of meat, such as ground beef, sausage, and processed meats (for example, bologna, hot dogs, and deli meats) Poultry with the skin High-fat dairy products like whole-milk cheeses, whole milk, cream, butter, and ice cream Lard, coconut, and palm oils, which are found in many processed foods Trans fat is found mainly in: Foods with partially hydrogenated oils, such as many hard margarines and shortening Baked products and snack foods, such as crackers, cookies, doughnuts, and breads Foods fried in hydrogenated shortening, such as french fries and chicken Cholesterol mainly is found in: Egg yolks Organ meats, such as liver Shrimp Whole milk or whole-milk products, such as butter, cream, and cheese Limiting foods and drinks with added sugars, like high-fructose corn syrup, is important. Added sugars will give you extra calories without nutrients like vitamins and minerals. Added sugars are found in many desserts, canned fruit packed in syrup, fruit drinks, and nondiet drinks. Check the list of ingredients on food packages for added sugars like high-fructose corn syrup. Drinks that contain alcohol also will add calories, so it's a good idea to limit your alcohol intake. Portion size. A portion is the amount of food that you choose to eat for a meal or snack. It's different from a serving, which is a measured amount of food and is noted on the Nutrition Facts label on food packages. Anyone who has eaten out lately is likely to notice how big the portions are. In fact, over the past 40 years, portion sizes have grown significantly. These growing portion sizes have changed what we think of as a normal portion. Cutting back on portion size is a good way to eat fewer calories and balance your energy IN. Food weight. Studies have shown that we all tend to eat a constant "weight" of food. Ounce for ounce, our food intake is fairly consistent. Knowing this, you can lose weight if you eat foods that are lower in calories and fat for a given amount of food. For example, replacing a full-fat food product that weighs 2 ounces with a low-fat product that weighs the same helps you cut back on calories. Another helpful practice is to eat foods that contain a lot of water, such as vegetables, fruits, and soups. Physical Activity Being physically active and eating fewer calories will help you lose weight and keep weight off over time. Physical activity also will benefit you in other ways. It will: Lower your risk for heart disease, heart attack, diabetes, and cancers (such as breast, uterine, and colon cancers) Strengthen your heart and help your lungs work better Strengthen your muscles and keep your joints in good condition Slow bone loss Give you more energy Help you relax and better cope with stress Allow you to fall asleep more quickly and sleep more soundly Give you an enjoyable way to share time with friends and family The four main types of physical activity are aerobic, muscle-strengthening, bone strengthening, and stretching. You can do physical activity with light, moderate, or vigorous intensity. The level of intensity depends on how hard you have to work to do the activity. People vary in the amount of physical activity they need to control their weight. Many people can maintain their weight by doing 150 to 300 minutes (2 hours and 30 minutes to 5 hours) of moderate-intensity activity per week, such as brisk walking. People who want to lose a large amount of weight (more than 5 percent of their body weight) may need to do more than 300 minutes of moderate-intensity activity per week. This also may be true for people who want to keep off weight that they've lost. You don't have to do the activity all at once. You can break it up into short periods of at least 10 minutes each. If you have a heart problem or chronic disease, such as heart disease, diabetes, or high blood pressure, talk with your doctor about what types of physical activity are safe for you. You also should talk with your doctor about safe physical activities if you have symptoms such as chest pain or dizziness. Children should get at least 60 minutes or more of physical activity every day. Most physical activity should be moderate-intensity aerobic activity. Activity should vary and be a good fit for the child's age and physical development. Many people lead inactive lives and might not be motivated to do more physical activity. When starting a physical activity program, some people may need help and supervision to avoid injury. If you're obese, or if you haven't been active in the past, start physical activity slowly and build up the intensity a little at a time. When starting out, one way to be active is to do more everyday activities, such as taking the stairs instead of the elevator and doing household chores and yard work. The next step is to start walking, biking, or swimming at a slow pace, and then build up the amount of time you exercise or the intensity level of the activity. To lose weight and gain better health, it's important to get moderate-intensity physical activity. Choose activities that you enjoy and that fit into your daily life. A daily, brisk walk is an easy way to be more active and improve your health. Use a pedometer to count your daily steps and keep track of how much you're walking. Try to increase the number of steps you take each day. Other examples of moderate-intensity physical activity include dancing, gardening, and water aerobics. For greater health benefits, try to step up your level of activity or the length of time you're active. For example, start walking for 10 to 15 minutes three times a week, and then build up to brisk walking for 60 minutes, 5 days a week. For more information about physical activity, go to the Department of Health and Human Services "2008 Physical Activity Guidelines for Americans" and the Health Topics Physical Activity and Your Heart article. Behavioral Changes Changing your behaviors or habits related to food and physical activity is important for losing weight. The first step is to understand which habits lead you to overeat or have an inactive lifestyle. The next step is to change these habits. Below are some simple tips to help you adopt healthier habits. Change your surroundings. You might be more likely to overeat when watching TV, when treats are available at work, or when you're with a certain friend. You also might find it hard to motivate yourself to be physically active. However, you can change these habits. Instead of watching TV, dance to music in your living room or go for a walk. Leave the office break room right after you get a cup of coffee. Bring a change of clothes to work. Head straight to an exercise class on the way home from work. Put a note on your calendar to remind yourself to take a walk or go to your exercise class. Keep a record. A record of your food intake and the amount of physical activity that you do each day will help inspire you. You also can keep track of your weight. For example, when the record shows that you've been meeting your physical activity goals, you'll want to keep it up. A record also is an easy way to track how you're doing, especially if you're working with a registered dietitian or nutritionist. Seek support. Ask for help or encouragement from your friends, family, and health care provider. You can get support in person, through e-mail, or by talking on the phone. You also can join a support group. Reward success. Reward your success for meeting your weight-loss goals or other achievements with something you would like to do, not with food. Choose rewards that you'll enjoy, such as a movie, music CD, an afternoon off from work, a massage, or personal time. Weight-Loss Medicines Weight-loss medicines approved by the Food and Drug Administration (FDA) might be an option for some people. If you're not successful at losing 1 pound a week after 6 months of using lifestyle changes, medicines may help. You should only use medicines as part of a program that includes diet, physical activity, and behavioral changes. Weight-loss medicines might be suitable for adults who are obese (a BMI of 30 or greater). People who have BMIs of 27 or greater, and who are at risk for heart disease and other health conditions, also may benefit from weight-loss medicines. Sibutramine (Meridia®) As of October 2010, the weight-loss medicine sibutramine (Meridia®) was taken off the market in the United States. Research showed that the medicine may raise the risk of heart attack and stroke. Orlistat (Xenical® and Alli®) Orlistat (Xenical®) causes a weight loss between 5 and 10 pounds, although some people lose more weight. Most of the weight loss occurs within the first 6 months of taking the medicine. People taking Xenical need regular checkups with their doctors, especially during the first year of taking the medicine. During checkups, your doctor will check your weight, blood pressure, and pulse and may recommend other tests. He or she also will talk with you about any medicine side effects and answer your questions. The FDA also has approved Alli®, an over-the-counter (OTC) weight-loss aid for adults. Alli is the lower dose form of orlistat. Alli is meant to be used along with a reduced-calorie, low-fat diet and physical activity. In studies, most people taking Alli lost 5 to 10 pounds over 6 months. Both Xenical and Alli reduce the absorption of fats, fat calories, and vitamins A, D, E, and K to promote weight loss. Both medicines also can cause mild side effects, such as oily and loose stools. Although rare, some reports of liver disease have occurred with the use of orlistat. More research is needed to find out whether the medicine plays a role in causing liver disease. Talk with your doctor if you’re considering using Xenical or Alli to lose weight. He or she can discuss the risks and benefits with you. You also should talk with your doctor before starting orlistat if you’re taking blood-thinning medicines or being treated for diabetes or thyroid disease. Also, ask your doctor whether you should take a multivitamin due to the possible loss of some vitamins. Lorcaserin Hydrochloride (Belviq®) and Qsymia™ In July 2012, the FDA approved two new medicines for chronic (ongoing) weight management. Lorcaserin hydrochloride (Belviq®) and Qsymia™ are approved for adults who have a BMI of 30 or greater. (Qsymia is a combination of two FDA-approved medicines: phentermine and topiramate.) These medicines also are approved for adults with a BMI of 27 or greater who have at least one weight-related condition, such as high blood pressure, type 2 diabetes, or high blood cholesterol. Both medicines are meant to be used along with a reduced-calorie diet and physical activity. Other Medicines Some prescription medicines are used for weight loss, but aren't FDA-approved for treating obesity. They include: Medicines to treat depression. Some medicines for depression cause an initial weight loss and then a regain of weight while taking the medicine. Medicines to treat seizures. Two medicines used for seizures, topiramate and zonisamide, have been shown to cause weight loss. These medicines are being studied to see whether they will be useful in treating obesity. Medicines to treat diabetes. Metformin may cause small amounts of weight loss in people who have obesity and diabetes. It's not known how this medicine causes weight loss, but it has been shown to reduce hunger and food intake. Over-the-Counter Products Some OTC products claim to promote weight loss. The FDA doesn't regulate these products because they're considered dietary supplements, not medicines. However, many of these products have serious side effects and generally aren't recommended. Some of these OTC products include: Ephedra (also called ma huang). Ephedra comes from plants and has been sold as a dietary supplement. The active ingredient in the plant is called ephedrine. Ephedra can cause short-term weight loss, but it also has serious side effects. It causes high blood pressure and stresses the heart. In 2004, the FDA banned the sale of dietary supplements containing ephedra in the United States. Chromium. This is a mineral that's sold as a dietary supplement to reduce body fat. While studies haven't found any weight-loss benefit from chromium, there are few serious side effects from taking it. Diuretics and herbal laxatives. These products cause you to lose water weight, not fat. They also can lower your body's potassium levels, which may cause heart and muscle problems. Hoodia. Hoodia is a cactus that's native to Africa. It's sold in pill form as an appetite suppressant. However, no firm evidence shows that hoodia works. No large-scale research has been done on humans to show whether hoodia is effective or safe. Weight-Loss Surgery Weight-loss surgery might be an option for people who have extreme obesity (BMI of 40 or more) when other treatments have failed. Weight-loss surgery also is an option for people who have a BMI of 35 or more and life-threatening conditions, such as: Severe sleep apnea (a condition in which you have one or more pauses in breathing or shallow breaths while you sleep) Obesity-related cardiomyopathy (KAR-de-o-mi-OP-ah-thee; diseases of the heart muscle) Severe type 2 diabetes Types of Weight-Loss Surgery Two common weight-loss surgeries include banded gastroplasty and Roux-en-Y gastric bypass. For gastroplasty, a band or staples are used to create a small pouch at the top of your stomach. This surgery limits the amount of food and liquids the stomach can hold. For gastric bypass, a small stomach pouch is created with a bypass around part of the small intestine where most of the calories you eat are absorbed. This surgery limits food intake and reduces the calories your body absorbs. Weight-loss surgery can improve your health and weight. However, the surgery can be risky, depending on your overall health. Gastroplasty has few long-term side effects, but you must limit your food intake dramatically. Gastric bypass has more side effects. They include nausea (feeling sick to your stomach), bloating, diarrhea, and faintness. These side effects are all part of a condition called dumping syndrome. After gastric bypass, you may need multivitamins and minerals to prevent nutrient deficiencies. Lifelong medical followup is needed after both surgeries. Your doctor also may recommend a program both before and after surgery to help you with diet, physical activity, and coping skills. If you think you would benefit from weight-loss surgery, talk with your doctor. Ask whether you're a candidate for the surgery and discuss the risks, benefits, and what to expect. Weight-Loss Maintenance Maintaining your weight loss over time can be a challenge. For adults, weight loss is a success if you lose at least 10 percent of your initial weight and you don't regain more than 6 or 7 pounds in 2 years. You also must keep a lower waist circumference (at least 2 inches lower than your waist circumference before you lost weight). After 6 months of keeping off the weight, you can think about losing more if: You've already lost 5 to 10 percent of your body weight You're still overweight or obese The key to losing more weight or maintaining your weight loss is to continue with lifestyle changes. Adopt these changes as a new way of life. If you want to lose more weight, you may need to eat fewer calories and increase your activity level. For example, if you eat 1,600 calories a day but don't lose weight, you may want to cut back to 1,200 calories. It's also important to make physical activity part of your normal daily routine. Prevention Following a healthy lifestyle can help you prevent overweight and obesity. Many lifestyle habits begin during childhood. Thus, parents and families should encourage their children to make healthy choices, such as following a healthy diet and being physically active. Make following a healthy lifestyle a family goal. For example: Follow a healthy eating plan. Make healthy food choices, keep your calorie needs and your family's calorie needs in mind, and focus on the balance of energy IN and energy OUT. Focus on portion size. Watch the portion sizes in fast food and other restaurants. The portions served often are enough for two or three people. Children's portion sizes should be smaller than those for adults. Cutting back on portion size will help you balance energy IN and energy OUT. Be active. Make personal and family time active. Find activities that everyone will enjoy. For example, go for a brisk walk, bike or rollerblade, or train together for a walk or run. Reduce screen time. Limit the use of TVs, computers, DVDs, and videogames because they limit time for physical activity. Health experts recommend 2 hours or less a day of screen time that's not work- or homework-related. Keep track of your weight, body mass index, and waist circumference. Also, keep track of your children's growth. Led by the National Heart, Lung, and Blood Institute, four Institutes from the National Institutes of Health have come together to promote We Can!®—Ways to Enhance Children's Activity & Nutrition. We Can! is a national education program designed for parents and caregivers to help children 8 to 13 years old maintain a healthy weight. The evidence-based program offers parents and families tips and fun activities to encourage healthy eating, increase physical activity, and reduce time spent being inactive. Currently, more than 140 community groups around the country are participating in We Can! programs for parents and youth. These community groups include hospitals, health departments, clinics, faith-based organizations, YMCAs, schools, and more. ____________ ®We Can! is a registered trademark of the U.S. Department of Health and Human Services.
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Dehydration Overview Dehydration occurs when you use or lose more fluid than you take in, and your body doesn't have enough water and other fluids to carry out its normal functions. If you don't replace lost fluids, you will get dehydrated. Anyone may become dehydrated, but the condition is especially dangerous for young children and older adults. The most common cause of dehydration in young children is severe diarrhea and vomiting. Older adults naturally have a lower volume of water in their bodies, and may have conditions or take medications that increase the risk of dehydration. This means that even minor illnesses, such as infections affecting the lungs or bladder, can result in dehydration in older adults. Dehydration also can occur in any age group if you don't drink enough water during hot weather - especially if you are exercising vigorously. You can usually reverse mild to moderate dehydration by drinking more fluids, but severe dehydration needs immediate medical treatment. Symptoms Thirst isn't always a reliable early indicator of the body's need for water. Many people, particularly older adults, don't feel thirsty until they're already dehydrated. That's why it's important to increase water intake during hot weather or when you're ill. The signs and symptoms of dehydration also may differ by age. - Dry mouth and tongue - No tears when crying - No wet diapers for three hours - Sunken eyes, cheeks - Sunken soft spot on top of skull - Listlessness or irritability - Extreme thirst - Less frequent urination - Dark-colored urine - Fatigue - Dizziness - Confusion Call your family doctor if you or a loved one: - Has had diarrhea for 24 hours or more - Is irritable or disoriented and much sleepier or less active than usual - Can't keep down fluids - Has bloody or black stool Causes Sometimes dehydration occurs for simple reasons: You don't drink enough because you're sick or busy, or because you lack access to safe drinking water when you're traveling, hiking or camping. Other dehydration causes include: - Diarrhea, vomiting. Severe, acute diarrhea - that is, diarrhea that comes on suddenly and violently - can cause a tremendous loss of water and electrolytes in a short amount of time. If you have vomiting along with diarrhea, you lose even more fluids and minerals. - Fever. In general, the higher your fever, the more dehydrated you may become. The problem worsens if you have a fever in addition to diarrhea and vomiting. - Excessive sweating. You lose water when you sweat. If you do vigorous activity and don't replace fluids as you go along, you can become dehydrated. Hot, humid weather increases the amount you sweat and the amount of fluid you lose. - Increased urination. This may be due to undiagnosed or uncontrolled diabetes. Certain medications, such as diuretics and some blood pressure medications, also can lead to dehydration, generally because they cause you to urinate more. Risk factors Anyone can become dehydrated, but certain people are at greater risk: - Infants and children. The most likely group to experience severe diarrhea and vomiting, infants and children are especially vulnerable to dehydration. Having a higher surface area to volume area, they also lose a higher proportion of their fluids from a high fever or burns. Young children often can't tell you that they're thirsty, nor can they get a drink for themselves. - Older adults. As you age, your body's fluid reserve becomes smaller, your ability to conserve water is reduced and your thirst sense becomes less acute. These problems are compounded by chronic illnesses such as diabetes and dementia, and by the use of certain medications. Older adults also may have mobility problems that limit their ability to obtain water for themselves. - People with chronic illnesses. Having uncontrolled or untreated diabetes puts you at high risk of dehydration. Kidney disease also increases your risk, as do medications that increase urination. Even having a cold or sore throat makes you more susceptible to dehydration because you're less likely to feel like eating or drinking when you're sick. - People who work or exercise outside. When it's hot and humid, your risk of dehydration and heat illness increases. That's because when the air is humid, sweat can't evaporate and cool you as quickly as it normally does, and this can lead to an increased body temperature and the need for more fluids. Complications Dehydration can lead to serious complications, including: - Heat injury. If you don't drink enough fluids when you're exercising vigorously and perspiring heavily, you may end up with a heat injury, ranging in severity from mild heat cramps to heat exhaustion or potentially life-threatening heatstroke. - Urinary and kidney problems. Prolonged or repeated bouts of dehydration can cause urinary tract infections, kidney stones and even kidney failure. - Seizures. Electrolytes - such as potassium and sodium - help carry electrical signals from cell to cell. If your electrolytes are out of balance, the normal electrical messages can become mixed up, which can lead to involuntary muscle contractions and sometimes to a loss of consciousness. - Low blood volume shock (hypovolemic shock). This is one of the most serious, and sometimes life-threatening, complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body. Diagnosis Your doctor can often diagnose dehydration on the basis of physical signs and symptoms. If you're dehydrated, you're also likely to have low blood pressure, especially when moving from a lying to a standing position, a faster than normal heart rate and reduced blood flow to your extremities. To help confirm the diagnosis and pinpoint the degree of dehydration, you may have other tests, such as: - Blood tests. Blood samples may be used to check for a number of factors, such as the levels of your electrolytes - especially sodium and potassium - and how well your kidneys are working. - Urinalysis. Tests done on your urine can help show whether you're dehydrated and to what degree. They also can check for signs of a bladder infection. Treatment The only effective treatment for dehydration is to replace lost fluids and lost electrolytes. The best approach to dehydration treatment depends on age, the severity of dehydration and its cause. For infants and children who have become dehydrated from diarrhea, vomiting or fever, use an over-the-counter oral rehydration solution. These solutions contain water and salts in specific proportions to replenish both fluids and electrolytes. Start with about a teaspoon (5 milliliters) every one to five minutes and increase as tolerated. It may be easier to use a syringe for very young children. Older children can be given diluted sports drinks. Use 1 part sports drink to 1 part water. Most adults with mild to moderate dehydration from diarrhea, vomiting or fever can improve their condition by drinking more water or other liquids. Diarrhea may be worsened by full-strength fruit juice and soft drinks. If you work or exercise outdoors during hot or humid weather, cool water is your best bet. Sports drinks containing electrolytes and a carbohydrate solution also may be helpful. Children and adults who are severely dehydrated should be treated by emergency personnel arriving in an ambulance or in a hospital emergency room. Salts and fluids delivered through a vein (intravenously) are absorbed quickly and speed recovery.
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SHARE – Istraživanje o zdravlju, starenju i umirovljenju u Europi je istraživačka podatkovna infrastruktura koju je Europska komisija pozicionirala kao jedan od prioritetnih projekata u europskom istraživačkom prostoru U ovoj multidisciplinarnoj i transnacionalnoj bazi mikropodataka o zdravlju, socioekonomskom statusu te društvenim i obiteljskim mrežama nalaze se informacije o više od 140 000 osoba u dobi od 50 ili više godina iz 27 europskih zemalja i Izraela Cilj ovog rada jest prikazati metodološki profil studije SHARE s posebnim osvrtom na razdoblje od priključenja Hrvatske 2015 U radu se analizira proces provedbe ankete SHARE u Hrvatskoj s detaljnim prikazom modula i pitanja iz šestog i sedmog vala studije Svrha rada jest omogućiti hrvatskoj znanstvenoj zajednici bolji uvid u sadržaj ankete SHARE U radu se daje i poseban osvrt na osmi val, u kojem je zbog pandemije koronavirusa prekinuto anketiranje licem u lice i napravljen metodološki zaokret, tj prelazak na CATI anketu, tzv SHARE Corona Studija SHARE danas se suočava s brojnim izazovima, od kojih valja istaknuti zadržavanje europske pokrivenosti zbog nedostatnog financiranja, ali i budućeg načina provedbe ankete zbog utjecaja bolesti COVID-19 Alternate abstract:The Survey of Health, Ageing and Retirement in Europe (SHARE) is a multidisci¬plinary and cross-national panel database of microdata on health, socio-economic status and social and family networks of about 140,000 individuals aged 50 or older SHARE covers 27 European countries and Israel It is a research infrastructure that the European Commission has positioned as one of the priority projects in the Euro¬pean Research Area and one of the most significant panel studies in social sciences This paper aims to present the methodological profile of the SHARE study with a specific reference to the period since 2015 when Croatia joined it It also examines the process of SHARE study implementation in Croatia with a detailed presentation of modules and questions from the questionnaires in the sixth and seventh waves The specific purpose of this paper is to emphasise the content and research opportunities of the SHARE study for the Croatian scholarly community This paper highlights the specific aspects of the eighth wave of SHARE in which face-to-face interviewing has been suspended due to the coronavirus pandemic, and a methodological turn has been made, i e face-to-face interviews have been replaced with a short CATI (telephone) survey called "SHARE Corona " As a panel study, SHARE collects data in waves, every two years since 2004, sup¬ported by CAPI (computer-assisted personal interviewing) A SHARE interview is quite long, with an approximate duration of one hour Same respondents are inter¬viewed in regular waves, but new respondents can be added to refresher samples New respondents help to maintain the core sample and deal with sample attrition However, SHARE invests significant efforts in recovering panel respondents who have participated in the previous waves The strategy to minimise the absence of panel respondents includes regular contact with respondents, i e panel care (send¬ing birthday cards, season's greetings, brochures with selected SHARE results to re¬spondents or providing incentives) The SHARE study relies on ex-ante harmonisa¬tion and includes a core survey instrument that is common in all member countries Strict comparability is crucial Comparability is ascertained through identical ques¬tion design, a careful translation process with external certification, an electronic survey instrument (CAPI, CASE CTRL starting from Wave 8), and common training procedures ascertained by a train-the-trainer programme In addition to the variety of electronic instruments, SHARE relies on several "physical" survey instruments, which are mainly used to obtain objective health measures These instruments in¬clude dynamometers (to measure respondents' grip strength) and peak flow me¬ters (to measure respondents' lung capacity) Besides, SHARE collects da a from the walking speed test and chair stand test, data on waist circumference, self-reported weight and height, and biomarkers from a sample of dried blood spots (HbA1c, total cholesterol, C-reactive protein and vitamin D) In the participating SHARE countries, the institutional conditions with respect to sampling are so different that a uniform sampling design for the entire project is infeasible Good sampling frames for the target population of 50+ individuals and households with at least one 50+ individual do not exist or cannot be used in all countries Most countries keep registers of individuals that enable stratification by age In some of them, these registers are maintained at a regional level In these cases, a two- or multi-stage design is needed, in which regions are sampled first, and then individuals are selected within these regions As a result, sampling designs used vary from a simple random selection of households to rather complicated multi-stage de¬signs Taking into account the size of the population in each participating country, SHARE calculates weights to reduce the potential selection bias associated with non-response errors In the Croatian wave six, the sampling of potential respondents was based on probabilities from the administrative register of age-appropriate individu¬als From the database of insured persons of the Croatian Health Insurance Fund (HZZO), 4,990 persons born in 1963 and earlier were randomly selected Each person received an invitation letter for participation in the SHARE study in Croatia The response rate in SHARE wave six was 43 7% at the household level, while the indi¬vidual response rate was 41 9% These rates resulted in 2,495 individual surveys con¬ducted in 1,588 households in Croatia In all countries that had refresher samples, the response rate was 51 3% at the household level and 46 8% at the individual level The seventh SHARE wave, called SHARELIFE, was mainly retrospective, accomplishing a full EU coverage As a part of the seventh wave, a relatively small refresher sample was selected in Croatia i e 346 interviews were conducted in 234 households The minimum satisfactory response rate of 30% was achieved at the household level In Croatia, the retention rate of respondents in the seventh wave was 84 6%, which was the highest retention rate of respondents between waves six and seven In Slovenia, it was 82 9%, in Greece 82 8%, in Estonia 82 2%, in Belgium 70 4%, in France 64 9%, and in Italy 62% That retention rate in Croatia resulted in 2,062 SHARELIFE inter¬views with an additional 101 end-of-life interviews (interviews about the last year of life of a deceased respondent) The sampling procedure for the refresher sample in wave eight in Croatia followed the standard phases of two-stage sampling Primary sampling units were polling stations selected based on a probability proportional to the number of voters aged 50+ at each polling station The sample was stratified by counties and by settlement size In the second phase, the gross sample of individuals aged 50 or older was selected randomly The representativeness of the sample was achieved by weighting a set of eight calibration variables (men and women in age groups 50–59, 60–69, 70–79, and 80+) Following the spread of the coronavirus pandemic across Europe, in March 2020, all SHARE countries suspended field surveys By that date, 1,279 panel interviews (including end-of-life interviews) and 835 refresher interviews had been collected in Croatia In response to the pandemic, the SHARE Central, in cooperation with national teams, created the SHARE Corona questionnaire, designed for a computer-assisted telephone interview (CATI), lasting about 20–25 minutes This survey, con¬ducted in 27 European countries and Israel from June to August 2020, included panel respondents only The SHARE study is a prime example of a truly European research infrastructure that exists largely because of its European dimension It is crucial to point out that the data collected by the survey questionnaire are harmonised ex-ante across Europe, which significantly contributes to the improvement of international comparative re¬search The main value of this project lies with the diversity of collected data, with each participating country contributing to this diversity with data on living condi¬tions, health, pension and social policies Therefore, SHARE is much more than just a group of national surveys The SHARE study today faces a number of challenges, the most prominent ones being the retention of European coverage due to lack of fund¬ing and the future method of surveying in the light of COVID-19 In Croatia, joining the SHARE study was marked by significant challenges Firstly, SHARE is the first longitudinal study on demographic ageing conducted in our country Secondly, the SHARE survey requires ample financial resources, so the size of the Croatian sam¬ple had to be adjusted accordingly and to meet high scientific standards set by the SHARE study The third significant challenge that the SHARE research team faced were barriers to accessing the sampling framework Substantial efforts were under¬taken to demonstrate that the SHARE study adheres to all ethical standards and regulations related to the protection of the personal data of respondents Another is¬sue was the limited number of survey agencies in Croatia that can conduct demand¬ing surveys of this type This was especially evident in the sixth wave, when certain logistical issues arose because the fieldwork phase started quite late (end of June 2015), leading to the stagnation of surveys in some parts of the country (Dalmatia, Istria) Difficulties related to the recruitment of interviewers and their withdrawal in the early stages of the survey required significantefforts during the last month of the fieldwork However, experiences from the sixth wave contributed to the extremely successful implementation of the seventh wave (SHARELIFE)
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Scoliosis Overview Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown. Most cases of scoliosis are mild, but some children develop spine deformities that continue to get more severe as they grow. Severe scoliosis can be disabling. An especially severe spinal curve can reduce the amount of space within the chest, making it difficult for the lungs to function properly. Children who have mild scoliosis are monitored closely, usually with X-rays, to see if the curve is getting worse. In many cases, no treatment is necessary. Some children will need to wear a brace to stop the curve from worsening. Others may need surgery to keep the scoliosis from worsening and to straighten severe cases of scoliosis. Symptoms Signs and symptoms of scoliosis may include: - Uneven shoulders - One shoulder blade that appears more prominent than the other - Uneven waist - One hip higher than the other If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side. When to see a doctor Go to your doctor if you notice signs or symptoms of scoliosis in your child. Mild curves, however, can develop without the parent or child knowing it because they appear gradually and usually don't cause pain. Occasionally, teachers, friends and sports teammates are the first to notice a child's scoliosis. Causes Doctors don't know what causes the most common type of scoliosis - although it appears to involve hereditary factors, because the disorder tends to run in families. Less common types of scoliosis may be caused by: - Neuromuscular conditions, such as cerebral palsy or muscular dystrophy - Birth defects affecting the development of the bones of the spine - Injuries to or infections of the spine Risk factors Risk factors for developing the most common type of scoliosis include: - Age. Signs and symptoms typically begin during the growth spurt that occurs just prior to puberty. - Sex. Although both boys and girls develop mild scoliosis at about the same rate, girls have a much higher risk of the curve worsening and requiring treatment. - Family history. Scoliosis can run in families, but most children with scoliosis don't have a family history of the disease. Diagnosis The doctor will initially take a detailed medical history and may ask questions about recent growth. During the physical exam, your doctor may have your child stand and then bend forward from the waist, with arms hanging loosely, to see if one side of the rib cage is more prominent than the other. Your doctor may also perform a neurological exam to check for: - Muscle weakness - Numbness - Abnormal reflexes Imaging tests Plain X-rays can confirm the diagnosis of scoliosis and reveal the severity of the spinal curvature. If a doctor suspects that an underlying condition - such as a tumor - is causing the scoliosis, he or she may recommend additional imaging tests, such as an MRI. Treatment Most children with scoliosis have mild curves and probably won't need treatment with a brace or surgery. Children who have mild scoliosis may need checkups every four to six months to see if there have been changes in the curvature of their spines. While there are guidelines for mild, moderate and severe curves, the decision to begin treatment is always made on an individual basis. Factors to be considered include: - Sex. Girls have a much higher risk of progression than do boys. - Severity of curve. Larger curves are more likely to worsen with time. - Curve pattern. Double curves, also known as S-shaped curves, tend to worsen more often than do C-shaped curves. - Location of curve. Curves located in the center (thoracic) section of the spine worsen more often than do curves in the upper or lower sections of the spine. - Maturity. If a child's bones have stopped growing, the risk of curve progression is low. That also means that braces have the most effect in children whose bones are still growing. Braces If your child's bones are still growing and he or she has moderate scoliosis, your doctor may recommend a brace. Wearing a brace won't cure scoliosis or reverse the curve, but it usually prevents further progression of the curve. The most common type of brace is made of plastic and is contoured to conform to the body. This close-fitting brace is almost invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips. Most braces are worn day and night. A brace's effectiveness increases with the number of hours a day it's worn. Children who wear braces can usually participate in most activities and have few restrictions. If necessary, kids can take off the brace to participate in sports or other physical activities. Braces are discontinued after the bones stop growing. This typically occurs: - About two years after girls begin to menstruate - When boys need to shave daily - When there are no further changes in height Surgery Severe scoliosis typically progresses with time, so your doctor might suggest scoliosis surgery to reduce the severity of the spinal curve and to prevent it from getting worse. The most common type of scoliosis surgery is called spinal fusion. In spinal fusion, surgeons connect two or more of the bones in the spine (vertebrae) together, so they can't move independently. Pieces of bone or a bone-like material are placed between the vertebrae. Metal rods, hooks, screws or wires typically hold that part of the spine straight and still while the old and new bone material fuses together. If the scoliosis is progressing rapidly at a young age, surgeons can install a rod that can adjust in length as the child grows. This growing rod is attached to the top and bottom sections of the spinal curvature, and is usually lengthened every six months. Complications of spinal surgery may include bleeding, infection, pain or nerve damage. Rarely, the bone fails to heal and another surgery may be needed. Lifestyle and home remedies Although physical therapy exercises can't stop scoliosis, general exercise or participating in sports may have the benefit of improving overall health and well-being. Alternative medicine Studies indicate that the following treatments for scoliosis are ineffective: - Chiropractic manipulation - Electrical stimulation of muscles - Dietary supplements
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Obesity Overview Obesity is a complex disorder involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It increases your risk of diseases and health problems, such as heart disease, diabetes and high blood pressure. Being extremely obese means you are especially likely to have health problems related to your weight. The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. Dietary changes, increased physical activity and behavior changes can help you lose weight. Prescription medications and weight-loss surgery are additional options for treating obesity. Symptoms Obesity is diagnosed when your body mass index (BMI) is 30 or higher. Your body mass index is calculated by dividing your weight in kilograms (kg) by your height in meters (m) squared. For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obese category even though they don't have excess body fat. Ask your doctor if your BMI is a problem. When to see a doctor If you think you may be obese, and especially if you're concerned about weight-related health problems, see your doctor or health care provider. You and your provider can evaluate your health risks and discuss your weight-loss options. Causes Although there are genetic, behavioral and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat. Obesity can sometimes be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome, and other diseases and conditions. However, these disorders are rare and, in general, the principal causes of obesity are: - Inactivity. If you're not very active, you don't burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you use through exercise and normal daily activities. - Unhealthy diet and eating habits. Weight gain is inevitable if you regularly eat more calories than you burn. And most Americans' diets are too high in calories and are full of fast food and high-calorie beverages. Risk factors Obesity usually results from a combination of causes and contributing factors, including: - Genetics. Your genes may affect the amount of body fat you store, and where that fat is distributed. Genetics may also play a role in how efficiently your body converts food into energy and how your body burns calories during exercise. - Family lifestyle. Obesity tends to run in families. If one or both of your parents are obese, your risk of being obese is increased. That's not just because of genetics. Family members tend to share similar eating and activity habits. - Inactivity. If you're not very active, you don't burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Having medical problems, such as arthritis, can lead to decreased activity, which contributes to weight gain. - Unhealthy diet. A diet that's high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain. - Medical problems. In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain. - Certain medications. Some medications can lead to weight gain if you don't compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers. - Social and economic issues. Research has linked social and economic factors to obesity. Avoiding obesity is difficult if you don't have safe areas to exercise. Similarly, you may not have been taught healthy ways of cooking, or you may not have money to buy healthier foods. In addition, the people you spend time with may influence your weight - you're more likely to become obese if you have obese friends or relatives. - Age. Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs, and can make it harder to keep off excess weight. If you don't consciously control what you eat and become more physically active as you age, you'll likely gain weight. - Pregnancy. During pregnancy, a woman's weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women. - Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain that the person becomes obese. In the long run, however, quitting smoking is still a greater benefit to your health than continuing to smoke. - Lack of sleep. Not getting enough sleep or getting too much sleep can cause changes in hormones that increase your appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain. Even if you have one or more of these risk factors, it doesn't mean that you're destined to become obese. You can counteract most risk factors through diet, physical activity and exercise, and behavior changes. Complications If you're obese, you're more likely to develop a number of potentially serious health problems, including: - High triglycerides and low high-density lipoprotein (HDL) cholesterol - Type 2 diabetes - High blood pressure - Metabolic syndrome - a combination of high blood sugar, high blood pressure, high triglycerides and low HDL cholesterol - Heart disease - Stroke - Cancer, including cancer of the uterus, cervix, endometrium, ovaries, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate - Breathing disorders, including sleep apnea, a potentially serious sleep disorder in which breathing repeatedly stops and starts - Gallbladder disease - Gynecological problems, such as infertility and irregular periods - Erectile dysfunction and sexual health issues - Nonalcoholic fatty liver disease, a condition in which fat builds up in the liver and can cause inflammation or scarring - Osteoarthritis Quality of life When you're obese, your overall quality of life may be diminished. You may not be able to do things you used to do, such as participating in enjoyable activities. You may avoid public places. Obese people may even encounter discrimination. Other weight-related issues that may affect your quality of life include: - Depression - Disability - Sexual problems - Shame and guilt - Social isolation - Lower work achievement Diagnosis If your BMI is in the obese range, your health care provider will typically review your health history in detail, perform a physical exam and recommend some tests. These exams and tests generally include: - Taking your health history. Your doctor may review your weight history, weight-loss efforts, exercise habits, eating patterns, what other conditions you've had, medications, stress levels and other issues about your health. Your doctor may also review your family's health history to see if you may be predisposed to certain conditions. - A general physical exam. This includes also measuring your height; checking vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen. - Calculating your BMI. Your doctor will check your body mass index (BMI) to determine your level of obesity. This should be done at least once a year. Your BMI also helps determine your overall health risk and what treatment may be appropriate. - Measuring your waist circumference. Fat stored around your waist, sometimes called visceral fat or abdominal fat, may further increase your risk of diseases, such as diabetes and heart disease. Women with a waist measurement (circumference) of more than 35 inches (80 centimeters, or cm) and men with a waist measurement of more than 40 inches (102 cm) may have more health risks than do people with smaller waist measurements. Like the BMI measurement, your waist circumference should be checked at least once a year. - Checking for other health problems. If you have known health problems, your doctor will evaluate them. Your doctor will also check for other possible health problems, such as high blood pressure and diabetes. - Blood tests. What tests you have depend on your health, risk factors and any current symptoms you may be having. Tests may include a cholesterol test, liver function tests, a fasting glucose, a thyroid test and others. Your doctor may also recommend certain heart tests, such as an electrocardiogram. Gathering all this information helps you and your doctor determine how much weight you need to lose and what health conditions or risks you already have. And this will guide treatment decisions. Treatment The goal of obesity treatment is to reach and stay at a healthy weight. You may need to work with a team of health professionals - including a dietitian, behavior counselor or an obesity specialist - to help you understand and make changes in your eating and activity habits. The initial treatment goal is usually a modest weight loss - 3 to 5 percent of your total weight. That means that if you weigh 200 pounds (91 kg) and are obese by BMI standards, you would need to lose only about 6 to 10 pounds (2.7 to 4.5 kg) for your health to begin to improve. However, the more weight you lose, the greater the benefits. All weight-loss programs require changes in your eating habits and increased physical activity. The treatment methods that are right for you depend on your level of obesity, your overall health and your willingness to participate in your weight-loss plan. Other treatment tools include: - Dietary changes - Exercise and activity - Behavior change - Prescription weight-loss medications - Weight-loss surgery Dietary changes Reducing calories and practicing healthier eating habits are vital to overcoming obesity. Although you may lose weight quickly at first, slow and steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently. Avoid drastic and unrealistic diet changes, such as crash diets, because they're unlikely to help you keep excess weight off for the long term. Plan to participate in a comprehensive weight-loss program for at least six months and in the maintenance phase of a program for at least a year to boost your odds of weight-loss success. There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include: - Cutting calories. The key to weight loss is reducing how many calories you take in. You and your health care providers can review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You and your doctor can decide how many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men. - Feeling full on less. The concept of energy density can help you satisfy your hunger with fewer calories. All foods have a certain number of calories within a given amount (volume). Some foods - such as desserts, candies, fats and processed foods - are high in energy density. This means that a small volume of that food has a large number of calories. In contrast, other foods, such as fruits and vegetables, have lower energy density. These foods provide a larger portion size with a fewer number of calories. By eating larger portions of foods that have fewer calories, you reduce hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall. - Making healthier choices. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole-grain carbohydrates. Also emphasize lean sources of protein - such as beans, lentils and soy - and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Stick with low-fat dairy products. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as olive, canola and nut oils. - Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods. Ask your doctor which diet plans have been found effective and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume more calories than you intended, and limiting these drinks or eliminating them altogether is a good place to start cutting calories. - Meal replacements. These plans suggest that you replace one or two meals with their products - such as low-calorie shakes or meal bars - and eat healthy snacks and a healthy, balanced third meal that's low in fat and calories. In the short term, this type of diet can help you lose weight. Keep in mind that these diets likely won't teach you how to change your overall lifestyle, though, so you may have to keep this up if you want to keep your weight off. Be wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term, but the long-term results don't appear to be any better than other diets. Similarly, you may lose weight on a crash diet, but you're likely to regain it when you stop the diet. To lose weight - and keep it off - you have to adopt healthy-eating habits that you can maintain over time. Exercise and activity Increased physical activity or exercise is an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking. To boost your activity level: - Exercise. People who are overweight or obese need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight. To achieve more-significant weight loss, you may need to exercise 300 minutes or more a week. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve. - Keep moving. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Making simple changes throughout your day can add up to big benefits. Park farther from store entrances, rev up your household chores, garden, get up and move around periodically, and wear a pedometer to track how many steps you actually take over the course of a day. Behavior changes A behavior modification program can help you make lifestyle changes and lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity. Everyone is different and has different obstacles to managing weight, such as a lack of time to exercise or late-night eating. Tailor your behavior changes to address your individual concerns. Behavior modification, sometimes called behavior therapy, can include: - Counseling. Therapy or interventions with trained mental health or other professionals can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers, and cope with food cravings. Therapy can take place on both an individual and group basis. More-intensive programs - those that include 12 to 26 sessions a year - may be more helpful in achieving your weight-loss goals. - Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area, such as Weight Watchers. Prescription weight-loss medication Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help. Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them. If you don't make these other changes in your life, medication is unlikely to work. Your doctor may recommend weight-loss medication if other methods of weight loss haven't worked for you and you meet one of the following criteria: - Your body mass index (BMI) is 30 or greater - Your BMI is greater than 27, and you also have medical complications of obesity, such as diabetes, high blood pressure or sleep apnea Before selecting a medication for you, your doctor will consider your health history, as well as possible side effects. Some weight-loss medications can't be used by women who are pregnant, or people who take certain medications or have chronic health conditions. Commonly prescribed weight-loss medications include orlistat (Xenical), lorcaserin (Belviq), phentermine and topiramate (Qsymia), buproprion and naltrexone (Contrave), and liraglutide (Saxenda). You will need close medical monitoring while taking a prescription weight-loss medication. Also, keep in mind that a weight-loss medication may not work for everyone, and the effects may wane over time. When you stop taking a weight-loss medication, you may regain much or all of the weight you lost. Weight-loss surgery In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery limits the amount of food you're able to comfortably eat or decreases the absorption of food and calories or both. While weight-loss surgery offers the best chance of losing the most weight, it can pose serious risks. Weight-loss surgery for obesity may be considered if you have tried other methods to lose weight that haven't worked and: - You have extreme obesity (BMI of 40 or higher) - Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure - You're committed to making the lifestyle changes that are necessary for surgery to work It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits. Common weight-loss surgeries include: - Gastric bypass surgery. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a small pouch at the top of your stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of your stomach. - Laparoscopic adjustable gastric banding (LAGB). In this procedure, your stomach is separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently. - Biliopancreatic diversion with duodenal switch. This procedure begins with the surgeon removing a large part of the stomach. The surgeon leaves the valve that releases food to the small intestine and the first part of the small intestine (duodenum). Then the surgeon closes off the middle section of the intestine and attaches the last part directly to the duodenum. The separated section of the intestine is reattached to the end of the intestine to allow bile and digestive juices to flow into this part of the intestine. - Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir for food. It's a less complicated surgery than gastric bypass or biliopancreatic diversion with duodenal switch. Other treatments Vagal nerve blockade is another treatment for obesity. It involves implanting a device under the skin of the abdomen that sends intermittent electrical pulses to the abdominal vagus nerve, which tells the brain when the stomach feels empty or full. This new technology received FDA approval in 2014 for use by adults who have not been able to lose weight with a weight-loss program and who have a BMI of 35 to 45 with at least one obesity-related condition, such as type 2 diabetes. Preventing weight regain after obesity treatment Unfortunately, it's common to regain weight no matter what obesity treatment methods you try. If you take weight-loss medications, you'll probably regain weight when you stop taking them. You might even regain weight after weight-loss surgery if you continue to overeat or overindulge in high-calorie foods. But that doesn't mean your weight-loss efforts are futile. One of the best ways to prevent regaining the weight you've lost is to get regular physical activity. Aim for 60 minutes a day. Keep track of your physical activity if it helps you stay motivated and on course. As you lose weight and gain better health, talk to your doctor about what additional activities you might be able to do and, if appropriate, how to give your activity and exercise a boost. You may always have to remain vigilant about your weight. Combining a healthier diet and more activity in a practical and sustainable manner are the best ways to keep the weight you lost off for the long term. Take your weight loss and weight maintenance one day at a time and surround yourself with supportive resources to help ensure your success. Find a healthier way of living that you can stick with for the long term. Lifestyle and home remedies Your effort to overcome obesity is more likely to be successful if you follow strategies at home in addition to your formal treatment plan. These can include: - Learning about your condition. Education about obesity can help you learn more about why you became obese and what you can do about it. You may feel more empowered to take control and stick to your treatment plan. Read reputable self-help books and consider talking about them with your doctor or therapist. - Setting realistic goals. When you have to lose a significant amount of weight, you may set goals that are unrealistic, such as trying to lose too much too fast. Don't set yourself up for failure. Set daily or weekly goals for exercise and weight loss. Make small changes in your diet instead of attempting drastic changes that you're not likely to stick with for the long haul. - Sticking to your treatment plan. Changing a lifestyle you may have lived with for many years can be difficult. Be honest with your doctor, therapist or other health care providers if you find your activity or eating goals slipping. You can work together to come up with new ideas or new approaches. - Enlisting support. Get your family and friends on board with your weight-loss goals. Surround yourself with people who will support you and help you, not sabotage your efforts. Make sure they understand how important weight loss is to your health. You might also want to join a weight-loss support group. - Keeping a record. Keep a food and activity log. This record can help you remain accountable for your eating and exercise habits. You can discover behavior that may be holding you back and, conversely, what works well for you. You can also use your log to track other important health parameters such as blood pressure and cholesterol levels and overall fitness. - Identifying and avoiding food triggers. Distract yourself from your desire to eat with something positive, such as calling a friend. Practice saying no to unhealthy foods and big portions. Eat when you're actually hungry - not simply when the clock says it's time to eat. - Taking your medications as directed. If you take weight-loss medications or medications to treat obesity-related conditions, such as high blood pressure or diabetes, take them exactly as prescribed. If you have a problem sticking with your medication regimen or have unpleasant side effects, talk to your doctor. Alternative medicine Numerous dietary supplements that promise to help you shed weight quickly are available. The effectiveness, particularly the long-term effectiveness, and safety of these products are often questionable. Herbal remedies, vitamins and minerals, all considered dietary supplements by the Food and Drug Administration, don't have the same rigorous testing and labeling process as over-the-counter and prescription medications do. Yet some of these substances, including products labeled as "natural," have drug-like effects that can be dangerous. Even some vitamins and minerals can cause problems when taken in excessive amounts. Ingredients may not be standard, and they can cause unpredictable and harmful side effects. Dietary supplements also can cause dangerous interactions with prescription medications you take. Talk to your doctor before taking any dietary supplements. Mind-body therapies - such as acupuncture, mindfulness meditation and yoga - may complement other obesity treatments. However, these therapies generally haven't been well-studied in the treatment of weight loss. Talk to your doctor if you're interested in adding a mind-body therapy to your treatment.
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Heart attack Myocardial infarction MI Acute MI ST - elevation myocardial infarction Non-ST - elevation myocardial infarction NSTEMI CAD - heart attack Coronary artery disease - heart attack Summary Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. If the blood flow is blocked, the heart is starved of oxygen and heart cells die. The medical term for this is myocardial infarction. Causes A substance called plaque can build up in the walls of your coronary arteries. This plaque is made up of cholesterol and other cells. A heart attack may occur when: A tear in the plaque occurs. This triggers blood platelets and other substances to form a blood clot at the site that blocks most or all of the oxygen-carrying blood from flowing to a part of the heart muscle. This is the most common cause of heart attack. A slow buildup of plaque may narrow one of the coronary arteries so that it is almost blocked. In either case, there is not enough blood flow to the heart muscle and heart muscle dies. The cause of heart attack is not always known. Heart attack may occur: When you are resting or asleep After a sudden increase in physical activity When you are active outside in cold weather After sudden, severe emotional or physical stress, including an illness Many risk factors may lead to the development of plaque buildup and a heart attack. Symptoms A heart attack is a medical emergency. If you have symptoms of a heart attack, call 911 or your local emergency number right away. DO NOT try to drive yourself to the hospital. DO NOT WAIT. You are at greatest risk of sudden death in the early hours of a heart attack. Chest pain is the most common symptom of a heart attack. You may feel the pain in only one part of your body OR Pain may move from your chest to your arms, shoulder, neck, teeth, jaw, belly area, or back The pain can be severe or mild. It can feel like: A tight band around the chest Bad indigestion Something heavy sitting on your chest Squeezing or heavy pressure The pain most often lasts longer than 20 minutes. Rest and a medicine to relax the blood vessels (called nitroglycerin) may not completely relieve the pain of a heart attack. Symptoms may also go away and come back. Other symptoms of a heart attack can include: Anxiety Cough Fainting Lightheadedness, dizziness Nausea and vomiting Palpitations (feeling like your heart is beating too fast or irregularly) Shortness of breath Sweating, which may be very heavy Some people (the older adults, people with diabetes, and women) may have little or no chest pain. Or, they may have unusual symptoms such as shortness of breath, fatigue, and weakness. A "silent heart attack" is a heart attack with no symptoms. Exams and Tests A health care provider will perform a physical exam and listen to your chest using a stethoscope. The provider may hear abnormal sounds in your lungs (called crackles), a heart murmur, or other abnormal sounds. You may have a fast or uneven pulse. Your blood pressure may be normal, high, or low. You will have an electrocardiogram (ECG) to look for heart damage. Most of the time, certain changes on the ECG indicate you are having a heart attack. Sometimes these changes are not present, even though other tests indicate you have had a heart attack. This can be called non-ST elevation myocardial infarction (NSTEMI). A blood test can show if you have heart tissue damage. This test can confirm that you are having a heart attack. You will likely have this test 3 times over the first 6 to 12 hours. Coronary angiography may be done right away or when you are more stable. This test uses a special dye and x-rays to see how blood flows through your heart. It can help your doctor decide which treatments you need next. Other tests to look at your heart that may be done while you are in the hospital: Echocardiography with or with stress testing Exercise stress test Nuclear stress test Heart CT scan or heart MRI Treatment IMMEDIATE TREATMENT You will be hooked up to a heart monitor, so the health care team can see how regularly your heart is beating. You will receive oxygen so that your heart doesn't have to work as hard. An intravenous line (IV) will be placed into one of your veins. Medicines and fluids pass through this IV. You may get nitroglycerin and morphine to help reduce chest pain. You may receive aspirin, unless it would not be safe for you. In that case, you will be given another medicine that prevents blood clots. Dangerous abnormal heartbeats (arrhythmias) may be treated with medicine or electric shocks. EMERGENCY PROCEDURES Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. Angioplasty is often the first choice of treatment. It should be done within 90 minutes after you get to the hospital, and usually no later than 12 hours after a heart attack. A stent is a small, metal mesh tube that opens up (expands) inside a coronary artery. A stent is usually placed after or during angioplasty. It helps prevent the artery from closing up again. You may be given drugs to break up the clot. This is called thrombolytic therapy. It is best if these drugs are given soon after the onset of symptoms, usually no later than 12 hours after it and ideally within 30 minutes of arriving to the hospital. Some people may also have heart bypass surgery to open narrowed or blocked blood vessels that supply blood to the heart. This procedure is also called coronary artery bypass grafting and/or open heart surgery. TREATMENT AFTER A HEART ATTACK After several days, you will be discharged from the hospital. You will likely need to take medicines, some for the rest of your life. Always talk to your provider before stopping or changing how you take any medicines. Stopping certain medicines can be deadly. While under the care of your health care team, you will learn: How to take medicines to treat your heart problem and prevent more heart attacks How to eat a heart-healthy diet How to be active and exercise safely What to do when you have chest pain How to stop smoking Strong emotions are common after a heart attack. You may feel sad You may feel anxious and worry about being careful about everything you do All of these feelings are normal. They go away for most people after 2 or 3 weeks. You may also feel tired when you leave the hospital to go home. Most people who have had a heart attack take part in a cardiac rehabilitation program. Support Groups Many people benefit from taking part in support groups for people with heart disease. Outlook (Prognosis) After a heart attack, you have a higher chance of having another heart attack. How well you do after a heart attack depends on several factors such as: The amount of damage to your heart muscle and heart valves Where that damage is located Your medical care after the heart attack If your heart can no longer pump blood out to your body as well as it used to, you may develop heart failure. Abnormal heart rhythms can occur, and they can be life threatening. Most people can slowly go back to normal activities after a heart attack. This includes sexual activity. Talk to your provider about how much activity is good for you. Review Date 6/18/2018 Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Nicotine dependence Overview Nicotine dependence -- also called tobacco dependence -- is an addiction to tobacco products caused by the drug nicotine. Nicotine dependence means you can't stop using the substance, even though it's causing you harm. Nicotine produces physical and mood-altering effects in your brain that are temporarily pleasing. These effects make you want to use tobacco and lead to dependence. At the same time, stopping tobacco use causes withdrawal symptoms, including irritability and anxiety. While it's the nicotine in tobacco that causes nicotine dependence, the toxic effects of tobacco result from other substances in tobacco. Smokers have much higher rates of heart disease, stroke and cancer than nonsmokers do. Regardless of how long you've smoked, stopping smoking can improve your health. Many effective treatments for nicotine dependence are available to help you manage withdrawal and stop smoking for good. Ask your doctor for help. Symptoms For some people, using any amount of tobacco can quickly lead to nicotine dependence. Signs that you may be addicted include: - You can't stop smoking. You've made one or more serious, but unsuccessful, attempts to stop. - You experience withdrawal symptoms when you try to stop. Your attempts at stopping have caused physical and mood-related symptoms, such as strong cravings, anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration, anger, increased hunger, insomnia, constipation or diarrhea. - You keep smoking despite health problems. Even though you've developed health problems with your lungs or your heart, you haven't been able to stop. - You give up social or recreational activities in order to smoke. You may stop going to smoke-free restaurants or stop socializing with certain family members or friends because you can't smoke in these locations or situations. You're not alone if you've tried to stop smoking but haven't been able to stop for good. Most smokers make many attempts to stop smoking before they achieve stable, long-term abstinence from smoking. You're more likely to stop for good if you follow a treatment plan that addresses both the physical and the behavioral aspects of nicotine dependence. Using medications and working with a counselor specially trained to help people stop smoking (a tobacco treatment specialist) will significantly boost your chances of success. Ask your doctor, counselor or therapist to help you develop a treatment plan that works for you or to advise you on where to get help to stop smoking. Causes Nicotine is the chemical in tobacco that keeps you smoking. Nicotine is very addictive when delivered by inhaling tobacco smoke into the lungs, which quickly releases nicotine into the blood allowing it to get into the brain within seconds of taking a puff. In the brain nicotine increases the release of brain chemicals called neurotransmitters, which help regulate mood and behavior. Dopamine, one of these neurotransmitters, is released in the "reward center" of the brain and causes improved mood and feelings of pleasure. Experiencing these effects from nicotine is what makes tobacco so addictive. Nicotine dependence involves behavioral (routines, habits, feelings) as well as physical factors. These behavioral associations with smoking may act as triggers - situations or feelings that activate a craving for tobacco, even if you have not smoked for some time. Behaviors and cues that you may associate with smoking include: - Certain times of the day, such as first thing in the morning, with morning coffee or during breaks at work - After a meal - Drinking alcohol - Certain places or friends - Talking on the phone - Stressful situations or when you're feeling down - Sight or smell of a burning cigarette - Driving your car To overcome your dependence on tobacco, you need to become aware of your triggers and develop a plan to deal with the behaviors and routines that you associate with smoking. Risk factors Anyone who smokes or uses other forms of tobacco is at risk of becoming dependent. Factors that influence who will use tobacco include: - Genetics. The likelihood that you will start smoking and keep smoking may be partly inherited - genetic factors may influence how receptors on the surface of your brain's nerve cells respond to high doses of nicotine delivered by cigarettes. - Home and peer influence. Children who grow up with parents who smoke are more likely to become smokers. Children with friends who smoke also are more likely to try cigarettes. Evidence suggests that smoking shown in movies and on the Internet can encourage young people to smoke. - Age. Most people begin smoking during childhood or the teen years. The younger you are when you begin smoking, the greater the chance that you'll become a heavy smoker as an adult. - Depression or other mental illness. Many studies show an association between depression and smoking. People who have depression, schizophrenia, post-traumatic stress disorder (PTSD) or other forms of mental illness are more likely to be smokers. - Substance use. People who abuse alcohol and illegal drugs are more likely to be smokers. Complications Tobacco smoke contains more than 60 known cancer-causing chemicals and thousands of other harmful substances. Even "all natural" or herbal cigarettes have chemicals that are harmful to your health. Smoking harms almost every organ of your body and impairs your body's immune system. About half of all regular smokers will die of a disease caused by tobacco. Women smokers are now at equal risk to men smokers of dying from lung cancer, COPD and cardiovascular disease caused by using tobacco. The negative health effects include: - Lung cancer and other lung diseases. Smoking causes nearly 9 out of 10 lung cancer cases. In addition, smoking causes other lung diseases, such as emphysema and chronic bronchitis. Smoking also makes asthma worse. - Other cancers. Smoking is a major cause of cancers of the esophagus, larynx, throat (pharynx) and mouth and is related to cancers of the bladder, pancreas, kidney and cervix, and some leukemias. Overall, smoking causes 30 percent of all cancer deaths. - Heart and circulatory system problems. Smoking increases your risk of dying of heart and blood vessel (cardiovascular) disease, including heart attack and stroke. Even smoking just one to four cigarettes daily increases your risk of heart disease. If you have heart or blood vessel disease, such as heart failure, smoking worsens your condition. However, stopping smoking reduces your risk of having a heart attack by 50 percent in the first year. - Diabetes. Smoking increases insulin resistance, which can set the stage for the development of type 2 diabetes. If you have diabetes, smoking can speed the progress of complications, such as kidney disease and eye problems. - Eye problems. Smoking can increase your risk of serious eye problems such as cataracts and loss of eyesight from macular degeneration. - Infertility and impotence. Smoking increases the risk of reduced fertility in women and the risk of impotence in men. - Pregnancy and newborn complications. Mothers who smoke while pregnant face a higher risk of miscarriage, preterm delivery, lower birth weight and sudden infant death syndrome (SIDS) in their newborns. - Cold, flu and other illnesses. Smokers are more prone to respiratory infections, such as colds, flu and bronchitis. - Weakened senses. Smoking deadens your senses of taste and smell, so food isn't as appetizing. - Teeth and gum disease. Smoking is associated with an increased risk of developing inflammation of the gum (gingivitis) and a serious gum infection that can destroy the support system for teeth (periodontitis). - Physical appearance. The chemicals in tobacco smoke can change the structure of your skin, causing premature aging and wrinkles. Smoking also yellows your teeth, fingers and fingernails. - Risks to your family. Nonsmoking spouses and partners of smokers have a higher risk of lung cancer and heart disease compared with people who don't live with a smoker. If you smoke, your children will be more prone to SIDS, worsening asthma, ear infections and colds. Diagnosis Your doctor may ask you questions or have you complete a questionnaire to get a sense of how dependent you are on nicotine. The more cigarettes you smoke each day and the sooner you smoke after awakening, the more dependent you are. Knowing your degree of dependence will help your doctor determine the best treatment plan for you. Treatment Like most smokers, you've probably made at least one serious attempt to stop. But it's rare to stop smoking on your first attempt - especially if you try to do it without help. You're much more likely to stop if you use medications and counseling, which have both been proved effective, especially in combination. Medications Many treatments, including nicotine replacement therapy and non-nicotine medications, have been approved as safe and effective in treating nicotine dependence. Using more than one medication may help you get better results. For example, combining a longer acting medication with a short-acting nicotine replacement product may be beneficial. Talk to your health care provider about the right treatment for you. If you're pregnant or breast-feeding, you smoke fewer than 10 cigarettes a day, or you're under age 18, talk to your doctor before taking any over-the-counter nicotine replacement products. Nicotine replacement therapy Nicotine replacement therapy gives you nicotine without tobacco and the harmful chemicals in tobacco smoke. Nicotine replacement products help relieve withdrawal symptoms and cravings. The best time to start using nicotine replacement medication is on the date you've set to stop smoking. Some smokers start earlier in order to reduce smoking on their way to stopping altogether. The following nicotine replacement products are available over-the-counter: - Nicotine patch (NicoDerm CQ, Habitrol, others). The patch delivers nicotine through your skin and into your bloodstream. You wear a new patch each day. You typically use the patch for eight weeks or longer. If you haven't been able to stop smoking completely after two weeks of wearing the patch, ask your doctor about adjusting the dose or adding another nicotine replacement product. Common side effects include skin irritation, insomnia and vivid dreams. - Nicotine gum (Nicorette, others). This gum delivers nicotine to your blood through the lining of your mouth. Nicotine gum is often recommended to curb cravings. Chew the gum for a few times until you feel a mild tingling or peppery taste, then park the gum between your cheek and gumline for several minutes. This chewing and parking allows nicotine to be gradually absorbed in your bloodstream. Mouth irritation is a common side effect. Other side effects are often a result of overly vigorous chewing that releases nicotine too quickly. These include heartburn, nausea and hiccups. - Nicotine lozenge (Commit, Nicorette mini lozenge, others). This lozenge dissolves in your mouth and, like nicotine gum, delivers nicotine through the lining of your mouth. Place the lozenge in your mouth between your gumline and cheek or under your tongue and allow it to dissolve. You'll start with one lozenge every one to two hours and gradually increase the time between lozenges. Avoid drinking anything right before, while using or right after the lozenge. Side effects include mouth irritation as well as nicotine-related effects such as heartburn, nausea and hiccups. These nicotine replacement products are available by prescription: - Nicotine nasal spray (Nicotrol NS). The nicotine in this product, sprayed directly into each nostril, is absorbed through your nasal membranes into your blood vessels. The nasal spray delivers nicotine a bit quicker than gum, lozenges or the patch, but not as rapidly as smoking a cigarette. It's usually prescribed for three-month periods for up to six months. Nasal and throat irritation, runny nose, sneezing and coughing are common side effects. - Nicotine inhaler (Nicotrol). This device is shaped something like a cigarette holder. You puff on it, and it delivers nicotine vapor into your mouth. You absorb the nicotine through the lining in your mouth, where it then enters your bloodstream. Common side effects are mouth and throat irritation and occasional coughing. Non-nicotine medications Medications that don't contain nicotine and are available by prescription include: - Bupropion (Zyban). The antidepressant drug bupropion increases levels of dopamine and norepinephrine, brain chemicals that are also boosted by nicotine. Typically your doctor will advise you to start bupropion one week before you stop smoking. Bupropion has the advantage of helping to minimize weight gain after you quit smoking. Common side effects include insomnia, agitation, headache and dry mouth. If you have a history of seizures or serious head trauma, such as a skull fracture, you shouldn't take this drug. - Varenicline (Chantix). This medication acts on the brain's nicotine receptors, decreasing withdrawal symptoms and reducing the feelings of pleasure you get from smoking. Typically your doctor will advise you to start varenicline one week before you stop smoking. Common side effects include nausea, headache, insomnia and vivid dreams. Rarely, varenicline has been associated with serious psychiatric symptoms, such as depressed mood and suicidal thoughts. - Nortriptyline (Pamelor). This medication may be prescribed if other medications haven't helped. This tricyclic antidepressant acts by increasing the levels of the brain neurotransmitter norepinephrine. Common side effects may include dry mouth, drowsiness, dizziness and constipation. Counseling, support groups and other programs Combining medications with behavioral counseling provides the best chance for establishing long-term smoking abstinence. Medications help you cope by reducing withdrawal symptoms including tobacco craving, while behavioral treatments help you develop the skills you need to avoid tobacco over the long run. The more time you spend with a counselor, the better your treatment results will be. Several types of counseling and support can help with stopping smoking: - Telephone counseling. No matter where you live, you can take advantage of phone counseling to help you give up tobacco. Every state in the U.S. has a telephone quit line, and some have more than one. To find the options in your state, call 800-QUIT-NOW (800-784-8669). - Individual or group counseling program. Your doctor may recommend local support groups or a treatment program where counseling is provided by a tobacco treatment specialist. Counseling helps you learn techniques for preparing to stop smoking and provides support for you during the process. Many hospitals, health care plans, health care providers and employers offer treatment programs or have tobacco treatment specialists who are certified to provide treatment for nicotine dependence. Nicotine Anonymous groups are available in many locations to provide support for smokers trying to quit. Some medical centers provide residential treatment programs - the most intensive treatment available. - Internet-based programs. Several websites offer support and strategies for people who want to stop smoking. BecomeAnEX is free and provides information and techniques as well as blogs, community forums, ask the expert and many other features. Text messaging services, including personalized reminders about a quit-smoking plan, also may prove helpful. Methods to avoid It's not a good idea to substitute another type of tobacco use for cigarette smoking. Tobacco in any form is not safe. Even products that deliver nicotine without tobacco are risky. Stick with proven stop-smoking aids and steer clear of the following products: - Dissolvable tobacco products. Tobacco pouches, lozenges, strips or other products contain small amounts of tobacco and nicotine you hold or dissolve in your mouth. There is no evidence they will help you stop smoking and little is known about their health effects. - E-cigarettes. Electronic cigarettes, or e-cigarettes, are battery-powered devices that heat liquid containing nicotine into a vapor to be inhaled. Because these products are new, there isn't much data about possible safety risks. Studies of e-cigarettes for smoking cessation have shown mixed results. For these reasons, e-cigarettes aren't recommended for people trying to quit smoking. - Flavored cigarettes. Clove cigarettes (kreteks) and flavored cigarettes (bidis) carry the same health risks as smoking regular cigarettes and can cause additional health problems. Although they're banned in the United States, flavored cigarettes are available in other countries. - Hookahs (narghiles). These are water pipes that burn tobacco, and the smoke is inhaled through a hose. They are not safer than cigarettes. The water does not filter out toxins in the smoke, and the water and pipe have a risk of transmitting infections. - Nicotine lollipops and balms. Products containing nicotine salicylate are not approved by the Food and Drug Administration, and they pose a risk for accidental use by children. - Pipes and cigars. These products have similar, though less frequent, health risks as cigarettes, and they are not a safe alternative. - Smokeless tobacco and snuff (snus). These products contain nicotine in amounts similar to cigarettes and increase your risk of mouth and throat cancer, tooth and gum diseases, and other health problems. Lifestyle and home remedies It's important to have a plan for managing nicotine withdrawal symptoms. Withdrawal symptoms are usually the most intense during the first week after you stop smoking. They may continue for several weeks, with declining intensity. Although most nicotine withdrawal symptoms pass within a month, you may occasionally experience a strong urge or craving to smoke months after stopping. Triggers or cues that were associated with your smoking can provoke these urges or cravings. Here's what you can do to help manage nicotine withdrawal symptoms: - Exercise regularly. Regular physical activity has been found to reduce withdrawal symptoms and help people stop smoking. Exercise also helps avoid potential weight gain often associated with stopping. - Wait out cravings. Cravings or urges usually last less than five minutes. Wash the dishes, go for a walk or have a healthy snack, such as carrots, an apple or sunflower seeds, which will keep your mouth busy. Do something that keeps your hands busy, and before you know it, the urge will have passed. This is why you want to get rid of tobacco supplies when you decide to quit. You don't want to have any on hand when a craving hits. - Identify rationalizations. If you find yourself thinking, "I'll just smoke one to get through this tough time" or "Just one won't hurt," recognize it as a message that can derail your plan. Review your reasons for quitting, and replace that thought with something positive to support your stopping. - Talk to a support person. If you're feeling anxious or depressed or need encouragement, a support person can help you get through a difficult craving. - Avoid high-risk situations. Know your triggers, and stay away from people, places and situations that tempt you to smoke. - Eat regular, healthy meals. Include plenty of fruits and vegetables, and drink more water. Alternative medicine Many products claim to be smoking-cessation aids. Many also claim to be "natural." Just remember that "natural" doesn't necessarily mean "safe." Talk with your doctor before trying any alternative medicine treatments. - Acupuncture. Acupuncture involves stimulating points on the body, typically with thin, solid, metallic needles. Several studies have been conducted on the effects of acupuncture or acupressure for smoking cessation, but there's no definitive evidence that it works. - Herbs and supplements. A few studies have been conducted on the dietary supplements SAMe, silver acetate and St. John's wort for the treatment of tobacco dependence, but there is no current evidence that any natural product improves smoking cessation rates. - Hypnosis. Although no evidence supports the use of hypnosis - also called hypnotherapy - in smoking cessation, some people find it helpful. If you choose to pursue hypnosis, talk to your doctor about finding a reputable therapist. - Meditation. Although no evidence supports the effectiveness of meditation in smoking cessation, some people find it helpful to reduce symptoms of anxiety.
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Pancreatic Cancer Overview The pancreas lies behind the stomach and in front of the spine. There are two kinds of cells in the pancreas. Exocrine pancreas cells make enzymes that are released into the small intestine to help the body digest food. Neuroendocrine pancreas cells (such as islet cells) make several hormones, including insulin and glucagon, that help control sugar levels in the blood. Most pancreatic cancers form in exocrine cells. These tumors do not secrete hormones and do not cause signs or symptoms. This makes it hard to diagnose this type of pancreatic cancer early. For most patients with exocrine pancreatic cancer, current treatments do not cure the cancer. Some types of malignant pancreatic neuroendocrine tumors, such as islet cell tumors, have a better prognosis than pancreatic exocrine cancers. General Information About Pancreatic Cancer Key Points - Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas. - Smoking and health history can affect the risk of pancreatic cancer. - Signs and symptoms of pancreatic cancer include jaundice, pain, and weight loss. - Pancreatic cancer is difficult to detect (find) and diagnose early. - Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer. - Certain factors affect prognosis (chance of recovery) and treatment options. Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas. The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies between the stomach and the spine. Enlarge Anatomy of the pancreas. The pancreas has three areas: head, body, and tail. It is found in the abdomen near the stomach, intestines, and other organs. The pancreas has two main jobs in the body: - To make juices that help digest (break down) food. - To make hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food. The digestive juices are made by exocrine pancreas cells and the hormones are made by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells. This summary is about exocrine pancreatic cancer. For information on endocrine pancreatic cancer, see the PDQ summary on Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment. For information on pancreatic cancer in children, see the PDQ summary on Unusual Cancers of Childhood Treatment. Smoking and health history can affect the risk of pancreatic cancer. Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for pancreatic cancer include the following: - Smoking. - Being very overweight. - Having a personal history of diabetes or chronic pancreatitis. - Having a family history of pancreatic cancer or pancreatitis. - Having certain hereditary conditions, such as: - Multiple endocrine neoplasia type 1 (MEN1) syndrome. - Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome). - von Hippel-Lindau syndrome. - Peutz-Jeghers syndrome. - Hereditary breast and ovarian cancer syndrome. - Familial atypical multiple mole melanoma (FAMMM) syndrome. Signs and symptoms of pancreatic cancer include jaundice, pain, and weight loss. Pancreatic cancer may not cause early signs or symptoms. Signs and symptoms may be caused by pancreatic cancer or by other conditions. Check with your doctor if you have any of the following: - Jaundice (yellowing of the skin and whites of the eyes). - Light-colored stools. - Dark urine. - Pain in the upper or middle abdomen and back. - Weight loss for no known reason. - Loss of appetite. - Feeling very tired. Pancreatic cancer is difficult to detect (find) and diagnose early. Pancreatic cancer is difficult to detect and diagnose for the following reasons: - There aren't any noticeable signs or symptoms in the early stages of pancreatic cancer. - The signs and symptoms of pancreatic cancer, when present, are like the signs and symptoms of many other illnesses. - The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts. Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer. Pancreatic cancer is usually diagnosed with tests and procedures that make pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time. In order to plan treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed by surgery. The following tests and procedures may be used: - Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken. - Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances, such as bilirubin, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. - Tumor marker test : A procedure in which a sample of blood, urine, or tissue is checked to measure the amounts of certain substances, such as CA 19-9, and carcinoembryonic antigen (CEA), made by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the body. These are called tumor markers. - MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). - CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path. - PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT. - Abdominal ultrasound : An ultrasound exam used to make pictures of the inside of the abdomen. The ultrasound transducer is pressed against the skin of the abdomen and directs high-energy sound waves (ultrasound) into the abdomen. The sound waves bounce off the internal tissues and organs and make echoes. The transducer receives the echoes and sends them to a computer, which uses the echoes to make pictures called sonograms. The picture can be printed to be looked at later. - Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. - Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken. - Percutaneous transhepatic cholangiography (PTC): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done. - Laparoscopy : A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. The laparoscope may have an ultrasound probe at the end in order to bounce high-energy sound waves off internal organs, such as the pancreas. This is called laparoscopic ultrasound. Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples from the pancreas or a sample of fluid from the abdomen to check for cancer. - Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer. A fine needle or a core needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy. Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: - Whether or not the tumor can be removed by surgery. - The stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body). - The patient's general health. - Whether the cancer has just been diagnosed or has recurred (come back). Pancreatic cancer can be controlled only if it is found before it has spread, when it can be completely removed by surgery. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease. Stages of Pancreatic Cancer Key Points - Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for pancreatic cancer: - Stage 0 (Carcinoma in Situ) - Stage I - Stage II - Stage III - Stage IV Tests and procedures to stage pancreatic cancer are usually done at the same time as diagnosis. The process used to find out if cancer has spread within the pancreas or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of some of the tests used to diagnose pancreatic cancer are often also used to stage the disease. See the General Information section for more information. There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood: - Tissue. The cancer spreads from where it began by growing into nearby areas. - Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. - Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood. - Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body. - Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if pancreatic cancer spreads to the liver, the cancer cells in the liver are actually pancreatic cancer cells. The disease is metastatic pancreatic cancer, not liver cancer. The following stages are used for pancreatic cancer: Stage 0 (Carcinoma in Situ) In stage 0, abnormal cells are found in the lining of the pancreas. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ. Enlarge Tumor sizes. The size of a tumor may be compared to the size of a pea (1 cm), peanut (2 cm), grape (3 cm), walnut (4 cm), lime (5 cm), egg (6 cm), peach (7 cm), or grapefruit (10 cm). Stage I Enlarge Stage I pancreatic cancer. In stage IA, the tumor is 2 centimeters or smaller. In stage IB, the tumor is larger than 2 centimeters. In stage I, cancer has formed and is found in the pancreas only. Stage I is divided into stage IA and stage IB, based on the size of the tumor. - Stage IA: The tumor is 2 centimeters or smaller. - Stage IB: The tumor is larger than 2 centimeters. Stage II In stage II, cancer may have spread to nearby tissue and organs, and may have spread to lymph nodes near the pancreas. Stage II is divided into stage IIA and stage IIB, based on where the cancer has spread. - Stage IIA: Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes. Enlarge Stage IIA pancreatic cancer. Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes. - Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs. Enlarge Stage IIB pancreatic cancer. Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs. Stage III Enlarge Stage III pancreatic cancer. Cancer has spread to the major blood vessels near the pancreas. These include the superior mesenteric artery, celiac axis, common hepatic artery, and portal vein. Cancer may have spread to nearby lymph nodes. In stage III, cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes. Stage IV Enlarge Stage IV pancreatic cancer. Cancer may be any size and has spread to other parts of the body, such as the lung, liver, and peritoneal cavity (the space in the abdomen that contains the intestines, stomach, and liver). Cancer may also have spread to tissues and organs near the pancreas or to lymph nodes. In stage IV, cancer may be of any size and has spread to distant organs, such as the liver, lung, and peritoneal cavity. It may have also spread to organs and tissues near the pancreas or to lymph nodes. Stage 0 (Carcinoma in Situ) In stage 0, abnormal cells are found in the lining of the pancreas. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ. Stage I Enlarge Stage I pancreatic cancer. In stage IA, the tumor is 2 centimeters or smaller. In stage IB, the tumor is larger than 2 centimeters. In stage I, cancer has formed and is found in the pancreas only. Stage I is divided into stage IA and stage IB, based on the size of the tumor. - Stage IA: The tumor is 2 centimeters or smaller. - Stage IB: The tumor is larger than 2 centimeters. Stage II In stage II, cancer may have spread to nearby tissue and organs, and may have spread to lymph nodes near the pancreas. Stage II is divided into stage IIA and stage IIB, based on where the cancer has spread. - Stage IIA: Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes. Enlarge Stage IIA pancreatic cancer. Cancer has spread to nearby tissue and organs but has not spread to nearby lymph nodes. - Stage IIB: Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs. Enlarge Stage IIB pancreatic cancer. Cancer has spread to nearby lymph nodes and may have spread to nearby tissue and organs. Stage III Enlarge Stage III pancreatic cancer. Cancer has spread to the major blood vessels near the pancreas. These include the superior mesenteric artery, celiac axis, common hepatic artery, and portal vein. Cancer may have spread to nearby lymph nodes. In stage III, cancer has spread to the major blood vessels near the pancreas and may have spread to nearby lymph nodes. Stage IV Enlarge Stage IV pancreatic cancer. Cancer may be any size and has spread to other parts of the body, such as the lung, liver, and peritoneal cavity (the space in the abdomen that contains the intestines, stomach, and liver). Cancer may also have spread to tissues and organs near the pancreas or to lymph nodes. In stage IV, cancer may be of any size and has spread to distant organs, such as the liver, lung, and peritoneal cavity. It may have also spread to organs and tissues near the pancreas or to lymph nodes. Recurrent Pancreatic Cancer Treatment Option Overview Key Points - There are different types of treatment for patients with pancreatic cancer. - Five types of standard treatment are used: - Surgery - Radiation therapy - Chemotherapy - Chemoradiation therapy - Targeted therapy - There are treatments for pain caused by pancreatic cancer. - Patients with pancreatic cancer have special nutritional needs. - New types of treatment are being tested in clinical trials. - Biologic therapy - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed There are different types of treatment for patients with pancreatic cancer. Different types of treatment are available for patients with pancreatic cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Five types of standard treatment are used: Surgery One of the following types of surgery may be used to take out the tumor: - Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin. - Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes. - Distal pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed. If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms and improve quality of life: - Surgical biliary bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area. - Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine. - Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally. Radiation therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy: - External radiation therapy uses a machine outside the body to send radiation toward the cancer. - Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat pancreatic cancer. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated. See Drugs Approved for Pancreatic Cancer for more information. Chemoradiation therapy Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Tyrosine kinase inhibitors (TKIs) are targeted therapy drugs that block signals needed for tumors to grow. Erlotinib is a type of TKI used to treat pancreatic cancer. See Drugs Approved for Pancreatic Cancer for more information. Surgery One of the following types of surgery may be used to take out the tumor: - Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to produce digestive juices and insulin. - Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes. - Distal pancreatectomy: The body and the tail of the pancreas and usually the spleen are removed. If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms and improve quality of life: - Surgical biliary bypass: If cancer is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area. - Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine. - Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally. Radiation therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy: - External radiation therapy uses a machine outside the body to send radiation toward the cancer. - Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat pancreatic cancer. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated. See Drugs Approved for Pancreatic Cancer for more information. Chemoradiation therapy Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Tyrosine kinase inhibitors (TKIs) are targeted therapy drugs that block signals needed for tumors to grow. Erlotinib is a type of TKI used to treat pancreatic cancer. See Drugs Approved for Pancreatic Cancer for more information. There are treatments for pain caused by pancreatic cancer. Pain can occur when the tumor presses on nerves or other organs near the pancreas. When pain medicine is not enough, there are treatments that act on nerves in the abdomen to relieve the pain. The doctor may inject medicine into the area around affected nerves or may cut the nerves to block the feeling of pain. Radiation therapy with or without chemotherapy can also help relieve pain by shrinking the tumor. See the PDQ summary on Cancer Pain for more information. Patients with pancreatic cancer have special nutritional needs. Surgery to remove the pancreas may affect its ability to make pancreatic enzymes that help to digest food. As a result, patients may have problems digesting food and absorbing nutrients into the body. To prevent malnutrition, the doctor may prescribe medicines that replace these enzymes. See the PDQ summary on Nutrition in Cancer Care for more information. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Biologic therapy Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Biologic therapy Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI's clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website. Follow-up tests may be needed Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups. Treatment Options by Stage Stages I and II Pancreatic Cancer Treatment of stage I and stage II pancreatic cancer may include the following: - Surgery. - Surgery followed by chemotherapy. - Surgery followed by chemoradiation. - A clinical trial of combination chemotherapy. - A clinical trial of chemotherapy and targeted therapy, with or without chemoradiation. - A clinical trial of chemotherapy and/or radiation therapy before surgery. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage III Pancreatic Cancer Treatment of stage III pancreatic cancer may include the following: - Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine. - Chemotherapy followed by chemoradiation. - Chemoradiation followed by chemotherapy. - Chemotherapy with or without targeted therapy. - A clinical trial of new anticancer therapies together with chemotherapy or chemoradiation. - A clinical trial of radiation therapy given during surgery or internal radiation therapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage IV Pancreatic Cancer Treatment of stage IV pancreatic cancer may include the following: - Palliative treatments to relieve pain, such as nerve blocks, and other supportive care. - Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine. - Chemotherapy with or without targeted therapy. - Clinical trials of new anticancer agents with or without chemotherapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Treatment Options for Recurrent Pancreatic Cancer General Information About Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Key Points - Pancreatic neuroendocrine tumors form in hormone-making cells (islet cells) of the pancreas. - Pancreatic NETs may or may not cause signs or symptoms. - There are different kinds of functional pancreatic NETs. - Having certain syndromes can increase the risk of pancreatic NETs. - Different types of pancreatic NETs have different signs and symptoms. - Lab tests and imaging tests are used to detect (find) and diagnose pancreatic NETs. - Other kinds of lab tests are used to check for the specific type of pancreatic NETs. - Certain factors affect prognosis (chance of recovery) and treatment options. Pancreatic neuroendocrine tumors form in hormone-making cells (islet cells) of the pancreas. The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies behind the stomach and in front of the spine. Enlarge Anatomy of the pancreas. The pancreas has three areas: head, body, and tail. It is found in the abdomen near the stomach, intestines, and other organs. There are two kinds of cells in the pancreas: - Endocrine pancreas cells make several kinds of hormones (chemicals that control the actions of certain cells or organs in the body), such as insulin to control blood sugar. They cluster together in many small groups (islets) throughout the pancreas. Endocrine pancreas cells are also called islet cells or islets of Langerhans. Tumors that form in islet cells are called islet cell tumors, pancreatic endocrine tumors, or pancreatic neuroendocrine tumors (pancreatic NETs). - Exocrine pancreas cells make enzymes that are released into the small intestine to help the body digest food. Most of the pancreas is made of ducts with small sacs at the end of the ducts, which are lined with exocrine cells. This summary discusses islet cell tumors of the endocrine pancreas. See the PDQ summary on Pancreatic Cancer Treatment for information on exocrine pancreatic cancer. Pancreatic neuroendocrine tumors (NETs) may be benign (not cancer) or malignant (cancer). When pancreatic NETs are malignant, they are called pancreatic endocrine cancer or islet cell carcinoma. Pancreatic NETs are much less common than pancreatic exocrine tumors and have a better prognosis. Pancreatic NETs may or may not cause signs or symptoms. Pancreatic NETs may be functional or nonfunctional: - Functional tumors make extra amounts of hormones, such as gastrin, insulin, and glucagon, that cause signs and symptoms. - Nonfunctional tumors do not make extra amounts of hormones. Signs and symptoms are caused by the tumor as it spreads and grows. Most nonfunctional tumors are malignant (cancer). Most pancreatic NETs are functional tumors. There are different kinds of functional pancreatic NETs. Pancreatic NETs make different kinds of hormones such as gastrin, insulin, and glucagon. Functional pancreatic NETs include the following: - Gastrinoma: A tumor that forms in cells that make gastrin. Gastrin is a hormone that causes the stomach to release an acid that helps digest food. Both gastrin and stomach acid are increased by gastrinomas. When increased stomach acid, stomach ulcers, and diarrhea are caused by a tumor that makes gastrin, it is called Zollinger-Ellison syndrome. A gastrinoma usually forms in the head of the pancreas and sometimes forms in the small intestine. Most gastrinomas are malignant (cancer). - Insulinoma: A tumor that forms in cells that make insulin. Insulin is a hormone that controls the amount of glucose (sugar) in the blood. It moves glucose into the cells, where it can be used by the body for energy. Insulinomas are usually slow-growing tumors that rarely spread. An insulinoma forms in the head, body, or tail of the pancreas. Insulinomas are usually benign (not cancer). - Glucagonoma: A tumor that forms in cells that make glucagon. Glucagon is a hormone that increases the amount of glucose in the blood. It causes the liver to break down glycogen. Too much glucagon causes hyperglycemia (high blood sugar). A glucagonoma usually forms in the tail of the pancreas. Most glucagonomas are malignant (cancer). - Other types of tumors: There are other rare types of functional pancreatic NETs that make hormones, including hormones that control the balance of sugar, salt, and water in the body. These tumors include: - VIPomas, which make vasoactive intestinal peptide. VIPoma may also be called Verner-Morrison syndrome. - Somatostatinomas, which make somatostatin. These other types of tumors are grouped together because they are treated in much the same way. Having certain syndromes can increase the risk of pancreatic NETs. Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Multiple endocrine neoplasia type 1 (MEN1) syndrome is a risk factor for pancreatic NETs. Different types of pancreatic NETs have different signs and symptoms. Signs or symptoms can be caused by the growth of the tumor and/or by hormones the tumor makes or by other conditions. Some tumors may not cause signs or symptoms. Check with your doctor if you have any of these problems. Signs and symptoms of a non-functional pancreatic NET A non-functional pancreatic NET may grow for a long time without causing signs or symptoms. It may grow large or spread to other parts of the body before it causes signs or symptoms, such as: - Diarrhea. - Indigestion. - A lump in the abdomen. - Pain in the abdomen or back. - Yellowing of the skin and whites of the eyes. Signs and symptoms of a functional pancreatic NET The signs and symptoms of a functional pancreatic NET depend on the type of hormone being made. Too much gastrin may cause: - Stomach ulcers that keep coming back. - Pain in the abdomen, which may spread to the back. The pain may come and go and it may go away after taking an antacid. - The flow of stomach contents back into the esophagus (gastroesophageal reflux). - Diarrhea. Too much insulin may cause: - Low blood sugar. This can cause blurred vision, headache, and feeling lightheaded, tired, weak, shaky, nervous, irritable, sweaty, confused, or hungry. - Fast heartbeat. Too much glucagon may cause: - Skin rash on the face, stomach, or legs. - High blood sugar. This can cause headaches, frequent urination, dry skin and mouth, or feeling hungry, thirsty, tired, or weak. - Blood clots. Blood clots in the lung can cause shortness of breath, cough, or pain in the chest. Blood clots in the arm or leg can cause pain, swelling, warmth, or redness of the arm or leg. - Diarrhea. - Weight loss for no known reason. - Sore tongue or sores at the corners of the mouth. Too much vasoactive intestinal peptide (VIP) may cause: - Very large amounts of watery diarrhea. - Dehydration. This can cause feeling thirsty, making less urine, dry skin and mouth, headaches, dizziness, or feeling tired. - Low potassium level in the blood. This can cause muscle weakness, aching, or cramps, numbness and tingling, frequent urination, fast heartbeat, and feeling confused or thirsty. - Cramps or pain in the abdomen. - Weight loss for no known reason. Too much somatostatin may cause: - High blood sugar. This can cause headaches, frequent urination, dry skin and mouth, or feeling hungry, thirsty, tired, or weak. - Diarrhea. - Steatorrhea (very foul-smelling stool that floats). - Gallstones. - Yellowing of the skin and whites of the eyes. - Weight loss for no known reason. Lab tests and imaging tests are used to detect (find) and diagnose pancreatic NETs. The following tests and procedures may be used: - Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken. - Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances, such as glucose (sugar), released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. - Chromogranin A test: A test in which a blood sample is checked to measure the amount of chromogranin A in the blood. A higher than normal amount of chromogranin A and normal amounts of hormones such as gastrin, insulin, and glucagon can be a sign of a non-functional pancreatic NET. - Abdominal CT scan (CAT scan): A procedure that makes a series of detailed pictures of the abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. - MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). - Somatostatin receptor scintigraphy : A type of radionuclide scan that may be used to find small pancreatic NETs. A small amount of radioactive octreotide (a hormone that attaches to tumors) is injected into a vein and travels through the blood. The radioactive octreotide attaches to the tumor and a special camera that detects radioactivity is used to show where the tumors are in the body. This procedure is also called octreotide scan and SRS. - Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography. - Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope is passed through the mouth, esophagus, and stomach into the first part of the small intestine. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken and checked under a microscope for signs of cancer. - Angiogram : A procedure to look at blood vessels and the flow of blood. A contrast dye is injected into the blood vessel. As the contrast dye moves through the blood vessel, x-rays are taken to see if there are any blockages. - Laparotomy : A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease. - Intraoperative ultrasound : A procedure that uses high-energy sound waves (ultrasound) to create images of internal organs or tissues during surgery. A transducer placed directly on the organ or tissue is used to make the sound waves, which create echoes. The transducer receives the echoes and sends them to a computer, which uses the echoes to make pictures called sonograms. - Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreatic NETs. Cells may be removed using a fine or wide needle inserted into the pancreas during an x-ray or ultrasound. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen). - Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in bones with cancer and is detected by a scanner. Other kinds of lab tests are used to check for the specific type of pancreatic NETs. The following tests and procedures may be used: Gastrinoma - Fasting serum gastrin test: A test in which a blood sample is checked to measure the amount of gastrin in the blood. This test is done after the patient has had nothing to eat or drink for at least 8 hours. Conditions other than gastrinoma can cause an increase in the amount of gastrin in the blood. - Basal acid output test: A test to measure the amount of acid made by the stomach. The test is done after the patient has had nothing to eat or drink for at least 8 hours. A tube is inserted through the nose or throat, into the stomach. The stomach contents are removed and four samples of gastric acid are removed through the tube. These samples are used to find out the amount of gastric acid made during the test and the pH level of the gastric secretions. - Secretin stimulation test : If the basal acid output test result is not normal, a secretin stimulation test may be done. The tube is moved into the small intestine and samples are taken from the small intestine after a drug called secretin is injected. Secretin causes the small intestine to make acid. When there is a gastrinoma, the secretin causes an increase in how much gastric acid is made and the level of gastrin in the blood. - Somatostatin receptor scintigraphy: A type of radionuclide scan that may be used to find small pancreatic NETs. A small amount of radioactive octreotide (a hormone that attaches to tumors) is injected into a vein and travels through the blood. The radioactive octreotide attaches to the tumor and a special camera that detects radioactivity is used to show where the tumors are in the body. This procedure is also called octreotide scan and SRS. Insulinoma - Fasting serum glucose and insulin test: A test in which a blood sample is checked to measure the amounts of glucose (sugar) and insulin in the blood. The test is done after the patient has had nothing to eat or drink for at least 24 hours. Glucagonoma - Fasting serum glucagon test: A test in which a blood sample is checked to measure the amount of glucagon in the blood. The test is done after the patient has had nothing to eat or drink for at least 8 hours. Other tumor types - VIPoma - Serum VIP (vasoactive intestinal peptide) test: A test in which a blood sample is checked to measure the amount of VIP. - Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. In VIPoma, there is a lower than normal amount of potassium. - Stool analysis : A stool sample is checked for a higher than normal sodium (salt) and potassium levels. - Somatostatinoma - Fasting serum somatostatin test: A test in which a blood sample is checked to measure the amount of somatostatin in the blood. The test is done after the patient has had nothing to eat or drink for at least 8 hours. - Somatostatin receptor scintigraphy: A type of radionuclide scan that may be used to find small pancreatic NETs. A small amount of radioactive octreotide (a hormone that attaches to tumors) is injected into a vein and travels through the blood. The radioactive octreotide attaches to the tumor and a special camera that detects radioactivity is used to show where the tumors are in the body. This procedure is also called octreotide scan and SRS. Certain factors affect prognosis (chance of recovery) and treatment options. Pancreatic NETs can often be cured. The prognosis (chance of recovery) and treatment options depend on the following: - The type of cancer cell. - Where the tumor is found in the pancreas. - Whether the tumor has spread to more than one place in the pancreas or to other parts of the body. - Whether the patient has MEN1 syndrome. - The patient's age and general health. - Whether the cancer has just been diagnosed or has recurred (come back). Stages of Pancreatic Neuroendocrine Tumors Key Points - The plan for cancer treatment depends on where the NET is found in the pancreas and whether it has spread. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. The plan for cancer treatment depends on where the NET is found in the pancreas and whether it has spread. The process used to find out if cancer has spread within the pancreas or to other parts of the body is called staging. The results of the tests and procedures used to diagnose pancreatic neuroendocrine tumors (NETs) are also used to find out whether the cancer has spread. See the General Information section for a description of these tests and procedures. Although there is a standard staging system for pancreatic NETs, it is not used to plan treatment. Treatment of pancreatic NETs is based on the following: - Whether the cancer is found in one place in the pancreas. - Whether the cancer is found in several places in the pancreas. - Whether the cancer has spread to lymph nodes near the pancreas or to other parts of the body such as the liver, lung, peritoneum, or bone. There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood: - Tissue. The cancer spreads from where it began by growing into nearby areas. - Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. - Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood. - Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body. - Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. The metastatic tumor is the same type of tumor as the primary tumor. For example, if a pancreatic neuroendocrine tumor spreads to the liver, the tumor cells in the liver are actually neuroendocrine tumor cells. The disease is metastatic pancreatic neuroendocrine tumor, not liver cancer. View this video on YouTube. Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body. Recurrent Pancreatic Neuroendocrine Tumors Treatment Option Overview Key Points - There are different types of treatment for patients with pancreatic NETs. - Six types of standard treatment are used: - Surgery - Chemotherapy - Hormone therapy - Hepatic arterial occlusion or chemoembolization - Targeted therapy - Supportive care - New types of treatment are being tested in clinical trials. - Treatment for pancreatic neuroendocrine tumors may cause side effects. - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed. There are different types of treatment for patients with pancreatic NETs. Different types of treatments are available for patients with pancreatic neuroendocrine tumors (NETs). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Six types of standard treatment are used: Surgery An operation may be done to remove the tumor. One of the following types of surgery may be used: - Enucleation: Surgery to remove the tumor only. This may be done when cancer occurs in one place in the pancreas. - Pancreatoduodenectomy: A surgical procedure in which the head of the pancreas, the gallbladder, nearby lymph nodes and part of the stomach, small intestine, and bile duct are removed. Enough of the pancreas is left to make digestive juices and insulin. The organs removed during this procedure depend on the patient's condition. This is also called the Whipple procedure. - Distal pancreatectomy: Surgery to remove the body and tail of the pancreas. The spleen may also be removed. - Total gastrectomy: Surgery to remove the whole stomach. - Parietal cell vagotomy: Surgery to cut the nerve that causes stomach cells to make acid. - Liver resection: Surgery to remove part or all of the liver. - Radiofrequency ablation: The use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital with general anesthesia. - Cryosurgical ablation: A procedure in which tissue is frozen to destroy abnormal cells. This is usually done with a special instrument that contains liquid nitrogen or liquid carbon dioxide. The instrument may be used during surgery or laparoscopy or inserted through the skin. This procedure is also called cryoablation. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type of the cancer being treated. Hormone therapy Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working. Hepatic arterial occlusion or chemoembolization Hepatic arterial occlusion uses drugs, small particles, or other agents to block or reduce the flow of blood to the liver through the hepatic artery (the major blood vessel that carries blood to the liver). This is done to kill cancer cells growing in the liver. The tumor is prevented from getting the oxygen and nutrients it needs to grow. The liver continues to receive blood from the hepatic portal vein, which carries blood from the stomach and intestine. Chemotherapy delivered during hepatic arterial occlusion is called chemoembolization. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with the substance that blocks the artery and cuts off blood flow to the tumor. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Certain types of targeted therapies are being studied in the treatment of pancreatic NETs. Supportive care Supportive care is given to lessen the problems caused by the disease or its treatment. Supportive care for pancreatic NETs may include treatment for the following: - Stomach ulcers may be treated with drug therapy such as: - Proton pump inhibitor drugs such as omeprazole, lansoprazole, or pantoprazole. - Histamine blocking drugs such as cimetidine, ranitidine, or famotidine. - Somatostatin-type drugs such as octreotide. - Diarrhea may be treated with: - Intravenous (IV) fluids with electrolytes such as potassium or chloride. - Somatostatin-type drugs such as octreotide. - Low blood sugar may be treated by having small, frequent meals or with drug therapy to maintain a normal blood sugar level. - High blood sugar may be treated with drugs taken by mouth or insulin by injection. Surgery An operation may be done to remove the tumor. One of the following types of surgery may be used: - Enucleation: Surgery to remove the tumor only. This may be done when cancer occurs in one place in the pancreas. - Pancreatoduodenectomy: A surgical procedure in which the head of the pancreas, the gallbladder, nearby lymph nodes and part of the stomach, small intestine, and bile duct are removed. Enough of the pancreas is left to make digestive juices and insulin. The organs removed during this procedure depend on the patient's condition. This is also called the Whipple procedure. - Distal pancreatectomy: Surgery to remove the body and tail of the pancreas. The spleen may also be removed. - Total gastrectomy: Surgery to remove the whole stomach. - Parietal cell vagotomy: Surgery to cut the nerve that causes stomach cells to make acid. - Liver resection: Surgery to remove part or all of the liver. - Radiofrequency ablation: The use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in the hospital with general anesthesia. - Cryosurgical ablation: A procedure in which tissue is frozen to destroy abnormal cells. This is usually done with a special instrument that contains liquid nitrogen or liquid carbon dioxide. The instrument may be used during surgery or laparoscopy or inserted through the skin. This procedure is also called cryoablation. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type of the cancer being treated. Hormone therapy Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working. Hepatic arterial occlusion or chemoembolization Hepatic arterial occlusion uses drugs, small particles, or other agents to block or reduce the flow of blood to the liver through the hepatic artery (the major blood vessel that carries blood to the liver). This is done to kill cancer cells growing in the liver. The tumor is prevented from getting the oxygen and nutrients it needs to grow. The liver continues to receive blood from the hepatic portal vein, which carries blood from the stomach and intestine. Chemotherapy delivered during hepatic arterial occlusion is called chemoembolization. The anticancer drug is injected into the hepatic artery through a catheter (thin tube). The drug is mixed with the substance that blocks the artery and cuts off blood flow to the tumor. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. The blockage may be temporary or permanent, depending on the substance used to block the artery. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Certain types of targeted therapies are being studied in the treatment of pancreatic NETs. Supportive care Supportive care is given to lessen the problems caused by the disease or its treatment. Supportive care for pancreatic NETs may include treatment for the following: - Stomach ulcers may be treated with drug therapy such as: - Proton pump inhibitor drugs such as omeprazole, lansoprazole, or pantoprazole. - Histamine blocking drugs such as cimetidine, ranitidine, or famotidine. - Somatostatin-type drugs such as octreotide. - Diarrhea may be treated with: - Intravenous (IV) fluids with electrolytes such as potassium or chloride. - Somatostatin-type drugs such as octreotide. - Low blood sugar may be treated by having small, frequent meals or with drug therapy to maintain a normal blood sugar level. - High blood sugar may be treated with drugs taken by mouth or insulin by injection. New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Treatment for pancreatic neuroendocrine tumors may cause side effects. For information about side effects caused by treatment for cancer, see our Side Effects page. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI's clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website. Follow-up tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups. Treatment Options for Pancreatic Neuroendocrine Tumors Gastrinoma Treatment of gastrinoma may include supportive care and the following: - For symptoms caused by too much stomach acid, treatment may be a drug that decreases the amount of acid made by the stomach. - For a single tumor in the head of the pancreas: - Surgery to remove the tumor. - Surgery to cut the nerve that causes stomach cells to make acid and treatment with a drug that decreases stomach acid. - Surgery to remove the whole stomach (rare). - For a single tumor in the body or tail of the pancreas, treatment is usually surgery to remove the body or tail of the pancreas. - For several tumors in the pancreas, treatment is usually surgery to remove the body or tail of the pancreas. If tumor remains after surgery, treatment may include either: - Surgery to cut the nerve that causes stomach cells to make acid and treatment with a drug that decreases stomach acid; or - Surgery to remove the whole stomach (rare). - For one or more tumors in the duodenum (the part of the small intestine that connects to the stomach), treatment is usually pancreatoduodenectomy (surgery to remove the head of the pancreas, the gallbladder, nearby lymph nodes and part of the stomach, small intestine, and bile duct). - If no tumor is found, treatment may include the following: - Surgery to cut the nerve that causes stomach cells to make acid and treatment with a drug that decreases stomach acid. - Surgery to remove the whole stomach (rare). - If the cancer has spread to the liver, treatment may include: - Surgery to remove part or all of the liver. - Radiofrequency ablation or cryosurgical ablation. - Chemoembolization. - If cancer has spread to other parts of the body or does not get better with surgery or drugs to decrease stomach acid, treatment may include: - Chemotherapy. - Hormone therapy. - If the cancer mostly affects the liver and the patient has severe symptoms from hormones or from the size of tumor, treatment may include: - Hepatic arterial occlusion, with or without systemic chemotherapy. - Chemoembolization, with or without systemic chemotherapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Insulinoma Treatment of insulinoma may include the following: - For one small tumor in the head or tail of the pancreas, treatment is usually surgery to remove the tumor. - For one large tumor in the head of the pancreas that cannot be removed by surgery, treatment is usually pancreatoduodenectomy (surgery to remove the head of the pancreas, the gallbladder, nearby lymph nodes and part of the stomach, small intestine, and bile duct). - For one large tumor in the body or tail of the pancreas, treatment is usually a distal pancreatectomy (surgery to remove the body and tail of the pancreas). - For more than one tumor in the pancreas, treatment is usually surgery to remove any tumors in the head of the pancreas and the body and tail of the pancreas. - For tumors that cannot be removed by surgery, treatment may include the following: - Combination chemotherapy. - Palliative drug therapy to decrease the amount of insulin made by the pancreas. - Hormone therapy. - Radiofrequency ablation or cryosurgical ablation. - For cancer that has spread to lymph nodes or other parts of the body, treatment may include the following: - Surgery to remove the cancer. - Radiofrequency ablation or cryosurgical ablation, if the cancer cannot be removed by surgery. - If the cancer mostly affects the liver and the patient has severe symptoms from hormones or from the size of tumor, treatment may include: - Hepatic arterial occlusion, with or without systemic chemotherapy. - Chemoembolization, with or without systemic chemotherapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Glucagonoma Treatment may include the following: - For one small tumor in the head or tail of the pancreas, treatment is usually surgery to remove the tumor. - For one large tumor in the head of the pancreas that cannot be removed by surgery, treatment is usually pancreatoduodenectomy (surgery to remove the head of the pancreas, the gallbladder, nearby lymph nodes and part of the stomach, small intestine, and bile duct). - For more than one tumor in the pancreas, treatment is usually surgery to remove the tumor or surgery to remove the body and tail of the pancreas. - For tumors that cannot be removed by surgery, treatment may include the following: - Combination chemotherapy. - Hormone therapy. - Radiofrequency ablation or cryosurgical ablation. - For cancer that has spread to lymph nodes or other parts of the body, treatment may include the following: - Surgery to remove the cancer. - Radiofrequency ablation or cryosurgical ablation, if the cancer cannot be removed by surgery. - If the cancer mostly affects the liver and the patient has severe symptoms from hormones or from the size of tumor, treatment may include: - Hepatic arterial occlusion, with or without systemic chemotherapy. - Chemoembolization, with or without systemic chemotherapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Other Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) For VIPoma, treatment may include the following: - Fluids and hormone therapy to replace fluids and electrolytes that have been lost from the body. - Surgery to remove the tumor and nearby lymph nodes. - Surgery to remove as much of the tumor as possible when the tumor cannot be completely removed or has spread to distant parts of the body. This is palliative therapy to relieve symptoms and improve the quality of life. - For tumors that have spread to lymph nodes or other parts of the body, treatment may include the following: - Surgery to remove the tumor. - Radiofrequency ablation or cryosurgical ablation, if the tumor cannot be removed by surgery. - For tumors that continue to grow during treatment or have spread to other parts of the body, treatment may include the following: - Chemotherapy. - Targeted therapy. For somatostatinoma, treatment may include the following: - Surgery to remove the tumor. - For cancer that has spread to distant parts of the body, surgery to remove as much of the cancer as possible to relieve symptoms and improve quality of life. - For tumors that continue to grow during treatment or have spread to other parts of the body, treatment may include the following: - Chemotherapy. - Targeted therapy. Treatment of other types of pancreatic neuroendocrine tumors (NETs) may include the following: - Surgery to remove the tumor. - For cancer that has spread to distant parts of the body, surgery to remove as much of the cancer as possible or hormone therapy to relieve symptoms and improve quality of life. - For tumors that continue to grow during treatment or have spread to other parts of the body, treatment may include the following: - Chemotherapy. - Targeted therapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Recurrent or Progressive Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment of pancreatic neuroendocrine tumors (NETs) that continue to grow during treatment or recur (come back) may include the following: - Surgery to remove the tumor. - Chemotherapy. - Hormone therapy. - Targeted therapy. - For liver metastases: - Regional chemotherapy. - Hepatic arterial occlusion or chemoembolization, with or without systemic chemotherapy. - A clinical trial of a new therapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
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Cystic fibrosis CF Summary Cystic fibrosis is a disease that causes thick, sticky mucus to build up in the lungs, digestive tract, and other areas of the body. It is one of the most common chronic lung diseases in children and young adults. It is a life-threatening disorder. Causes Cystic fibrosis (CF) is a disease that is passed down through families. It is caused by a defective gene that makes the body produce abnormally thick and sticky fluid, called mucus. This mucus builds up in the breathing passages of the lungs and in the pancreas. The buildup of mucus results in life-threatening lung infections and serious digestion problems. The disease may also affect the sweat glands and a man's reproductive system. Many people carry a CF gene, but do not have symptoms. This is because a person with CF must inherit 2 defective genes, 1 from each parent. Some white Americans have the CF gene. It is more common among those of northern or central European descent. Most children with CF are diagnosed by age 2. For a small number, the disease is not detected until age 18 or older. These children often have a milder form of the disease. Symptoms Symptoms in newborns may include: Delayed growth Failure to gain weight normally during childhood No bowel movements in first 24 to 48 hours of life Salty-tasting skin Symptoms related to bowel function may include: Belly pain from severe constipation Increased gas, bloating, or a belly that appears swollen (distended) Nausea and loss of appetite Stools that are pale or clay-colored, foul smelling, have mucus, or that float Weight loss Symptoms related to the lungs and sinuses may include: Coughing or increased mucus in the sinuses or lungs Fatigue Nasal congestion caused by nasal polyps Repeated episodes of pneumonia (symptoms of pneumonia in someone with cystic fibrosis include fever, increased coughing and shortness of breath, increased mucus, and loss of appetite) Sinus pain or pressure caused by infection or polyps Symptoms that may be noticed later in life: Infertility (in men) Repeated inflammation of the pancreas (pancreatitis) Respiratory symptoms Clubbed fingers Exams and Tests A blood test is done to help detect CF. The test looks for changes in the CF gene. Other tests used to diagnose CF include: Immunoreactive trypsinogen (IRT) test is a standard newborn screening test for CF. A high level of IRT suggests possible CF and requires further testing. Sweat chloride test is the standard diagnostic test for CF. A high salt level in the person's sweat is a sign of the disease. Other tests that identify problems that can be related to CF include: Chest x-ray or CT scan Fecal fat test Lung function tests Measurement of pancreatic function Secretin stimulation test Trypsin and chymotrypsin in stool Upper GI and small bowel series Treatment An early diagnosis of CF and treatment plan can improve both survival and quality of life. Follow-up and monitoring are very important. When possible, care should be received at a cystic fibrosis specialty clinic. When children reach adulthood, they should transfer to a cystic fibrosis specialty center for adults. Treatment for lung problems includes: Antibiotics to prevent and treat lung and sinus infections. They may be taken by mouth, or given in the veins or by breathing treatments. People with CF may take antibiotics only when needed, or all the time. Doses are often higher than normal. Inhaled medicines to help open the airways. Other medicines that are given by a breathing treatment to thin mucus and make it easier to cough up are DNAse enzyme. therapy and highly concentrated salt solutions (hypertonic saline). Flu vaccine and pneumococcal polysaccharide vaccine (PPV) yearly (ask your health care provider). Lung transplant is an option in some cases. Oxygen therapy may be needed as lung disease gets worse. Lung problems are also treated with therapies to thin the mucus. This makes it easier to cough the mucus out of the lungs. These methods include: Activity or exercise that causes you to breathe deeply Devices that are used during the day to help clear the airways of too much mucus Manual chest percussion (or chest physiotherapy), in which a family member or a therapist lightly claps the person's chest, back, and area under the arms Treatment for bowel and nutritional problems may include: A special diet high in protein and calories for older children and adults Pancreatic enzymes to help absorb fats and protein, which are taken with every meal Vitamin supplements, especially vitamins A, D, E, and K Your provider can advise other treatments if you have very hard stools Ivacaftor and Lumacaftor are medicines that treat certain types of CF. They improve the function of one of the defective genes that causes CF. As a result, there is less buildup of thick mucus in the lungs. Other CF symptoms are improved as well. Care and monitoring at home should include: Avoiding smoke, dust, dirt, fumes, household chemicals, fireplace smoke, and mold or mildew. Giving plenty of fluids, especially to infants and children in hot weather, when there is diarrhea or loose stools, or during extra physical activity. Exercising 2 or 3 times each week. Swimming, jogging, and cycling are good options. Clearing or bringing up mucus or secretions from the airways. This must be done 1 to 4 times each day. Patients, families, and caregivers must learn about doing chest percussion and postural drainage to help keep the airways clear. Support Groups You can ease the stress of illness by joining a cystic fibrosis support group. Sharing with others who have common experiences and problems can help your family to not feel alone. Outlook (Prognosis) Most children with CF stay in good health until they reach adulthood. They are able to take part in most activities and attend school. Many young adults with CF finish college or find jobs. Lung disease eventually worsens to the point where the person is disabled. Today, the average life span for people with CF who live to adulthood is about 37 years. Death is most often caused by lung complications. Possible Complications The most common complication is chronic respiratory infection. Other complications include: Bowel problems, such as gallstones, intestinal blockage, and rectal prolapse Coughing up blood Chronic respiratory failure Diabetes Infertility Liver disease or liver failure, pancreatitis, biliary cirrhosis Malnutrition Nasal polyps and sinusitis Osteoporosis and arthritis Pneumonia that keeps coming back Pneumothorax Right-sided heart failure (cor pulmonale) When to Contact a Medical Professional Call your provider if an infant or child has symptoms of CF, and experiences: Fever, increased coughing, changes in sputum or blood in sputum, loss of appetite, or other signs of pneumonia Increased weight loss More frequent bowel movements or stools that are foul-smelling or have more mucus Swollen belly or increased bloating Call your provider if a person with CF develops new symptoms or if symptoms get worse, particularly severe breathing difficulty or coughing up blood. Prevention CF cannot be prevented. Screening those with a family history of the disease may detect the CF gene in many carriers. Review Date 2/19/2018 Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Endometriosis Overview Endometriosis (en-doe-me-tree-O-sis) is an often painful disorder in which tissue that normally lines the inside of your uterus - the endometrium - grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs. With endometriosis, displaced endometrial tissue continues to act as it normally would - it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions - abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other. Endometriosis can cause pain - sometimes severe - especially during your period. Fertility problems also may develop. Fortunately, effective treatments are available. Symptoms The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual pain that's far worse than usual. They also tend to report that the pain increases over time. Common signs and symptoms of endometriosis may include: - Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before your period and extend several days into your period. You may also have lower back and abdominal pain. - Pain with intercourse. Pain during or after sex is common with endometriosis. - Pain with bowel movements or urination. You're most likely to experience these symptoms during your period. - Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia). - Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility. - Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods. The severity of your pain isn't necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all. Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis. See your doctor if you have signs and symptoms that may indicate endometriosis. Endometriosis can be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team and an understanding of your diagnosis may result in better management of your symptoms. Causes Although the exact cause of endometriosis is not certain, possible explanations include: - Retrograde menstruation. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle. - Transformation of peritoneal cells. In what's known as the "induction theory," experts propose that hormones or immune factors promote transformation of peritoneal cells - cells that line the inner side of your abdomen - into endometrial cells. - Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells - cells in the earliest stages of development - into endometrial cell implants during puberty. - Surgical scar implantation. After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision. - Endometrial cells transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body. - Immune system disorder. It's possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that's growing outside the uterus. Risk factors Several factors place you at greater risk of developing endometriosis, such as: - Never giving birth - Starting your period at an early age - Going through menopause at an older age - Short menstrual cycles - for instance, less than 27 days - Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces - Low body mass index - Alcohol consumption - One or more relatives (mother, aunt or sister) with endometriosis - Any medical condition that prevents the normal passage of menstrual flow out of the body - Uterine abnormalities Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause, unless you're taking estrogen. Diagnosis To diagnose endometriosis and other conditions that can cause pelvic pain, your doctor will ask you to describe your symptoms, including the location of your pain and when it occurs. Tests to check for physical clues of endometriosis include: - Pelvic exam. During a pelvic exam, your doctor manually feels (palpates) areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus. Often it's not possible to feel small areas of endometriosis, unless they've caused a cyst to form. - Ultrasound. This test uses high-frequency sound waves to create images of the inside of your body. To capture the images, a device called a transducer is either pressed against your abdomen or inserted into your vagina (transvaginal ultrasound). Both types of ultrasound may be done to get the best view of your reproductive organs. Ultrasound imaging won't definitively tell your doctor whether you have endometriosis, but it can identify cysts associated with endometriosis (endometriomas). - Laparoscopy. Medical management is usually tried first. But to be certain you have endometriosis, your doctor may refer you to a surgeon to look inside your abdomen for signs of endometriosis using a surgical procedure called laparoscopy. While you're under general anesthesia, your surgeon makes a tiny incision near your navel and inserts a slender viewing instrument (laparoscope), looking for endometrial tissue outside the uterus. He or she may take samples of tissue (biopsy). Laparoscopy can provide information about the location, extent and size of the endometrial implants to help determine the best treatment options. Treatment Treatment for endometriosis is usually with medications or surgery. The approach you and your doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant. Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort. Pain medications Your doctor may recommend that you take an over-the-counter pain reliever, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others), to help ease painful menstrual cramps. If you find that taking the maximum dose of these medications doesn't provide full relief, you may need to try another approach to manage your signs and symptoms. Hormone therapy Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Hormone medication may slow endometrial tissue growth and prevent new implants of endometrial tissue. Hormone therapy isn't a permanent fix for endometriosis. You could experience a return of your symptoms after stopping treatment. Therapies used to treat endometriosis include: - Hormonal contraceptives. Birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Most women have lighter and shorter menstrual flow when they're using a hormonal contraceptive. Using hormonal contraceptives - especially continuous cycle regimens - may reduce or eliminate the pain of mild to moderate endometriosis. - Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Because these drugs create an artificial menopause, taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may decrease menopausal side effects, such as hot flashes, vaginal dryness and bone loss. Your periods and the ability to get pregnant return when you stop taking the medication. - Progestin therapy. A progestin-only contraceptive, such as an intrauterine device (Mirena), contraceptive implant or contraceptive injection (Depo-Provera), can halt menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms. - Danazol. This drug suppresses the growth of the endometrium by blocking the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis. However, danazol may not be the first choice because it can cause serious side effects and can be harmful to the baby if you become pregnant while taking this medication. Conservative surgery If you have endometriosis and are trying to become pregnant, surgery to remove as much endometriosis as possible while preserving your uterus and ovaries (conservative surgery) may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery - however, endometriosis and pain may return. Your doctor may do this procedure laparoscopically or through traditional abdominal surgery in more extensive cases. In laparoscopic surgery, your surgeon inserts a slender viewing instrument (laparoscope) through a small incision near your navel and inserts instruments to remove endometrial tissue through another small incision. Assisted reproductive technologies Assisted reproductive technologies, such as in vitro fertilization, to help you become pregnant are sometimes preferable to conservative surgery. Doctors often suggest one of these approaches if conservative surgery doesn't work. Hysterectomy In severe cases of endometriosis, surgery to remove the uterus and cervix (total hysterectomy) as well as both ovaries may be the best treatment. A hysterectomy alone is not effective - the estrogen your ovaries produce can stimulate any remaining endometriosis and cause pain to persist. A hysterectomy is typically considered a last resort, especially for women still in their reproductive years. You can't get pregnant after a hysterectomy. Long-term health risks after hysterectomy may include an increased risk of heart and blood vessel (cardiovascular) diseases and certain metabolic conditions, especially if you have the surgery before age 35. Finding a doctor with whom you feel comfortable is crucial in managing and treating endometriosis. You may also want to get a second opinion before starting any treatment to be sure you know all of your options and the possible outcomes. Lifestyle and home remedies If your pain persists or if finding a treatment that works takes some time, you can try measures at home to relieve your discomfort. - Warm baths and a heating pad can help relax pelvic muscles, reducing cramping and pain. - Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others), can help ease painful menstrual cramps. - Regular exercise may help improve symptoms.
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Gastroparesis Overview Gastroparesis is a condition that affects the normal spontaneous movement of the muscles (motility) in your stomach. Ordinarily, strong muscular contractions propel food through your digestive tract. But if you have gastroparesis, your stomach's motility is slowed down or doesn't work at all, preventing your stomach from emptying properly. Certain medications, such as opioid pain relievers, some antidepressants, and high blood pressure and allergy medications, can lead to slow gastric emptying and cause similar symptoms. For people who already have gastroparesis, these medications may make their condition worse. Gastroparesis can interfere with normal digestion, cause nausea and vomiting, and cause problems with blood sugar levels and nutrition. The cause of gastroparesis is usually unknown. Sometimes it's a complication of diabetes, and some people develop gastroparesis after surgery. Although there's no cure for gastroparesis, changes to your diet, along with medication, can offer some relief. Gastroparesis care at Mayo Clinic Symptoms Signs and symptoms of gastroparesis include: - Vomiting - Nausea - A feeling of fullness after eating just a few bites - Vomiting undigested food eaten a few hours earlier - Acid reflux - Abdominal bloating - Abdominal pain - Changes in blood sugar levels - Lack of appetite - Weight loss and malnutrition Many people with gastroparesis don't have any noticeable signs and symptoms. Make an appointment with your doctor if you have any signs or symptoms that worry you. Causes It's not always clear what leads to gastroparesis. But in many cases, gastroparesis is believed to be caused by damage to a nerve that controls the stomach muscles (vagus nerve). The vagus nerve helps manage the complex processes in your digestive tract, including signaling the muscles in your stomach to contract and push food into the small intestine. A damaged vagus nerve can't send signals normally to your stomach muscles. This may cause food to remain in your stomach longer, rather than move normally into your small intestine to be digested. The vagus nerve can be damaged by diseases, such as diabetes, or by surgery to the stomach or small intestine. Risk factors Factors that can increase your risk of gastroparesis: - Diabetes - Abdominal or esophageal surgery - Infection, usually a virus - Certain medications that slow the rate of stomach emptying, such as narcotic pain medications - Scleroderma (a connective tissue disease) - Nervous system diseases, such as Parkinson's disease or multiple sclerosis - Hypothyroidism (low thyroid) Women are more likely to develop gastroparesis than are men. Diagnosis Doctors use several tests to help diagnose gastroparesis and rule out conditions that may cause similar symptoms. Tests may include: - Gastric emptying study. This is the most important test used in making a diagnosis of gastroparesis. It involves eating a light meal, such as eggs and toast, that contains a small amount of radioactive material. A scanner that detects the movement of the radioactive material is placed over your abdomen to monitor the rate at which food leaves your stomach. You'll need to stop taking any medications that could slow gastric emptying. Ask your doctor if any of your medications might slow your digestion. - Upper gastrointestinal (GI) endoscopy. This procedure is used to visually examine your upper digestive system - your esophagus, stomach and beginning of the small intestine (duodenum) - with a tiny camera on the end of a long, flexible tube.This test can also diagnose other conditions, such as peptic ulcer disease or pyloric stenosis, which can have symptoms similar to those of gastroparesis. - Ultrasound. This test uses high-frequency sound waves to produce images of structures within your body. Ultrasound can help diagnose whether problems with your gallbladder or your kidneys could be causing your symptoms. - Upper gastrointestinal series. This is a series of X-rays in which you drink a white, chalky liquid (barium) that coats the digestive system to help abnormalities show up. Treatment Treating gastroparesis begins with identifying and treating the underlying condition. If diabetes is causing your gastroparesis, your doctor can work with you to help you control it. Changes to your diet Maintaining adequate nutrition is the most important goal in the treatment of gastroparesis. Many people can manage gastroparesis with diet changes and dietary changes are the first step in managing this condition. Your doctor may refer you to a dietitian who can work with you to find foods that are easier for you to digest so that you're more likely to get enough calories and nutrients from the food you eat. A dietitian might suggest that you try to: - Eat smaller meals more frequently - Chew food thoroughly - Eat well-cooked fruits and vegetables rather than raw fruits and vegetables - Avoid fibrous fruits and vegetables, such as oranges and broccoli, which may cause bezoars - Choose mostly low-fat foods, but if you can tolerate them, add small servings of fatty foods to your diet - Try soups and pureed foods if liquids are easier for you to swallow - Drink about 34 to 51 ounces (1 to 1.5 liters) of water a day - Exercise gently after you eat, such as going for a walk - Avoid carbonated drinks, alcohol and smoking - Try to avoid lying down for 2 hours after a meal - Take a multivitamin daily Here's a brief list of foods recommended for people with gastroparesis (your dietitian can give you a more comprehensive list): - White bread and rolls and "light" whole-wheat bread without nuts or seeds - Plain or egg bagels - English muffins - Flour or corn tortillas - Pancakes - Puffed wheat and rice cereals - Cream of wheat or rice - White crackers - Potatoes, white or sweet (no skin) - Baked french fries - Rice - Pasta - Lean beef, veal and pork (not fried) - Chicken or turkey (no skin and not fried) - Crab, lobster, shrimp, clams, scallops, oysters - Tuna (packed in water) - Cottage cheese - Eggs - Tofu - Strained meat baby food - Baby food vegetables and fruits - Tomato sauce, paste, puree, juice - Carrots (cooked) - Beets (cooked) - Mushrooms (cooked) - Vegetable juice - Vegetable broth - Fruit juices and drinks - Applesauce - Bananas - Peaches and pears (canned) - Milk, if tolerated - Yogurt (without fruit pieces) - Custard and pudding - Frozen yogurt Medications Medications to treat gastroparesis may include: - Medications to stimulate the stomach muscles. These medications include metoclopramide (Reglan) and erythromycin (Eryc, E.E.S.). Metoclopramide has a risk of serious side effects. Erythromycin may lose its effectiveness over time, and can cause side effects, such as diarrhea. A newer medication, domperidone, with fewer side effects, is also available with restricted access. - Medications to control nausea and vomiting. Drugs that help ease nausea and vomiting include prochlorperazine (Compro) and diphenhydramine (Benadryl, Unisom). A class of medications that includes ondansetron (Zofran) is sometimes used to help nausea and vomiting. Surgical treatment Some people with gastroparesis may be unable to tolerate any food or liquids. In these situations, doctors may recommend a feeding tube (jejunostomy tube) be placed in the small intestine. Or doctors may recommend a gastric venting tube to help relieve pressure from gastric contents. Feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin. The tube is usually temporary and is only used when gastroparesis is severe or when blood sugar levels can't be controlled by any other method. Some people may require an IV (parenteral) feeding tube that goes directly into a vein in the chest. Treatments under investigation Researchers are continuing to investigate new medications to treat gastroparesis. One example is a new drug in development called relamorelin. The results of a phase 2 clinical trial found the drug could speed up gastric emptying and reduce vomiting. The drug is not yet approved by the Food and Drug Administration (FDA), but a larger clinical trial is currently underway. A number of new therapies are being tried with the help of endoscopy - a slender tube that's threaded down the esophagus. One procedure used endoscopy to place a small tube (stent) where the stomach connects to the small intestine (duodenum) to keep this connection open. Several research trials investigated the use of botulinum toxin administered through endoscopy without much success. This treatment is not recommended. Doctors are also studying the use of a minimally invasive surgical technique when someone needs a feeding tube placed directly into the small intestine (jejunostomy tube). Gastric electrical stimulation and pacing Gastric electrical stimulation is a surgically implanted device that provides electrical stimulation to stimulate stomach muscles to move food more efficiently. Study results have been mixed. However, the device seems to be most helpful for people with diabetic gastroparesis. The FDA allows the device to be used under a compassionate use exemption for those who can't control their gastroparesis symptoms with diet changes or medications. However, larger studies are needed. Gastric pacing also involves a surgically implanted device that stimulates the stomach muscles, but this device tries to more closely mimic normal stomach contractions. Currently, the device is too large and causes discomfort. Gastric pacing devices are only available in clinical trials right now. Lifestyle and home remedies If you're a smoker, stop. Your gastroparesis symptoms are less likely to improve over time if you keep smoking. People with gastroparesis who are overweight are also less likely to get better over time. Alternative medicine There is some evidence that certain alternative treatments can be helpful to people with gastroparesis, although more studies are needed. Some treatments that look promising include: - Acupuncture and electroacupuncture. Acupuncture involves the insertion of extremely thin needles through your skin at strategic points on your body. During electroacupuncture, a small electrical current is passed through the needles. Studies have shown these treatments to ease gastroparesis symptoms more than a sham treatment. - STW 5 (Iberogast). This herbal formula from Germany contains nine different herbal extracts. It hasn't been shown to speed up gastric emptying, but was slightly better at easing digestive symptoms than a placebo. - Rikkunshito. This Japanese herbal formula also contains nine herbs. It may help reduce abdominal pain and the feeling of post-meal fullness. - Cannabis. There aren't any published clinical trials on cannabis and gastroparesis. However, cannabis - commonly known as marijuana - is thought to ease nausea and other digestive complaints. Derivatives of cannabis have been used by people who have cancer in the past, but there are better FDA-approved medications available to control nausea now. Because cannabis is often smoked, there's concern about possible addiction and harm, similar to what occurs with tobacco smoke. In addition, daily users of marijuana (cannabis) may develop a condition that mimics the symptoms of gastroparesis called cannabis hyperemesis syndrome. Symptoms can include nausea, vomiting and abdominal pain. Quitting cannabis may help.
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Peripheral neuropathy Overview Peripheral neuropathy, a result of damage to your peripheral nerves, often causes weakness, numbness and pain, usually in your hands and feet. It can also affect other areas of your body. Your peripheral nervous system sends information from your brain and spinal cord (central nervous system) to the rest of your body. Peripheral neuropathy can result from traumatic injuries, infections, metabolic problems, inherited causes and exposure to toxins. One of the most common causes is diabetes mellitus. People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. In many cases, symptoms improve, especially if caused by a treatable condition. Medications can reduce the pain of peripheral neuropathy. Peripheral neuropathy care at Mayo Clinic Symptoms Every nerve in your peripheral system has a specific function, so symptoms depend on the type of nerves affected. Nerves are classified into: - Sensory nerves that receive sensation, such as temperature, pain, vibration or touch, from the skin - Motor nerves that control muscle movement - Autonomic nerves that control functions such as blood pressure, heart rate, digestion and bladder Signs and symptoms of peripheral neuropathy might include: - Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms - Sharp, jabbing, throbbing, freezing or burning pain - Extreme sensitivity to touch - Lack of coordination and falling - Muscle weakness or paralysis if motor nerves are affected If autonomic nerves are affected, signs and symptoms might include: - Heat intolerance and altered sweating - Bowel, bladder or digestive problems - Changes in blood pressure, causing dizziness or lightheadedness Peripheral neuropathy can affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathy) or many nerves (polyneuropathy). Carpal tunnel syndrome is an example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy. Seek medical care right away if you notice unusual tingling, weakness or pain in your hands or feet. Early diagnosis and treatment offer the best chance for controlling your symptoms and preventing further damage to your peripheral nerves. Causes Not a single disease, peripheral neuropathy is nerve damage caused by a number of conditions. Causes of neuropathies include: - Alcoholism. Poor dietary choices made by people with alcoholism can lead to vitamin deficiencies. - Autoimmune diseases. These include Sjogren's syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and necrotizing vasculitis. - Diabetes. More than half the people with diabetes develop some type of neuropathy. - Exposure to poisons. Toxic substances include heavy metals or chemicals. - Medications. Certain medications, especially those used to treat cancer (chemotherapy), can cause peripheral neuropathy. - Infections. These include certain viral or bacterial infections, including Lyme disease, shingles, Epstein-Barr virus, hepatitis C, leprosy, diphtheria and HIV. - Inherited disorders. Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy. - Trauma or pressure on the nerve. Traumas, such as from motor vehicle accidents, falls or sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from having a cast or using crutches or repeating a motion such as typing many times. - Tumors. Growths, cancerous (malignant) and noncancerous (benign), can develop on the nerves or press nerves. Also, polyneuropathy can arise as a result of some cancers related to the body's immune response. These are a form of paraneoplastic syndrome. - Vitamin deficiencies. B vitamins - including B-1, B-6 and B-12 - vitamin E and niacin are crucial to nerve health. - Bone marrow disorders. These include abnormal protein in the blood (monoclonal gammopathies), a form of bone cancer (osteosclerotic myeloma), lymphoma and amyloidosis. - Other diseases. These include kidney disease, liver disease, connective tissue disorders and an underactive thyroid (hypothyroidism). In a number of cases, no cause can be identified (idiopathic). Risk factors Peripheral neuropathy risk factors include: - Diabetes mellitus, especially if your sugar levels are poorly controlled - Alcohol abuse - Vitamin deficiencies, particularly B vitamins - Infections, such as Lyme disease, shingles, Epstein-Barr virus, hepatitis C and HIV - Autoimmune diseases, such as rheumatoid arthritis and lupus, in which your immune system attacks your own tissues - Kidney, liver or thyroid disorders - Exposure to toxins - Repetitive motion, such as those performed for certain jobs - Family history of neuropathy Complications Complications of peripheral neuropathy can include: - Burns and skin trauma. You might not feel temperature changes or pain on parts of your body that are numb. - Infection. Your feet and other areas lacking sensation can become injured without your knowing. Check these areas regularly and treat minor injuries before they become infected, especially if you have diabetes mellitus. - Falls. Weakness and loss of sensation may be associated with lack of balance and falling. Diagnosis Peripheral neuropathy has many potential causes. Besides a physical exam, which may include blood tests, diagnosis usually requires: - A full medical history. Your doctor will review your medical history, including your symptoms, your lifestyle, exposure to toxins, drinking habits and a family history of nervous system (neurological) diseases. - Neurological examination. Your doctor might check your tendon reflexes, your muscle strength and tone, your ability to feel certain sensations, and your posture and coordination. Your doctor may order tests, including: - Blood tests. These can detect vitamin deficiencies, diabetes, abnormal immune function and other indications of conditions that can cause peripheral neuropathy. - Imaging tests. CT or MRI scans can look for herniated disks, tumors or other abnormalities. - Nerve function tests. Electromyography records electrical activity in your muscles to detect nerve damage. A probe sends electrical signals to a nerve, and an electrode placed along the nerve's pathway records the nerve's response to the signals (nerve conduction studies). - Other nerve function tests. These might include an autonomic reflex screen that records how the autonomic nerve fibers work, a sweat test, and sensory tests that record how you feel touch, vibration, cooling and heat. - Nerve biopsy. This involves removing a small portion of a nerve, usually a sensory nerve, to look for abnormalities. - Skin biopsy. Your doctor removes a small portion of skin to look for a reduction in nerve endings. Treatment Treatment goals are to manage the condition causing your neuropathy and to relieve symptoms. If your lab tests indicate no underlying condition, your doctor might recommend watchful waiting to see if your neuropathy improves. Medications Besides medications used to treat conditions associated with peripheral neuropathy, medications used to relieve peripheral neuropathy signs and symptoms include: - Pain relievers. Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs, can relieve mild symptoms. For more-severe symptoms, your doctor might prescribe painkillers. Medications containing opioids, such as tramadol (Conzip, Ultram) or oxycodone (Oxycontin, Roxicodone, others), can lead to dependence and addiction, so these drugs generally are prescribed only when other treatments fail. - Anti-seizure medications. Medications such as gabapentin (Gralise, Neurontin) and pregabalin (Lyrica), developed to treat epilepsy, may relieve nerve pain. Side effects can include drowsiness and dizziness. - Topical treatments. Capsaicin cream, which contains a substance found in hot peppers, can cause modest improvements in peripheral neuropathy symptoms. You might have skin burning and irritation where you apply the cream, but this usually lessens over time. Some people, however, can't tolerate it. Lidocaine patches are another treatment you apply to your skin that might offer pain relief. Side effects can include drowsiness, dizziness and numbness at the site of the patch. - Antidepressants. Certain tricyclic antidepressants, such as amitriptyline, doxepin and nortriptyline (Pamelor), have been found to help relieve pain by interfering with chemical processes in your brain and spinal cord that cause you to feel pain. The serotonin and norepinephrine reuptake inhibitor duloxetine (Cymbalta) and the extended-release antidepressant venlafaxine (Effexor XR) also might ease the pain of peripheral neuropathy caused by diabetes. Side effects may include dry mouth, nausea, drowsiness, dizziness, decreased appetite and constipation. Therapies Various therapies and procedures might help ease the signs and symptoms of peripheral neuropathy. - Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on the skin deliver a gentle electric current at varying frequencies. TENS should be applied for 30 minutes daily for about a month. - Plasma exchange and intravenous immune globulin. These procedures, which help suppress immune system activity, might benefit people with certain inflammatory conditions. Plasma exchange involves removing your blood, then removing antibodies and other proteins from the blood and returning the blood to your body. In immune globulin therapy, you receive high levels of proteins that work as antibodies (immunoglobulins). - Physical therapy. If you have muscle weakness, physical therapy can help improve your movements. You may also need hand or foot braces, a cane, a walker, or a wheelchair. - Surgery. If you have neuropathies caused by pressure on nerves, such as pressure from tumors, you might need surgery to reduce the pressure. Lifestyle and home remedies To help you manage peripheral neuropathy: - Take care of your feet, especially if you have diabetes. Check daily for blisters, cuts or calluses. Wear soft, loose cotton socks and padded shoes. You can use a semicircular hoop, which is available in medical supply stores, to keep bedcovers off hot or sensitive feet. - Exercise. Regular exercise, such as walking three times a week, can reduce neuropathy pain, improve muscle strength and help control blood sugar levels. Gentle routines such as yoga and tai chi might also help. - Quit smoking. Cigarette smoking can affect circulation, increasing the risk of foot problems and other neuropathy complications. - Eat healthy meals. Good nutrition is especially important to ensure that you get essential vitamins and minerals. Include fruits, vegetables, whole grains and lean protein in your diet. - Avoid excessive alcohol. Alcohol can worsen peripheral neuropathy. - Monitor your blood glucose levels. If you have diabetes, this will help keep your blood glucose under control and might help improve your neuropathy. Alternative medicine Some people with peripheral neuropathy try complementary treatments for relief. Although researchers haven't studied these techniques as thoroughly as they have most medications, the following therapies have shown some promise: - Acupuncture. Inserting thin needles into various points on your body might reduce peripheral neuropathy symptoms. You might need multiple sessions before you notice improvement. Acupuncture is generally considered safe when performed by a certified practitioner using sterile needles. - Alpha-lipoic acid. This has been used as a treatment for peripheral neuropathy in Europe for years. Discuss using alpha-lipoic acid with your doctor because it can affect blood sugar levels. Other side effects can include stomach upset and skin rash. - Herbs. Certain herbs, such as evening primrose oil, might help reduce neuropathy pain in people with diabetes. Some herbs interact with medications, so discuss herbs you're considering with your doctor. - Amino acids. Amino acids, such as acetyl-L-carnitine, might benefit people who have undergone chemotherapy and people with diabetes. Side effects might include nausea and vomiting.
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Preventing Diabetes Problems Heart Disease and Stroke Diabetes can damage blood vessels and lead to heart disease and stroke. You can do a lot to prevent heart disease and stroke by managing your blood glucose, blood pressure, and cholesterol levels; and by not smoking. What is the link between diabetes, heart disease, and stroke? Over time, high blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. The longer you have diabetes, the higher the chances that you will develop heart disease.1People with diabetes tend to develop heart disease at a younger age than people without diabetes. In adults with diabetes, the most common causes of death are heart disease and stroke. Adults with diabetes are nearly twice as likely to die from heart disease or stroke as people without diabetes.2The good news is that the steps you take to manage your diabetes also help to lower your chances of having heart disease or stroke. What else increases my chances of heart disease or stroke if I have diabetes? If you have diabetes, other factors add to your chances of developing heart disease or having a stroke.Smoking raises your risk of developing heart disease. If you have diabetes, it is important to stop smoking because both smoking and diabetes narrow blood vessels. Smoking also increases your chances of developing other long-term problems such as lung disease. Smoking also can damage the blood vessels in your legs and increase the risk of lower leg infections, ulcers, and amputation.If you have high blood pressure, your heart must work harder to pump blood. High blood pressure can strain your heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.Cholesterol is a type of fat produced by your liver and found in your blood. You have two kinds of cholesterol in your blood: LDL and HDL.LDL, often called “bad” cholesterol, can build up and clog your blood vessels. High levels of LDL cholesterol raise your risk of developing heart disease.Another type of blood fat, triglycerides, also can raise your risk of heart disease when the levels are higher than recommended by your health care team.Being overweight or obese can affect your ability to manage your diabetes and increase your risk for many health problems, including heart disease and high blood pressure. If you are overweight, a healthy eating plan with reduced calories often will lower your glucose levels and reduce your need for medications.Excess belly fat around your waist, even if you are not overweight, can raise your chances of developing heart disease.You have excess belly fat if your waist measuresmore than 40 inches and you are a man more than 35 inches and you are a womanLearn how to correctly measure your waist.A family history of heart disease may also add to your chances of developing heart disease. If one or more of your family members had a heart attack before age 50, you may have an even higher chance of developing heart disease.3You can’t change whether heart disease runs in your family, but if you have diabetes, it’s even more important to take steps to protect yourself from heart disease and decrease your chances of having a stroke. How can I lower my chances of a heart attack or stroke if I have diabetes? Taking care of your diabetes is important to help you take care of your heart. You can lower your chances of having a heart attack or stroke by taking the following steps to manage your diabetes to keep your heart and blood vessels healthy.Knowing your diabetes ABCs will help you manage your blood glucose, blood pressure, and cholesterol. Stopping smoking if you have diabetes is also important to lower your chances for heart disease.A is for the A1C test. The A1C test shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks that you do every day. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months. High levels of blood glucose can harm your heart, blood vessels, kidneys, feet, and eyes.The A1C goal for many people with diabetes is below 7 percent. Some people may do better with a slightly higher A1C goal. Ask your health care team what your goal should be.B is for blood pressure. Blood pressure is the force of your blood against the wall of your blood vessels. If your blood pressure gets too high, it makes your heart work too hard. High blood pressure can cause a heart attack or stroke and damage your kidneys and eyes.The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask what your goal should be.C is for cholesterol. You have two kinds of cholesterol in your blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog your blood vessels. Too much bad cholesterol can cause a heart attack or stroke. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels.Ask your health care team what your cholesterol numbers should be. If you are over 40 years of age, you may need to take medicine such as a statin to lower your cholesterol and protect your heart. Some people with very high LDL (“bad”) cholesterol may need to take medicine at a younger age.S is for stop smoking. Not smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels, so your heart has to work harder.If you quit smokingyou will lower your risk for heart attack, stroke, nerve disease, kidney disease, eye disease, and amputation your blood glucose, blood pressure, and cholesterol levels may improve your blood circulation will improve you may have an easier time being physically activeIf you smoke or use other tobacco products, stop. Ask for help so you don’t have to do it alone. You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to Smokefree.gov.Ask your health care team about your goals for A1C, blood pressure, and cholesterol, and what you can do to reach these goals.Developing or maintaining healthy lifestyle habits can help you manage your diabetes and prevent heart disease.Follow your healthy eating plan. Make physical activity part of your routine. Stay at or get to a healthy weight Get enough sleep.Learn more about these tips to manage diabetes.Watch a video about what you can do to keep your heart healthy.Managing diabetes is not always easy. Feeling stressed, sad, or angry is common when you are living with diabetes. You may know what to do to stay healthy but may have trouble sticking with your plan over time. Long-term stress can raise your blood glucose and blood pressure, but you can learn ways to lower your stress. Try deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music. Learn more about healthy ways to cope with stress.Medicines may be an important part of your treatment plan. Your doctor will prescribe medicine based on your specific needs. Medicine may help youmeet your A1C (blood glucose), blood pressure, and cholesterol goals. reduce your risk of blood clots, heart attack, or stroke. treat angina, or chest pain that is often a symptom of heart disease. (Angina can also be an early symptom of a heart attack.)Ask your doctor whether you should take aspirin. Aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take.Statins can reduce the risk of having a heart attack or stroke in some people with diabetes. Statins are a type of medicine often used to help people meet their cholesterol goals. Talk with your doctor to find out whether taking a statin is right for you.Talk with your doctor if you have questions about your medicines. Before you start a new medicine, ask your doctor about possible side effects and how you can avoid them. If the side effects of your medicine bother you, tell your doctor. Don’t stop taking your medicines without checking with your doctor first. How do doctors diagnose heart disease in diabetes? Doctors diagnose heart disease in diabetes based onyour symptoms your medical and family history how likely you are to have heart disease a physical exam results from tests and proceduresTests used to monitor your diabetes—A1C, blood pressure, and cholesterol—help your doctor decide whether it is important to do other tests to check your heart health. What are the warning signs of heart attack and stroke? pain or pressure in your chest that lasts longer than a few minutes or goes away and comes back pain or discomfort in one or both of your arms or shoulders; or your back, neck, or jaw shortness of breath sweating or light-headedness indigestion or nausea (feeling sick to your stomach) feeling very tiredTreatment works best when it is given right away. Warning signs can be different in different people. You may not have all of these symptoms.If you have angina, it’s important to know how and when to seek medical treatment.Women sometimes have nausea and vomiting, feel very tired (sometimes for days), and have pain in the back, shoulders, or jaw without any chest pain.People with diabetes-related nerve damage may not notice any chest pain.weakness or numbness of your face, arm, or leg on one side of your body confusion, or trouble talking or understanding dizziness, loss of balance, or trouble walking trouble seeing out of one or both eyes sudden severe headacheIf you have any one of these warning signs, call 9-1-1. You can help prevent permanent damage by getting to a hospital within an hour of a stroke. Heart Disease & Stroke The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov. Low Blood Glucose (Hypoglycemia) Hypoglycemia occurs when your blood glucose drops too low. Certain diabetes medicines make low blood glucose more likely. You can prevent hypoglycemia by following your meal plan and balancing your physical activity, food, and medicines. Testing your blood glucose regularly can also help prevent hypoglycemia. What is hypoglycemia? Hypoglycemia, also called low blood glucose or low blood sugar, occurs when the level of glucose in your blood drops below normal. For many people with diabetes, that means a level of 70 milligrams per deciliter (mg/dL) or less. Your numbers might be different, so check with your health care provider to find out what level is too low for you. What are the symptoms of hypoglycemia? Symptoms of hypoglycemia tend to come on quickly and can vary from person to person. You may have one or more mild-to-moderate symptoms listed in the table below. Sometimes people don’t feel any symptoms.Severe hypoglycemia is when your blood glucose level becomes so low that you’re unable to treat yourself and need help from another person. Severe hypoglycemia is dangerous and needs to be treated right away. This condition is more common in people with type 1 diabetes.Some symptoms of hypoglycemia during sleep arecrying out or having nightmares sweating enough to make your pajamas or sheets damp feeling tired, irritable, or confused after waking up What causes hypoglycemia in diabetes? Hypoglycemia can be a side effect of insulin or other types of diabetes medicines that help your body make more insulin. Two types of diabetes pills can cause hypoglycemia: sulfonylureas and meglitinides. Ask your health care team if your diabetes medicine can cause hypoglycemia.Although other diabetes medicines don’t cause hypoglycemia by themselves, they can increase the chances of hypoglycemia if you also take insulin, a sulfonylurea, or a meglitinide. What other factors contribute to hypoglycemia in diabetes? If you take insulin or diabetes medicines that increase the amount of insulin your body makes—but don’t match your medications with your food or physical activity—you could develop hypoglycemia. The following factors can make hypoglycemia more likely:When you eat foods containing carbohydrates, your digestive system breaks down the sugars and starches into glucose. Glucose then enters your bloodstream and raises your blood glucose level. If you don’t eat enough carbohydrates to match your medication, your blood glucose could drop too low.If you skip or delay a meal, your blood glucose could drop too low. Hypoglycemia also can occur when you are asleep and haven’t eaten for several hours.Increasing your physical activity level beyond your normal routine can lower your blood glucose level for up to 24 hours after the activity.Alcohol makes it harder for your body to keep your blood glucose level steady, especially if you haven’t eaten in a while. The effects of alcohol can also keep you from feeling the symptoms of hypoglycemia, which may lead to severe hypoglycemia.When you’re sick, you may not be able to eat as much or keep food down, which can cause low blood glucose. Learn more about taking care of your diabetes when you’re sick. How can I prevent hypoglycemia if I have diabetes? If you are taking insulin, a sulfonylurea, or a meglitinide, using your diabetes management plan and working with your health care team to adjust your plan as needed can help you prevent hypoglycemia. The following actions can also help prevent hypoglycemia:Knowing your blood glucose level can help you decide how much medicine to take, what food to eat, and how physically active to be. To find out your blood glucose level, check yourself with a blood glucose meter as often as your doctor advises.Hypoglycemia unawareness. Sometimes people with diabetes don’t feel or recognize the symptoms of hypoglycemia, a problem called hypoglycemia unawareness. If you have had hypoglycemia without feeling any symptoms, you may need to check your blood glucose more often so you know when you need to treat your hypoglycemia or take steps to prevent it. Be sure to check your blood glucose before you drive.If you have hypoglycemia unawareness or have hypoglycemia often, ask your health care provider about a continuous glucose monitor (CGM). A CGM checks your blood glucose level at regular times throughout the day and night. CGMs can tell you if your blood glucose is falling quickly and sound an alarm if your blood glucose falls too low. CGM alarms can wake you up if you have hypoglycemia during sleep.Your meal plan is key to preventing hypoglycemia. Eat regular meals and snacks with the correct amount of carbohydrates to help keep your blood glucose level from going too low. Also, if you drink alcoholic beverages, it’s best to eat some food at the same time.Physical activity can lower your blood glucose during the activity and for hours afterward. To help prevent hypoglycemia, you may need to check your blood glucose before, during, and after physical activity and adjust your medicine or carbohydrate intake. For example, you might eat a snack before being physically active or decrease your insulin dose as directed by your health care provider to keep your blood glucose from dropping too low.Tell your health care team if you have had hypoglycemia. Your health care team may adjust your diabetes medicines or other aspects of your management plan. Learn about balancing your medicines, eating plan, and physical activity to prevent hypoglycemia. Ask if you should have a glucagon emergency kit to carry with you at all times. How do I treat hypoglycemia? If you begin to feel one or more hypoglycemia symptoms, check your blood glucose. If your blood glucose level is below your target or less than 70, eat or drink 15 grams of carbohydrates right away. Examples includefour glucose tablets or one tube of glucose gel 1/2 cup (4 ounces) of fruit juice—not low-calorie or reduced sugar* 1/2 can (4 to 6 ounces) of soda—not low-calorie or reduced sugar 1 tablespoon of sugar, honey, or corn syrup 2 tablespoons of raisinsWait 15 minutes and check your blood glucose again. If your glucose level is still low, eat or drink another 15 grams of glucose or carbohydrates. Check your blood glucose again after another 15 minutes. Repeat these steps until your glucose level is back to normal.If your next meal is more than 1 hour away, have a snack to keep your blood glucose level in your target range. Try crackers or a piece of fruit. *People who have kidney disease shouldn’t drink orange juice for their 15 grams of carbohydrates because it contains a lot of potassium. Apple, grape, or cranberry juice are good options.If you take acarbose or miglitol along with diabetes medicines that can cause hypoglycemia, you will need to take glucose tablets or glucose gel if your blood glucose level is too low. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough. Low Blood Glucose (Hypoglycemia) Someone will need to give you a glucagon injection if you have severe hypoglycemia. An injection of glucagon will quickly raise your blood glucose level. Talk with your health care provider about when and how to use a glucagon emergency kit. If you have an emergency kit, check the date on the package to make sure it hasn’t expired.If you are likely to have severe hypoglycemia, teach your family, friends, and coworkers when and how to give you a glucagon injection. Also, tell your family, friends, and coworkers to call 911 right away after giving you a glucagon injection or if you don’t have a glucagon emergency kit with you.If you have hypoglycemia often or have had severe hypoglycemia, you should wear a medical alert bracelet or pendant. A medical alert ID tells other people that you have diabetes and need care right away. Getting prompt care can help prevent the serious problems that hypoglycemia can cause. Nerve Damage (Diabetic Neuropathy) Diabetic neuropathy is nerve damage that can result from diabetes. Different types of nerve damage affect different parts of your body. Managing your diabetes can help prevent nerve damage that affects your feet and limbs, and organs such as your heart. Nerve Damage (Diabetic Neuropathy) Kidney Disease Diabetic kidney disease, also called diabetic nephropathy, is kidney disease caused by diabetes. You can help protect your kidneys by managing your diabetes and meeting your blood pressure goals. What is diabetic kidney disease? Diabetic kidney disease is a type of kidney disease caused by diabetes.Diabetes is the leading cause of kidney disease. About 1 out of 4 adults with diabetes has kidney disease.1The main job of the kidneys is to filter wastes and extra water out of your blood to make urine. Your kidneys also help control blood pressure and make hormones that your body needs to stay healthy.When your kidneys are damaged, they can’t filter blood like they should, which can cause wastes to build up in your body. Kidney damage can also cause other health problems.Kidney damage caused by diabetes usually occurs slowly, over many years. You can take steps to protect your kidneys and to prevent or delay kidney damage.Watch a video about Diabetes and Kidney Disease.Diabetic kidney disease is also called DKD, chronic kidney disease, CKD, kidney disease of diabetes, or diabetic nephropathy. How does diabetes cause kidney disease? High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys. Learn more about high blood pressure and kidney disease. What increases my chances of developing diabetic kidney disease? Having diabetes for a longer time increases the chances that you will have kidney damage. If you have diabetes, you are more likely to develop kidney disease if yourblood glucose is too high blood pressure is too highAfrican Americans, American Indians, and Hispanics/Latinos develop diabetes, kidney disease, and kidney failure at a higher rate than Caucasians.You are also more likely to develop kidney disease if you have diabetes andsmoke don’t follow your diabetes eating plan eat foods high in salt are not active are overweight have heart disease have a family history of kidney failure How can I tell if I have diabetic kidney disease? Most people with diabetic kidney disease do not have symptoms. The only way to know if you have diabetic kidney disease is to get your kidneys checked.Health care professionals use blood and urine tests to check for diabetic kidney disease. Your health care professional will check your urine for albumin and will also do a blood test to see how well your kidneys are filtering your blood.You should get tested every year for kidney disease if youhave type 2 diabetes have had type 1 diabetes for more than 5 years How can I keep my kidneys healthy if I have diabetes? The best way to slow or prevent diabetes-related kidney disease is to try to reach your blood glucose and blood pressure goals. Healthy lifestyle habits and taking your medicines as prescribed can help you achieve these goals and improve your health overall.Your health care professional will test your A1C. The A1C is a blood test that shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks that you may do yourself. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months.The A1C goal for many people with diabetes is below 7 percent. Ask your health care team what your goal should be. Reaching your goal numbers will help you protect your kidneys.To reach your A1C goal, your health care professional may ask you to check your blood glucose levels. Work with your health care team to use the results to guide decisions about food, physical activity, and medicines. Ask your health care team how often you should check your blood glucose level.Blood pressure is the force of your blood against the wall of your blood vessels. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.Your health care team will also work with you to help you set and reach your blood pressure goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask your health care team what your goal should be.Medicines that lower blood pressure can also help slow kidney damage. Two types of blood pressure medicines, ACE inhibitors and ARBs, play a special role in protecting your kidneys. Each has been found to slow kidney damage in people with diabetes who have high blood pressure and DKD. The names of these medicines end in –pril or –sartan. ACE inhibitors and ARBs are not safe for women who are pregnant.Healthy lifestyle habits can help you reach your blood glucose and blood pressure goals. Following the steps below will also help you keep your kidneys healthy:Stop smoking. Work with a dietitian to develop a diabetes meal plan and limit salt and sodium. Make physical activity part of your routine. Stay at or get to a healthy weight. Get enough sleep. Aim for 7 to 8 hours of sleep each night.Learn more about these tips to manage diabetes.Medicines may be an important part of your treatment plan. Your health care professional will prescribe medicine based on your specific needs. Medicine can help you meet your blood glucose and blood pressure goals. You may need to take more than one kind of medicine to control your blood pressure. How can I cope with the stress of managing my diabetes? Managing diabetes isn’t always easy. Feeling stressed, sad, or angry is common when you are living with diabetes. You may know what to do to stay healthy but may have trouble sticking with your plan over time. Long-term stress can raise your blood glucose and blood pressure, but you can learn ways to lower your stress. Try deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music. Learn more about healthy ways to cope with stress. Does diabetic kidney disease get worse over time? Kidney damage from diabetes can get worse over time. However, you can take steps to keep your kidneys healthy and help slow kidney damage to prevent or delay kidney failure. Kidney failure means that your kidneys have lost most of their ability to function—less than 15 percent of normal kidney function. However, most people with diabetes and kidney disease don’t end up with kidney failure.If your kidneys become damaged as a result of diabetes, learn how to manage kidney disease. Kidney Disease Foot Problems Diabetes can cause nerve damage and poor blood flow, which can lead to serious foot problems. Common foot problems, such as a callus, can lead to pain or an infection that makes it hard to walk. Get a foot checkup at each visit with your health care team. How can diabetes affect my feet? Over time, diabetes may cause nerve damage, also called diabetic neuropathy, that can cause tingling and pain, and can make you lose feeling in your feet. When you lose feeling in your feet, you may not feel a pebble inside your sock or a blister on your foot, which can lead to cuts and sores. Cuts and sores can become infected.Diabetes also can lower the amount of blood flow in your feet. Not having enough blood flowing to your legs and feet can make it hard for a sore or an infection to heal. Sometimes, a bad infection never heals. The infection might lead to gangrene.Gangrene and foot ulcers that do not get better with treatment can lead to an amputation of your toe, foot, or part of your leg. A surgeon may perform an amputation to prevent a bad infection from spreading to the rest of your body, and to save your life. Good foot care is very important to prevent serious infections and gangrene.Although rare, nerve damage from diabetes can lead to changes in the shape of your feet, such as Charcot’s foot. Charcot’s foot may start with redness, warmth, and swelling. Later, bones in your feet and toes can shift or break, which can cause your feet to have an odd shape, such as a “rocker bottom.” What can I do to keep my feet healthy? Work with your health care team to make a diabetes self-care plan, which is an action plan for how you will manage your diabetes. Your plan should include foot care. A foot doctor, also called a podiatrist, and other specialists may be part of your health care team.Include these steps in your foot care plan:You may have foot problems, but feel no pain in your feet. Checking your feet each day will help you spot problems early before they get worse. A good way to remember is to check your feet each evening when you take off your shoes. Also check between your toes. If you have trouble bending over to see your feet, try using a mirror to see them, or ask someone else to look at your feet.Look for problems such ascuts, sores, or red spots swelling or fluid-filled blisters ingrown toenails, in which the edge of your nail grows into your skin corns or calluses, which are spots of rough skin caused by too much rubbing or pressure on the same spot plantar warts, which are flesh-colored growths on the bottom of the feet athlete’s foot warm spotsIf you have certain foot problems that make it more likely you will develop a sore on your foot, your doctor may recommend taking the temperature of the skin on different parts of your feet. A “hot spot” can be the first sign that a blister or an ulcer is starting.Cover a blister, cut, or sore with a bandage. Smooth corns and calluses as explained below.Wash your feet with soap in warm, not hot, water. Test the water to make sure it is not too hot. You can use a thermometer (90° to 95° F is safe) or your elbow to test the warmth of the water. Do not soak your feet because your skin will get too dry.After washing and drying your feet, put talcum powder or cornstarch between your toes. Skin between the toes tends to stay moist. Powder will keep the skin dry to help prevent an infection.Thick patches of skin called corns or calluses can grow on the feet. If you have corns or calluses, talk with your foot doctor about the best way to care for these foot problems. If you have nerve damage, these patches can become ulcers.If your doctor tells you to, use a pumice stone to smooth corns and calluses after bathing or showering. A pumice stone is a type of rock used to smooth the skin. Rub gently, only in one direction, to avoid tearing the skin.Do NOTcut corns and calluses use corn plasters, which are medicated pads use liquid corn and callus removersCutting and over-the counter corn removal products can damage your skin and cause an infection.To keep your skin smooth and soft, rub a thin coat of lotion, cream, or petroleum jelly on the tops and bottoms of your feet. Do not put lotion or cream between your toes because moistness might cause an infection.Trim your toenails, when needed, after you wash and dry your feet. Using toenail clippers, trim your toenails straight across. Do not cut into the corners of your toenail. Gently smooth each nail with an emery board or nonsharp nail file. Trimming this way helps prevent cutting your skin and keeps the nails from growing into your skin.Have a foot doctor trim your toenails ifyou cannot see, feel, or reach your feet your toenails are thick or yellowed your nails curve and grow into the skinIf you want to get a pedicure at a salon, you should bring your own nail tools to prevent getting an infection. You can ask your health care provider what other steps you can take at the salon to prevent infection.Wear shoes and socks at all times. Do not walk barefoot or in just socks – even when you are indoors. You could step on something and hurt your feet. You may not feel any pain and may not know that you hurt yourself.Check the inside of your shoes before putting them on, to make sure the lining is smooth and free of pebbles or other objects.Make sure you wear socks, stockings, or nylons with your shoes to keep from getting blisters and sores. Choose clean, lightly padded socks that fit well. Socks with no seams are best.Wear shoes that fit well and protect your feet. Here are some tips for finding the right type of shoes:Walking shoes and athletic shoes are good for daily wear. They support your feet and allow them to “breathe.” Do not wear vinyl or plastic shoes, because they do not stretch or “breathe.” When buying shoes, make sure they feel good and have enough room for your toes. Buy shoes at the end of the day, when your feet are the largest, so that you can find the best fit. If you have a bunion, or hammertoes, which are toes that curl under your feet, you may need extra-wide or deep shoes.1 Do not wear shoes with pointed toes or high heels, because they put too much pressure on your toes. If your feet have changed shape, such as from Charcot’s foot, you may need special shoes or shoe inserts, called orthotics. You also may need inserts if you have bunions, hammertoes, or other foot problems.When breaking in new shoes, only wear them for a few hours at first and then check your feet for areas of soreness.Medicare Part B insurance and other health insurance programs may help pay for these special shoes or inserts. Ask your insurance plan if it covers your special shoes or inserts.If you have nerve damage from diabetes, you may burn your feet and not know you did. Take the following steps to protect your feet from heat:Wear shoes at the beach and on hot pavement. Put sunscreen on the tops of your feet to prevent sunburn. Keep your feet away from heaters and open fires. Do not put a hot water bottle or heating pad on your feet.Wear socks in bed if your feet get cold. In the winter, wear lined, waterproof boots to keep your feet warm and dry.Try the following tips to improve blood flow to your feet:Put your feet up when you are sitting. Wiggle your toes for a few minutes throughout the day. Move your ankles up and down and in and out to help blood flow in your feet and legs. Do not wear tight socks or elastic stockings. Do not try to hold up loose socks with rubber bands. Be more physically active. Choose activities that are easy on your feet, such as walking, dancing, yoga or stretching, swimming, or bike riding. Stop smoking.Smoking can lower the amount of blood flow to your feet. If you smoke, ask for help to stop. You can get help by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to SmokeFree.gov.Ask your health care team to check your feet at each visit. Take off your shoes and socks when you’re in the exam room so they will remember to check your feet. At least once a year, get a thorough foot exam, including a check of the feeling and pulses in your feet.Get a thorough foot exam at each health care visit if you havechanges in the shape of your feet loss of feeling in your feet peripheral artery disease had foot ulcers or an amputation in the past1Ask your health care team to show you how to care for your feet. When should I see my health care provider about foot problems? Call your health care provider right away if you havea cut, blister, or bruise on your foot that does not start to heal after a few days skin on your foot that becomes red, warm, or painful—signs of a possible infection a callus with dried blood inside of it,which often can be the first sign of a wound under the callus a foot infection that becomes black and smelly—signs you might have gangreneAsk your provider to refer you to a foot doctor, or podiatrist, if needed. Foot Problems The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov. Eye Disease Diabetes can damage your eyes and lead to low vision and blindness. The best way to prevent eye disease is to manage your blood glucose, blood pressure, and cholesterol; and to not smoke. Also, have a dilated eye exam at least once a year. What is diabetic eye disease? Diabetic eye disease is a group of eye problems that can affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema, cataracts, and glaucoma.Over time, diabetes can cause damage to your eyes that can lead to poor vision or even blindness. But you can take steps to prevent diabetic eye disease, or keep it from getting worse, by taking care of your diabetes.The best ways to manage your diabetes and keep your eyes healthy are tomanage your blood glucose, blood pressure, and cholesterol, sometimes called the diabetes ABCs If you smoke, get help to quit smoking have a dilated eye exam once a yearOften, there are no warning signs of diabetic eye disease or vision loss when damage first develops. A full, dilated eye exam helps your doctor find and treat eye problems early—often before much vision loss can occur. How does diabetes affect my eyes? Diabetes affects your eyes when your blood glucose, also called blood sugar, is too high.In the short term, you are not likely to have vision loss from high blood glucose. People sometimes have blurry vision for a few days or weeks when they’re changing their diabetes care plan or medicines. High glucose can change fluid levels or cause swelling in the tissues of your eyes that help you to focus, causing blurred vision. This type of blurry vision is temporary and goes away when your glucose level gets closer to normal.If your blood glucose stays high over time, it can damage the tiny blood vessels in the back of your eyes. This damage can begin during prediabetes, when blood glucose is higher than normal, but not high enough for you to be diagnosed with diabetes. Damaged blood vessels may leak fluid and cause swelling. New, weak blood vessels may also begin to grow. These blood vessels can bleed into the middle part of the eye, lead to scarring, or cause dangerously high pressure inside your eye.Most serious diabetic eye diseases begin with blood vessel problems. The four eye diseases that can threaten your sight areThe retina is the inner lining at the back of each eye. The retina senses light and turns it into signals that your brain decodes, so you can see the world around you. Damaged blood vessels can harm the retina, causing a disease called diabetic retinopathy.In early diabetic retinopathy, blood vessels can weaken, bulge, or leak into the retina. This stage is called nonproliferative diabetic retinopathy.If the disease gets worse, some blood vessels close off, which causes new blood vessels to grow, or proliferate, on the surface of the retina. This stage is called proliferative diabetic retinopathy. These abnormal new blood vessels can lead to serious vision problems.The part of your retina that you need for reading, driving, and seeing faces is called the macula. Diabetes can lead to swelling in the macula, which is called diabetic macular edema. Over time, this disease can destroy the sharp vision in this part of the eye, leading to partial vision loss or blindness. Macular edema usually develops in people who already have other signs of diabetic retinopathy.Glaucoma is a group of eye diseases that can damage the optic nerve—the bundle of nerves that connects the eye to the brain. Diabetes doubles the chances of having glaucoma, which can lead to vision loss and blindness if not treated early.Symptoms depend on which type of glaucoma you have. Learn more about glaucoma.The lenses within our eyes are clear structures that help provide sharp vision—but they tend to become cloudy as we age. People with diabetes are more likely to develop cloudy lenses, called cataracts. People with diabetes can develop cataracts at an earlier age than people without diabetes. Researchers think that high glucose levels cause deposits to build up in the lenses of your eyes. How common is diabetic eye disease? About one in three people with diabetes who are older than age 40 already have some signs of diabetic retinopathy.1 Diabetic retinopathy is the most common cause of vision loss in people with diabetes. Each person’s outlook for the future, however, depends in large part on regular care. Finding and treating diabetic retinopathy early can reduce the risk of blindness by 95 percent.Your chances of developing glaucoma or cataracts are about twice that of someone without diabetes. Who is more likely to develop diabetic eye disease? Anyone with diabetes can develop diabetic eye disease. Your risk is greater withhigh blood glucose that is not treated high blood pressure that is not treatedHigh blood cholesterol and smoking may also raise your risk for diabetic eye disease.Some groups are affected more than others. African Americans, American Indians and Alaska Natives, Hispanics/Latinos, Pacific Islanders, and older adults are at greater risk of losing vision or going blind from diabetes.If you have diabetes and become pregnant, you can develop eye problems very quickly during your pregnancy. If you already have some diabetic retinopathy, it can get worse during pregnancy. Changes that help your body support a growing baby may put stress on the blood vessels in your eyes. Your health care team will suggest regular eye exams during pregnancy to catch and treat problems early and protect your vision.Diabetes that occurs only during pregnancy, called gestational diabetes, does not usually cause eye problems. Researchers aren't sure why this is the case.Your chances of developing diabetic eye disease increase the longer you have diabetes. What are the symptoms of diabetic eye disease? Often there are no early symptoms of diabetic eye disease. You may have no pain and no change in your vision as damage begins to grow inside your eyes, particularly with diabetic retinopathy.When symptoms do occur, they may includeblurry or wavy vision frequently changing vision—sometimes from day to day dark areas or vision loss poor color vision spots or dark strings (also called floaters) flashes of lightTalk with your eye doctor if you have any of these symptoms. When should I see a doctor right away? Call a doctor right away if you notice sudden changes to your vision, including flashes of light or many more spots (floaters) than usual. You also should see a doctor right away if it looks like a curtain is pulled over your eyes. These changes in your sight can be symptoms of a detached retina, which is a medical emergency. How do doctors diagnose eye problems from diabetes? Having a full, dilated eye exam is the best way to check for eye problems from diabetes. Your doctor will place drops in your eyes to widen your pupils. This allows the doctor to examine a larger area at the back of each eye, using a special magnifying lens. Your vision will be blurry for a few hours after a dilated exam.Your doctor will alsotest your vision measure the pressure in your eyesYour doctor may suggest other tests, too, depending on your health history.Most people with diabetes should see an eye care professional once a year for a complete eye exam. Your own health care team may suggest a different plan, based on your type of diabetes and the time since you were first diagnosed. How do doctors treat diabetic eye disease? Your doctor may recommend having eye exams more often than once a year, along with management of your diabetes. This means managing your diabetes ABCs, which include your A1c, blood pressure, and cholesterol; and quitting smoking. Ask your health care team what you can do to reach your goals.Doctors may treat advanced eye problems with medicine, laser treatments, surgery, or a combination of these options.Your doctor may treat your eyes with anti-VEGF medicine, such as aflibercept, bevacizumab, or ranibizumab. These medicines block the growth of abnormal blood vessels in the eye. Anti-VEGF medicines can also stop fluid leaks, which can help treat diabetic macular edema.The doctor will inject an anti-VEGF medicine into your eyes during office visits. You'll have several treatments during the first few months, then fewer treatments after you finish the first round of therapy. Your doctor will use medicine to numb your eyes so you don’t feel pain. The needle is about the thickness of a human hair.Anti-VEGF treatments can stop further vision loss and may improve vision in some people.Laser treatment, also called photocoagulation, creates tiny burns inside the eye with a beam of light. This method treats leaky blood vessels and extra fluid, called edema. Your doctor usually provides this treatment during several office visits, using medicine to numb your eyes. Laser treatment can keep eye disease from getting worse, which is important to prevent vision loss or blindness. But laser treatment is less likely to bring back vision you’ve already lost compared with anti-VEGF medicines.There are two types of laser treatment:Focal/grid laser treatment works on a small area of the retina to treat diabetic macular edema. Scatter laser treatment, also called panretinal photocoagulation (PRP), covers a larger area of the retina. This method treats the growth of abnormal blood vessels, called proliferative diabetic retinopathy.Vitrectomy is a surgery to remove the clear gel that fills the center of the eye, called the vitreous gel. The procedure treats problems with severe bleeding or scar tissue caused by proliferative diabetic retinopathy. Scar tissue can force the retina to peel away from the tissue beneath it, like wallpaper peeling away from a wall. A retina that comes completely loose, or detaches, can cause blindness.During vitrectomy, a clear salt solution is gently pumped into the eye to maintain eye pressure during surgery and to replace the removed vitreous. Vitrectomy is done in a surgery center or hospital with pain medicine.In a surgery center or hospital visit, your doctor can remove the cloudy lens in your eye, where the cataract has grown, and replace it with an artificial lens. People who have cataract surgery generally have better vision afterward. After your eye heals, you may need a new prescription for your glasses. Your vision following cataract surgery may also depend on treating any damage from diabetic retinopathy or macular edema. What can I do to protect my eyes? To prevent diabetic eye disease, or to keep it from getting worse, manage your diabetes ABCs: your A1c, blood pressure, and cholesterol; and quit smoking if you smoke. Read more information on how to manage diabetes.Also, have a dilated eye exam at least once a year—or more often if recommended by your eye care professional. These actions are powerful ways to protect the health of your eyes—and can prevent blindness.The sooner you work to manage your diabetes and other health conditions, the better. And, even if you’ve struggled in the past to manage your health, taking better care of yourself now can protect your eyes for the future. It’s never too late to begin. What if I already have some vision loss from diabetes? Ask your eye care professional to help you find a low vision and rehabilitation clinic. Special eye care professionals can help you manage vision loss that cannot be corrected with glasses, contact lenses, medicine, or surgery. Special devices and training may help you make the most of your remaining vision so that you can continue to be active, enjoy hobbies, visit friends and family members, and live without help from others. Eye Disease Gum Disease and Other Dental Problems Diabetes can lead to problems in your mouth, such as infection, gum disease, or dry mouth. To help keep your mouth healthy, manage your blood glucose, brush your teeth twice a day, see your dentist at least once a year, and don’t smoke. Gum Disease & Other Dental Problems Sexual and Urologic Problems Having diabetes can increase your chance of having bladder problems and changes in sexual function. Following your diabetes management plan is important to help prevent or delay sexual and urologic problems. Diabetes and Sexual Problems Both men and women with diabetes can develop sexual problems because of damage to nerves and small blood vessels. When a person wants to lift an arm or take a step, the brain sends nerve signals to the appropriate muscles. Nerve signals also control internal organs like the heart and bladder, but people do not have the same kind of conscious control over them as they do over their arms and legs. The nerves that control internal organs are called autonomic nerves, which signal the body to digest food and circulate blood without a person having to think about it. The body's response to sexual stimuli is also involuntary, governed by autonomic nerve signals that increase blood flow to the genitals and cause smooth muscle tissue to relax. Damage to these autonomic nerves can hinder normal function. Reduced blood flow resulting from damage to blood vessels can also contribute to sexual dysfunction. What sexual problems can occur in men with diabetes? Erectile dysfunction is a consistent inability to have an erection firm enough for sexual intercourse. The condition includes the total inability to have an erection and the inability to sustain an erection.Estimates of the prevalence of erectile dysfunction in men with diabetes vary widely, ranging from 20 to 75 percent. Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes. Among men with erectile dysfunction, those with diabetes may experience the problem as much as 10 to 15 years earlier than men without diabetes. Research suggests that erectile dysfunction may be an early marker of diabetes, particularly in men ages 45 and younger.In addition to diabetes, other major causes of erectile dysfunction include high blood pressure, kidney disease, alcohol abuse, and blood vessel disease. Erectile dysfunction may also occur because of the side effects of medications, psychological factors, smoking, and hormonal deficiencies.Men who experience erectile dysfunction should consider talking with a health care provider. The health care provider may ask about the patient's medical history, the type and frequency of sexual problems, medications, smoking and drinking habits, and other health conditions. A physical exam and laboratory tests may help pinpoint causes of sexual problems. The health care provider will check blood glucose control and hormone levels and may ask the patient to do a test at home that checks for erections that occur during sleep. The health care provider may also ask whether the patient is depressed or has recently experienced upsetting changes in his life.Treatments for erectile dysfunction caused by nerve damage, also called neuropathy, vary widely and range from oral pills, a vacuum pump, pellets placed in the urethra, and shots directly into the penis, to surgery. All of these methods have advantages and disadvantages. Psychological counseling to reduce anxiety or address other issues may be necessary. Surgery to implant a device to aid in erection or to repair arteries is usually used as a treatment after all others fail.Retrograde ejaculation is a condition in which part or all of a man's semen goes into the bladder instead of out the tip of the penis during ejaculation. Retrograde ejaculation occurs when internal muscles, called sphincters, do not function normally. A sphincter automatically opens or closes a passage in the body. With retrograde ejaculation, semen enters the bladder, mixes with urine, and leaves the body during urination without harming the bladder. A man experiencing retrograde ejaculation may notice that little semen is discharged during ejaculation or may become aware of the condition if fertility problems arise. Analysis of a urine sample after ejaculation will reveal the presence of semen.Poor blood glucose control and the resulting nerve damage can cause retrograde ejaculation. Other causes include prostate surgery and some medications.Retrograde ejaculation caused by diabetes or surgery may be helped with a medication that strengthens the muscle tone of the sphincter in the bladder. A urologist experienced in infertility treatments may assist with techniques to promote fertility, such as collecting sperm from the urine and then using the sperm for artificial insemination. What sexual problems can occur in women with diabetes? Many women with diabetes experience sexual problems. Although research about sexual problems in women with diabetes is limited, one study found 27 percent of women with type 1 diabetes experienced sexual dysfunction. Another study found 18 percent of women with type 1 diabetes and 42 percent of women with type 2 diabetes experienced sexual dysfunction.Sexual problems may includedecreased vaginal lubrication, resulting in vaginal dryness uncomfortable or painful sexual intercourse decreased or no desire for sexual activity decreased or absent sexual responseDecreased or absent sexual response can include the inability to become or remain aroused, reduced or no sensation in the genital area, and the constant or occasional inability to reach orgasm.Causes of sexual problems in women with diabetes include nerve damage, reduced blood flow to genital and vaginal tissues, and hormonal changes. Other possible causes include some medications, alcohol abuse, smoking, psychological problems such as anxiety or depression, gynecologic infections, other diseases, and conditions relating to pregnancy or menopause.Women who experience sexual problems or notice a change in sexual response should consider talking with a health care provider. The health care provider will ask about the patient's medical history, any gynecologic conditions or infections, the type and frequency of sexual problems, medications, smoking and drinking habits, and other health conditions. The health care provider may ask whether the patient might be pregnant or has reached menopause and whether she is depressed or has recently experienced upsetting changes in her life. A physical exam and laboratory tests may also help pinpoint causes of sexual problems. The health care provider will also talk with the patient about blood glucose control.Prescription or over-the-counter vaginal lubricants may be useful for women experiencing vaginal dryness. Techniques to treat decreased sexual response include changes in position and stimulation during sexual relations. Psychological counseling may be helpful. Kegel exercises that help strengthen the pelvic muscles may improve sexual response. Studies of drug treatments are under way. Diabetes and Urologic Problems Urologic problems that affect men and women with diabetes include bladder problems and urinary tract infections. Sexual & Urologic Problems
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Autosomal dominant nocturnal frontal lobe epilepsy ADNFLE Epilepsy, nocturnal frontal lobe, 1 ENFL1 Summary Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is an uncommon, inherited form of epilepsy. People with ADNFLE have seizures that usually occur at night during sleep. Some people with ADNFLE also have seizures during the day. These seizures can last from a few seconds to a few minutes, and can vary from causing simple arousal from sleep, to dramatic muscle spasms and movements. The onset of ADNFLE ranges from infancy to adulthood, but most cases begin in childhood. Episodes tend to become milder and less frequent with age. [1] [2] It is diagnosed based on symptoms and the results of tests such as an EEG . ADNFLE is inherited in an autosomal dominant manner and may be caused by a mutation in any of several genes . In most cases however, the genetic cause is not found. Seizures can usually be controlled with anti-seizure medications. [2] Symptoms The main symptom in people with autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is seizures that generally occur at night. Seizures may begin anywhere from early childhood to adulthood, but most often begin in childhood. [3] [4] Seizures may last from a few seconds to a few minutes. [1] The frequency of seizures varies from several per year to several per night. [3] Seizures may become less frequent or more mild as a person gets older. [1] Some people with ADNFLE occasionally have seizures while they are awake. [4] When a person with ADNFLE is having a seizure, they may experience a variety of movement-related symptoms ranging from mild to severe. Examples include: [1] [3] [4] Short bursts of random, repetitive movements of the limbs, trunk, or head, lasting 2 to 4 seconds. Brief, sudden arousal (waking), sometimes with repetitive movements, making sounds, crying, or feelings of fear. Major attacks lasting 20 to 30 seconds, characterized by extreme stiffening of muscles, or movements such as pelvic thrusting, pedaling, twisting and writhing, or fast, forceful motions of the limbs. Recurring episodes of exertion during the night may lead to sleepiness during the day. [4] Most people with ADNFLE have normal intellect (thinking abilities), but in some cases, intellect is reduced. Some people with ADNFLE also have psychiatric disorders or behavior problems, but it is unclear if these are directly related to ADNFLE. [1] [3] This table lists symptoms that people with this disease may have. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. This information comes from a database called the Human Phenotype Ontology (HPO) . The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly. Use the HPO ID to access more in-depth information about a symptom. Showing of Medical Terms Other Names Learn More: HPO ID 5%-29% of people have these symptoms Intellectual disability Mental deficiency Mental retardation Mental retardation, nonspecific Mental-retardation 0001249 Percent of people who have these symptoms is not available through HPO Autosomal dominant inheritance 0000006 Childhood onset Symptoms begin in childhood 0011463 Focal-onset seizure 0007359 Incomplete penetrance 0003829 Showing of Diagnosis A diagnosis of autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is made based on signs and symptoms. In addition to the doctor taking a detailed medical and family history from the person with symptoms, obtaining information from others who see episodes occur is very helpful. In some cases, video- EEG monitoring during sleep is needed. The features that suggest a diagnosis of ADNFLE include: Clusters of seizures that occur mainly during sleep. A normal neurologic exam and normal findings on brain imaging tests. A normal EEG recorded during a seizure (ictal EEG), or one that is obscured by movement of the cables or electrodes. An EEG recorded between seizures (interictal EEG) that shows few or no instances of patterns seen in people with epilepsy. The presence of the same disorder in other family members, with evidence of autosomal dominant If ADNFLE is suspected, genetic testing may be ordered. However, genetic testing can confirm the diagnosis in only 20% of people with a family history of ADNFLE, and in fewer than 5% of people with no family history. [2] Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. Find a Specialist If you need medical advice, you can look for doctors or other healthcare professionals who have experience with this disease. You may find these specialists through advocacy organizations, clinical trials, or articles published in medical journals. You may also want to contact a university or tertiary medical center in your area, because these centers tend to see more complex cases and have the latest technology and treatments. If you can't find a specialist in your local area, try contacting national or international specialists. They may be able to refer you to someone they know through conferences or research efforts. Some specialists may be willing to consult with you or your local doctors over the phone or by email if you can't travel to them for care. You can find more tips in our guide, How to Find a Disease Specialist. We also encourage you to explore the rest of this page to find resources that can help you find specialists. Healthcare Resources To find a medical professional who specializes in genetics, you can ask your doctor for a referral or you can search for one yourself. Online directories are provided by the American College of Medical Genetics and the National Society of Genetic Counselors. If you need additional help, contact a GARD Information Specialist. You can also learn more about genetic consultations from Genetics Home Reference. Related Diseases Related diseases are conditions that have similar signs and symptoms. A health care provider may consider these conditions in the table below when making a diagnosis. Please note that the table may not include all the possible conditions related to this disease. Conditions with similar signs and symptoms from Orphanet Differential diagnoses include sporadic NFLE, paroxysmal dyskinesia, familial focal epilepsy with variable foci (see these terms), restless legs syndrome, periodic limb movement disorders (PLMS), REM sleep behavior disorders (RBD), nocturnal panic attacks, non-REM parasomnias, obstructive sleep apnea syndrome, and arousal disorders. Visit the Orphanet disease page for more information.
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Diabetes Diabetes - type 1 Diabetes - type 2 Diabetes - gestational Type 1 diabetes Type 2 diabetes Gestational diabetes Diabetes mellitus Summary Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood. Causes Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested and absorbed: A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body. An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and other cells, where it can be stored or used as fuel. People with diabetes have high blood sugar because their body cannot move sugar from the blood into muscle and fat cells to be burned or stored for energy, and/or because their liver makes too much glucose and releases it into the blood. This is because either: Their pancreas does not make enough insulin Their cells do not respond to insulin normally Both of the above There are two major types of diabetes. The causes and risk factors are different for each type: Type 1 diabetes is less common. It can occur at any age, but it is most often diagnosed in children, teens, or young adults. In this disease, the body makes little or no insulin. This is because the pancreas cells that make insulin stop working. Daily injections of insulin are needed. The exact cause of the failure to make enough insulin is unknown. Type 2 diabetes is more common. It most often occurs in adulthood, but because of high obesity rates, children and teens are now being diagnosed with this disease. Some people with type 2 diabetes do not know they have it. With type 2 diabetes, the body is resistant to insulin and doesn't use insulin as well as it should. Not all people with type 2 diabetes are overweight or obese. There are other causes of diabetes, and some people cannot be classified as type 1 or type 2. Gestational diabetes is high blood sugar that develops at any time during pregnancy in a woman who does not have diabetes. If your parent, brother, or sister has diabetes, you may be more likely to develop the disease. Symptoms A high blood sugar level can cause several symptoms, including: Blurry vision Excess thirst Fatigue Frequent urination Hunger Weight loss Because type 2 diabetes develops slowly, some people with high blood sugar have no symptoms. Symptoms of type 1 diabetes develop over a short period. People may be very sick by the time they are diagnosed. After many years, diabetes can lead to other serious problems. These problems are known as diabetes complications, and include: Eye problems, including trouble seeing (especially at night), light sensitivity, and blindness Sores and infections of the leg or foot, which if untreated, can lead to amputation of the leg or foot Damage to nerves in the body, causing pain, tingling, a loss of feeling, problems digesting food, and erectile dysfunction Kidney problems, which can lead to kidney failure Weakened immune system, which can lead to more frequent infections Increased chance of having a heart attack or stroke Exams and Tests A urine analysis may show high blood sugar. But a urine test alone does not diagnose diabetes. Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL (11.1 mmol/L). To confirm the diagnosis, one or more of the following tests must be done. Blood tests: Fasting blood glucose level. Diabetes is diagnosed if the fasting glucose level is higher than 126 mg/dL (7.0 mmol/L) on two different tests. Levels between 100 and 126 mg/dL (5.5 and 7.0 mmol/L) are called impaired fasting glucose or prediabetes. These levels are risk factors for type 2 diabetes. Hemoglobin A1c (A1C) test. Normal is less than 5.7%; prediabetes is 5.7% to 6.4%; and diabetes is 6.5% or higher. Oral glucose tolerance test. Diabetes is diagnosed if the glucose level is higher than 200 mg/dL (11.1 mmol/L) 2 hours after drinking a sugar drink (this test is used more often for type 2 diabetes). Screening for type 2 diabetes in people who have no symptoms is recommended for: Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 3 years. Overweight adults (BMI of 25 or higher) who have other risk factors such as having high blood pressure, or having a mother, father, sister or brother with diabetes. Adults over age 45, repeated every 3 years. Treatment Type 2 diabetes can sometimes be reversed with lifestyle changes, especially losing weight with exercise and by eating healthier foods. Some cases of type 2 diabetes can also be improved with weight loss surgery. There is no cure for type 1 diabetes (except for a pancreas or islet cell transplant). Treating either type 1 diabetes or type 2 diabetes involves nutrition, activity and medicines to control blood sugar level. Everyone with diabetes should receive proper education and support about the best ways to manage their diabetes. Ask your provider about seeing a certified diabetes educator (CDE). Getting better control over your blood sugar, cholesterol, and blood pressure levels helps reduce the risk for kidney disease, eye disease, nervous system disease, heart attack, and stroke. To prevent diabetes complications, visit your provider at least 2 to 4 times a year. Talk about any problems you are having. Follow your provider's instructions on managing your diabetes. Support Groups Many resources can help you understand more about diabetes. If you have diabetes, you can also learn ways to manage your condition and prevent diabetes complications. Outlook (Prognosis) Diabetes is a lifelong disease for most people who have it. Tight control of blood glucose can prevent or delay diabetes complications. But these problems can occur, even in people with good diabetes control. Possible Complications After many years, diabetes can lead to serious health problems: You could have eye problems, including trouble seeing (especially at night), and light sensitivity. You could become blind. Your feet and skin can develop sores and infections. After a long time, your foot or leg may need to be amputated. Infection can also cause pain and itching in other parts of the body. Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart attack, stroke, and other problems. It can become harder for blood to flow to your legs and feet. Nerves in your body can get damaged, causing pain, tingling, and numbness. Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can make it harder for men to have an erection. High blood sugar and other problems can lead to kidney damage. Your kidneys may not work as well as they used to. They may even stop working so that you need dialysis or a kidney transplant. Your immune system can weaken, which can lead to frequent infections. Prevention Keeping an ideal body weight and an active lifestyle may prevent or delay the start of type 2 diabetes. If you're overweight, losing just 5% of your body weight can reduce your risk. Some medicines can also be used to delay or prevent the start of type 2 diabetes. At this time, type 1 diabetes cannot be prevented. But there is promising research that shows type 1 diabetes may be delayed in some high risk people. Review Date 2/22/2018 Updated by: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Broken nose Overview A broken nose, also called a nasal fracture, is a break or crack in a bone in your nose - often the bone over the bridge of your nose. Common causes of a broken nose include contact sports, physical fights, falls and motor vehicle accidents that result in facial trauma. A broken nose can cause pain, along with swelling and bruising around your nose and under your eyes. Your nose may look crooked, and you may have trouble breathing. Treatment for a broken nose may include procedures that realign your nose. Surgery usually isn't necessary for a broken nose. Symptoms Signs and symptoms of a broken nose: - Pain or tenderness, especially when touching your nose - Swelling of your nose and surrounding areas - Bleeding from your nose - Bruising around your nose or eyes - Crooked or misshapen nose - Difficulty breathing through your nose - Discharge of mucus from your nose - Feeling that one or both of your nasal passages are blocked When to see a doctor Seek emergency medical attention if you experience a nose injury accompanied by: - A head or neck injury, which may be marked by severe headache, neck pain, vomiting or loss of consciousness - Difficulty breathing - Bleeding you can't stop - A noticeable change in the shape of your nose that isn't related to swelling, such as a crooked or twisted appearance - Clear, watery fluid draining from your nose Causes Common causes of a broken nose include: - Injury from contact sports, such as football or hockey - Physical altercations - Motor vehicle accidents - Falls A broken nose can even be caused by walking into a fixed object, such as a door or wall, or by rough, wrestling-type play. Risk factors Any activity that increases your risk of a facial injury increases your risk of a broken nose. Such activities may include: - Playing contact sports, such as football and hockey, especially without a helmet that has a face mask - Engaging in a physical fight - Riding a bicycle - Lifting weights, especially if you don't use a spotter - Riding in a motor vehicle, especially without a seat belt Complications Complications or injuries related to a broken nose may include: - Deviated septum. A nose fracture may cause a deviated septum, a condition that occurs when the thin wall dividing the two sides of your nose (nasal septum) is displaced, narrowing your nasal passage. Medications, such as decongestants and antihistamines, can help you manage a deviated septum, but surgery is required to correct the condition. - Collection of blood. Sometimes, pools of clotted blood form in a broken nose, creating a condition called a septal hematoma. A septal hematoma can block one or both nostrils. Septal hematoma requires prompt surgical drainage to prevent cartilage damage. - Cartilage fracture. If your fracture is due to a forceful blow, such as from an automobile accident, you also may experience a cartilage fracture. If your injury is severe enough to warrant surgical treatment, the surgeon should address both your bone and cartilage injuries. - Neck injury. Likewise, nose fractures resulting from high-velocity injuries - like those experienced in motor vehicle accidents - may be accompanied by injuries to your neck. If a blow is strong enough to break your nose, it may also be strong enough to damage the bones in your neck. If you suspect a neck injury, see your doctor immediately. Diagnosis Your doctor may press gently on the outside of your nose and its surrounding areas. He or she may look inside your nasal passage to check for obstruction and further signs of broken bones. Your doctor may use anesthetics - either a nasal spray or local injections - to make you more comfortable during the exam. X-rays and other imaging studies are usually unnecessary. However, your doctor may recommend a computerized tomography (CT) scan if the severity of your injuries makes a thorough physical exam impossible or if your doctor suspects you may have other injuries. Treatment If you have a minor fracture that hasn't caused your nose to become crooked or otherwise misshapen, you may not need professional medical treatment. Your doctor may recommend simple self-care measures, such as using ice on the area and taking over-the-counter pain medications. Fixing displacements and breaks Your doctor may be able to realign your nose manually, or you may need surgery. Manual realignment If the break has displaced the bones and cartilage in your nose, your doctor may be able to manually realign them. This needs to be done within 14 days from when the fracture occurred, preferably sooner. During this procedure, your doctor: - Administers medication by injection or nasal spray to ease discomfort - Opens your nostrils with a nasal speculum - Uses special instruments to help realign your broken bones and cartilage Your doctor will also splint your nose using packing in your nose and a dressing on the outside. Sometimes, an internal splint is also necessary for a short time. The packing usually needs to stay in for a week. You'll also be given a prescription for antibiotics to prevent infection with the bacteria that may normally reside in your nose. Surgery Severe breaks, multiple breaks or breaks that have gone untreated for more than 14 days may not be candidates for manual realignment. In these cases, surgery to realign the bones and reshape your nose may be necessary. If the break has damaged your nasal septum, causing obstruction or difficulty breathing, reconstructive surgery may be recommended. Surgery is typically performed on an outpatient basis. Lifestyle and home remedies If you think you may have broken your nose, take these steps to reduce pain and swelling before seeing your doctor: - Act quickly. When the break first occurs, breathe through your mouth and lean forward to reduce the amount of blood that drains into your throat. - Use ice. Apply ice packs or cold compresses immediately after the injury, and then at least four times a day for the first 24 to 48 hours to reduce swelling. Keep the ice or cold compress on for 10 to 15 minutes at a time. Wrap the ice in a washcloth to prevent frostbite. Try not to apply too much pressure, which can cause additional pain or damage to your nose. - Relieve pain. Take over-the-counter pain relievers, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), as necessary. - Keep your head up. Elevate your head - especially when sleeping - so as not to worsen swelling and throbbing. - Limit your activities. For the first two weeks after treatment, don't play any sports. Avoid contact sports for at least six weeks after your injury.
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Epilepsy - overview Seizure disorder Epileptic - epilepsy Summary Epilepsy is a brain disorder in which a person has repeated seizures over time. Seizures are episodes of uncontrolled and abnormal firing of brain cells that may cause changes in attention or behavior. Causes Epilepsy occurs when changes in the brain cause it to be too excitable or irritable. As a result, the brain sends out abnormal signals. This leads to repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.) Epilepsy may be due to a medical condition or injury that affects the brain. Or, the cause may be unknown (idiopathic). Common causes of epilepsy include: Stroke or transient ischemic attack (TIA) Dementia, such as Alzheimer disease Traumatic brain injury Infections, including brain abscess, meningitis, encephalitis, and HIV/AIDS Brain problems that are present at birth (congenital brain defect) Brain injury that occurs during or near birth Metabolism disorders present at birth (such as phenylketonuria) Brain tumor Abnormal blood vessels in the brain Other illness that damages or destroys brain tissue Seizure disorders that run in families (hereditary epilepsy) Epileptic seizures usually begin between ages 5 and 20. There is also a higher chance of seizures in adults older than 60. But epileptic seizures can happen at any age. There may be a family history of seizures or epilepsy. Symptoms Symptoms vary from person to person. Some people may have simple staring spells. Others have violent shaking and loss of alertness. The type of seizure depends on the part of the brain that is affected. Most of the time, the seizure is similar to the one before it. Some people with epilepsy have a strange sensation before each seizure. Sensations may be tingling, smelling an odor that is not actually there, or emotional changes. This is called an aura. Your doctor can tell you more about the specific type of seizure you may have: Absence (petit mal) seizure (staring spells) Generalized tonic-clonic (grand mal) seizure (involves the entire body, including aura, rigid muscles, and loss of alertness) Partial (focal) seizure (can involve any of the symptoms described above, depending on where in the brain the seizure starts) Exams and Tests The doctor will perform a physical exam. This will include a detailed look at the brain and nervous system. An EEG (electroencephalogram) will be done to check the electrical activity in the brain. People with epilepsy often have abnormal electrical activity seen on this test. In some cases, the test shows the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures. To diagnose epilepsy or plan for epilepsy surgery, you may need to: Wear an EEG recorder for days or weeks as you go about your everyday life. Stay in a special hospital where brain activity can be recorded while video cameras capture what happens to you during the seizure. This is called video EEG. Tests that may be done include: Blood chemistry Blood sugar Complete blood count (CBC) Kidney function tests Liver function tests Lumbar puncture (spinal tap) Tests for infectious diseases Head CT or MRI scan is often done to find the cause and location of the problem in the brain. Treatment Treatment for epilepsy includes taking medicines, lifestyle changes, and sometimes surgery. If epilepsy is due to a tumor, abnormal blood vessels, or bleeding in the brain, surgery to treat these disorders may make the seizures stop. Medicines to prevent seizures, called anticonvulsants (or antiepileptic drugs), may reduce the number of future seizures: These drugs are taken by mouth. Which type you are prescribed depends on the type of seizures you have. Your dosage may need to be changed from time to time. You may need regular blood tests to check for side effects. Always take your medicine on time and as directed. Missing a dose can cause you to have a seizure. DO NOT stop taking or change medicines on your own. Talk to your doctor first. Many epilepsy medicines cause birth defects. Women who plan to become pregnant should tell their doctor in advance in order to adjust medicines. Many epilepsy drugs may affect the health of your bones. Talk to your doctor about whether you need vitamins and other supplements. Epilepsy that does not get better after 2 or 3 anti-seizure drugs have been tried is called "medically refractory epilepsy." In this case, the doctor may recommend surgery to: Remove the abnormal brain cells causing the seizures. Place a vagal nerve stimulator (VNS). This device is similar to a heart pacemaker. It can help reduce the number of seizures. Some children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults. Be sure to discuss these options with your doctor before trying them. Lifestyle or medical changes can increase the risk for a seizure in adults and children with epilepsy. Talk with your doctor about: New prescribed drugs, vitamins, or supplements Emotional stress Illness, especially infection Lack of sleep Pregnancy Skipping doses of epilepsy medicines Use of alcohol or other recreational drugs Other considerations: People with epilepsy should wear medical alert jewelry so that prompt treatment can be obtained if a seizure occurs. People with poorly controlled epilepsy should not drive. Check your state's law about which people with a history of seizures are allowed to drive. DO NOT use machinery or do activities that can cause loss of awareness, such as climbing to high places, biking, and swimming alone. Support Groups The stress of having epilepsy or being a caretaker of someone with epilepsy can often be helped by joining a support group. In these groups, members share common experiences and problems. Outlook (Prognosis) Some people with epilepsy may be able to reduce or even stop their anti-seizure medicines after having no seizures for several years. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s. For many people, epilepsy is a lifelong condition. In these cases, anti-seizure drugs need to be continued. There is a very low risk for sudden death with epilepsy. Possible Complications Complications may include: Difficulty learning Breathing in food or saliva into the lungs during a seizure, which can cause aspiration pneumonia Injury from falls, bumps, self-inflicted bites, driving or operating machinery during a seizure Permanent brain damage (stroke or other damage) Side effects of medicines When to Contact a Medical Professional Call your local emergency number (such as 911) if: This is the first time a person has a seizure A seizure occurs in someone who is not wearing a medical ID bracelet (which has instructions explaining what to do) In the case of someone who has had seizures before, call 911 for any of these emergency situations: This is a longer seizure than the person normally has, or an unusual number of seizures for the person Repeated seizures over a few minutes Repeated seizures in which consciousness or normal behavior is not regained between them (status epilepticus) Call your doctor if any new symptoms occur: Loss of hair Nausea or vomiting Rash Side effects of medicines, such as drowsiness, restlessness, confusion, sedation Tremors or abnormal movements, or problems with coordination Prevention There is no known way to prevent epilepsy. Proper diet and sleep, and staying away from alcohol and illegal drugs may decrease the likelihood of triggering seizures in people with epilepsy. Reduce the risk for head injury by wearing a helmet during risky activities. This can lessen the likelihood of a brain injury that leads to seizures and epilepsy. Review Date 2/27/2018 Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Rheumatoid arthritis Overview Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition also can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels. An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities. Symptoms Signs and symptoms of rheumatoid arthritis may include: - Tender, warm, swollen joints - Joint stiffness that is usually worse in the mornings and after inactivity - Fatigue, fever and weight loss Early rheumatoid arthritis tends to affect your smaller joints first - particularly the joints that attach your fingers to your hands and your toes to your feet. As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body. About 40 percent of the people who have rheumatoid arthritis also experience signs and symptoms that don't involve the joints. Rheumatoid arthritis can affect many nonjoint structures, including: - Skin - Eyes - Lungs - Heart - Kidneys - Salivary glands - Nerve tissue - Bone marrow - Blood vessels Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission - when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place. Make an appointment with your doctor if you have persistent discomfort and swelling in your joints. Causes Rheumatoid arthritis occurs when your immune system attacks the synovium - the lining of the membranes that surround your joints. The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint. The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment. Doctors don't know what starts this process, although a genetic component appears likely. While your genes don't actually cause rheumatoid arthritis, they can make you more susceptible to environmental factors - such as infection with certain viruses and bacteria - that may trigger the disease. Risk factors Factors that may increase your risk of rheumatoid arthritis include: - Your sex. Women are more likely than men to develop rheumatoid arthritis. - Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60. - Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease. - Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity. - Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis. - Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger. Diagnosis Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis. During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she may also check your reflexes and muscle strength. Blood tests People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP), which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Imaging tests Your doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joints over time. MRI and ultrasound tests can help your doctor judge the severity of the disease in your body. Treatment There is no cure for rheumatoid arthritis. But recent discoveries indicate that remission of symptoms is more likely when treatment begins early with strong medications known as disease-modifying antirheumatic drugs (DMARDs). Medications The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you've had rheumatoid arthritis. - NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include ringing in your ears, stomach irritation, heart problems, and liver and kidney damage. - Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication. - Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, Rasuvo), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Side effects vary but may include liver damage, bone marrow suppression and severe lung infections. - Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), tocilizumab (Actemra) and tofacitinib (Xeljanz). These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. These types of drugs also increase the risk of infections. Biologic DMARDs are usually most effective when paired with a nonbiologic DMARD, such as methotrexate. Therapy Your doctor may send you to a physical or occupational therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, if your fingers are sore, you may want to pick up an object using your forearms. Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a saw handle helps protect your finger and wrist joints. Certain tools, such as buttonhooks, can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas. Surgery If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities. Rheumatoid arthritis surgery may involve one or more of the following procedures: - Synovectomy. Surgery to remove the inflamed synovium (lining of the joint). Synovectomy can be performed on knees, elbows, wrists, fingers and hips. - Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint. - Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option. - Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic. Surgery carries a risk of bleeding, infection and pain. Discuss the benefits and risks with your doctor. Lifestyle and home remedies You can take steps to care for your body if you have rheumatoid arthritis. These self-care measures, when used along with your rheumatoid arthritis medications, can help you manage your signs and symptoms: - Exercise regularly. Gentle exercise can help strengthen the muscles around your joints, and it can help fight fatigue you might feel. Check with your doctor before you start exercising. If you're just getting started, begin by taking a walk. Try swimming or gentle water aerobics. Avoid exercising tender, injured or severely inflamed joints. - Apply heat or cold. Heat can help ease your pain and relax tense, painful muscles. Cold may dull the sensation of pain. Cold also has a numbing effect and decreases muscle spasms. - Relax. Find ways to cope with pain by reducing stress in your life. Techniques such as guided imagery, distraction and muscle relaxation can all be used to control pain. Alternative medicine Some common complementary and alternative treatments that have shown promise for rheumatoid arthritis include: - Fish oil. Some preliminary studies have found that fish oil supplements may reduce rheumatoid arthritis pain and stiffness. Side effects can include nausea, belching and a fishy taste in the mouth. Fish oil can interfere with medications, so check with your doctor first. - Plant oils. The seeds of evening primrose, borage and black currant contain a type of fatty acid that may help with rheumatoid arthritis pain and morning stiffness. Side effects may include nausea, diarrhea and gas. Some plant oils can cause liver damage or interfere with medications, so check with your doctor first. - Tai chi. This movement therapy involves gentle exercises and stretches combined with deep breathing. Many people use tai chi to relieve stress in their lives. Small studies have found that tai chi may reduce rheumatoid arthritis pain. When led by a knowledgeable instructor, tai chi is safe. But don't do any moves that cause pain.
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Sickle beta thalassemia Hemoglobin sickle-beta thalassemia Hb S beta-thalassemia Sickle cell - beta-thalassemia disease Hemoglobin sickle-beta thalassemia Hb S beta-thalassemia Sickle cell - beta-thalassemia disease HbS - beta-thalassemia HbS-beta-thalassemia syndrome Sickle cell-beta-thalassemia disease syndrome See More Summary Sickle beta thalassemia is an inherited condition that affects hemoglobin, the protein in red blood cells that carries oxygen to different parts of the body. It is a type of sickle cell disease. Affected people have a different change ( mutation ) in each copy of their HBB gene : one that causes red blood cells to form a "sickle" or crescent shape and a second that is associated with beta thalassemia, a blood disorder that reduces the production of hemoglobin. Depending on the beta thalassemia mutation, people may have no normal hemoglobin (called sickle beta zero thalassemia) or a reduced amount of normal hemoglobin (called sickle beta plus thalassemia). The presence of sickle-shaped red blood cells, which often breakdown prematurely and can get stuck in blood vessels, combined with the reduction or absence of mature red blood cells leads to the many signs and symptoms of sickle beta thalassemia. Features, which may include anemia (low levels of red blood cells), repeated infections, and frequent episodes of pain, generally develop in early childhood and vary in severity depending on the amount of normal hemoglobin made. Sickle beta thalassemia is inherited in an autosomal recessive manner. Treatment is supportive and depends on the signs and symptoms present in each person. [1] [2] [3] Symptoms Signs and symptoms of sickle beta thalassemia may include: [3] [4] Anemia (low levels of red blood cells ) Repeated infections Frequent episodes of pain Pulmonary hypertension Acute chest syndrome (pneumonia-like condition due to entrapment of infection or sickle cells in the lungs) Stroke Enlarged spleen and/or liver Heart murmurs Delayed puberty Slowed growth Jaundice The symptoms of sickle beta thalassemia vary in severity based on the amount of normal hemoglobin made. Affected people may have no normal hemoglobin (called sickle beta zero thalassemia) or a reduced amount of normal hemoglobin (called sickle beta plus thalassemia). Although these two forms share many of the same features, people with sickle beta zero thalassemia are generally more severely affected than those with sickle beta plus thalassemia. For example, people with sickle beta plus thalassemia generally experience less frequent episodes of pain and are less likely to develop stroke, pulmonary hypertension and acute chest syndrome. [4] Cause Sickle beta thalassemia is caused by changes ( mutations ) in the HBB gene . HBB encodes a component of hemoglobin called "beta globin". Different mutations in HBB impact the production of hemoglobin in various ways. One specific mutation leads to an abnormal form of hemoglobin (called hemoglobin S) that causes red blood cells to form a "sickle" or crescent shape. Other mutations reduce the production of beta globin, which leads to low levels of functional hemoglobin and a low number or mature red blood cells (beta thalassemia). [2] People affected by sickle beta thalassemia have a different mutation in each copy of the HBB gene: one that produces hemoglobin S and a second that is associated with beta thalassemia. Depending on the beta thalassemia mutation, people may have no normal hemoglobin (called sickle beta zero thalassemia) or a reduced amount of normal hemoglobin (called sickle beta plus thalassemia). The presence of sickle-shaped red blood cells, which often breakdown prematurely and can get stuck in blood vessels, combined with the reduction or absence of mature red blood cells leads to the many signs and symptoms of sickle beta thalassemia. [2] Inheritance Sickle beta thalassemia is inherited in an autosomal recessive manner. This means that to be affected, a person must have a mutation in both copies of the responsible gene in each cell . People affected by sickle beta thalassemia inherit a different mutation in the HBB gene from each parent: one that produces sickle hemoglobin (called sickle trait ) and a second that results in reduced levels of functional hemoglobin (called beta thalassemia). [1] The parents of an affected person usually each carry one mutated copy of the gene and are referred to as carriers . Carriers typically do not show signs or symptoms of the condition. When two carriers of an autosomal recessive condition have children, each child has a 25% (1 in 4) risk to have the condition, a 50% (1 in 2) risk to be a carrier like each of the parents, and a 25% chance to not have the condition and not be a carrier. Diagnosis In the United States, babies affected by sickle beta thalassemia are often diagnosed at birth through newborn screening . In the absence of newborn screening , a diagnosis is usually suspected in infants or young children with signs and symptoms associated with the condition. Specialized laboratory tests that measure the amounts of abnormal hemoglobin in the blood and/or genetic testing to identify changes ( mutations ) in the HBB gene can be used to confirm a diagnosis. [1] Carrier testing for at-risk relatives and prenatal testing are possible if both disease-causing mutations in the family are known. [1] The Genetic Testing Registry (GTR) is a centralized online resource for information about genetic tests. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. Newborn Screening An ACTion (ACT) sheet is available for this condition that describes the short-term actions a health professional should follow when an infant has a positive newborn screening result. ACT sheets were developed by experts in collaboration with the American College of Medical Genetics. An Algorithm flowchart is available for this condition for determining the final diagnosis in an infant with a positive newborn screening result. Algorithms are developed by experts in collaboration with the American College of Medical Genetics. Baby's First Test is the nation's newborn screening education center for families and providers. This site provides information and resources about screening at the local, state, and national levels and serves as the Clearinghouse for newborn screening information. The Newborn Screening Coding and Terminology Guide has information on the standard codes used for newborn screening tests. Using these standards helps compare data across different laboratories. This resource was created by the National Library of Medicine. National Newborn Screening and Global Resource Center (NNSGRC) provides information and resources in the area of newborn screening and genetics to benefit health professionals, the public health community, consumers and government officials. Treatment Treatment for sickle beta thalassemia is supportive and usually depends on the signs and symptoms present in each person. It is generally recommended that all affected people drink plenty of water; avoid climate extremes, activities that lead to inflammation and extreme fatigue; and stay up-to-date on all immunizations. Because sickle beta thalassemia is associated with a variety of health problems, affected people are usually followed closely by their healthcare provider with regular physical examinations that may include specialized laboratory tests and imaging studies (i.e. chest X-ray, transcranial doppler ultrasound, ECG). Blood transfusions may be prescribed on a regular basis for affected people with a history of or risk factors for stroke and other specific health problems, such as pulmonary hypertension. Hydroxyurea, a drug approved by the U.S. Food and Drug Administration for the treatment of sickle cell disease, can decrease the frequency and severity of pain episodes; reduce the need of blood transfusions; and increase life span. [1] [3] For more information regarding the treatment of sickle beta thalassemia and other sickle cell diseases, please click here. Prognosis The long-term outlook ( prognosis ) for people with sickle beta thalassemia varies depending on the severity of the condition. Sickle beta zero thalassemia (no normal hemoglobin) is usually associated with a worse prognosis and more severe disease course than sickle beta plus thalassmia (a reduced amount of normal hemoglobin). Although sickle cell diseases, including sickle beta thalassemia, can be fatal and are often associated with a shortened life span, early detection and the introduction of new treatment options have lead to significant increases in life expectancy and survival of people with these conditions. [5]
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Rheumatoid Arthritis: - Rheumatoid arthritis is a disease that causes pain, swelling, and stiffness in your joints. This disease often occurs in more than one joint and can affect any joint in the body. If you have this disease, you may feel sick and tired, and sometimes get fevers. - Anyone can get arthritis, but it occurs more often in women and is most common in older people. - Genes, environmental factors, and hormones may play roles in the development of rheumatoid arthritis. - Treatment may involve medicine, surgery, and alternative therapies. - Regular rest, joint care, activity, a healthy diet, and reduced stress can ease symptoms. Rheumatoid arthritis is a disease that affects your joints. Joints are where two or more bones join together, such as at your knees, hips, or shoulders. Rheumatoid arthritis causes pain, swelling, and stiffness. If joints on one side of your body have rheumatoid arthritis, usually those joints on the other side do too. This disease often occurs in more than one joint. It can affect any joint in the body. If you have this disease, you also may feel sick and tired, and sometimes get fevers. - Rheumatoid arthritis is a disease that causes pain, swelling, and stiffness in your joints. This disease often occurs in more than one joint and can affect any joint in the body. If you have this disease, you may feel sick and tired, and sometimes get fevers. - Anyone can get arthritis, but it occurs more often in women and is most common in older people. - Genes, environmental factors, and hormones may play roles in the development of rheumatoid arthritis. - Treatment may involve medicine, surgery, and alternative therapies. - Regular rest, joint care, activity, a healthy diet, and reduced stress can ease symptoms. - Rheumatoid arthritis is a disease that causes pain, swelling, and stiffness in your joints. This disease often occurs in more than one joint and can affect any joint in the body. If you have this disease, you may feel sick and tired, and sometimes get fevers. - Anyone can get arthritis, but it occurs more often in women and is most common in older people. - Genes, environmental factors, and hormones may play roles in the development of rheumatoid arthritis. - Treatment may involve medicine, surgery, and alternative therapies. - Regular rest, joint care, activity, a healthy diet, and reduced stress can ease symptoms. Rheumatoid arthritis is a disease that affects your joints. Joints are where two or more bones join together, such as at your knees, hips, or shoulders. Rheumatoid arthritis causes pain, swelling, and stiffness. If joints on one side of your body have rheumatoid arthritis, usually those joints on the other side do too. This disease often occurs in more than one joint. It can affect any joint in the body. If you have this disease, you also may feel sick and tired, and sometimes get fevers. Anyone can get this disease, though it occurs more often in women. Rheumatoid arthritis often starts in middle age and is common in older people. But children and young adults can also get it. Anyone can get this disease, though it occurs more often in women. Rheumatoid arthritis often starts in middle age and is common in older people. But children and young adults can also get it. Doctors don't know the exact cause of rheumatoid arthritis. They know that with this type of arthritis, a person's immune system attacks his or her own body tissues. The immune system normally attacks invaders to the body, such as a cold virus or bacteria. Researchers are learning many things about why and how this happens. Things that may cause rheumatoid arthritis are: - Genes (passed from parent to child). - Environmental factors. - Hormones. Doctors don't know the exact cause of rheumatoid arthritis. They know that with this type of arthritis, a person's immune system attacks his or her own body tissues. The immune system normally attacks invaders to the body, such as a cold virus or bacteria. Researchers are learning many things about why and how this happens. Things that may cause rheumatoid arthritis are: - Genes (passed from parent to child). - Environmental factors. - Hormones. Doctors don't know the exact cause of rheumatoid arthritis. They know that with this type of arthritis, a person's immune system attacks his or her own body tissues. The immune system normally attacks invaders to the body, such as a cold virus or bacteria. Researchers are learning many things about why and how this happens. Things that may cause rheumatoid arthritis are: - Genes (passed from parent to child). - Environmental factors. - Hormones. Rheumatoid arthritis can be hard to diagnose because: - There is no single test for the disease. - The symptoms can be the same as in other kinds of joint disease. - The full symptoms can take time to develop. To diagnose rheumatoid arthritis, doctors use medical history, a physical exam, x-rays and other imaging tests, and lab tests. Rheumatoid arthritis can be hard to diagnose because: - There is no single test for the disease. - The symptoms can be the same as in other kinds of joint disease. - The full symptoms can take time to develop. To diagnose rheumatoid arthritis, doctors use medical history, a physical exam, x-rays and other imaging tests, and lab tests. Rheumatoid arthritis can be hard to diagnose because: - There is no single test for the disease. - The symptoms can be the same as in other kinds of joint disease. - The full symptoms can take time to develop. To diagnose rheumatoid arthritis, doctors use medical history, a physical exam, x-rays and other imaging tests, and lab tests. Doctors have many ways to treat rheumatoid arthritis. Treatment may involve: - Medicine. - Surgery. - Regular doctor visits. - Complementary therapies. The goals of treatment are to: - Take away pain. - Reduce swelling. - Slow down or stop joint damage. - Help you feel better. - Help you stay active. Medicine Most people with rheumatoid arthritis take medicine. Drugs can be used for pain relief, to reduce swelling, and to stop the disease from getting worse. What a doctor prescribes depends on: - Your general health. - How serious the rheumatoid arthritis is. - How serious the rheumatoid arthritis may become. - How long you will take the drug. - How well the drug works. - Possible side effects. Surgery There are many kinds of surgery for people with a lot of joint damage. Surgery may: - Reduce your pain. - Help your joint work better. - Help you be able to do daily activities. Surgery is not for everyone. Talk with your doctor to decide what is best for you. Regular Doctor Visits Regular medical care is important so doctors can: - See if the disease is getting worse. - See if drugs are helping. - Discuss any drug side effects. - Change treatment when needed. Complementary Therapies Special diets, vitamins, and other complementary therapies are sometimes suggested to treat rheumatoid arthritis. Many of these treatments are not harmful, but they may not be well tested or have any real benefits. Ask your doctor about things you can do to manage your pain, such as exercise programs, support groups, and education classes. Before starting any complementary therapy, talk with your doctor to make sure it isn’t harmful. Doctors have many ways to treat rheumatoid arthritis. Treatment may involve: - Medicine. - Surgery. - Regular doctor visits. - Complementary therapies. The goals of treatment are to: - Take away pain. - Reduce swelling. - Slow down or stop joint damage. - Help you feel better. - Help you stay active. Medicine Most people with rheumatoid arthritis take medicine. Drugs can be used for pain relief, to reduce swelling, and to stop the disease from getting worse. What a doctor prescribes depends on: - Your general health. - How serious the rheumatoid arthritis is. - How serious the rheumatoid arthritis may become. - How long you will take the drug. - How well the drug works. - Possible side effects. Surgery There are many kinds of surgery for people with a lot of joint damage. Surgery may: - Reduce your pain. - Help your joint work better. - Help you be able to do daily activities. Surgery is not for everyone. Talk with your doctor to decide what is best for you. Regular Doctor Visits Regular medical care is important so doctors can: - See if the disease is getting worse. - See if drugs are helping. - Discuss any drug side effects. - Change treatment when needed. Complementary Therapies Special diets, vitamins, and other complementary therapies are sometimes suggested to treat rheumatoid arthritis. Many of these treatments are not harmful, but they may not be well tested or have any real benefits. Ask your doctor about things you can do to manage your pain, such as exercise programs, support groups, and education classes. Before starting any complementary therapy, talk with your doctor to make sure it isn’t harmful. Doctors have many ways to treat rheumatoid arthritis. Treatment may involve: - Medicine. - Surgery. - Regular doctor visits. - Complementary therapies. The goals of treatment are to: - Take away pain. - Reduce swelling. - Slow down or stop joint damage. - Help you feel better. - Help you stay active. Medicine Most people with rheumatoid arthritis take medicine. Drugs can be used for pain relief, to reduce swelling, and to stop the disease from getting worse. What a doctor prescribes depends on: - Your general health. - How serious the rheumatoid arthritis is. - How serious the rheumatoid arthritis may become. - How long you will take the drug. - How well the drug works. - Possible side effects. Surgery There are many kinds of surgery for people with a lot of joint damage. Surgery may: - Reduce your pain. - Help your joint work better. - Help you be able to do daily activities. Surgery is not for everyone. Talk with your doctor to decide what is best for you. Regular Doctor Visits Regular medical care is important so doctors can: - See if the disease is getting worse. - See if drugs are helping. - Discuss any drug side effects. - Change treatment when needed. Complementary Therapies Special diets, vitamins, and other complementary therapies are sometimes suggested to treat rheumatoid arthritis. Many of these treatments are not harmful, but they may not be well tested or have any real benefits. Ask your doctor about things you can do to manage your pain, such as exercise programs, support groups, and education classes. Before starting any complementary therapy, talk with your doctor to make sure it isn’t harmful. Several types of health care professionals may treat you, including: - Internist, who diagnoses and treats adults. - Rheumatologist, who treats arthritis and other disease of the bones, joints, and muscles. - Orthopaedists, who treat and perform surgery for bone and joint diseases. - Physical therapists, who help to improve joint function. - Occupational therapists, who teach ways to protect joints, reduce pain, perform activities of daily living, and conserve energy. - Dietitians, who teach ways to use a good diet to improve health and maintain a healthy weight. Several types of health care professionals may treat you, including: - Internist, who diagnoses and treats adults. - Rheumatologist, who treats arthritis and other disease of the bones, joints, and muscles. - Orthopaedists, who treat and perform surgery for bone and joint diseases. - Physical therapists, who help to improve joint function. - Occupational therapists, who teach ways to protect joints, reduce pain, perform activities of daily living, and conserve energy. - Dietitians, who teach ways to use a good diet to improve health and maintain a healthy weight. Several types of health care professionals may treat you, including: - Internist, who diagnoses and treats adults. - Rheumatologist, who treats arthritis and other disease of the bones, joints, and muscles. - Orthopaedists, who treat and perform surgery for bone and joint diseases. - Physical therapists, who help to improve joint function. - Occupational therapists, who teach ways to protect joints, reduce pain, perform activities of daily living, and conserve energy. - Dietitians, who teach ways to use a good diet to improve health and maintain a healthy weight. With rheumatoid arthritis, you can still lead a full life. Besides going to your doctor and therapists regularly, you can also do these activities to help reduce your symptoms. Joint Care Look for ways to reduce stress on your joints. Some people find wearing a splint around a painful joint for a short time helps. Talk with your doctor to see if a splint may work for you. In addition, some special equipment can help such as a zipper puller or long-handled shoe horn. Rest Keep a good balance between rest and activity. Try to take frequent breaks, especially when your symptoms are bothering you. Lowering Stress Try to lower your stress by taking the time to relax, doing hobbies you enjoy, or joining a support group. Support groups can reduce your stress by helping you to: - Learn about the disease. - Cope with your emotions about your symptoms. - Feel more control over the disease. - Build confidence. A Healthy Diet Eat a healthy diet which will help you manage your weight and get a variety of nutrients for overall health. With rheumatoid arthritis, you can still lead a full life. Besides going to your doctor and therapists regularly, you can also do these activities to help reduce your symptoms. Joint Care Look for ways to reduce stress on your joints. Some people find wearing a splint around a painful joint for a short time helps. Talk with your doctor to see if a splint may work for you. In addition, some special equipment can help such as a zipper puller or long-handled shoe horn. Rest Keep a good balance between rest and activity. Try to take frequent breaks, especially when your symptoms are bothering you. Lowering Stress Try to lower your stress by taking the time to relax, doing hobbies you enjoy, or joining a support group. Support groups can reduce your stress by helping you to: - Learn about the disease. - Cope with your emotions about your symptoms. - Feel more control over the disease. - Build confidence. A Healthy Diet Eat a healthy diet which will help you manage your weight and get a variety of nutrients for overall health. You may also experience other health problems as a result of your rheumatoid arthritis. Be sure to talk with your doctor if any of these occur. Many people with rheumatoid arthritis may also have: - Anemia, a condition in which your blood has a lower than normal count of red blood cells. - Depression. - Anxiety. Other effects that occur less often include: - Neck pain. - Dry eyes. - Dry mouth. Very rarely, people may have inflammation of their: - Blood vessels. - Lining of the lungs. - Sac enclosing the heart. You may also experience other health problems as a result of your rheumatoid arthritis. Be sure to talk with your doctor if any of these occur. Many people with rheumatoid arthritis may also have: - Anemia, a condition in which your blood has a lower than normal count of red blood cells. - Depression. - Anxiety. Other effects that occur less often include: - Neck pain. - Dry eyes. - Dry mouth. Very rarely, people may have inflammation of their: - Blood vessels. - Lining of the lungs. - Sac enclosing the heart.
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Fibromyalgia: Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals. Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event. Women are more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression. While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help. Symptoms of fibromyalgia include: - Widespread pain. The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist. - Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea. - Cognitive difficulties. A symptom commonly referred to as "fibro fog" impairs the ability to focus, pay attention and concentrate on mental tasks. Fibromyalgia often co-exists with other painful conditions, such as: - Irritable bowel syndrome - Migraine and other types of headaches - Interstitial cystitis or painful bladder syndrome - Temporomandibular joint disorders Doctors don't know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include: - Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder. - Infections. Some illnesses appear to trigger or aggravate fibromyalgia. - Physical or emotional trauma. Fibromyalgia can sometimes be triggered by a physical trauma, such as a car accident. Psychological stress may also trigger the condition. Why does it hurt? Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals. Risk factors for fibromyalgia include: - Your sex. Fibromyalgia is diagnosed more often in women than in men. - Family history. You may be more likely to develop fibromyalgia if a relative also has the condition. - Other disorders. If you have osteoarthritis, rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia. In the past, doctors would check 18 specific points on a person's body to see how many of them were painful when pressed firmly. Newer guidelines don't require a tender point exam. Instead, a fibromyalgia diagnosis can be made if a person has had widespread pain for more than three months - with no underlying medical condition that could cause the pain. Blood tests While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include: - Complete blood count - Erythrocyte sedimentation rate - Cyclic citrullinated peptide test - Rheumatoid factor - Thyroid function tests In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms. Medications Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include: - Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Your doctor might suggest a prescription pain reliever such as tramadol (Ultram). Narcotics are not advised, because they can lead to dependence and may even worsen the pain over time. - Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep. - Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia. Therapy A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your life. Examples include: - Physical therapy. A physical therapist can teach you exercises that will improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful. - Occupational therapy. An occupational therapist can help you make adjustments to your work area or the way you perform certain tasks that will cause less stress on your body. - Counseling. Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations. Self-care is critical in the management of fibromyalgia. - Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation. - Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping. - Exercise regularly. At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful. - Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not overdoing it on your good days, but likewise it means not self-limiting or doing too little on the days when symptoms flare. - Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day. Complementary and alternative therapies for pain and stress management aren't new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia. Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven't been adequately studied. - Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit. - Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety. - Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.
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Preeclampsia: Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal. Even a slight rise in blood pressure may be a sign of preeclampsia. Left untreated, preeclampsia can lead to serious - even fatal - complications for both you and your baby. If you have preeclampsia, the only cure is delivery of your baby. If you're diagnosed with preeclampsia too early in your pregnancy to deliver your baby, you and your doctor face a challenging task. Your baby needs more time to mature, but you need to avoid putting yourself or your baby at risk of serious complications. Preeclampsia sometimes develops without any symptoms. High blood pressure may develop slowly, or it may have a sudden onset. Monitoring your blood pressure is an important part of prenatal care because the first sign of preeclampsia is commonly a rise in blood pressure. Blood pressure that exceeds 140/90 millimeters of mercury (mm Hg) or greater - documented on two occasions, at least four hours apart - is abnormal. Other signs and symptoms of preeclampsia may include: - Excess protein in your urine (proteinuria) or additional signs of kidney problems - Severe headaches - Changes in vision, including temporary loss of vision, blurred vision or light sensitivity - Upper abdominal pain, usually under your ribs on the right side - Nausea or vomiting - Decreased urine output - Decreased levels of platelets in your blood (thrombocytopenia) - Impaired liver function - Shortness of breath, caused by fluid in your lungs Sudden weight gain and swelling (edema) - particularly in your face and hands - may occur with preeclampsia. But these also occur in many normal pregnancies, so they're not considered reliable signs of preeclampsia. Make sure you attend your prenatal visits so that your care provider can monitor your blood pressure. Contact your doctor immediately or go to an emergency room if you have severe headaches, blurred vision or other visual disturbance, severe pain in your abdomen, or severe shortness of breath. Because headaches, nausea, and aches and pains are common pregnancy complaints, it's difficult to know when new symptoms are simply part of being pregnant and when they may indicate a serious problem - especially if it's your first pregnancy. If you're concerned about your symptoms, contact your doctor. The exact cause of preeclampsia involves several factors. Experts believe it begins in the placenta - the organ that nourishes the fetus throughout pregnancy. Early in pregnancy, new blood vessels develop and evolve to efficiently send blood to the placenta. In women with preeclampsia, these blood vessels don't seem to develop or function properly. They're narrower than normal blood vessels and react differently to hormonal signaling, which limits the amount of blood that can flow through them. Causes of this abnormal development may include: - Insufficient blood flow to the uterus - Damage to the blood vessels - A problem with the immune system - Certain genes Preeclampsia is classified as one of four high blood pressure disorders that can occur during pregnancy. The other three are: - Gestational hypertension. Women with gestational hypertension have high blood pressure but no excess protein in their urine or other signs of organ damage. Some women with gestational hypertension eventually develop preeclampsia. - Chronic hypertension. Chronic hypertension is high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy. But because high blood pressure usually doesn't have symptoms, it may be hard to determine when it began. - Chronic hypertension with superimposed preeclampsia. This condition occurs in women who have been diagnosed with chronic high blood pressure before pregnancy, but then develop worsening high blood pressure and protein in the urine or other health complications during pregnancy. Preeclampsia develops only as a complication of pregnancy. Risk factors include: - History of preeclampsia. A personal or family history of preeclampsia significantly raises your risk of preeclampsia. - Chronic hypertension. If you already have chronic hypertension, you have a higher risk of developing preeclampsia. - First pregnancy. The risk of developing preeclampsia is highest during your first pregnancy. - New paternity. Each pregnancy with a new partner increases the risk of preeclampsia more than does a second or third pregnancy with the same partner. - Age. The risk of preeclampsia is higher for very young pregnant women as well as pregnant women older than 40. - Obesity. The risk of preeclampsia is higher if you're obese. - Multiple pregnancy. Preeclampsia is more common in women who are carrying twins, triplets or other multiples. - Interval between pregnancies. Having babies less than two years or more than 10 years apart leads to a higher risk of preeclampsia. - History of certain conditions. Having certain conditions before you become pregnant - such as chronic high blood pressure, migraines, type 1 or type 2 diabetes, kidney disease, a tendency to develop blood clots, or lupus - increases your risk of preeclampsia. - In vitro fertilization. Your risk of preeclampsia is increased if your baby was conceived with in vitro fertilization. The more severe your preeclampsia and the earlier it occurs in your pregnancy, the greater the risks for you and your baby. Preeclampsia may require induced labor and delivery. Delivery by cesarean delivery (C-section) may be necessary if there are clinical or obstetric conditions that require a speedy delivery. Your obstetric provider will assist you in deciding what type of delivery is correct for your condition. Complications of preeclampsia may include: - Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn't get enough blood, your baby may receive inadequate blood and oxygen and fewer nutrients. This can lead to slow growth known as fetal growth restriction, low birth weight or preterm birth. - Preterm birth. If you have preeclampsia with severe features, you may need to be delivered early, to save the life of you and your baby. Prematurity can lead to breathing and other problems for your baby. Your health care provider will help you understand when is the ideal time for your delivery. - Placental abruption. Preeclampsia increases your risk of placental abruption, a condition in which the placenta separates from the inner wall of your uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both you and your baby. - HELLP syndrome. HELLP - which stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count - syndrome is a more severe form of preeclampsia, and can rapidly become life-threatening for both you and your baby. Symptoms of HELLP syndrome include nausea and vomiting, headache, and upper right abdominal pain. HELLP syndrome is particularly dangerous because it represents damage to several organ systems. On occasion, it may develop suddenly, even before high blood pressure is detected or it may develop without any symptoms at all. - Eclampsia. When preeclampsia isn't controlled, eclampsia - which is essentially preeclampsia plus seizures - can develop. It is very difficult to predict which patients will have preeclampsia that is severe enough to result in eclampsia. Often, there are no symptoms or warning signs to predict eclampsia. Because eclampsia can have serious consequences for both mom and baby, delivery becomes necessary, regardless of how far along the pregnancy is. - Other organ damage. Preeclampsia may result in kidney, liver, lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of injury to other organs depends on the severity of preeclampsia. - Cardiovascular disease. Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease. The risk is even greater if you've had preeclampsia more than once or you've had a preterm delivery. To minimize this risk, after delivery try to maintain your ideal weight, eat a variety of fruits and vegetables, exercise regularly, and don't smoke. To diagnose preeclampsia, you have to have high blood pressure and one or more of the following complications after the 20th week of pregnancy: - Protein in your urine (proteinuria) - A low platelet count - Impaired liver function - Signs of kidney trouble other than protein in the urine - Fluid in the lungs (pulmonary edema) - New-onset headaches or visual disturbances Previously, preeclampsia was only diagnosed if high blood pressure and protein in the urine were present. However, experts now know that it's possible to have preeclampsia, yet never have protein in the urine. A blood pressure reading in excess of 140/90 mm Hg is abnormal in pregnancy. However, a single high blood pressure reading doesn't mean you have preeclampsia. If you have one reading in the abnormal range - or a reading that's substantially higher than your usual blood pressure - your doctor will closely observe your numbers. Having a second abnormal blood pressure reading four hours after the first may confirm your doctor's suspicion of preeclampsia. Your doctor may have you come in for additional blood pressure readings and blood and urine tests. Tests that may be needed If your doctor suspects preeclampsia, you may need certain tests, including: - Blood tests. Your doctor will order liver function tests, kidney function tests and also measure your platelets - the cells that help blood clot. - Urine analysis. Your doctor will ask you to collect your urine for 24 hours, for measurement of the amount of protein in your urine. A single urine sample that measures the ratio of protein to creatinine - a chemical that's always present in the urine - also may be used to make the diagnosis. - Fetal ultrasound. Your doctor may also recommend close monitoring of your baby's growth, typically through ultrasound. The images of your baby created during the ultrasound exam allow your doctor to estimate fetal weight and the amount of fluid in the uterus (amniotic fluid). - Nonstress test or biophysical profile. A nonstress test is a simple procedure that checks how your baby's heart rate reacts when your baby moves. A biophysical profile uses an ultrasound to measure your baby's breathing, muscle tone, movement and the volume of amniotic fluid in your uterus. The only cure for preeclampsia is delivery. You're at increased risk of seizures, placental abruption, stroke and possibly severe bleeding until your blood pressure decreases. Of course, if it's too early in your pregnancy, delivery may not be the best thing for your baby. If you're diagnosed with preeclampsia, your doctor will let you know how often you'll need to come in for prenatal visits - likely more frequently than what's typically recommended for pregnancy. You'll also need more frequent blood tests, ultrasounds and nonstress tests than would be expected in an uncomplicated pregnancy. Medications Possible treatment for preeclampsia may include: - Medications to lower blood pressure. These medications, called antihypertensives, are used to lower your blood pressure if it's dangerously high. Blood pressure in the 140/90 millimeters of mercury (mm Hg) range generally isn't treated. Although there are many different types of antihypertensive medications, a number of them aren't safe to use during pregnancy. Discuss with your doctor whether you need to use an antihypertensive medicine in your situation to control your blood pressure. - Corticosteroids. If you have severe preeclampsia or HELLP syndrome, corticosteroid medications can temporarily improve liver and platelet function to help prolong your pregnancy. Corticosteroids can also help your baby's lungs become more mature in as little as 48 hours - an important step in preparing a premature baby for life outside the womb. - Anticonvulsant medications. If your preeclampsia is severe, your doctor may prescribe an anticonvulsant medication, such as magnesium sulfate, to prevent a first seizure. Bed rest Bed rest used to be routinely recommended for women with preeclampsia. But research hasn't shown a benefit from this practice, and it can increase your risk of blood clots, as well as impact your economic and social lives. For most women, bed rest is no longer recommended. Hospitalization Severe preeclampsia may require that you be hospitalized. In the hospital, your doctor may perform regular nonstress tests or biophysical profiles to monitor your baby's well-being and measure the volume of amniotic fluid. A lack of amniotic fluid is a sign of poor blood supply to the baby. Delivery If you're diagnosed with preeclampsia near the end of your pregnancy, your doctor may recommend inducing labor right away. The readiness of your cervix - whether it's beginning to open (dilate), thin (efface) and soften (ripen) - also may be a factor in determining whether or when labor will be induced. In severe cases, it may not be possible to consider your baby's gestational age or the readiness of your cervix. If it's not possible to wait, your doctor may induce labor or schedule a C-section right away. During delivery, you may be given magnesium sulfate intravenously to prevent seizures. If you need pain-relieving medication after your delivery, ask your doctor what you should take. NSAIDs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), can increase your blood pressure.
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Ibuprofen dosing for children Motrin Advil Summary Taking ibuprofen can help children feel better when they have colds or minor injuries. As with all drugs, it is important to give children the correct dose. Ibuprofen is safe when taken as directed. But taking too much of this medicine can be harmful. How Ibuprofen can Help Your Child Ibuprofen is a type of nonsteroidal anti-inflammatory drug (NSAID). It can help: Reduce aches, pain, sore throat, or fever in children with a cold or the flu Relieve headaches or toothaches Reduce pain and swelling from an injury or broken bone Proper Dosing Ibuprofen can be taken as liquid or chewable tablets. To give the correct dose, you need to know your child's weight. You also need to know how much ibuprofen is in a tablet, teaspoon (tsp), 1.25 milliliters (mL), or 5 mL of the product you are using. You can read the label to find out. For chewable tablets, the label will tell you how many milligrams (mg) are found in each tablet, for example 50 mg per tablet. For liquids, the label will tell you how many mg are found in 1 tsp, in 1.25 mL, or in 5mL. For example, the label may read 100 mg/1 tsp, 50 mg/1.25 mL, or 100 mg/5 mL. For syrups, you need some type of dosing syringe. It may come with the medicine, or you can ask your pharmacist. Make sure to clean it out after every usage. <strong>If your child weighs 12 to 17 pounds (lbs) or 5.4 to 7.7 kilograms (kg):</strong> For infant drops that say 50mg/1.25 mL on the label, give a 1.25 mL dose. For liquid that says 100 mg/1 teaspoon (tsp) on the label, give a 1/2 tsp dose. For liquid that says 100 mg/5 mL on the label, give a 2.5 mL dose. <strong>If your child weighs 18 to 23 lbs or 8 to 10 kg:</strong> For infant drops that say 50mg/1.25 mL on the label, give a 1.875 mL dose. For liquid that says 100 mg/1 tsp on the label, give a 3/4 tsp dose. For liquid that says 100 mg/5 mL on the label, give a 4 mL dose. <strong>If your child weighs 24 to 35 lbs or 10.5 to 15.5 kg:</strong> For infant drops that say 50mg/1.25 mL on the label, give a 2.5 mL dose. For liquid that says 100 mg/1 tsp on the label, give a 1 tsp dose. For liquid that says 100 mg/5 mL on the label, give a 5 mL dose. For chewable tablets that say 50 mg tablets on the label, give 2 tablets. <strong>If your child weighs 36 to 47 lbs or 16 to 21 kg:</strong> For infant drops that say 50mg/1.25 mL on the label, give a 3.75 mL dose. For liquid that says 100 mg/1 tsp on the label, give a 11/2 tsp dose. For liquid that says 100 mg/5 mL on the label, give a 7.5 mL dose. For chewable tablets that say 50 mg tablets on the label, give 3 tablets. <strong>If your child weighs 48 to 59 lbs or 21.5 to 26.5 kg:</strong> For infant drops that say 50mg/1.25 mL on the label, give a 5 mL dose. For liquid that says 100 mg/1 tsp on the label, give a 2 tsp dose. For liquid that says 100 mg/5 mL on the label, give a 10 mL dose. For chewable tablets that say 50 mg tablets on the label, give 4 tablets. For junior-strength tablets that say 100 mg tablets on the label, give 2 tablets. <strong>If your child weighs 60 to 71 lbs or 27 to 32 kg:</strong> For liquid that says 100 mg/1 tsp on the label, give a 21/2 tsp dose. For liquid that says 100 mg/5 mL on the label, give a 12.5 mL dose. For chewable tablets that say 50 mg tablets on the label, give 5 tablets. For junior-strength tablets that say 100 mg tablets on the label, give 21/2 tablets. <strong>If your child weighs 72 to 95 lbs or 32.5 to 43 kg:</strong> For liquid that says 100 mg/1 tsp on the label, give a 3 tsp dose. For liquid that says 100 mg/5 mL on the label, give a 15 mL dose. For chewable tablets that say 50 mg tablets on the label, give 6 tablets. For junior-strength tablets that say 100 mg tablets on the label, give 3 tablets. <strong>If your child weighs 96 lbs or 43.5 kg or more:</strong> For liquid that says 100 mg/1 tsp on the label, give a 4 tsp dose. For liquid that says 100 mg/5 mL on the label, give a 20 mL dose. For chewable tablets that say 50 mg tablets on the label, give 8 tablets. For junior-strength tablets that say 100 mg tablets on the label, give 4 tablets. Try giving your child the medicine with food to avoid stomach upset. If you are not sure how much to give your child, call your health care provider. DO NOT give ibuprofen to children under 6 months of age, unless directed by your provider. You should also check with your provider before giving ibuprofen to children under 2 years old or less than 12 pounds or 5.5 kilograms. Giving Medicine to Children Make sure you don't give your child more than one medicine with ibuprofen. For example, ibuprofen can be found in many allergy and cold remedies. Read the label before giving any medicine to children. You should not give medicine with more than one active ingredient to children under age 6. There are important child medicine safety tips to follow. Carefully read all of the instructions on the label before giving your child medicine. Make sure you know the strength of the medicine in the bottle you purchased. Use the syringe, dropper, or dosing cup that comes with your child's liquid medicine. You can also get one at your local pharmacy. Make sure you are using the right unit of measurement when filling medicine. You may have the option of milliliters (mL) or teaspoon (tsp) dosing. If you are not sure what medicine to give your child, call your provider. Children with certain medical conditions or taking certain medicines should not take ibuprofen. Check with your provider. If Your Child Takes too Much Be sure to post the number for the poison control center by your home phone. If you think your child has taken too much medicine, call the poison control center at 1-800-222-1222. It is open 24 hours a day. Signs of poisoning include nausea, vomiting, fatigue, and abdominal pain. Go to the nearest emergency room. Your child may need: Activated charcoal. Charcoal stops the body from absorbing the medicine. It has to be given within an hour. It does not work for every medicine. To be admitted to the hospital to be monitored. Blood tests to see what the medicine is doing. To have his or her heart rate, breathing rate, and blood pressure monitored. When to Call the Doctor Call your provider if: You are not sure what dose of medicine to give your infant or child. You are having trouble getting your child to take medicine. Your child's symptoms do not go away when you would expect. Your child is an infant and has signs of illness, such as fever. Review Date 12/9/2016 Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Spina Bifida Myelomeningocele Meningocele Spina bifida occulta Overview Spina bifida (pronounced SPAHY-nuh BIF-i-duh) is a neural tube defect that frequently occurs in families. Spina bifida occurs because of an abnormality of the development of the spinal cord that occurs in the first trimester of pregnancy. Within the first 4 weeks after a fetus is conceived, the backbone and membranes that cover and protect the spinal cord and spine do not form and close properly. This can result in an opening anywhere along the spine and may cause damage to the spinal cord and nerves. The defect may be associated with a protrusion of the membrane covering the spinal cord (meninges) alone, called a meningocele, or with some neural elements, called a meningomyelocele. Or the defect may not be noticed until later in life. The NICHD plays a leading role, along with the Centers for Disease Control and Prevention (CDC), in distributing federal funding for spina bifida research. NICHD-supported scientists are investigating genetic, neurological, and environmental variables that cause spina bifida or that influence neurobehavioral outcomes for children with spina bifida. These scientists also are assessing spina bifida's effects on physical and cognitive development in early childhood, developing new diagnostic ultrasound techniques, and studying the advantages of in utero (pronounced in-YOO-tuh-roh, in the uterus) spinal cord repair for infants with spina bifida. Condition Information What is spina bifida? Spina bifida (pronounced SPAHY-nuh BIF-i-duh) is a neural tube defect that frequently occurs in families. Spina bifida occurs because of an abnormality of the development of the spinal cord that occurs in the first trimester of pregnancy. Within the first 4 weeks after a fetus is conceived, the backbone and membranes that cover and protect the spinal cord and spine does not form and close properly. This can result in an opening anywhere along the spine and may cause damage to the spinal cord and nerves. The defect may be associated with a protrusion of the membrane covering the spinal cord (meninges) alone, called a meningocele, or with some neural elements, called a meningomyelocele. Or the defect may not be noticed until later in life. Spina bifida can cause physical and mental disabilities ranging from mild to severe, depending on the size and location of the opening in the spine, and whether the spinal cord and nerves are affected. The three most common types of spina bifida are as follows: Myelomeningocele (pronounced mahy-uh-loh-MUH-ning-guh-seel), in which a sac of fluid containing part of the spinal cord and nerves comes through an opening in the infant’s back, causing nerve damage. Also called “open spina bifida,” this condition causes moderate to severe disabilities, such as problems going to the bathroom, loss of feeling in the legs or feet, and paralysis in the legs. Meningocele (pronounced muh-NING-guh-seel), in which a sac of fluid without the spinal cord comes through an opening in the infant’s back. This type of spina bifida can cause minor disabilities, but there is usually little or no nerve damage. Spina Bifida Occulta (pronounced SPAHY-nuh BIF-i-duh uh-KUHL-tuh), the mildest type of spina bifida, in which there is a small gap in the spine but no opening or sac on the back. Some infants have a dimple, hairy patch, dark spot, or swelling at the affected place on the back, but the spinal cord and the nerves usually are not damaged. This type of spina bifida usually does not cause any disabilities. Often, spina bifida occulta is not discovered until late childhood or adulthood and sometimes not at all. This is why it is sometimes called “hidden” spina bifida. How many people are affected/at risk? » How many people are affected/at risk? About 1,500 infants are born with spina bifida each year in the United States. Anyone can give birth to an infant with spina bifida. However, parents who already have had a child with spina bifida or another neural tube defect have a 4% increased risk of having a second child with spina bifida. Parents of two children with spina bifida have about a 10% chance of having another child with this condition. When one parent has spina bifida, there is about a 4% chance that his or her child also will have it. Women who are obese, have poorly controlled diabetes, or take certain antiseizure medications are at greater risk of having a child with spina bifida. « Condition Information What causes it? » What causes it? Scientists believe that spina bifida is caused by a combination of genetic and environmental factors, such as the mother’s nutrition. Research has shown that getting enough folic acid (a B vitamin) before and during pregnancy can prevent most cases of spina bifida. « How many people are affected/at risk? How is it diagnosed? » How is it diagnosed? Doctors diagnose spina bifida before or after the infant is born. Spina bifida occulta might not be identified until late childhood or adulthood, or it might not be identified at all. During Pregnancy Screening tests can check for spina bifida and other birth defects. - Blood tests. A “triple screen” examines blood in several ways to look for neural tube defects, such as spina bifida, and other issues. One of these tests measures AFP, or alpha-fetoprotein (pronounced al-fuh FEE-toh-proh-teen), which the fetus produces. A high AFP level might mean that the child has spina bifida. - Amniocentesis (pronounced am-nee-oh-sen-TEE-sis). The doctor uses a long needle to obtain some of the amniotic fluid surrounding the fetus in the womb. The fluid can be tested for high levels of AFP, which can mean that the fetus has spina bifida. - Ultrasound. This technology allows doctors to look at and take pictures of the fetus while it is inside the mother’s womb. Often, spina bifida can be identified through ultrasound. After the Child Is Born Sometimes spina bifida is discovered only after the infant is born, especially if the mother did not have prenatal tests or if the ultrasound could not give a clear picture of the spine. Sometimes there is a hairy patch, dimple, dark spot, or swelling on the infant’s back, at the site of the gap in the spine. A doctor can examine the infant’s spine and bones in the back using an image scan such as an X-ray, MRI, or CT. « What causes it? Is there a cure? » Is there a cure? There is no cure for spina bifida, but there are treatments for a wide array of related conditions. Visit the section on treatments for more information. « How is it diagnosed? Are there associated conditions? » Are there associated conditions? Health issues are different for each person with spina bifida. Open spina bifida (myelomeningocele)—in which the spinal cord is exposed—tends to cause more severe problems. Hydrocephalus Many infants born with spina bifida get extra fluid in and around the brain, a condition called hydrocephalus, or water on the brain. The extra fluid can cause swelling of the head, which may lead to brain injury. Chiari II Malformation The brains of most children with open spina bifida are positioned abnormally. The lower part of the brain rests farther down than normal, partially in the upper spinal canal. The cerebrospinal (pronounced suh-ree-broh-SPAHYN-l) fluid can get blocked and cause hydrocephalus. While most affected children have no other symptoms, a few may have upper body weakness and trouble breathing and swallowing. Tethered Spinal Cord Typically, the bottom of the spinal cord floats freely in the spinal canal, but for many people with spina bifida, the spinal cord is attached to the spinal canal. Thus, the spinal cord stretches as a person grows, and this stretching can cause spinal nerve damage. The person might have back pain, scoliosis (crooked spine, pronounced skoh-lee-OH-sis), weakness in the legs and feet, bladder or bowel control problems, and other issues. Paralysis, Mobility Limitations People with spina bifida high on the back (near the head, for instance) might not be able to move their legs. People with spina bifida low on the back (near the hips, for example) might have some leg mobility and be able to walk unassisted or with crutches, braces, or walkers. Lack of Bladder and Bowel Control People with spina bifida often cannot control their bladder and bowel movements. They also can develop urinary tract infections. Latex Allergy Many people with spina bifida—possibly three-quarters of those with the condition—are allergic to latex, or natural rubber. While researchers still don’t entirely understand why the rate in those with spina bifida is so high, some experts believe such an allergy can be caused by frequent exposure to latex, which is common for people with spina bifida who have shunts and have had many surgeries. Learning Disabilities While at least 80% of children with open spina bifida do not have learning deficiencies, some do have learning problems. Other Conditions Some people with open spina bifida have additional physical and psychological conditions, including digestive, vision, sexual, social, and emotional problems; obesity; and depression. « Is there a cure? What are the treatments? » What are the treatments? Open Spina Bifida An infant with open spina bifida (myelomeningocele), in which the spinal cord is exposed, can have surgery to close the hole in the back before birth or within the first few days after birth. Hydrocephalus If an infant with spina bifida has hydrocephalus (water on the brain), a surgeon can implant a shunt—a small hollow tube to drain the extra fluid and relieve pressure on the brain. The shunt may need to be replaced during childhood. Tethered Spinal Cord For a child with this condition, in which the spinal cord is attached to the spinal canal and stretches as the child grows, surgery can separate the spinal cord from surrounding tissue, allowing the child to regain his or her usual level of functioning. Paralysis, Mobility Limitations People with spina bifida use different ways to get around, according to their needs. They may be able to walk without assistance, or they may use braces, crutches, walkers, or wheelchairs. Urinary Tract Infections, Lack of Bladder and Bowel Control People with open spina bifida often have nerve damage that prevents the bladder from completely emptying, a condition that can cause urinary tract infections and kidney damage. The child or parent can address this problem by inserting a plastic tube called a catheter into the bladder several times a day to allow the bladder to empty fully. Medications, injections, and surgery can also help address incontinence issues and preserve kidney and bladder function for the long term. Children with spina bifida should see a urologist (a doctor who specializes in urinary tract problems) regularly. « Are there associated conditions?
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Burns Overview Burns can be minor medical problems or life-threatening emergencies. Many people die each year from fire-related burn injuries. Electricity and chemicals also cause severe burns. Scalding liquids are the most common cause of burns in children. Treatment of burns depends on the location and severity of the injury. Sunburns and small scalds can usually be treated at home. Deep or widespread burns need immediate medical attention. People with severe burns often require treatment at specialized burn centers. They may need skin grafts to cover large wounds or to minimize scarring with deep wounds. And they may need emotional support and months of follow-up care, such as physical therapy. Symptoms Burns don't affect the skin uniformly, so a single injury can reach varying depths. Distinguishing a minor burn from a more serious burn involves determining the extent of tissue damage. The following are three classifications of burns: - First-degree burn. This minor burn affects only the outer layer of the skin (epidermis). It may cause redness, swelling and pain. It usually heals with first-aid measures within several days to a week. Sunburn is a classic example. - Second-degree burn. This type of burn affects both the epidermis and the second layer of skin (dermis). It may cause red, white or splotchy skin, pain, and swelling. And the wound often looks wet or moist. Blisters may develop, and pain can be severe. Deep second-degree burns can cause scarring. - Third-degree burn. This burn reaches into the fat layer beneath the skin. Burned areas may be charred black or white. The skin may look waxy or leathery. Third-degree burns can destroy nerves, causing numbness. A person with this type of burn may also have difficulty breathing or experience smoke inhalation or carbon monoxide poisoning. When to see a doctor Seek emergency medical assistance for: - Burns that cover the hands, feet, face, groin, buttocks, a major joint or a large area of the body - Deep burns, which means burns affecting all layers of the skin and even other tissues - Burns caused by chemicals or electricity - Difficulty breathing or burns to the airway Minor burns can be cared for at home, but call your doctor if you experience: - Large blisters - Signs of infection, such as oozing from the wound, increased pain, redness and swelling - A burn or blister that doesn't heal in several weeks - New, unexplained symptoms - Significant scarring Causes Many things can cause burns, including: - Fire - Hot liquid or steam - Hot metal, glass or other objects - Electrical currents - Radiation from X-rays or radiation therapy to treat cancer - Sunlight or ultraviolet light from a sunlamp or tanning bed - Chemicals such as strong acids, lye, paint thinner or gasoline - Abuse Complications Deep or widespread burns can lead to many complications, including: - Infection. Burns can leave skin vulnerable to bacterial infection and increase your risk of sepsis. Sepsis is a life-threatening infection that travels through the bloodstream and affects your whole body. It progresses rapidly and can cause shock and organ failure. - Low blood volume. Burns can damage blood vessels and cause fluid loss. This may result in low blood volume (hypovolemia). Severe blood and fluid loss prevents the heart from pumping enough blood to the body. - Dangerously low body temperature. The skin helps control the body's temperature, so when a large portion of the skin is injured, you lose body heat. This increases your risk of a dangerously low body temperature (hypothermia). Hypothermia is a condition in which the body loses heat faster than it can produce heat. - Breathing problems. Breathing hot air or smoke can burn airways and cause breathing (respiratory) difficulties. Smoke inhalation damages the lungs and can cause respiratory failure. - Scarring. Burns can cause scars and ridged areas caused by an overgrowth of scar tissue (keloids). - Bone and joint problems. Deep burns can limit movement of the bones and joints. Scar tissue can form and cause shortening and tightening of skin, muscles or tendons (contractures). This condition may permanently pull joints out of position. Diagnosis During the physical exam, your doctor will examine your burned skin and determine what percentage of your total body surface area is involved. In general, an area of skin roughly equal to the size of your palm equals 1 percent of your total body surface area. For people ages 10 to 40, the American Burn Association defines a severe burn as one that involves 25 percent total body surface area or any burn involving the eyes, ears, face, hands, feet or groin. You'll also be examined for other injuries and to determine whether the burn has affected the rest of your body. You may need lab tests, X-rays or other diagnostic procedures. Treatment Treatment of burns depends on the type and extent of the injuries. Most minor burns can be treated at home using over-the-counter products or aloe. They usually heal within a few weeks. For serious burns, after appropriate first aid care and wound assessment, your treatment may involve medications, wound dressings, therapy and surgery. The goals of treatment are to control pain, remove dead tissue, prevent infection, reduce scarring, regain function and address emotional needs. You may need months of additional treatments and therapy. This may be done during a hospital stay, on an outpatient basis or at home. Factors affecting this choice include your wishes, other conditions and abilities, such as whether you're able to change bandages. Medications and wound healing products For major burns, various medications and products are used to encourage healing. - Water-based treatments. Your care team may use techniques such as ultrasound mist therapy to clean and stimulate the wound tissue. - Fluids to prevent dehydration. You may need intravenous (IV) fluids to prevent dehydration and organ failure. - Pain and anxiety medications. Healing burns can be incredibly painful. You may need morphine and anti-anxiety medications - particularly for dressing changes. - Burn creams and ointments. Your care team can select from a variety of topical products for wound healing. These help keep the wound moist, reduce pain, prevent infection and speed healing. - Dressings. Your care team may also use various specialty wound dressings. These create a moist environment that fights infection and helps the burn heal. - Drugs that fight infection. If you develop an infection, you may need IV antibiotics. - Tetanus shot. Your doctor might recommend a tetanus shot after a burn injury. Physical and occupational therapy If the burned area is large, especially if it covers any joints, you may need physical therapy exercises. These can help stretch the skin so the joints can remain flexible. Other types of exercises can improve muscle strength and coordination. And occupational therapy may help if you have difficulty doing your normal daily activities. Surgical and other procedures You may need one or more of the following procedures: - Breathing assistance. If you've been burned on the face or neck, your throat may swell shut. If that appears likely, your doctor may insert a tube down your windpipe (trachea) to keep oxygen supplied to your lungs. - Tube feeding. Your metabolism goes into overdrive when your body starts trying to heal your burns. To provide adequate nutrition for this task, you doctor may thread a feeding tube through your nose to your stomach. - Easing blood flow around the wound. If a burn scab (eschar) goes completely around a limb, it can tighten and cut off the blood circulation. A scab (eschar) that goes completely around the chest can make it difficult to breathe. Your doctor may cut the eschar in several places to relieve this pressure. This procedure is called decompression. - Skin grafts. A skin graft is a surgical procedure in which sections of your own healthy skin are used to replace the scar tissue caused by deep burns. Donor skin from cadavers or pigs can be used as a temporary solution. - Plastic surgery. Plastic surgery (reconstruction) can improve the appearance of burn scars and increase the flexibility of joints affected by scarring. Lifestyle and home remedies To treat minor burns, follow these steps: - Cool the burn. Run cool (not cold) tap water over the burn for 10 to 15 minutes or until the pain eases. Or apply a clean towel dampened with cool tap water. Don't use ice. Putting ice directly on a burn can cause further damage to the tissue. - Remove rings or other tight items from the burned area. Try to do this quickly and gently, before the area swells. - Don't break small blisters (no bigger than your little fingernail). If blisters break, gently clean the area with mild soap and water, apply an antibiotic ointment, and cover it with a nonstick gauze bandage. - Apply moisturizer or aloe vera lotion or gel. This may soothe the area and prevent dryness as the wound heals. - If needed, take an over-the-counter pain reliever. Nonprescription products include ibuprofen (Advil, Motrin IB, others), naproxen (Aleve) and acetaminophen (Tylenol, others). - Consider a tetanus shot. Make sure that your tetanus booster is up to date. Doctors recommend people get a tetanus shot at least every 10 years. Whether your burn was minor or serious, use sunscreen and moisturizer regularly once the wound is healed.
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Overweight, obesity, and weight loss Overview Over 60 percent of U.S. adult women are overweight, according to 2007 estimates from the National Center for Health Statistics of the Center for Disease Control and Prevention. Just over one-third of overweight adult women are obese. How do I know if I'm overweight or obese? Find out your body mass index (BMI). BMI is a measure of body fat based on height and weight. People with a BMI of 25 to 29.9 are considered overweight. People with a BMI of 30 or more are considered obese. You can find out your BMI by using this calculator or the chart. What causes someone to become overweight or obese? You can become overweight or obese when you eat more calories (KAL-oh-rees) than you use. A calorie is a unit of energy in the food you eat. Your body needs this energy to function and to be active. But if you take in more energy than your body uses, you will gain weight. Many factors can play a role in becoming overweight or obese. These factors include: Overweight and obesity problems keep getting worse in the United States. Some cultural reasons for this include: What are the health effects of being overweight or obese? Being overweight or obese can increase your risk of: But excess body weight isn't the only health risk. The places where you store your body fat also affect your health. Women with a "pear" shape tend to store fat in their hips and buttocks. Women with an "apple" shape store fat around their waists. If your waist is more than 35 inches, you may have a higher risk of weight-related health problems. What is the best way for me to lose weight? The best way to lose weight is to use more calories than you take in. You can do this by following a healthy eating plan and being more active. Before you start a weight-loss program, talk to your doctor. Safe weight-loss programs that work well: How can I make healthier food choices? The U.S. Department of Health and Human Services (HHS) and Department of Agriculture (USDA) offer tips for healthy eating in Dietary Guidelines for All Americans. How can physical activity help? The new 2008 Physical Activity Guidelines for Americans state that an active lifestyle can lower your risk of early death from a variety of causes. There is strong evidence that regular physical activity can also lower your risk of: Regular activity can help prevent unhealthy weight gain and also help with weight loss, when combined with lower calorie intake. If you are overweight or obese, losing weight can lower your risk for many diseases. Being overweight or obese increases your risk of heart disease, high blood pressure, stroke, type 2 diabetes, breathing problems, osteoarthritis, gallbladder disease, sleep apnea (breathing problems while sleeping), and some cancers. Regular physical activity can also improve your cardiorespiratory (heart, lungs, and blood vessels) and muscular fitness. For older adults, activity can improve mental function. Physical activity may also help: Health benefits are gained by doing the following each week: This physical activity should be in addition to your routine activities of daily living, such as cleaning or spending a few minutes walking from the parking lot to your office. If you want to lose a substantial (more than 5 percent of body weight) amount of weight, you need a high amount of physical activity unless you also lower calorie intake. This is also the case if you are trying to keep the weight off. Many people need to do more than 300 minutes of moderate-intensity activity a week to meet weight-control goals. During moderate-intensity activities you should notice an increase in your heart rate, but you should still be able to talk comfortably. An example of a moderate-intensity activity is walking on a level surface at a brisk pace (about 3 to 4 miles per hour). Other examples include ballroom dancing, leisurely bicycling, moderate housework, and waiting tables. If your heart rate increases a lot and you are breathing so hard that it is difficult to carry on a conversation, you are probably doing vigorous-intensity activity. Examples of vigorous-intensity activities include jogging, bicycling fast or uphill, singles tennis, and pushing a hand mower. How you can increase your physical activity What medicines are approved for long-term treatment of obesity? The Food and Drug Administration has approved two medicines for long-term treatment of obesity: These medicines are for people who: If you take these medicines, you will need to follow a healthy eating and physical activity plan at the same time. Before taking these medicines, talk with your doctor about the benefits and the side effects. What surgical options are used to treat obesity? Weight loss surgeries - also called bariatric (bair-ee-AT-rik) surgeries - can help treat obesity. You should only consider surgical treatment for weight loss if you: Common types of weight loss surgeries are: If you are thinking about weight-loss surgery, talk with your doctor about changes you will need to make after the surgery. You will need to: You should also talk to your doctor about risks and side effects of weight loss surgery. Side effects may include: Is liposuction a treatment for obesity? Liposuction (LY-poh-suhk-shuhn) is not a treatment for obesity. In this procedure, a surgeon removes fat from under the skin. Liposuction can be used to reshape parts of your body. But this surgery does not promise lasting weight loss. I'm concerned about my children's eating and physical activity levels. How can I help improve their habits? The things children learn when they are young are hard to change as they get older. This is true for their eating and physical activity habits. Many children have a poor diet and are not very active. They may eat foods high in calories and fat and not eat enough fruits and vegetables. They also may watch TV, play video games, or use the computer instead of being active. Kids who are overweight have a greater chance of becoming obese adults. Overweight children may develop weight-related health problems like high blood pressure and diabetes at a young age. You can find out if your child is overweight or obese by using this Body Mass Index calculator for children and teens. You can help your child build healthy eating and activity habits. We know children do what they see - not always what they are told. Set a good example for your children. Your kids will learn to eat right and be active by watching you. Setting a good example can mean a lifetime of good habits for you and your kids. Did we answer your question about overweight, obesity, and weight loss? For more information about overweight, obesity, and weight loss, call womenshealth.gov at 1-800-994-9662 (TDD: 888-220-5446) or contact the following organizations:
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Chronic kidney disease: Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body. In the early stages of chronic kidney disease, you may have few signs or symptoms. Chronic kidney disease may not become apparent until your kidney function is significantly impaired. Treatment for chronic kidney disease focuses on slowing the progression of the kidney damage, usually by controlling the underlying cause. Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant. Chronic kidney disease care at Mayo Clinic Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. Signs and symptoms of kidney disease may include: - Nausea - Vomiting - Loss of appetite - Fatigue and weakness - Sleep problems - Changes in how much you urinate - Decreased mental sharpness - Muscle twitches and cramps - Swelling of feet and ankles - Persistent itching - Chest pain, if fluid builds up around the lining of the heart - Shortness of breath, if fluid builds up in the lungs - High blood pressure (hypertension) that's difficult to control Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by other illnesses. Because your kidneys are highly adaptable and able to compensate for lost function, signs and symptoms may not appear until irreversible damage has occurred. Make an appointment with your doctor if you have any signs or symptoms of kidney disease. If you have a medical condition that increases your risk of kidney disease, your doctor is likely to monitor your blood pressure and kidney function with urine and blood tests during regular office visits. Ask your doctor whether these tests are necessary for you. Chronic kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years. Diseases and conditions that cause chronic kidney disease include: - Type 1 or type 2 diabetes - High blood pressure - Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an inflammation of the kidney's filtering units (glomeruli) - Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney's tubules and surrounding structures - Polycystic kidney disease - Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers - Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys - Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis) Factors that may increase your risk of chronic kidney disease include: - Diabetes - High blood pressure - Heart and blood vessel (cardiovascular) disease - Smoking - Obesity - Being African-American, Native American or Asian-American - Family history of kidney disease - Abnormal kidney structure - Older age Chronic kidney disease can affect almost every part of your body. Potential complications may include: - Fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema) - A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart's ability to function and may be life-threatening - Heart and blood vessel (cardiovascular) disease - Weak bones and an increased risk of bone fractures - Anemia - Decreased sex drive, erectile dysfunction or reduced fertility - Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures - Decreased immune response, which makes you more vulnerable to infection - Pericarditis, an inflammation of the saclike membrane that envelops your heart (pericardium) - Pregnancy complications that carry risks for the mother and the developing fetus - Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival As a first step toward diagnosis of kidney disease, your doctor discusses your personal and family history with you. Among other things, your doctor might ask questions about whether you've been diagnosed with high blood pressure, if you've taken a medication that might affect kidney function, if you've noticed changes in your urinary habits, and whether you have any family members who have kidney disease. Next, your doctor performs a physical exam, also checking for signs of problems with your heart or blood vessels, and conducts a neurological exam. For kidney disease diagnosis, you may also need certain tests and procedures, such as: - Blood tests. Kidney function tests look for the level of waste products, such as creatinine and urea, in your blood. - Urine tests. Analyzing a sample of your urine may reveal abnormalities that point to chronic kidney failure and help identify the cause of chronic kidney disease. - Imaging tests. Your doctor may use ultrasound to assess your kidneys' structure and size. Other imaging tests may be used in some cases. - Removing a sample of kidney tissue for testing. Your doctor may recommend a kidney biopsy to remove a sample of kidney tissue. Kidney biopsy is often done with local anesthesia using a long, thin needle that's inserted through your skin and into your kidney. The biopsy sample is sent to a lab for testing to help determine what's causing your kidney problem. Depending on the underlying cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure. Treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If your kidneys become severely damaged, you may need treatment for end-stage kidney disease. Treating the cause Your doctor will work to slow or control the cause of your kidney disease. Treatment options vary, depending on the cause. But kidney damage can continue to worsen even when an underlying condition, such as high blood pressure, has been controlled. Treating complications Kidney disease complications can be controlled to make you more comfortable. Treatments may include: - High blood pressure medications. People with kidney disease may experience worsening high blood pressure. Your doctor may recommend medications to lower your blood pressure - commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers - and to preserve kidney function. High blood pressure medications can initially decrease kidney function and change electrolyte levels, so you may need frequent blood tests to monitor your condition. Your doctor will likely also recommend a water pill (diuretic) and a low-salt diet. - Medications to lower cholesterol levels. Your doctor may recommend medications called statins to lower your cholesterol. People with chronic kidney disease often experience high levels of bad cholesterol, which can increase the risk of heart disease. - Medications to treat anemia. In certain situations, your doctor may recommend supplements of the hormone erythropoietin (uh-rith-roe-POI-uh-tin), sometimes with added iron. Erythropoietin supplements aid in production of more red blood cells, which may relieve fatigue and weakness associated with anemia. - Medications to relieve swelling. People with chronic kidney disease may retain fluids. This can lead to swelling in the legs, as well as high blood pressure. Medications called diuretics can help maintain the balance of fluids in your body. - Medications to protect your bones. Your doctor may prescribe calcium and vitamin D supplements to prevent weak bones and lower your risk of fracture. You may also take medication known as a phosphate binder to lower the amount of phosphate in your blood, and protect your blood vessels from damage by calcium deposits (calcification). - A lower protein diet to minimize waste products in your blood. As your body processes protein from foods, it creates waste products that your kidneys must filter from your blood. To reduce the amount of work your kidneys must do, your doctor may recommend eating less protein. Your doctor may also ask you to meet with a dietitian who can suggest ways to lower your protein intake while still eating a healthy diet. Your doctor may recommend follow-up testing at regular intervals to see whether your kidney disease remains stable or progresses. Treatment for end-stage kidney disease If your kidneys can't keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a kidney transplant. - Dialysis. Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood. In peritoneal dialysis, a thin tube (catheter) inserted into your abdomen fills your abdominal cavity with a dialysis solution that absorbs waste and excess fluids. After a period of time, the dialysis solution drains from your body, carrying the waste with it. - Kidney transplant. A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors. You'll need to take medications for the rest of your life to keep your body from rejecting the new organ. You don't need to be on dialysis to have a kidney transplant. For some who choose not to have dialysis or a kidney transplant, a third option is to treat kidney failure with conservative measures. However, once you have complete kidney failure, your life expectancy generally would be only a few months. Potential future treatments Regenerative medicine holds the potential to fully heal damaged tissues and organs, offering solutions and hope for people who have conditions that today are beyond repair. Regenerative medicine approaches include: - Boosting the body's natural ability to heal itself - Using healthy cells, tissues or organs from a living or deceased donor to replace damaged ones - Delivering specific types of cells or cell products to diseased tissues or organs to restore tissue and organ function For people with chronic kidney disease, regenerative medicine approaches may be developed in the future to help slow progression of the disease. As part of your treatment for chronic kidney disease, your doctor may recommend a special diet to help support your kidneys and limit the work they must do. Ask your doctor for a referral to a dietitian who can analyze your current diet and suggest ways to make your diet easier on your kidneys. Depending on your situation, kidney function and overall health, your dietitian may recommend that you: - Avoid products with added salt. Lower the amount of sodium you eat each day by avoiding products with added salt, including many convenience foods, such as frozen dinners, canned soups and fast foods. Other foods with added salt include salty snack foods, canned vegetables, and processed meats and cheeses. - Choose lower potassium foods. Your dietitian may recommend that you choose lower potassium foods at each meal. High-potassium foods include bananas, oranges, potatoes, spinach and tomatoes. Examples of low-potassium foods include apples, cabbage, carrots, green beans, grapes and strawberries. Be aware that many salt substitutes contain potassium, so you generally should avoid them if you have kidney failure. - Limit the amount of protein you eat. Your dietitian will estimate the appropriate number of grams of protein you need each day and make recommendations based on that amount. High-protein foods include lean meats, eggs, milk, cheese and beans. Low-protein foods include vegetables, fruits, breads and cereals.
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Rheumatoid Arthritis What is it? Points To Remember About Rheumatoid Arthritis What is rheumatoid arthritis? Rheumatoid arthritis is a disease that causes pain, swelling, and stiffness in your joints. This disease often occurs in more than one joint and can affect any joint in the body. If you have this disease, you may feel sick and tired, and sometimes get fevers.Anyone can get rheumatoid arthritis, but it occurs more often in women and is most common in older people.Genes, environmental factors, and hormones may play roles in the development of rheumatoid arthritis.Treatment may involve medicine, surgery, and alternative therapies.Regular rest, joint care, activity, a healthy diet, and reduced stress can ease symptoms.Rheumatoid arthritis is a disease that affects your joints. Joints are where two or more bones join together, such as at your knees, hips, or shoulders. Rheumatoid arthritis causes pain, swelling, and stiffness. If joints on one side of your body have rheumatoid arthritis, usually those joints on the other side do too. This disease often occurs in more than one joint. It can affect any joint in the body.If you have this disease, you also may feel sick and tired, and sometimes get fevers. Rheumatoid arthritis is a disease that causes pain, swelling, and stiffness in your joints. This disease often occurs in more than one joint and can affect any joint in the body. If you have this disease, you may feel sick and tired, and sometimes get fevers.Anyone can get rheumatoid arthritis, but it occurs more often in women and is most common in older people.Genes, environmental factors, and hormones may play roles in the development of rheumatoid arthritis.Treatment may involve medicine, surgery, and alternative therapies.Regular rest, joint care, activity, a healthy diet, and reduced stress can ease symptoms. Rheumatoid arthritis is a disease that causes pain, swelling, and stiffness in your joints. This disease often occurs in more than one joint and can affect any joint in the body. If you have this disease, you may feel sick and tired, and sometimes get fevers.Anyone can get rheumatoid arthritis, but it occurs more often in women and is most common in older people.Genes, environmental factors, and hormones may play roles in the development of rheumatoid arthritis.Treatment may involve medicine, surgery, and alternative therapies.Regular rest, joint care, activity, a healthy diet, and reduced stress can ease symptoms.Rheumatoid arthritis is a disease that affects your joints. Joints are where two or more bones join together, such as at your knees, hips, or shoulders. Rheumatoid arthritis causes pain, swelling, and stiffness. If joints on one side of your body have rheumatoid arthritis, usually those joints on the other side do too. This disease often occurs in more than one joint. It can affect any joint in the body.If you have this disease, you also may feel sick and tired, and sometimes get fevers. Who gets it? Who gets rheumatoid arthritis? Anyone can get this disease, though it occurs more often in women. Rheumatoid arthritis often starts in middle age and is common in older people. But children and young adults can also get it.Anyone can get this disease, though it occurs more often in women. Rheumatoid arthritis often starts in middle age and is common in older people. But children and young adults can also get it. What causes it? What causes rheumatoid arthritis? Doctors don't know the exact cause of rheumatoid arthritis. They know that with this type of arthritis, a person's immune system attacks his or her own body tissues. The immune system normally attacks invaders to the body, such as a cold virus or bacteria. Researchers are learning many things about why and how this happens. Things that may cause rheumatoid arthritis are: Genes (passed from parent to child).Environmental factors.Hormones.Doctors don't know the exact cause of rheumatoid arthritis. They know that with this type of arthritis, a person's immune system attacks his or her own body tissues. The immune system normally attacks invaders to the body, such as a cold virus or bacteria. Researchers are learning many things about why and how this happens. Things that may cause rheumatoid arthritis are: Genes (passed from parent to child).Environmental factors.Hormones.Doctors don't know the exact cause of rheumatoid arthritis. They know that with this type of arthritis, a person's immune system attacks his or her own body tissues. The immune system normally attacks invaders to the body, such as a cold virus or bacteria. Researchers are learning many things about why and how this happens. Things that may cause rheumatoid arthritis are: Genes (passed from parent to child).Environmental factors.Hormones. Is there a test? Is there a test for rheumatoid arthritis? Rheumatoid arthritis can be hard to diagnose because: There is no single test for the disease.The symptoms can be the same as in other kinds of joint disease.The full symptoms can take time to develop.To diagnose rheumatoid arthritis, doctors use medical history, a physical exam, x-rays and other imaging tests, and lab tests.Rheumatoid arthritis can be hard to diagnose because: There is no single test for the disease.The symptoms can be the same as in other kinds of joint disease.The full symptoms can take time to develop.To diagnose rheumatoid arthritis, doctors use medical history, a physical exam, x-rays and other imaging tests, and lab tests.Rheumatoid arthritis can be hard to diagnose because: There is no single test for the disease.The symptoms can be the same as in other kinds of joint disease.The full symptoms can take time to develop.To diagnose rheumatoid arthritis, doctors use medical history, a physical exam, x-rays and other imaging tests, and lab tests. How is it treated? How is rheumatoid arthritis treated? Doctors have many ways to treat rheumatoid arthritis. Treatment may involve: Medicine.Surgery.Regular doctor visits.Complementary therapies.The goals of treatment are to: Take away pain.Reduce swelling.Slow down or stop joint damage.Help you feel better.Help you stay active. <h3>Medicine</h3> Most people with rheumatoid arthritis take medicine. Drugs can be used for pain relief, to reduce swelling, and to stop the disease from getting worse. What a doctor prescribes depends on: Your general health.How serious the rheumatoid arthritis is.How serious the rheumatoid arthritis may become.How long you will take the drug.How well the drug works.Possible side effects. <h3>How is it treated?</h3> <h3>Surgery</h3> There are many kinds of surgery for people with a lot of joint damage. Surgery may: Reduce your pain.Help your joint work better.Help you be able to do daily activities.Surgery is not for everyone. Talk with your doctor to decide what is best for you. <h3>Regular Doctor Visits</h3> Regular medical care is important so doctors can: See if the disease is getting worse.See if drugs are helping.Discuss any drug side effects.Change treatment when needed. <h3>Complementary Therapies</h3> Special diets, vitamins, and other complementary therapies are sometimes suggested to treat rheumatoid arthritis. Many of these treatments are not harmful, but they may not be well tested or have any real benefits.Ask your doctor about things you can do to manage your pain, such as exercise programs, support groups, and education classes. Before starting any complementary therapy, talk with your doctor to make sure it isn't harmful.Doctors have many ways to treat rheumatoid arthritis. Treatment may involve: Medicine.Surgery.Regular doctor visits.Complementary therapies.The goals of treatment are to: Take away pain.Reduce swelling.Slow down or stop joint damage.Help you feel better.Help you stay active. <h3>Medicine</h3> Most people with rheumatoid arthritis take medicine. Drugs can be used for pain relief, to reduce swelling, and to stop the disease from getting worse. What a doctor prescribes depends on: Your general health.How serious the rheumatoid arthritis is.How serious the rheumatoid arthritis may become.How long you will take the drug.How well the drug works.Possible side effects. <h3>How is it treated?</h3> <h3>Surgery</h3> There are many kinds of surgery for people with a lot of joint damage. Surgery may: Reduce your pain.Help your joint work better.Help you be able to do daily activities.Surgery is not for everyone. Talk with your doctor to decide what is best for you. <h3>Regular Doctor Visits</h3> Regular medical care is important so doctors can: See if the disease is getting worse.See if drugs are helping.Discuss any drug side effects.Change treatment when needed. <h3>Complementary Therapies</h3> Special diets, vitamins, and other complementary therapies are sometimes suggested to treat rheumatoid arthritis. Many of these treatments are not harmful, but they may not be well tested or have any real benefits.Ask your doctor about things you can do to manage your pain, such as exercise programs, support groups, and education classes. Before starting any complementary therapy, talk with your doctor to make sure it isn't harmful.Doctors have many ways to treat rheumatoid arthritis. Treatment may involve: Medicine.Surgery.Regular doctor visits.Complementary therapies.The goals of treatment are to: Take away pain.Reduce swelling.Slow down or stop joint damage.Help you feel better.Help you stay active. <h3>Medicine</h3> Most people with rheumatoid arthritis take medicine. Drugs can be used for pain relief, to reduce swelling, and to stop the disease from getting worse. What a doctor prescribes depends on: Your general health.How serious the rheumatoid arthritis is.How serious the rheumatoid arthritis may become.How long you will take the drug.How well the drug works.Possible side effects. <h3>How is it treated?</h3> <h3>Surgery</h3> There are many kinds of surgery for people with a lot of joint damage. Surgery may: Reduce your pain.Help your joint work better.Help you be able to do daily activities.Surgery is not for everyone. Talk with your doctor to decide what is best for you. <h3>Regular Doctor Visits</h3> Regular medical care is important so doctors can: See if the disease is getting worse.See if drugs are helping.Discuss any drug side effects.Change treatment when needed. <h3>Complementary Therapies</h3> Special diets, vitamins, and other complementary therapies are sometimes suggested to treat rheumatoid arthritis. Many of these treatments are not harmful, but they may not be well tested or have any real benefits.Ask your doctor about things you can do to manage your pain, such as exercise programs, support groups, and education classes. Before starting any complementary therapy, talk with your doctor to make sure it isn't harmful. Who treats it? Who treats rheumatoid arthritis? Several types of health care professionals may treat you, including: Internist, who diagnoses and treats adults.Rheumatologist, who treats arthritis and other disease of the bones, joints, and muscles.Orthopaedists, who treat and perform surgery for bone and joint diseases.Physical therapists, who help to improve joint function.Occupational therapists, who teach ways to protect joints, reduce pain, perform activities of daily living, and conserve energy.Dietitians, who teach ways to use a good diet to improve health and maintain a healthy weight.Several types of health care professionals may treat you, including: Internist, who diagnoses and treats adults.Rheumatologist, who treats arthritis and other disease of the bones, joints, and muscles.Orthopaedists, who treat and perform surgery for bone and joint diseases.Physical therapists, who help to improve joint function.Occupational therapists, who teach ways to protect joints, reduce pain, perform activities of daily living, and conserve energy.Dietitians, who teach ways to use a good diet to improve health and maintain a healthy weight.Several types of health care professionals may treat you, including: Internist, who diagnoses and treats adults.Rheumatologist, who treats arthritis and other disease of the bones, joints, and muscles.Orthopaedists, who treat and perform surgery for bone and joint diseases.Physical therapists, who help to improve joint function.Occupational therapists, who teach ways to protect joints, reduce pain, perform activities of daily living, and conserve energy.Dietitians, who teach ways to use a good diet to improve health and maintain a healthy weight. Living with It Living with rheumatoid arthritis With rheumatoid arthritis, you can still lead a full life. Besides going to your doctor and therapists regularly, you can also do these activities to help reduce your symptoms. <h3>Joint Care</h3> Look for ways to reduce stress on your joints. Some people find wearing a splint around a painful joint for a short time helps. Talk with your doctor to see if a splint may work for you. In addition, some special equipment can help such as a zipper puller or long-handled shoe horn. <h3>Rest</h3> Keep a good balance between rest and activity. Try to take frequent breaks, especially when your symptoms are bothering you. <h3>Lowering Stress</h3> Try to lower your stress by taking the time to relax, doing hobbies you enjoy, or joining a support group. Support groups can reduce your stress by helping you to: Learn about the disease.Cope with your emotions about your symptoms.Feel more control over the disease.Build confidence. <h3>A Healthy Diet</h3> Eat a healthy diet which will help you manage your weight and get a variety of nutrients for overall health.With rheumatoid arthritis, you can still lead a full life. Besides going to your doctor and therapists regularly, you can also do these activities to help reduce your symptoms. <h3>Joint Care</h3> Look for ways to reduce stress on your joints. Some people find wearing a splint around a painful joint for a short time helps. Talk with your doctor to see if a splint may work for you. In addition, some special equipment can help such as a zipper puller or long-handled shoe horn. <h3>Rest</h3> Keep a good balance between rest and activity. Try to take frequent breaks, especially when your symptoms are bothering you. <h3>Lowering Stress</h3> Try to lower your stress by taking the time to relax, doing hobbies you enjoy, or joining a support group. Support groups can reduce your stress by helping you to: Learn about the disease.Cope with your emotions about your symptoms.Feel more control over the disease.Build confidence. <h3>A Healthy Diet</h3> Eat a healthy diet which will help you manage your weight and get a variety of nutrients for overall health. Other Medical Problems Other medical problems related to rheumatoid arthritis You may also experience other health problems as a result of your rheumatoid arthritis. Be sure to talk with your doctor if any of these occur.Many people with rheumatoid arthritis may also have: Anemia, a condition in which your blood has a lower than normal count of red blood cells.Depression.Anxiety.Other effects that occur less often include: Neck pain.Dry eyes.Dry mouth.Very rarely, people may have inflammation of their: Blood vessels.Lining of the lungs.Sac enclosing the heart.You may also experience other health problems as a result of your rheumatoid arthritis. Be sure to talk with your doctor if any of these occur.Many people with rheumatoid arthritis may also have: Anemia, a condition in which your blood has a lower than normal count of red blood cells.Depression.Anxiety.Other effects that occur less often include: Neck pain.Dry eyes.Dry mouth.Very rarely, people may have inflammation of their: Blood vessels.Lining of the lungs.Sac enclosing the heart.
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Gonorrhea Overview Gonorrhea is an infection caused by a sexually transmitted bacterium that can infect both males and females. Gonorrhea most often affects the urethra, rectum or throat. In females, gonorrhea can also infect the cervix. Gonorrhea is most commonly spread during sex. But babies can be infected during childbirth if their mothers are infected. In babies, gonorrhea most commonly affects the eyes. Gonorrhea is a common infection that, in many cases, causes no symptoms. You may not even know that you're infected. Abstaining from sex, using a condom if you do have sex and being in a mutually monogamous relationship are the best ways to prevent sexually transmitted infections. Symptoms In many cases, gonorrhea infection causes no symptoms. When symptoms do appear, gonorrhea infection can affect multiple sites in your body, but it commonly appears in the genital tract. Gonorrhea affecting the genital tract Signs and symptoms of gonorrhea infection in men include: - Painful urination - Pus-like discharge from the tip of the penis - Pain or swelling in one testicle Signs and symptoms of gonorrhea infection in women include: - Increased vaginal discharge - Painful urination - Vaginal bleeding between periods, such as after vaginal intercourse - Painful intercourse - Abdominal or pelvic pain Gonorrhea at other sites in the body Gonorrhea can also affect these parts of the body: - Rectum. Signs and symptoms include anal itching, pus-like discharge from the rectum, spots of bright red blood on toilet tissue and having to strain during bowel movements. - Eyes. Gonorrhea that affects your eyes may cause eye pain, sensitivity to light, and pus-like discharge from one or both eyes. - Throat. Signs and symptoms of a throat infection may include a sore throat and swollen lymph nodes in the neck. - Joints. If one or more joints become infected by bacteria (septic arthritis), the affected joints may be warm, red, swollen and extremely painful, especially when you move an affected joint. When to see your doctor Make an appointment with your doctor if you notice any troubling signs or symptoms, such as a burning sensation when you urinate or a pus-like discharge from your penis, vagina or rectum. Also make an appointment with your doctor if your partner has been diagnosed with gonorrhea. You may not experience signs or symptoms that prompt you to seek medical attention. But without treatment, you can reinfect your partner even after he or she has been treated for gonorrhea. Causes Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. The gonorrhea bacteria are most often passed from one person to another during sexual contact, including oral, anal or vaginal intercourse. Risk factors Factors that may increase your risk of gonorrhea infection include: - Younger age - A new sex partner - A sex partner who has concurrent partners - Multiple sex partners - Previous gonorrhea diagnosis - Having other sexually transmitted infections Complications Untreated gonorrhea can lead to significant complications, such as: - Infertility in women. Untreated gonorrhea can spread into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID), which may result in scarring of the tubes, greater risk of pregnancy complications and infertility. PID is a serious infection that requires immediate treatment. - Infertility in men. Men with untreated gonorrhea can experience epididymitis - inflammation of a small, coiled tube in the rear portion of the testicles where the sperm ducts are located (epididymis). Epididymitis is treatable, but if left untreated, it may lead to infertility. - Infection that spreads to the joints and other areas of your body. The bacterium that causes gonorrhea can spread through the bloodstream and infect other parts of your body, including your joints. Fever, rash, skin sores, joint pain, swelling and stiffness are possible results. - Increased risk of HIV/AIDS. Having gonorrhea makes you more susceptible to infection with human immunodeficiency virus (HIV), the virus that leads to AIDS. People who have both gonorrhea and HIV are able to pass both diseases more readily to their partners. - Complications in babies. Babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections. Diagnosis To determine whether the gonorrhea bacterium is present in your body, your doctor will analyze a sample of cells. Samples can be collected by: - Urine test. This may help identify bacteria in your urethra. - Swab of affected area. A swab of your throat, urethra, vagina or rectum may collect bacteria that can be identified in a laboratory. For women, home test kits are available for gonorrhea. Home test kits include vaginal swabs for self-testing that are sent to a specified lab for testing. If you prefer, you can choose to be notified by email or text message when your results are ready. You may then view your results online or receive them by calling a toll-free hotline. Testing for other sexually transmitted infections Your doctor may recommend tests for other sexually transmitted infections. Gonorrhea increases your risk of these infections, particularly chlamydia, which often accompanies gonorrhea. Testing for HIV also is recommended for anyone diagnosed with a sexually transmitted infection. Depending on your risk factors, tests for additional sexually transmitted infections could be beneficial as well. Treatment Gonorrhea treatment in adults Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated only with the antibiotic ceftriaxone - given as an injection - in combination with either azithromycin (Zithromax, Zmax) or doxycycline (Monodox, Vibramycin, others) - two antibiotics that are taken orally. Some research indicates that oral gemifloxacin (Factive) or injectable gentamicin, combined with oral azithromycin, is highly successful in treating gonorrhea. This treatment may be helpful in treating people who are allergic to cephalosporin antibiotics, such as ceftriaxone. Gonorrhea treatment for partners Your partner also should undergo testing and treatment for gonorrhea, even if he or she has no signs or symptoms. Your partner receives the same treatment you do. Even if you've been treated for gonorrhea, you can be reinfected if your partner isn't treated. Gonorrhea treatment for babies Babies born to mothers with gonorrhea receive a medication in their eyes soon after birth to prevent infection. If an eye infection develops, babies can be treated with antibiotics.
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Type 2 diabetes Overview Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body's important source of fuel. With type 2 diabetes, your body either resists the effects of insulin - a hormone that regulates the movement of sugar into your cells - or doesn't produce enough insulin to maintain a normal glucose level. More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There's no cure for type 2 diabetes, but you may be able to manage the condition by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enough to manage your blood sugar well, you also may need diabetes medications or insulin therapy. Symptoms Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for: - Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink - and urinate - more than usual. - Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger. - Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine. - Fatigue. If your cells are deprived of sugar, you may become tired and irritable. - Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus. - Slow-healing sores or frequent infections. Type 2 diabetes affects your ability to heal and resist infections. - Areas of darkened skin. Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies - usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance. When to see a doctor See your doctor if you notice any type 2 diabetes symptoms. Causes Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin. Exactly why this happens is unknown, although genetics and environmental factors, such as excess weight and inactivity, seem to be contributing factors. How insulin works Insulin is a hormone that comes from the gland situated behind and below the stomach (pancreas). - The pancreas secretes insulin into the bloodstream. - The insulin circulates, enabling sugar to enter your cells. - Insulin lowers the amount of sugar in your bloodstream. - As your blood sugar level drops, so does the secretion of insulin from your pancreas. The role of glucose Glucose - a sugar - is a main source of energy for the cells that make up muscles and other tissues. - Glucose comes from two major sources: food and your liver. - Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin. - Your liver stores and makes glucose. - When your glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range. In type 2 diabetes, this process doesn't work well. Instead of moving into your cells, sugar builds up in your bloodstream. As blood sugar levels increase, the insulin-producing beta cells in the pancreas release more insulin, but eventually these cells become impaired and can't make enough insulin to meet the body's demands. In the much less common type 1 diabetes, the immune system destroys the beta cells, leaving the body with little to no insulin. Risk factors Researchers don't fully understand why some people develop type 2 diabetes and others don't. It's clear, however, that certain factors increase the risk, including: - Weight. Being overweight is a primary risk factor for type 2 diabetes. The more fatty tissue you have, the more resistant your cells become to insulin. However, you don't have to be overweight to develop type 2 diabetes. - Fat distribution. If your body stores fat primarily in your abdomen, your risk of type 2 diabetes is greater than if your body stores fat elsewhere, such as your hips and thighs. - Inactivity. The less active you are, the greater your risk of type 2 diabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin. - Family history. The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes. - Race. Although it's unclear why, people of certain races - including blacks, Hispanics, American Indians and Asian-Americans - are more likely to develop type 2 diabetes than whites are. - Age. The risk of type 2 diabetes increases as you get older, especially after age 45. That's probably because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults. - Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes. - Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing type 2 diabetes increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes. - Polycystic ovarian syndrome. For women, having polycystic ovarian syndrome - a common condition characterized by irregular menstrual periods, excess hair growth and obesity - increases the risk of diabetes. Complications Type 2 diabetes can be easy to ignore, especially in the early stages when you're feeling fine. But diabetes affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Controlling your blood sugar levels can help prevent these complications. Although long-term complications of diabetes develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes include: - Heart and blood vessel disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure. - Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar can eventually cause you to lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue. - Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which often eventually requires dialysis or a kidney transplant. - Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma. - Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation. - Hearing impairment. Hearing problems are more common in people with diabetes. - Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections. - Alzheimer's disease. Type 2 diabetes may increase the risk of Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to be. The exact connection between these two conditions still remains unclear. Diagnosis To diagnose type 2 diabetes, you'll be given a: - Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent. If the A1C test isn't available, or if you have certain conditions - such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) - that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes: - Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. - Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. - Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes. A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours may indicate diabetes. The American Diabetes Association recommends routine screening for type 2 diabetes beginning at age 45, especially if you're overweight. If the results are normal, repeat the test every three years. If the results are borderline, ask your doctor when to come back for another test. Screening is also recommended for people who are under 45 and overweight if there are other heart disease or diabetes risk factors present, such as a sedentary lifestyle, a family history of type 2 diabetes, a personal history of gestational diabetes or blood pressure above 140/90 millimeters of mercury (mm Hg). If you're diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes - since the two conditions often require different treatments. After the diagnosis A1C levels need to be checked between two and four times a year. Your target A1C goal may vary depending on your age and other factors. However, for most people, the American Diabetes Association recommends an A1C level below 7 percent. Ask your doctor what your A1C target is. Compared with repeated daily blood sugar tests, the A1C test is a better indicator of how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your medication, meal plan or activity level. In addition to the A1C test, your doctor will take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. The doctor will also assess your blood pressure. Regular eye and foot exams also are important. Treatment Management of type 2 diabetes includes: - Healthy eating - Regular exercise - Possibly, diabetes medication or insulin therapy - Blood sugar monitoring These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications. Healthy eating Contrary to popular perception, there's no specific diabetes diet. However, it's important to center your diet on these high-fiber, low-fat foods: - Fruits - Vegetables - Whole grains You'll also need to eat fewer animal products, refined carbohydrates and sweets. Low glycemic index foods also may be helpful. The glycemic index is a measure of how quickly a food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar quickly. Low glycemic index foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber. A registered dietitian can help you put together a meal plan that fits your health goals, food preferences and lifestyle. He or she can also teach you how to monitor your carbohydrate intake and let you know about how many carbohydrates you need to eat with your meals and snacks to keep your blood sugar levels more stable. Physical activity Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Get your doctor's OK before you start an exercise program. Then choose activities you enjoy, such as walking, swimming and biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise five days of the week. Stretching and strength training exercises are important, too. If you haven't been active for a while, start slowly and build up gradually. A combination of exercises - aerobic exercises, such as walking or dancing on most days, combined with resistance training, such as weightlifting or yoga twice a week - often helps control blood sugar more effectively than either type of exercise alone. Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar. Monitoring your blood sugar Depending on your treatment plan, you may need to check and record your blood sugar level every now and then or, if you're on insulin, multiple times a day. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. Sometimes, blood sugar levels can be unpredictable. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to food, exercise, alcohol, illness and medication. Diabetes medications and insulin therapy Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways. Examples of possible treatments for type 2 diabetes include: - Metformin (Glucophage, Glumetza, others). Generally, metformin is the first medication prescribed for type 2 diabetes. It works by improving the sensitivity of your body tissues to insulin so that your body uses insulin more effectively. Metformin also lowers glucose production in the liver. Metformin may not lower blood sugar enough on its own. Your doctor will also recommend lifestyle changes, such as losing weight and becoming more active. Nausea and diarrhea are possible side effects of metformin. These side effects usually go away as your body gets used to the medicine. If metformin and lifestyles changes aren't enough to control your blood sugar level, other oral or injected medications can be added. - Sulfonylureas. These medications help your body secrete more insulin. Examples of medications in this class include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side effects include low blood sugar and weight gain. - Meglitinides. These medications work like sulfonylureas by stimulating the pancreas to secrete more insulin, but they're faster acting, and the duration of their effect in the body is shorter. They also have a risk of causing low blood sugar, but this risk is lower than with sulfonylureas. Weight gain is a possibility with this class of medications as well. Examples include repaglinide (Prandin) and nateglinide (Starlix). - Thiazolidinediones. Like metformin, these medications make the body's tissues more sensitive to insulin. This class of medications has been linked to weight gain and other more-serious side effects, such as an increased risk of heart failure and fractures. Because of these risks, these medications generally aren't a first-choice treatment. Rosiglitazone (Avandia) and pioglitazone (Actos) are examples of thiazolidinediones. - DPP-4 inhibitors. These medications help reduce blood sugar levels, but tend to have a modest effect. They don't cause weight gain. Examples of these medications are sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta). - GLP-1 receptor agonists. These medications slow digestion and help lower blood sugar levels, though not as much as sulfonylureas. Their use is often associated with some weight loss. This class of medications isn't recommended for use by itself. Exenatide (Byetta) and liraglutide (Victoza) are examples of GLP-1 receptor agonists. Possible side effects include nausea and an increased risk of pancreatitis. - SGLT2 inhibitors. These are the newest diabetes drugs on the market. They work by preventing the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine. Examples include canagliflozin (Invokana) and dapagliflozin (Farxiga). Side effects may include yeast infections and urinary tract infections, increased urination and hypotension. - Insulin therapy. Some people who have type 2 diabetes need insulin therapy as well. In the past, insulin therapy was used as a last resort, but today it's often prescribed sooner because of its benefits. Because normal digestion interferes with insulin taken by mouth, insulin must be injected. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night. Often, people with type 2 diabetes start insulin use with one long-acting shot at night. Insulin injections involve using a fine needle and syringe or an insulin pen injector - a device that looks similar to an ink pen, except the cartridge is filled with insulin. There are many types of insulin, and they each work in a different way. Options include: - Insulin glulisine (Apidra) - Insulin lispro (Humalog) - Insulin aspart (Novolog) - Insulin glargine (Lantus) - Insulin detemir (Levemir) - Insulin isophane (Humulin N, Novolin N) Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you after considering many factors, including costs and other aspects of your health. In addition to diabetes medications, your doctor might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease. Bariatric surgery If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery). Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the procedure performed. Surgeries that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries. Drawbacks to the surgery include its high cost, and there are risks involved, including a risk of death. Additionally, drastic lifestyle changes are required and long-term complications may include nutritional deficiencies and osteoporosis. Pregnancy Women with type 2 diabetes may need to alter their treatment during pregnancy. Many women will require insulin therapy during pregnancy. Cholesterol-lowering medications and some blood pressure drugs can't be used during pregnancy. If you have signs of diabetic retinopathy, it may worsen during pregnancy. Visit your ophthalmologist during the first trimester of your pregnancy and at one year postpartum. Signs of trouble Because so many factors can affect your blood sugar, problems sometimes arise that require immediate care, such as: - High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication. Check your blood sugar level often, and watch for signs and symptoms of high blood sugar - frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you'll need to adjust your meal plan, medications or both. - Hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Signs and symptoms of this life-threatening condition include a blood sugar reading higher than 600 mg/dL (33.3 mmol/L), dry mouth, extreme thirst, fever greater than 101 F (38 C), drowsiness, confusion, vision loss, hallucinations and dark urine. Your blood sugar monitor may not be able to give you an exact reading at such high levels and may instead just read "high." HHNS is caused by sky-high blood sugar that turns blood thick and syrupy. It tends to be more common in older people with type 2 diabetes, and it's often preceded by an illness or infection. HHNS usually develops over days or weeks. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition. - Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces toxic acids known as ketones. Watch for thirst or a very dry mouth, frequent urination, vomiting, shortness of breath, fatigue and fruity-smelling breath. You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, consult your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes but can sometimes occur in people with type 2 diabetes. - Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar (hypoglycemia). Your blood sugar level can drop for many reasons, including skipping a meal, inadvertently taking more medication than usual or getting more physical activity than normal. Low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin or if you're taking insulin. Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar - sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, slurred speech, drowsiness, confusion and seizures. If you develop hypoglycemia during the night, you might wake with sweat-soaked pajamas or a headache. Due to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning. If you have signs or symptoms of low blood sugar, drink or eat something that will quickly raise your blood sugar level - fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Retest in 15 minutes to be sure your blood glucose levels have normalized. If they haven't, treat again and retest in another 15 minutes. If you lose consciousness, a family member or close contact may need to give you an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood. Lifestyle and home remedies Careful management of type 2 diabetes can reduce your risk of serious - even life-threatening - complications. Consider these tips: - Commit to managing your diabetes. Learn all you can about type 2 diabetes. Make healthy eating and physical activity part of your daily routine. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it. - Schedule a yearly physical exam and regular eye exams. Your regular diabetes checkups aren't meant to replace regular physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications, as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma. - Identify yourself. Wear a necklace or bracelet that says you have diabetes. - Keep your immunizations up to date. High blood sugar can weaken your immune system. Get a flu shot every year, and your doctor will likely recommend the pneumonia vaccine, as well. The Centers for Disease Control and Prevention (CDC) also recommends the hepatitis B vaccination if you haven't previously received this vaccine and you're an adult age 19 to 59 with type 1 or type 2 diabetes. The CDC advises vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you are age 60 or older, have diabetes and haven't previously received the vaccine, talk to your doctor about whether it's right for you. - Take care of your teeth. Diabetes may leave you prone to more-serious gum infections. Brush your teeth at least twice a day, floss your teeth once a day and schedule regular dental exams. Consult your dentist right away if your gums bleed or look red or swollen. - Pay attention to your feet. Wash your feet daily in lukewarm water. Dry them gently, especially between the toes, and moisturize with lotion. Check your feet every day for blisters, cuts, sores, redness and swelling. Consult your doctor if you have a sore or other foot problem that isn't healing. - Keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medication also may be needed. - If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco. - If you drink alcohol, do so responsibly. Alcohol, as well as drink mixers, can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so in moderation and always with a meal. The recommendation is no more than one drink daily for women, no more than two drinks daily for men age 65 and younger, and one drink a day for men over 65. If you're on insulin or other medications that lower your blood sugar, check your blood sugar before you go to sleep to make sure you're at a safe level. Alternative medicine Numerous alternative medicine substances have been shown to improve insulin sensitivity in some studies, while other studies fail to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, no alternative therapies are recommended to help with blood sugar management. If you decide to try an alternative therapy, don't stop taking the medications that your doctor has prescribed. Be sure to discuss the use of any of these therapies with your doctor to make sure that they won't cause adverse reactions or interact with your medications. No treatments - alternative or conventional - can cure diabetes. So it's critical that people who are using insulin therapy for diabetes don't stop using insulin unless directed to do so by their physicians.
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Glaucoma: Glaucoma is a group of eye conditions that can damage the optic nerve. This nerve sends the images you see to your brain. Most often, optic nerve damage is caused by increased pressure in the eye. This is called intraocular pressure. Watch this video about: Glaucoma Glaucoma is the second most common cause of blindness in the United States. There are four major types of glaucoma: - Open-angle glaucoma - Angle-closure glaucoma, also called closed-angle glaucoma - Congenital glaucoma - Secondary glaucoma The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is made in an area behind the colored part of the eye (iris). It leaves the eye through channels where the iris and cornea meet. This area is called the anterior chamber angle, or the angle. The cornea is the clear covering on the front of the eye that covers the iris, pupil, and angle. Anything that slows or blocks the flow of this fluid will cause pressure to build up in the eye. - In open-angle glaucoma, the increase in pressure is often small and slow. - In closed-angle glaucoma, the increase is often high and sudden. - Either type can damage the optic nerve. Open-angle glaucoma is the most common type of glaucoma. - The cause is unknown. The increase in eye pressure happens slowly over time. You cannot feel it. - The increased pressure pushes on the optic nerve. Damage to the optic nerve causes blind spots in your vision. - Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are also at higher risk for this disease. Closed-angle glaucoma occurs when the fluid is suddenly blocked and cannot flow out of the eye. This causes a quick, severe rise in eye pressure. - Dilating eye drops and certain medicines may trigger an acute glaucoma attack. - Closed-angle glaucoma is an emergency. - If you have had acute glaucoma in one eye, you are at risk for it in the second eye. Your health care provider is likely to treat your second eye to prevent a first attack in that eye. Secondary glaucoma occurs due to a known cause. Both open- and closed-angle glaucoma can be secondary when caused by something known. Causes include: - Drugs such as corticosteroids - Eye diseases such as uveitis (an infection of the middle layer of the eye) - Diseases such as diabetes - Eye injury Congenital glaucoma occurs in babies. - It often runs in families. - It is present at birth. - It is caused when the eye does not develop normally. OPEN-ANGLE GLAUCOMA - Most people have no symptoms. - Once vision loss occurs, the damage is already severe. - Slow loss of side (peripheral) vision (also called tunnel vision). - Advanced glaucoma can lead to blindness. ANGLE-CLOSURE GLAUCOMA Symptoms may come and go at first, or steadily become worse. You may notice: - Sudden, severe pain in one eye - Decreased or cloudy vision, often called "steamy" vision - Nausea and vomiting - Rainbow-like halos around lights - Red eye - Eye feels swollen CONGENITAL GLAUCOMA Symptoms are most often noticed when the child is a few months old. - Cloudiness of the front of the eye - Enlargement of one eye or both eyes - Red eye - Sensitivity to light - Tearing SECONDARY GLAUCOMA - Symptoms are most often related to the underlying problem causing the glaucoma. - Depending on the cause, symptoms may either be like open-angle glaucoma or angle-closure glaucoma. The only way to diagnose glaucoma is by having a complete eye exam. - You will be given a test to check your eye pressure. This is called tonometry. - In most cases, you will be given eye drops to widen (dilate) your pupil. - When your pupil is dilated, your eye doctor will look at the inside of your eye and the optic nerve. Eye pressure is different at different times of the day. Eye pressure can even be normal in some people with glaucoma. So you will need other tests to confirm glaucoma. They may include: - Using a special lens to look at the angle of the eye (gonioscopy). - Photographs or laser scanning images of the inside of your eye (optic nerve imaging). - Checking your retina. The retina is the light-sensitive tissue at the back of your eye. - Checking how your pupil responds to light (pupillary reflex response). - 3-D view of your eye (slit lamp examination). - Testing the clearness of your vision (visual acuity). - Testing your field of vision (visual field measurement). The goal of treatment is to reduce your eye pressure. Treatment depends on the type of glaucoma that you have. OPEN-ANGLE GLAUCOMA - If you have open-angle glaucoma, you will probably be given eye drops. - You may need more than one type. Most people can be treated with eye drops. - Most of the eye drops used today have fewer side effects than those used in the past. - You also may be given pills to lower pressure in the eye. If drops alone do not work, you may need other treatment: - Laser treatment uses a painless laser to open the channels where fluid flows out. - If drops and laser treatment do not work, you may need surgery. The doctor will open a new channel so fluid can escape. This will help lower your pressure. - Recently, new implants have been developed that can help treat glaucoma in people having cataract surgery. ACUTE ANGLE GLAUCOMA An acute angle-closure attack is a medical emergency. You can become blind in a few days if you are not treated. - You may be given drops, pills, and medicine given through a vein (by IV) to lower your eye pressure. - Some people also need an emergency operation, called an iridotomy. The doctor uses a laser to open a new channel in the iris. Sometimes this is done with surgery. The new channel relieves the attack and will prevent another attack. - To help prevent an attack in the other eye, the procedure will often be performed on the other eye. This may be done even if it has never had an attack. CONGENITAL GLAUCOMA - Congenital glaucoma is almost always treated with surgery. - This is done using general anesthesia. This means the child is asleep and feels no pain. SECONDARY GLAUCOMA If you have secondary glaucoma, treating the cause may help your symptoms go away. Other treatments also may be needed. Open-angle glaucoma cannot be cured. You can manage it and keep your sight by following your provider's directions. Closed-angle glaucoma is a medical emergency. You need treatment right away to save your vision. Babies with congenital glaucoma usually do well when surgery is done early. How you do with secondary glaucoma depends on what is causing the condition. If you have severe eye pain or a sudden loss of vision, get immediate medical help. These may be signs of closed-angle glaucoma. You cannot prevent open-angle glaucoma. Most people have no symptoms. But you can help prevent vision loss. - A complete eye exam can help find open-angle glaucoma early, when it is easier to treat. - All adults should have a complete eye exam by the age of 40. - If you are at risk for glaucoma, you should have a complete eye exam sooner than age 40. - You should have regular eye exams as recommended by your provider. If you are at risk for closed-angle glaucoma, your provider may recommend treatment before you have an attack to help prevent eye damage and vision loss. Updated by: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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Diabetes What is Diabetes? Too Much Glucose in the Blood Diabetes means your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn't good for your health. Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all of the cells in your body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body does not make enough insulin or if the insulin doesn't work the way it should, glucose can't get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing pre-diabetes or diabetes. Types of Diabetes There are three main kinds of diabetes: type 1, type 2, and gestational diabetes. The result of type 1 and type 2 diabetes is the same: glucose builds up in the blood, while the cells are starved of energy. Over the years, high blood glucose damages nerves and blood vessels, oftentimes leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. Type 1 Diabetes Type 1 diabetes, which used to be called called juvenile diabetes or insulin-dependent diabetes, develops most often in young people. However, type 1 diabetes can also develop in adults. With this form of diabetes, your body no longer makes insulin or doesn’t make enough insulin because your immune system has attacked and destroyed the insulin-producing cells. About 5 to 10 percent of people with diabetes have type 1 diabetes. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. Learn more about type 1 diabetes here. Type 2 Diabetes Type 2 diabetes, which used to be called adult-onset diabetes or non insulin-dependent diabetes, is the most common form of diabetes. Although people can develop type 2 diabetes at any age -- even during childhood -- type 2 diabetes develops most often in middle-aged and older people. Type 2 diabetes usually begins with insulin resistance—a condition that occurs when fat, muscle, and liver cells do not use insulin to carry glucose into the body’s cells to use for energy. As a result, the body needs more insulin to help glucose enter cells. At first, the pancreas keeps up with the added demand by making more insulin. Over time, the pancreas doesn’t make enough insulin when blood sugar levels increase, such as after meals. If your pancreas can no longer make enough insulin, you will need to treat your type 2 diabetes. Learn more about type 2 diabetes here. Gestational Diabetes Some women develop gestational diabetes during the late stages of pregnancy. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Although this form of diabetes usually goes away after the baby is born, a woman who has had it and her child are more likely to develop diabetes later in life. Prediabetes Prediabetes means your blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. People with prediabetes are at an increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is that if you have prediabetes, you can reduce your risk of getting type 2 diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes. Learn more about prediabetes here. Signs of Diabetes Many people with diabetes experience one or more symptoms, including extreme thirst or hunger, a frequent need to urinate and/or fatigue. Some lose weight without trying. Additional signs include sores that heal slowly, dry, itchy skin, loss of feeling or tingling in the feet and blurry eyesight. Some people with diabetes, however, have no symptoms at all. How Many Have Diabetes? Nearly 29 million Americans age 20 or older (12.3 percent of all people in this age group) have diabetes, according to 2014 estimates from the Centers for Disease Control and Prevention (CDC). About 1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010 alone. People can get diabetes at any age, but the risk increases as we get older. In 2014, over 11 million older adults living in the U.S -- nearly 26 percent of people 65 or older -- had diabetes. See more statistics about diabetes from the National Diabetes Statistics Report 2014. (Centers for Disease Control and Prevention.) If Diabetes is Not Managed Diabetes is a very serious disease. Over time, diabetes that is not well managed causes serious damage to the eyes, kidneys, nerves, heart, gums and teeth. If you have diabetes, you are more likely than people without diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or stroke at an earlier age than others. The best way to protect yourself from the serious complications of diabetes is to manage your blood glucose, blood pressure and cholesterol and to avoid smoking. It is not always easy, but people who make an ongoing effort to manage their diabetes can greatly improve their overall health. Risk Factors Diabetes is a serious, life-long disease. It can lead to problems such as heart disease, stroke, vision loss, kidney disease, and nerve damage. More than 8 million people in the United States have type 2 diabetes and don’t know it. Many people don’t find out they have diabetes until they are faced with problems such as blurry vision or heart trouble. Certain factors can increase your risk for diabetes, and it’s important to know what they are. Type 1 Diabetes Type 1 diabetes is an autoimmune disease. In an autoimmune reaction, antibodies, or immune cells, attach to the body’s own healthy tissues by mistake, signaling the body to attack them. At present, scientists do not know exactly what causes the body's immune system to attack the cells, but many believe that both genetic factors and environmental factors, such as viruses, are involved. Studies are now underway to identify these factors and prevent type 1 diabetes in people at risk. Learn more about the causes of type 1 diabetes. Type 2 Diabetes Type 2 diabetes -- the most common form -- is linked closely to overweight and obesity, high blood pressure, and abnormal cholesterol levels. Many people with type 2 diabetes are overweight. Being overweight can keep your body from using insulin properly. Genes also play an important role in a person's risk for type 2 diabetes. Having certain genes or combinations of genes may increase or decrease a person’s risk for developing the disease. Here are the risk factors for type 2 diabetes. - being over 45 years of age - being overweight or obese - having a first-degree relative -- a parent, brother, or sister -- with diabetes - being African American, American Indian or Alaska Native, Asian American or Pacific Islander, or Hispanic American/Latino. (Watch the video to learn more about native Americans and diabetes risk. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) being over 45 years of age being overweight or obese having a first-degree relative -- a parent, brother, or sister -- with diabetes being African American, American Indian or Alaska Native, Asian American or Pacific Islander, or Hispanic American/Latino. (Watch the video to learn more about native Americans and diabetes risk. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) - having gestational diabetes, or giving birth to at least one baby weighing more than 9 pounds - having blood pressure of 140/90 or higher, or having been told that you have high blood pressure. - having abnormal cholesterol levels -- an HDL cholesterol level of 35 or lower, or a triglyceride level of 250 or higher - being inactive or exercising fewer than three times a week. - having polycystic ovary syndrome, also called PCOS (women only) - on previous testing, having prediabetes (an A1C level of 5.7 to 6.4 percent), impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) - history of cardiovascular disease (disease affecting the heart and blood vessels). having gestational diabetes, or giving birth to at least one baby weighing more than 9 pounds having blood pressure of 140/90 or higher, or having been told that you have high blood pressure. having abnormal cholesterol levels -- an HDL cholesterol level of 35 or lower, or a triglyceride level of 250 or higher being inactive or exercising fewer than three times a week. having polycystic ovary syndrome, also called PCOS (women only) on previous testing, having prediabetes (an A1C level of 5.7 to 6.4 percent), impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) history of cardiovascular disease (disease affecting the heart and blood vessels). Learn more about the causes of type 2 diabetes. Prediabetes and Type 2 Diabetes Before people develop type 2 diabetes, they usually have prediabetes -- a condition in which blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. People with prediabetes are more likely to develop diabetes within 10 years and also are more likely to have a heart attack or stroke. Prediabetes is increasingly common in the U.S. adult population. In 2012, about 86 million people in the U.S. had pre-diabetes, and 51% of those 65 or older had prediabetes. Learn more about prediabetes. Gestational Diabetes Some women develop diabetes during the late stages of pregnancy. This is called gestational diabetes. Although this form of diabetes usually goes away after the baby is born, a woman who has had it has a lifelong risk for developing diabetes, mostly type 2. Prevention The two most common forms of diabetes are type 1 and type 2. Currently, there is no way to delay or prevent type 1 diabetes. However, research has shown that type 2 diabetes can be prevented or delayed in people at risk for the disease. Preventing type 2 diabetes can mean a healthier and longer life without serious complications from the disease such as heart disease, stroke, blindness, kidney failure, and amputations. Preventing Type 2 Diabetes Before people develop type 2 diabetes, they usually have prediabetes -- a condition in which blood glucose levels are higher than normal, but not yet high enough for a diagnosis of diabetes. The good news is that if you have prediabetes, there are ways to reduce your risk of getting type 2 diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes Benefits of Weight Loss and Exercise The Diabetes Prevention Program (DPP) is a landmark study by the National Institute of Diabetes and Digestive and Kidney Diseases. DPP researchers found that adults at high risk for type 2 diabetes were able to cut their risk in half by losing a modest amount of weight and being active almost every day. This means losing 5 to 7 percent of body weight (that's 10 pounds if you weigh 200 pounds) and getting 150 minutes of physical activity a week. The drug metformin reduced the risk of type 2 diabetes by 34 percent but was more effective in younger and heavier adults. (Watch the video to learn more about preventing type 2 diabetes. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) The benefits of weight loss and regular exercise have long-lasting value. In a DPP follow-up trial known as the Diabetes Prevention Program Outcome Study (DPPOS), people at risk of type 2 diabetes who kept off the weight they had lost and who continued to exercise regularly delayed the onset of type 2 diabetes by about 4 years. The DPP study also showed that modest weight loss (achieved by following a low calorie, low-fat diet) and moderate physical activity were especially effective in preventing or delaying the development of diabetes in older people. In fact, people over the age of 60 were able to reduce their risk for developing type 2 diabetes by 71 percent. How to Lower Your Risk Making modest lifestyle changes can help prevent or delay type 2 diabetes in people who are at risk. Here are some tips. Reach and Maintain a Reasonable Body Weight Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. It can also cause high blood pressure. The Body Mass Index chart (seen here) can be used to find out whether someone is normal weight, overweight, or obese. Body mass index is a measurement of body weight relative to height for adults age 20 or older. To use the chart - find the person's height in the left-hand column - move across the row to find the number closest to the person's weight - find the number at the top of that column - The number at the top of the column is the person’s BMI. find the person's height in the left-hand column move across the row to find the number closest to the person's weight find the number at the top of that column The number at the top of the column is the person’s BMI. The words above the BMI number indicate whether the person is normal weight, overweight, or obese. People who are overweight or obese should consider talking with a health care provider about ways to lose weight and reduce the risk of diabetes. The BMI has certain limitations. The BMI may overestimate body fat in athletes and others who have a muscular build and underestimate body fat in older adults and others who have lost muscle. Waist Measurement. In addition to weight, the location of excess fat on the body can be important. A waist measurement of 40 inches or more for men and 35 inches or more for women is linked to insulin resistance and increases a person’s risk for type 2 diabetes. This is true even if a person’s body mass index (BMI) falls within the normal range. To measure the waist, a person should - place a tape measure around the bare abdomen just above the hip bone - make sure the tape is snug but isn’t digging into the skin and is parallel to the floor - relax, exhale, and measure. place a tape measure around the bare abdomen just above the hip bone make sure the tape is snug but isn’t digging into the skin and is parallel to the floor relax, exhale, and measure. Make Healthy Food Choices What you eat has a big impact on your weight and overall health. By developing healthy eating habits, you can help manage your body weight, blood pressure, and cholesterol. Reducing portion size, increasing the amount of fiber you consume (by eating more fruits and vegetables) and limiting fatty and salty foods are key to a healthy diet. Here are more tips for eating well with diabetes. - Make a diabetes meal plan with help from your health care team. - Choose foods that are lower in calories, saturated fat, trans fat, sugar, and salt. - Eat foods with more fiber, such as whole grain cereals, breads, crackers, rice, or pasta. - Choose foods such as fruits, vegetables, whole grains, bread and cereals, and low-fat or skim milk and cheese. - Drink water instead of juice and regular soda. - When eating a meal, fill half of your plate with fruits and vegetables, one quarter with a lean protein, such as beans, or chicken or turkey without the skin, and one quarter with a whole grain, such as brown rice or whole wheat pasta. Make a diabetes meal plan with help from your health care team. Choose foods that are lower in calories, saturated fat, trans fat, sugar, and salt. Eat foods with more fiber, such as whole grain cereals, breads, crackers, rice, or pasta. Choose foods such as fruits, vegetables, whole grains, bread and cereals, and low-fat or skim milk and cheese. Drink water instead of juice and regular soda. When eating a meal, fill half of your plate with fruits and vegetables, one quarter with a lean protein, such as beans, or chicken or turkey without the skin, and one quarter with a whole grain, such as brown rice or whole wheat pasta. For more about healthy eating and older adults see "Eating Well as You Get Older." Be Physically Active Get at least 30 minutes of exercise at least five days a week. Regular exercise reduces diabetes risk in several ways. It - helps you lose weight - controls your cholesterol and blood pressure - improves your body's use of insulin. helps you lose weight controls your cholesterol and blood pressure improves your body's use of insulin. Many people make walking part of their daily routine because it’s easy, fun and convenient. But you can choose any activity that gets you moving. It’s fine to break up your 30 minutes of exercise into smaller increments, such as three 10-minute periods. Check with your doctor before beginning any exercise program. Many people make walking part of their daily routine because it’s easy, fun and convenient. But you can choose any activity that gets you moving. It’s fine to break up your 30 minutes of exercise into smaller increments, such as three 10-minute periods. Check with your doctor before beginning any exercise program. For more information on exercise and older adults, see Exercises to Try or visit Go4Life®, the exercise and physical activity campaign for older adults from the National Institute on Aging. Signs and Diagnosis Diabetes is often called a "silent" disease because it can cause serious complications even before you have symptoms. Symptoms can also be so mild that you don’t notice them. An estimated 8 million people in the United States have type 2 diabetes and don’t know it, according to 2012 estimates by the Centers for Disease Control and Prevention (CDC). Common Signs Some common symptoms of diabetes are: - being very thirsty - frequent urination - feeling very hungry or tired - losing weight without trying - having sores that heal slowly - having dry, itchy skin - loss of feeling or tingling in the feet - having blurry eyesight. being very thirsty frequent urination feeling very hungry or tired losing weight without trying having sores that heal slowly having dry, itchy skin loss of feeling or tingling in the feet having blurry eyesight. Signs of type 1 diabetes usually develop over a short period of time. The signs for type 2 diabetes develop more gradually. Tests for Diabetes The following tests are used to diagnose diabetes or prediabetes. - An A1C test measures your average blood glucose levels over the past 3 months. It can be used to diagnose type 2 diabetes and prediabetes. It does not require fasting and blood can be drawn for the test any time of the day. An A1C test measures your average blood glucose levels over the past 3 months. It can be used to diagnose type 2 diabetes and prediabetes. It does not require fasting and blood can be drawn for the test any time of the day. - A fasting plasma glucose, or FPG test, measures your blood glucose after you have gone at least 8 hours without eating. Doctors use this test to detect diabetes or prediabetes. A fasting plasma glucose, or FPG test, measures your blood glucose after you have gone at least 8 hours without eating. Doctors use this test to detect diabetes or prediabetes. - In a random plasma glucose test, your doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not prediabetes. In a random plasma glucose test, your doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not prediabetes. - An oral glucose tolerance test, or OGTT, measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a sweet beverage. Doctors also use the oral glucose tolerance test to diagnose gestational diabetes in pregnant women. An oral glucose tolerance test, or OGTT, measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a sweet beverage. Doctors also use the oral glucose tolerance test to diagnose gestational diabetes in pregnant women. If any of these tests show that you might have diabetes, your doctor will need to repeat the test with a second measurement unless there are clear symptoms of diabetes. Get more details about tests for diabetes. Who Should Get Tested? Because type 2 diabetes is more common in older people, anyone who is 45 or older should consider getting tested. If you are 45 or older and overweight, getting tested is strongly recommended. If you are younger than 45, overweight, and have one or more risk factors, you also should talk with your doctor about being tested. See risk factors for type 2 diabetes. Why Early Detection is Important Diabetes is a serious disease that can lead to a number of health problems such as heart disease, stroke, vision problems, kidney disease and even death. Sometimes people have symptoms but do not suspect diabetes. They delay scheduling a checkup because they do not feel sick. Many people do not find out they have the disease until they have diabetes complications, such as a heart attack or stroke. Finding out early if you have diabetes is important because treatment can prevent or delay the complications of the disease. Diet and Exercise Manage Your Diabetes Diabetes cannot be cured, but it can be managed. Managing blood glucose (blood sugar) as well as blood pressure and cholesterol is the best defense against the serious complications of diabetes. People with type 1 diabetes manage their blood sugar with insulin -- either delivered by injection or a pump. Many people with type 2 diabetes can manage blood glucose levels with diet and exercise alone. Others require oral medications or insulin, and some may need both. Diabetes is a progressive disease and, over time, people with diabetes may need both lifestyle modification and medications. Follow a Meal Plan Making healthy food choices is very important to help keep your blood glucose level under control. A registered dietitian can work with you to develop a healthy eating plan. He or she can help you design a meal plan that takes into consideration various factors including your weight and daily physical activity, blood glucose levels, other health conditions and medications. If you are overweight, a plan to help you achieve a weight that is right for you will help manage your blood glucose. Your dietitian can help you plan meals to include foods that you and your family like to eat and that are good for you. (Watch the video to learn about eating healthy with diabetes. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) What to Eat People with diabetes don't need to buy or prepare special foods. The foods that are best for someone with diabetes are excellent choices for everyone: foods that are low in fat, salt, and sugar, and high in fiber, such as beans, fruits, vegetables, and whole grains. These foods help you reach and stay at a weight that's good for your body, keep your blood pressure, glucose and cholesterol in your target range, and prevent or delay heart and blood vessel disease. For more information on nutrition and older adults, see Eating Well As You Get Older. Get Regular Physical Activity Regular physical activity is important for people with diabetes. Being physically active has been shown to improve blood glucose levels in older people whose levels are high. Exercise is especially good for people with diabetes because it - helps manage weight - helps insulin work better to lower blood glucose - is good for your heart and lungs - gives you more energy. helps manage weight helps insulin work better to lower blood glucose is good for your heart and lungs gives you more energy. Safety First Before you begin physical activity, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some activities like weightlifting may not be safe. Your health care team can help you find safe ways to be active. For tips on safety issues older adults should consider before starting a new exercise program, see Exercise: Safety First Walking, swimming, dancing, riding a bicycle, playing baseball, and bowling are all good ways to be physically active. You can even get exercise when you clean house or work in your garden. How Much? How Often? Try to be active almost every day for a total of about 30 to 60 minutes. If you haven't exercised lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day. (Tip: you don’t need to get your exercise in all at one time.) To see examples of exercises for older adults, see Exercises to Try. Or visit Go4Life®, the exercise and physical activity campaign from the National Institute on Aging. Medications Manage Your Diabetes Diabetes cannot be cured, but it can be managed. Managing blood glucose (blood sugar) as well as blood pressure and cholesterol is the best defense against the serious complications of diabetes. Diabetes pills and insulin and diabetes pills are the two kinds of medicines used to lower blood glucose. People with type 1 diabetes control their blood sugar with insulin -- either delivered by injection or a pump. Many people with type 2 diabetes can control blood glucose levels with diet and exercise alone. Others require oral medications or insulin, and some may need both, as well as lifestyle modification. Taking Diabetes Pills If your body is still making some insulin, but not enough to keep your blood glucose levels under control, you may need diabetes pills. Some medications are taken once a day; others must be taken more often. Ask your health care team when you should take your pills. Remember to take your medicines every day, even when you feel well. Be sure to tell your doctor if your pills make you feel sick or if you have any other problems. Remember, diabetes pills don't lower blood glucose all by themselves. You will still want to follow a meal plan and exercise to help lower your blood glucose. Taking Insulin You need insulin if your body has stopped making insulin or if your body doesn't make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do, too. Insulin can't be taken as a pill. It is usually taken by shots or with an insulin pump or insulin pen. Insulin pumps are small machines, usually worn on the hip, that contain insulin and deliver small steady doses of insulin throughout the day, Some pumps are attached directly to the skin. Other people use an insulin pen, which holds a cartridge of insulin that is dialed to the prescribed dose of insulin and then injected. Sometimes, people who take diabetes pills may need insulin shots for a while. If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose. Get more information about taking diabetes medicines. Know Your Diabetes ABCs Heart disease and stroke are the leading causes of death for people with diabetes. Controlling the ABCs of diabetes -- your blood glucose, your blood pressure, and your cholesterol as well as stopping smoking -- can help prevent these and other complications from diabetes. - A is for the A1C test - B is for Blood pressure - C is for Cholesterol A is for the A1C test B is for Blood pressure C is for Cholesterol The A1C Test The A1C test (A-one-C), also called the hemoglobin A1C test, shows overall blood glucose for the past 3 months. Your health care provider does this test to see what your blood glucose level is most of the time. This test should be done at least twice a year for all people with diabetes and for some people more often as needed. For many people with diabetes, an A1C test result of under 7 percent usually means that their diabetes treatment is working well and their blood glucose is under control. If your A1C is above your target goal, take action. You may need a change in your meal plan, your level of physical activity, or the medications you take to lower your chance of getting diabetes problems like heart disease or kidney damage. Talk with your health care provider about your A1C goal and how to reach it. Learn more about the A1C test. Check Your Blood Pressure High blood pressure makes your heart work too hard. This can lead to a stroke and other problems such as kidney disease. Your blood pressure should be checked at every doctor visit. The target blood pressure for most people with diabetes is less than 140/90 but may be different for you. Talk with your health care provider about your blood pressure goal. Learn about ways to check your blood pressure. Have Your LDL Cholesterol Checked Low density lipoprotein, or LDL cholesterol, is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year. Talk with your health care provider about your cholesterol goal. Learn more about lowering LDL cholesterol. Stop Smoking Smoking and diabetes are a dangerous mix. Smoking raises your risk for many diabetes problems. If you quit smoking, - you will lower your risk for heart attack, stroke, nerve disease, kidney disease, and amputation - your cholesterol and blood pressure levels might improve - your blood circulation will improve. you will lower your risk for heart attack, stroke, nerve disease, kidney disease, and amputation your cholesterol and blood pressure levels might improve your blood circulation will improve. If you smoke, stop smoking. Ask for help so that you don’t have to do it alone. You can start by calling 1–800–QUITNOW or 1–800–784–8669. For more on how to quit smoking, see Quitting Smoking for Older Adults. Manage Your Diabetes Every Day Diabetes cannot be cured, but it can be managed. Managing blood glucose (blood sugar) as well as blood pressure and cholesterol is the best defense against the serious complications of diabetes. Know What To Do Every Day To manage your diabetes, here are things to do every day. - Take your medicines. - Keep track of your blood glucose (blood sugar). - Check your blood pressure if your doctor advises. - Check your feet. - Brush your teeth and floss. - Stop smoking. - Eat well. - Be active. Take your medicines. Keep track of your blood glucose (blood sugar). Check your blood pressure if your doctor advises. Check your feet. Brush your teeth and floss. Stop smoking. Eat well. Be active. (Watch the video to learn more about what one woman does to manage her diabetes every day. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Take Your Diabetes Medicines People with type 1 diabetes control their blood sugar with insulin -- delivered either by injection or with a pump. Many people with type 2 diabetes can control blood glucose levels with diet and exercise alone. Others require oral medications or insulin, and some may need both, as well as lifestyle modification. Ask your doctor if you need to take aspirin every day to prevent a heart attack or stroke. Keep Track of Your Blood Glucose One of the best ways to find out how well you are taking care of your diabetes is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, exercise plan, or medication. Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three a day or even more. You may be told to check before eating, before bed, and sometimes in the middle of the night. Your doctor or diabetes educator will show you how to check your blood using a blood glucose meter. Your health insurance or Medicare may pay for some of the supplies and equipment you need to check your glucose levels. See what diabetes supplies and services Medicare covers. Check Your Blood Pressure Check your blood pressure if your doctor advises and keep a record of it. You can check your pressure at home with a home blood pressure measurement device or monitor. Blood pressure monitors can be bought at discount chain stores and drug stores. When you are taking your blood pressure at home, sit with your back supported and your feet flat on the floor. Rest your arm on a table at the level of your heart. Check with your health care provider to make sure you are using the monitor correctly. Check Your Feet Foot care is very important for people with diabetes. High blood glucose levels and a reduced blood supply to the limbs cause nerve damage that reduces feeling in the feet. Someone with nerve damage may not feel a pebble inside his or her sock that is causing a sore. Or a blister caused by poorly fitting shoes may go unnoticed. Foot injuries such as these can cause ulcers, which may, if not cared for, ultimately lead to the need for amputation. If you have diabetes, - check your feet every day and watch for any cuts, sores, red spots, swelling, and infected toenails. - report sores, blisters, breaks in the skin, infections, or buildup of calluses to a podiatrist or a family doctor. - never walk barefoot. - have your feet checked at every doctor visit. - take your shoes and socks off when you go into the examining room. This will remind the doctor to check your feet. check your feet every day and watch for any cuts, sores, red spots, swelling, and infected toenails. report sores, blisters, breaks in the skin, infections, or buildup of calluses to a podiatrist or a family doctor. never walk barefoot. have your feet checked at every doctor visit. take your shoes and socks off when you go into the examining room. This will remind the doctor to check your feet. Learn more about taking care of your feet. Brush Your Teeth and Floss People with diabetes can have tooth and gum problems more often if their blood glucose stays high. High blood glucose also can make tooth and gum problems worse. You can even lose your teeth. Here are ways to protect your teeth and gums. - Keep your blood glucose as close to normal as possible. - Use dental floss at least once a day. Flossing helps prevent the buildup of plaque on your teeth. Plaque can harden and grow under your gums and cause problems. Using a sawing motion, gently bring the floss between the teeth, scraping from bottom to top several times. - Brush your teeth after each meal and snack. Use a soft toothbrush. Turn the bristles against the gum line and brush gently. Use small, circular motions. Brush the front, back, and top of each tooth. - If you wear false teeth, keep them clean. - Call your dentist right away if you have problems with your teeth and gums. Keep your blood glucose as close to normal as possible. Use dental floss at least once a day. Flossing helps prevent the buildup of plaque on your teeth. Plaque can harden and grow under your gums and cause problems. Using a sawing motion, gently bring the floss between the teeth, scraping from bottom to top several times. Brush your teeth after each meal and snack. Use a soft toothbrush. Turn the bristles against the gum line and brush gently. Use small, circular motions. Brush the front, back, and top of each tooth. If you wear false teeth, keep them clean. Call your dentist right away if you have problems with your teeth and gums. Learn more about how diabetes can affect your mouth and teeth. Stop Smoking If you smoke, stop. Smoking raises your risk for many diabetes problems, including heart attack and stroke. Ask for help to quit. Call 1-800 QUITNOW (1-800-784-8669). For more information on smoking and older adults, see Quitting Smoking for Older Adults. Eat Well People with diabetes don't need to buy or prepare special foods. The foods that are best for someone with diabetes are excellent choices for everyone: foods that are low in fat, salt, and sugar, and high in fiber, such as beans, fruits, vegetables, and whole grains. These foods help you reach and stay at a weight that's good for your body, keep your blood pressure, glucose and cholesterol in a desirable range, and prevent or delay heart and blood vessel disease. For more on healthy eating, see Small Steps for Eating Healthy Foods. Be Active Try to exercise almost every day for a total of about 30 to 60 minutes. If you haven't exercised lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day. (Tip: you don’t need to get your exercise in all at one time.) For more information on exercise and older adults, see Exercise: How to Get Started or visit Go4Life®, the exercise and physical activity campaign for older adults from the National Institute on Aging. Be sure to check with your doctor before starting an exercise program. Other Areas To Manage Here are other areas to manage if you have diabetes. - Take care of your eyes. - Protect your kidneys. - Protect your skin. - Learn how to cope with stress. Take care of your eyes. Protect your kidneys. Protect your skin. Learn how to cope with stress. Take Care of Your Eyes High blood glucose and high blood pressure from diabetes can hurt your eyes. It can even cause blindness, or other painful eye problems. Here are ways to prevent diabetes eye problems. - Keep your blood glucose and blood pressure as close to normal as you can. - Have an eye care professional examine your eyes once a year. Have this exam even if your vision is okay. Keep your blood glucose and blood pressure as close to normal as you can. Have an eye care professional examine your eyes once a year. Have this exam even if your vision is okay. Learn more about eye disease and diabetes. Protect Your Kidneys High blood glucose and high blood pressure may damage the kidneys. Damaged kidneys do not do a good job of filtering out wastes and extra fluid. Here are ways to prevent diabetes kidney problems. - Keep your blood glucose and blood pressure as close to your target goal as you can. - Get tested at least once a year for kidney disease. Ask your doctor if you should be tested. - Follow the healthy eating plan you work out with your doctor or dietitian. If you already have kidney problems, your dietitian may suggest you cut back on protein. Keep your blood glucose and blood pressure as close to your target goal as you can. Get tested at least once a year for kidney disease. Ask your doctor if you should be tested. Follow the healthy eating plan you work out with your doctor or dietitian. If you already have kidney problems, your dietitian may suggest you cut back on protein. Learn more about keeping your kidneys healthy. Protect Your Skin Skin care is very important, too. Because people with diabetes may have more injuries and infections, they should protect their skin by keeping it clean and taking care of minor cuts and bruises. Learn How To Cope With Stress Stress can raise your blood glucose (blood sugar). While it is hard to remove stress from your life, you can learn to handle it. Try deep breathing, gardening, taking a walk, meditating, working on your hobby, or listening to your favorite music. Frequently Asked Questions What is diabetes? Diabetes means your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn't good for your health. Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all of the cells in your body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body does not make enough insulin or if the insulin doesn't work the way it should, glucose can't get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing pre-diabetes or diabetes. What is the difference between type 1 and type 2 diabetes? Type 1 diabetes, which used to be called called juvenile diabetes or insulin-dependent diabetes, develops most often in young people. However, type 1 diabetes can also develop in adults. With this form of diabetes, your body no longer makes insulin or doesn’t make enough insulin because your immune system has attacked and destroyed the insulin-producing cells. About 5 to 10 percent of people with diabetes have type 1 diabetes. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. Learn more about type 1 diabetes here. Learn more about type 1 diabetes here. Type 2 diabetes, which used to be called adult-onset diabetes or non insulin-dependent diabetes, is the most common form of diabetes. Although people can develop type 2 diabetes at any age -- even during childhood -- type 2 diabetes develops most often in middle-aged and older people. Type 2 diabetes usually begins with insulin resistance—a condition that occurs when fat, muscle, and liver cells do not use insulin to carry glucose into the body’s cells to use for energy. As a result, the body needs more insulin to help glucose enter cells. At first, the pancreas keeps up with the added demand by making more insulin. Over time, the pancreas doesn’t make enough insulin when blood sugar levels increase, such as after meals. If your pancreas can no longer make enough insulin, you will need to treat your type 2 diabetes. Learn more about type 2 diabetes here. How many people have diabetes? Nearly 29 million Americans age 20 or older (12.3 percent of all people in this age group) have diabetes, according to 2014 estimates from the Centers for Disease Control and Prevention (CDC). About 1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010 alone. People can get diabetes at any age, but the risk increases as we get older. In 2014, over 11 million older adults living in the U.S -- nearly 26 percent of people 65 or older -- had diabetes. See more statistics about diabetes from the National Diabetes Statistics Report 2014. (Centers for Disease Control and Prevention.) What is prediabetes? Prediabetes means your blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. In 2012, about 86 million people in the U.S. had prediabetes, and 51% of those 65 or older had prediabetes. People with prediabetes are at an increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is that if you have prediabetes, you can reduce your risk of getting type 2 diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes. Learn more about prediabetes here. Why can I do about prediabetes? Studies have shown that most people with prediabetes develop type 2 diabetes within a few years, unless they change their lifestyle. Most people with prediabetes don’t have any symptoms. Your doctor can test your blood to find out if your blood glucose levels are higher than normal. Losing weight—at least 5 to 10 percent of your starting weight—can prevent or delay diabetes or even reverse prediabetes. That’s 10 to 20 pounds for someone who weighs 200 pounds. You can lose weight by cutting the amount of calories and fat you consume and by being physically active at least 30 to 60 minutes every day. Physical activity also helps your body use the hormone insulin properly. Your body needs insulin to use glucose for energy. Medicine can help control the amount of glucose in your blood. Ask your doctor if medicine to control glucose is right for you. Learn more about prediabetes here. What are the signs of diabetes? Many people with diabetes experience one or more symptoms, including extreme thirst or hunger, a frequent need to urinate and/or fatigue. Some lose weight without trying. Additional signs include sores that heal slowly, dry, itchy skin, loss of feeling or tingling in the feet and blurry eyesight. Some people with diabetes, however, have no symptoms at all. What causes diabetes? Type 1 diabetes is an autoimmune disease. In an autoimmune reaction, antibodies, or immune cells, attach to the body's own healthy tissues by mistake, signaling the body to attack them. At present, scientists do not know exactly what causes the body's immune system to attack the insulin-producing cells in the pancreas in people with type 1 diabetes. However, many believe that both genetic factors and environmental factors are involved. Studies now are underway to identify these factors and prevent type 1 diabetes in people at risk. Type 2 diabetes—the most common form of diabetes—is caused by a combination of factors, including insulin resistance, a condition in which the body’s muscle, fat, and liver cells do not use insulin effectively. Type 2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin. Get more details about who should be tested for diabetes. If diabetes is not managed, what problems might occur? Diabetes is a very serious disease. Over time, diabetes that is not well managed causes serious damage to the eyes, kidneys, nerves, and heart, gums and teeth. If you have diabetes, you are more likely than someone who does not have diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or stroke at an earlier age than others. The best way to protect yourself from the serious complications of diabetes is to manage your blood glucose, blood pressure, and cholesterol and avoid smoking. It is not always easy, but people who make an ongoing effort to manage their diabetes can greatly improve their overall health. Who is at risk for developing type 2 diabetes? Here are the risk factors for type 2 diabetes. - being over 45 years of age - being overweight or obese - having a first-degree relative -- a parent, brother, or sister -- with diabetes - being African American, American Indian or Alaska Native, Asian American or Pacific Islander, or Hispanic American/Latino. (Watch the video to learn more about native Americans and diabetes risk. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) - having gestational diabetes, or giving birth to at least one baby weighing more than 9 pounds - having blood pressure of 140/90 or higher, or having been told that you have high blood pressure. - having abnormal cholesterol levels -- an HDL cholesterol level of 35 or lower, or a triglyceride level of 250 or higher - being inactive or exercising fewer than three times a week. - having polycystic ovary syndrome, also called PCOS (women only) - on previous testing, having prediabetes (an A1C level of 5.7 to 6.4 percent), impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) - history of cardiovascular disease (disease affecting the heart and blood vessels). being over 45 years of age being overweight or obese having a first-degree relative -- a parent, brother, or sister -- with diabetes being African American, American Indian or Alaska Native, Asian American or Pacific Islander, or Hispanic American/Latino. (Watch the video to learn more about native Americans and diabetes risk. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) having gestational diabetes, or giving birth to at least one baby weighing more than 9 pounds having blood pressure of 140/90 or higher, or having been told that you have high blood pressure. having abnormal cholesterol levels -- an HDL cholesterol level of 35 or lower, or a triglyceride level of 250 or higher being inactive or exercising fewer than three times a week. having polycystic ovary syndrome, also called PCOS (women only) on previous testing, having prediabetes (an A1C level of 5.7 to 6.4 percent), impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) history of cardiovascular disease (disease affecting the heart and blood vessels). Can diabetes be prevented? The two most common forms of diabetes are type 1 and type 2. Currently, there is no way to delay or prevent type 1 diabetes. However, research has shown that making modest lifestyle changes can prevent or delay type 2 diabetes in people at risk for the disease. In the Diabetes Prevention Program (DPP), a landmark study by the National Institute of Diabetes and Digestive and Kidney Diseases, researchers found that adults at high risk for type 2 diabetes were able to cut their risk in half by losing a modest amount of weight and being active almost every day. This means losing 5 to 7 percent of body weight (that's 10 pounds if you weigh 200 pounds) and getting 150 minutes of physical activity a week. The DPP study also showed that modest weight loss (achieved by following a low calorie, low-fat diet) and moderate physical activity were especially effective in preventing or delaying the development of diabetes in older people. In fact, people over the age of 60 were able to reduce their risk for developing type 2 diabetes by 71 percent. (Watch the video to learn more about preventing type 2 diabetes. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) What kind of meal plan should a person with diabetes follow? Ask your doctor to give you the name of someone trained to help you create a healthy eating plan, such as a dietitian. This plan, often called medical nutrition therapy, will include regular monitoring by your dietitian and education about how to adjust your eating habits as the need occurs. Medical nutrition therapy is usually covered by insurance or Medicare as long as your doctor refers you. Your dietitian can help you plan meals that include foods that you and your family like and that are good for you. Your healthy eating plan will include - breads, cereals, rice, and whole grains - fruits and vegetables - meat and meat substitutes - dairy products - healthy fats. breads, cereals, rice, and whole grains fruits and vegetables meat and meat substitutes dairy products healthy fats. Your plan will also help you learn how to eat the right amount, or portions, of food. Making good food choices will - help you reach and stay at a healthy weight - keep your blood glucose, blood pressure, and cholesterol levels under control - prevent heart and blood vessel disease. help you reach and stay at a healthy weight keep your blood glucose, blood pressure, and cholesterol levels under control prevent heart and blood vessel disease. (Watch the video to learn more about eating healthy with diabetes. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) If I have diabetes, should I avoid all sweets and sugars? If you have diabetes you should limit the amount of fats and sweets you eat. These foods have calories, but not much nutrition. Some contain saturated fats and cholesterol that increase your risk of heart disease. Limiting these foods will help you lose weight and keep your blood glucose and blood fats under control. It is okay to have sweets once in a while. Try having sugar-free popsicles, diet soda, fat-free ice cream or frozen yogurt, or sugar-free hot cocoa mix to satisfy a "sweet tooth." Remember, fat-free and low sugar foods still have calories. Talk with your diabetes educator about how to fit sweets into your meal plan. Who should be tested for diabetes? Because type 2 diabetes is more common in older people, anyone who is 45 or older should consider getting tested. If you are 45 or older and overweight, getting tested is strongly recommended. If you are younger than 45, overweight, and have one or more risk factors, you also should talk with your doctor about being tested. Get more information about tests for diabetes. How do doctors diagnose diabetes and pre-diabetes? Doctors use the following tests to diagnose diabetes. - An A1C test measures your average blood glucose levels over the past 3 months. It can be used to diagnose type 2 diabetes and pre-diabetes. It does not require fasting and blood can be drawn for the test any time of the day. An A1C test measures your average blood glucose levels over the past 3 months. It can be used to diagnose type 2 diabetes and pre-diabetes. It does not require fasting and blood can be drawn for the test any time of the day. - A fasting plasma glucose, or FPG test measures your blood glucose after you have gone at least 8 hours without eating. Doctors use this test to detect diabetes or prediabetes. A fasting plasma glucose, or FPG test measures your blood glucose after you have gone at least 8 hours without eating. Doctors use this test to detect diabetes or prediabetes. - In a random plasma glucose test, the doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes. In a random plasma glucose test, the doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes. - An oral glucose tolerance test, or OGTT measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a sweet beverage. Doctors also use the oral glucose tolerance test to diagnose gestational diabetes in pregnant women. An oral glucose tolerance test, or OGTT measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a sweet beverage. Doctors also use the oral glucose tolerance test to diagnose gestational diabetes in pregnant women. If any of these tests show that you might have diabetes, your doctor will need to repeat the test with a second measurement unless there are clear symptoms of diabetes. How do I manage my diabetes every day? People with type 1 diabetes control their blood sugar with insulin -- either with shots or an insulin pen. Many people with type 2 diabetes can control blood glucose levels with diet and exercise alone. Others require oral medications or insulin, and some people may need to take both, along with lifestyle modification. (Watch the video to learn how one woman manages her type 2 diabetes. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) To manage your diabetes, here are things to do every day. - Take your medicines for diabetes and for any other health problems, even when you feel good. Take your medicines for diabetes and for any other health problems, even when you feel good. - Keep track of your blood glucose (blood sugar). You may want to check it one or more times a day. Be sure to talk about it with your health care team. Keep track of your blood glucose (blood sugar). You may want to check it one or more times a day. Be sure to talk about it with your health care team. - Check your blood pressure if your doctor advises and keep a record of it. Check your blood pressure if your doctor advises and keep a record of it. - Check your feet every day for cuts, blisters, red spots and swelling. Call your health care team right away about any sores that do not go away. Check your feet every day for cuts, blisters, red spots and swelling. Call your health care team right away about any sores that do not go away. - Brush your teeth and floss every day to keep your mouth, teeth and gums healthy. Brush your teeth and floss every day to keep your mouth, teeth and gums healthy. - Stop smoking. Ask for help to quit. Call 1-800 QUIT NOW ( 1-800-784-8669) Stop smoking. Ask for help to quit. Call 1-800 QUIT NOW ( 1-800-784-8669) - Eat well. Ask your doctor to give you the name of someone trained to help you create a healthy eating plan, such as a dietitian. See small steps for eating healthy foods. Eat well. Ask your doctor to give you the name of someone trained to help you create a healthy eating plan, such as a dietitian. See small steps for eating healthy foods. - Be active. Try to exercise almost every day for a total of about 30 minutes. If you haven't exercised lately, begin slowly. To learn more, see Exercise: How To Get Started, or visit Go4Life®, the exercise and physical activity campaign for older adults from the National Institute on Aging. Be active. Try to exercise almost every day for a total of about 30 minutes. If you haven't exercised lately, begin slowly. To learn more, see Exercise: How To Get Started, or visit Go4Life®, the exercise and physical activity campaign for older adults from the National Institute on Aging. How should I take care of my feet? Foot care is very important for people with diabetes. High blood glucose levels and a reduced blood supply to the limbs cause nerve damage that reduces feeling in the feet. Someone with nerve damage may not feel a pebble inside his or her sock that is causing a sore. Or a blister caused by poorly fitting shoes may go unnoticed. Foot injuries such as these can cause ulcers, which may, if not cared for, ultimately lead to the need for amputation. If you have diabetes, - check your feet every day and watch for any cuts, sores, red spots, swelling, and infected toenails. - report sores, blisters, breaks in the skin, infections, or buildup of calluses to a podiatrist or a family doctor. - never walk barefoot. - have your feet checked at every doctor visit. - take your shoes and socks off when you go into the examining room. This will remind the doctor to check your feet. check your feet every day and watch for any cuts, sores, red spots, swelling, and infected toenails. report sores, blisters, breaks in the skin, infections, or buildup of calluses to a podiatrist or a family doctor. never walk barefoot. have your feet checked at every doctor visit. take your shoes and socks off when you go into the examining room. This will remind the doctor to check your feet. Learn more about taking care of your feet. How can diabetes affect my teeth and gums? People with diabetes can have tooth and gum problems more often if their blood glucose stays high. Glucose is present in your saliva—the fluid in your mouth that makes it wet. When diabetes is not controlled, high glucose levels in your saliva help harmful bacteria grow. These bacteria combine with food to form a soft, sticky film called plaque. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause tooth decay or cavities. Other types of plaque cause gum disease and bad breath. The most common mouth problems from diabetes are - gingivitis (unhealthy or inflamed gums) - periodontitis (an infection of the gums) - thrush or candidiasis - dry mouth - oral burning (a burning sensation inside the mouth). gingivitis (unhealthy or inflamed gums) periodontitis (an infection of the gums) thrush or candidiasis dry mouth oral burning (a burning sensation inside the mouth). How can I protect my teeth and gums? Here are ways to protect your teeth and gums. - Keep your blood glucose as close to normal as possible. - Use dental floss at least once a day. Flossing helps prevent the buildup of plaque on your teeth. Plaque can harden and grow under your gums and cause problems. Using a sawing motion, gently bring the floss between the teeth, scraping from bottom to top several times. - Brush your teeth after each meal and snack. Use a soft toothbrush. Turn the bristles against the gum line and brush gently. Use small, circular motions. Brush the front, back, and top of each tooth. - If you wear false teeth, keep them clean. - Call your dentist right away if you have problems with your teeth and gums. Keep your blood glucose as close to normal as possible. Use dental floss at least once a day. Flossing helps prevent the buildup of plaque on your teeth. Plaque can harden and grow under your gums and cause problems. Using a sawing motion, gently bring the floss between the teeth, scraping from bottom to top several times. Brush your teeth after each meal and snack. Use a soft toothbrush. Turn the bristles against the gum line and brush gently. Use small, circular motions. Brush the front, back, and top of each tooth. If you wear false teeth, keep them clean. Call your dentist right away if you have problems with your teeth and gums. What kinds of medication do people take for diabetes? Controlling blood glucose (blood sugar) is the best defense against the serious complications of diabetes. Insulin and diabetes pills are the two kinds of medicines used to lower blood glucose. You need insulin if your body has stopped making insulin or if it doesn't make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do, too. If your body makes insulin but the insulin doesn't lower your blood glucose, you may need diabetes pills. What are the ABCs of diabetes? Heart disease and stroke are the leading causes of death for people with diabetes. Controlling the ABCs of diabetes -- your blood glucose, your blood pressure, and your cholesterol, as well as stopping smoking -- can help prevent these and other complications from diabetes. - A is for the A1C test - B is for Blood pressure - C is for Cholesterol. A is for the A1C test B is for Blood pressure C is for Cholesterol. - The A1C test (A-one-C) shows you what your blood glucose has been over the last three months. Your health care provider does this test to see what your blood glucose level is most of the time. This test should be done at least twice a year for all people with diabetes and for some people more often as needed. For many people with diabetes, an A1C test result of under 7 percent usually means that their diabetes treatment is working well and their blood glucose is under control. The A1C test (A-one-C) shows you what your blood glucose has been over the last three months. Your health care provider does this test to see what your blood glucose level is most of the time. This test should be done at least twice a year for all people with diabetes and for some people more often as needed. For many people with diabetes, an A1C test result of under 7 percent usually means that their diabetes treatment is working well and their blood glucose is under control. - B is for Blood pressure. The goal for most people is 140/90 but may be different for you. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease. Your blood pressure should be checked at every doctor visit. Talk with your health care provider about your blood pressure goal. B is for Blood pressure. The goal for most people is 140/90 but may be different for you. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease. Your blood pressure should be checked at every doctor visit. Talk with your health care provider about your blood pressure goal. - C is for Cholesterol (ko-LES-ter-ol). The LDL goal for most people is less than 100. Low density lipoprotein, or LDL-cholesterol, is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year. Talk with your health care provider about your cholesterol goal. C is for Cholesterol (ko-LES-ter-ol). The LDL goal for most people is less than 100. Low density lipoprotein, or LDL-cholesterol, is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year. Talk with your health care provider about your cholesterol goal. Ask your health care team - what your A1C, blood pressure, and cholesterol numbers are. - what your ABCs should be. - what you can do to reach your target. what your A1C, blood pressure, and cholesterol numbers are. what your ABCs should be. what you can do to reach your target. How should I work with my health care team to manage my diabetes? See your health care team at least twice a year to find and treat any problems early. Ask what steps you can take to reach your goals. If you have diabetes, take these steps. At each visit, be sure you have a - blood pressure check - foot check - weight check - review of your self-care plan. blood pressure check foot check weight check review of your self-care plan. Two times each year, get - an A1C test. It may be checked more often if it is over 7. an A1C test. It may be checked more often if it is over 7. Once each year, be sure you have a - cholesterol test - triglyceride (try-GLISS-er-ide) test - a type of blood fat - complete foot exam - dental exam to check teeth and gums. Tell your dentist you have diabetes. - dilated eye exam to check for eye problems - flu shot - urine and a blood test to check for kidney problems. cholesterol test triglyceride (try-GLISS-er-ide) test - a type of blood fat complete foot exam dental exam to check teeth and gums. Tell your dentist you have diabetes. dilated eye exam to check for eye problems flu shot urine and a blood test to check for kidney problems. At least once, get a - pneumonia (nu-MOH-nya) shot. pneumonia (nu-MOH-nya) shot. If you have Medicare, ask your health care team if Medicare will cover some of the costs for - learning about healthy eating and diabetes self-care - special shoes, if you need them - medical supplies - diabetes medicines. learning about healthy eating and diabetes self-care special shoes, if you need them medical supplies diabetes medicines. (Watch the video for important things to remember when visiting your health care team. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Why is exercise important in controlling diabetes? Exercise is especially good for people with diabetes because it - helps control weight - helps insulin work better to lower blood glucose - is good for your heart and lungs - gives you more energy. helps control weight helps insulin work better to lower blood glucose is good for your heart and lungs gives you more energy. Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some exercises may not be safe. Your health care team can help you find safe exercises. What types of exercise should I do, and how often? People with diabetes should - do aerobic activities, such as brisk walking, which use the body’s large muscles to make the heart beat faster. The large muscles are those of the upper and lower arms and legs and those that control head, shoulder, and hip movements. - do activities to strengthen muscles and bone, such as sit-ups or lifting weights. Aim for two times a week. - stretch to increase flexibility, lower stress, and help prevent muscle soreness after physical activity. do aerobic activities, such as brisk walking, which use the body’s large muscles to make the heart beat faster. The large muscles are those of the upper and lower arms and legs and those that control head, shoulder, and hip movements. do activities to strengthen muscles and bone, such as sit-ups or lifting weights. Aim for two times a week. stretch to increase flexibility, lower stress, and help prevent muscle soreness after physical activity. Try to exercise almost every day for a total of about 30 minutes. If you haven't exercised lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day. (Tip: you don’t need to get your exercise in all at one time.) For more information on exercise and older adults, see Exercises To Try or visit Go4Life®, the exercise and physical activity campaign from the National Institute on Aging. Always talk with a doctor before starting a new physical activity program. What steps can I take to lose weight to prevent or delay type 2 diabetes? Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. It can also cause high blood pressure. If you are overweight or obese, choose sensible ways to reach and maintain a reasonable body weight. - Make healthy food choices. What you eat has a big impact on your weight and overall health. By developing healthy eating habits you can help control your body weight, blood pressure, and cholesterol. Reducing portion size, increasing the amount of fiber you consume (by eating more fruits and vegetables) and limiting fatty and salty foods are key to a healthy diet. Make healthy food choices. What you eat has a big impact on your weight and overall health. By developing healthy eating habits you can help control your body weight, blood pressure, and cholesterol. Reducing portion size, increasing the amount of fiber you consume (by eating more fruits and vegetables) and limiting fatty and salty foods are key to a healthy diet. - Get at least 30 minutes of exercise at least five days a week. Regular exercise reduces diabetes risk in several ways: it helps you lose weight, controls your cholesterol and blood pressure, and improves your body's use of insulin. Many people make walking part of their daily routine because it's easy, fun and convenient. But you can choose any activity that gets you moving. It's fine to break up your 30 minutes of exercise into smaller increments, such as three 10-minute periods. Check with your doctor before beginning any exercise program. Get at least 30 minutes of exercise at least five days a week. Regular exercise reduces diabetes risk in several ways: it helps you lose weight, controls your cholesterol and blood pressure, and improves your body's use of insulin. Many people make walking part of their daily routine because it's easy, fun and convenient. But you can choose any activity that gets you moving. It's fine to break up your 30 minutes of exercise into smaller increments, such as three 10-minute periods. Check with your doctor before beginning any exercise program. Does Medicare help pay for services and supplies for people with diabetes? Medicare helps pay for certain services and supplies for people with diabetes who have Medicare Part B. All require a doctor's prescription. The diabetes-related services and supplies that are covered include - blood sugar monitor and supplies - an A1C test, which is a lab test that measures how well your blood glucose has been controlled over the past 3 months. - dilated eye examinations to check for diabetic eye diseases - glaucoma screening - flu and pneumonia shots - diabetes self-management training - medical nutrition therapy services. blood sugar monitor and supplies an A1C test, which is a lab test that measures how well your blood glucose has been controlled over the past 3 months. dilated eye examinations to check for diabetic eye diseases glaucoma screening flu and pneumonia shots diabetes self-management training medical nutrition therapy services. Get more information about the diabetes supplies and services covered by Medicare. You can also contact the Centers for Medicare and Medicaid Services at 1-800-MEDICARE, or 1-800-633-4227. TTY users dial 1-877-486-2048.
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SLC4A1-associated distal renal tubular acidosis classic distal renal tubular acidosis renal tubular acidosis type I RTA, classic type Description SLC4A1-associated distal renal tubular acidosis is a kidney (renal) disorder that sometimes includes blood cell abnormalities. The kidneys normally filter fluid and waste products from the body and remove them in urine; however, in people with distal renal tubular acidosis, the kidneys are unable to remove enough acid from the body, and the blood becomes too acidic. This chemical imbalance is called metabolic acidosis. The inability to remove acids from the body often results in slowed growth and may also lead to softening and weakening of the bones, called rickets in children and osteomalacia in adults. This bone disorder is characterized by bone pain, bowed legs, and difficulty walking. In addition, most children and adults with SLC4A1-associated distal renal tubular acidosis have excess calcium in the urine (hypercalciuria), calcium deposits in the kidneys (nephrocalcinosis), and kidney stones (nephrolithiasis). In rare cases, these kidney abnormalities lead to life-threatening kidney failure. Affected individuals may also have low levels of potassium in the blood (hypokalemia). Individuals with the features described above have complete distal renal tubular acidosis, which usually becomes apparent in childhood. Some people do not develop metabolic acidosis even though their kidneys have trouble removing acids; these individuals are said to have incomplete distal renal tubular acidosis. Additionally, these individuals may have other features of distal renal tubular acidosis, such as bone problems and kidney stones. Often, people who initially have incomplete distal renal tubular acidosis develop metabolic acidosis later in life. Some people with SLC4A1-associated distal renal tubular acidosis also have blood cell abnormalities. These can vary in severity from no symptoms to a condition called hemolytic anemia, in which red blood cells prematurely break down (undergo hemolysis), causing a shortage of red blood cells (anemia). Hemolytic anemia can lead to unusually pale skin (pallor), extreme tiredness (fatigue), shortness of breath (dyspnea), and an enlarged spleen (splenomegaly). There are two forms of SLC4A1-associated distal renal tubular acidosis; they are distinguished by their inheritance pattern. The autosomal dominant form is more common and is usually less severe than the autosomal recessive form. The autosomal dominant form can be associated with incomplete or complete distal renal tubular acidosis and is rarely associated with blood cell abnormalities. The autosomal recessive form is always associated with complete distal renal tubular acidosis and is more commonly associated with blood cell abnormalities, although not everyone with this form has abnormal blood cells. Frequency The prevalence of SLC4A1-associated distal renal tubular acidosis is unknown. The condition is most common in Southeast Asia, especially Thailand. Causes Both the autosomal dominant and autosomal recessive forms of SLC4A1-associated distal renal tubular acidosis are caused by mutations in the SLC4A1 gene. This gene provides instructions for making the anion exchanger 1 (AE1) protein, which transports negatively charged atoms (anions) across cell membranes. Specifically, AE1 exchanges negatively charged atoms of chlorine (chloride ions) for negatively charged bicarbonate molecules (bicarbonate ions). The AE1 protein is found in the cell membrane of kidney cells and red blood cells. In kidney cells, the exchange of bicarbonate through AE1 allows acid to be released from the cell into the urine. In red blood cells, AE1 attaches to other proteins that make up the structural framework (the cytoskeleton) of the cells, helping to maintain their structure. The SLC4A1 gene mutations involved in either form of SLC4A1-associated distal renal tubular acidosis lead to production of altered AE1 proteins that cannot get to the correct location in the cell membrane. In the autosomal dominant form of the condition, gene mutations affect only one copy of the SLC4A1 gene, and normal AE1 protein is produced from the other copy. However, the altered protein attaches to the normal protein and keeps it from getting to the correct location, leading to a severe reduction or absence of AE1 protein in the cell membrane. In autosomal recessive distal renal tubular acidosis, both copies of the SLC4A1 gene are mutated, so all of the protein produced from this gene is altered and not able to get to the correct location. Improper location or absence of AE1 in kidney cell membranes disrupts bicarbonate exchange, and as a result, acid cannot be released into the urine. Instead, the acid builds up in the blood in most affected individuals, leading to metabolic acidosis and the other features of complete distal renal tubular acidosis. It is not clear why some people develop metabolic acidosis and others do not. Researchers suggest that in individuals with incomplete distal renal tubular acidosis, another mechanism is able to help regulate blood acidity (pH) and keep metabolic acidosis from developing. In red blood cells, interaction with a protein called glycophorin A can often help the altered AE1 protein get to the cell membrane where it can perform its function, which explains why most people with SLC4A1-associated distal renal tubular acidosis do not have blood cell abnormalities. However, some altered AE1 proteins cannot be helped by glycophorin A and are not found in the cell membrane. Without AE1, the red blood cells are unstable; breakdown of these abnormal red blood cells may lead to hemolytic anemia. Some people have nonhereditary forms of distal renal tubular acidosis; these forms can be caused by immune system problems or other conditions that damage the kidneys. These individuals often have additional signs and symptoms related to the original condition. Inheritance Pattern SLC4A1-associated distal renal tubular acidosis can have different patterns of inheritance. It is usually inherited in an autosomal dominant pattern, which means one copy of the altered SLC4A1 gene in each cell is sufficient to cause the disorder. In most cases, an affected person inherits the mutation from one affected parent. Other cases result from new mutations in the gene and occur in people with no history of the disorder in their family. Less commonly, SLC4A1-associated distal renal tubular acidosis has an autosomal recessive pattern of inheritance, which means a mutation must occur in both copies of the SLC4A1 gene for the condition to develop. This pattern occurs with certain types of SLC4A1 gene mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition. Sources for This Page Alper SL. Molecular physiology and genetics of Na+-independent SLC4 anion exchangers. J Exp Biol. 2009 Jun;212(Pt 11):1672-83. doi: 10.1242/jeb.029454. Review.
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Generalized anxiety disorder Overview It's normal to feel anxious from time to time, especially if your life is stressful. However, excessive, ongoing anxiety and worry that are difficult to control and interfere with day-to-day activities may be a sign of generalized anxiety disorder. It's possible to develop generalized anxiety disorder as a child or an adult. Generalized anxiety disorder has symptoms that are similar to panic disorder, obsessive-compulsive disorder and other types of anxiety, but they're all different conditions. Living with generalized anxiety disorder can be a long-term challenge. In many cases, it occurs along with other anxiety or mood disorders. In most cases, generalized anxiety disorder improves with psychotherapy or medications. Making lifestyle changes, learning coping skills and using relaxation techniques also can help. Generalized anxiety disorder care at Mayo Clinic Symptoms Generalized anxiety disorder symptoms can vary. They may include: - Persistent worrying or anxiety about a number of areas that are out of proportion to the impact of the events - Overthinking plans and solutions to all possible worst-case outcomes - Perceiving situations and events as threatening, even when they aren't - Difficulty handling uncertainty - Indecisiveness and fear of making the wrong decision - Inability to set aside or let go of a worry - Inability to relax, feeling restless, and feeling keyed up or on edge - Difficulty concentrating, or the feeling that your mind "goes blank" Physical signs and symptoms may include: - Fatigue - Trouble sleeping - Muscle tension or muscle aches - Trembling, feeling twitchy - Nervousness or being easily startled - Sweating - Nausea, diarrhea or irritable bowel syndrome - Irritability There may be times when your worries don't completely consume you, but you still feel anxious even when there's no apparent reason. For example, you may feel intense worry about your safety or that of your loved ones, or you may have a general sense that something bad is about to happen. Your anxiety, worry or physical symptoms cause you significant distress in social, work or other areas of your life. Worries can shift from one concern to another and may change with time and age. Children and teenagers may have similar worries to adults, but also may have excessive worries about: - Performance at school or sporting events - Family members' safety - Being on time (punctuality) - Earthquakes, nuclear war or other catastrophic events A child or teen with excessive worry may: - Feel overly anxious to fit in - Be a perfectionist - Redo tasks because they aren't perfect the first time - Spend excessive time doing homework - Lack confidence - Strive for approval - Require a lot of reassurance about performance - Have frequent stomachaches or other physical complaints - Avoid going to school or avoid social situations Some anxiety is normal, but see your doctor if: - You feel like you're worrying too much, and it's interfering with your work, relationships or other parts of your life - You feel depressed or irritable, have trouble with drinking or drugs, or you have other mental health concerns along with anxiety - You have suicidal thoughts or behaviors - seek emergency treatment immediately Your worries are unlikely to simply go away on their own, and they may actually get worse over time. Try to seek professional help before your anxiety becomes severe - it may be easier to treat early on. Causes As with many mental health conditions, the cause of generalized anxiety disorder likely arises from a complex interaction of biological and environmental factors, which may include: - Differences in brain chemistry and function - Genetics - Differences in the way threats are perceived - Development and personality Risk factors Women are diagnosed with generalized anxiety disorder somewhat more often than men are. The following factors may increase the risk of developing generalized anxiety disorder: - Personality. A person whose temperament is timid or negative or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are. - Genetics. Generalized anxiety disorder may run in families. - Experiences. People with generalized anxiety disorder may have a history of significant life changes, traumatic or negative experiences during childhood, or a recent traumatic or negative event. Chronic medical illnesses or other mental health disorders may increase risk. Complications Having generalized anxiety disorder can be disabling. It can: - Impair your ability to perform tasks quickly and efficiently because you have trouble concentrating - Take your time and focus from other activities - Sap your energy - Increase your risk of depression Generalized anxiety disorder can also lead to or worsen other physical health conditions, such as: - Digestive or bowel problems, such as irritable bowel syndrome or ulcers - Headaches and migraines - Chronic pain and illness - Sleep problems and insomnia - Heart-health issues Generalized anxiety disorder often occurs along with other mental health problems, which can make diagnosis and treatment more challenging. Some mental health disorders that commonly occur with generalized anxiety disorder include: - Phobias - Panic disorder - Post-traumatic stress disorder (PTSD) - Obsessive-compulsive disorder (OCD) - Depression - Suicidal thoughts or suicide - Substance abuse Diagnosis To help diagnose generalized anxiety disorder, your doctor or mental health professional may: - Do a physical exam to look for signs that your anxiety might be linked to medications or an underlying medical condition - Order blood or urine tests or other tests, if a medical condition is suspected - Ask detailed questions about your symptoms and medical history - Use psychological questionnaires to help determine a diagnosis - Use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association Treatment Treatment decisions are based on how significantly generalized anxiety disorder is affecting your ability to function in your daily life. The two main treatments for generalized anxiety disorder are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for you. Psychotherapy Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of psychotherapy for generalized anxiety disorder. Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to directly manage your worries and help you gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success. Medications Several types of medications are used to treat generalized anxiety disorder, including those below. Talk with your doctor about benefits, risks and possible side effects. - Antidepressants. Antidepressants, including medications in the selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) classes, are the first line medication treatments. Examples of antidepressants used to treat generalized anxiety disorder include escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva). Your doctor also may recommend other antidepressants. - Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing basis. As with most antidepressants, it typically takes up to several weeks to become fully effective. - Benzodiazepines. In limited circumstances, your doctor may prescribe a benzodiazepine for relief of anxiety symptoms. These sedatives are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these medications aren't a good choice if you have or had problems with alcohol or drug abuse. Lifestyle and home remedies While most people with anxiety disorders need psychotherapy or medications to get anxiety under control, lifestyle changes also can make a difference. Here's what you can do: - Keep physically active. Develop a routine so that you're physically active most days of the week. Exercise is a powerful stress reducer. It may improve your mood and help you stay healthy. Start out slowly and gradually increase the amount and intensity of your activities. - Make sleep a priority. Do what you can to make sure you're getting enough sleep to feel rested. If you aren't sleeping well, see your doctor. - Use relaxation techniques. Visualization techniques, meditation and yoga are examples of relaxation techniques that can ease anxiety. - Eat healthy. Healthy eating - such as focusing on vegetables, fruits, whole grains and fish - may be linked to reduced anxiety, but more research is needed. - Avoid alcohol and recreational drugs. These substances can worsen anxiety. - Quit smoking and cut back or quit drinking coffee. Both nicotine and caffeine can worsen anxiety. Alternative medicine Several herbal remedies have been studied as treatments for anxiety. Results tend to be mixed, and in several studies people report no benefits from their use. More research is needed to fully understand the risks and benefits. Some herbal supplements, such as kava and valerian, increase the risk of serious liver damage. Other supplements, such as passionflower or theanine, may have a calming effect, but they're often combined with other products so it's hard to tell whether they help with symptoms of anxiety. Before taking any herbal remedies or supplements, talk with your doctor to make sure they're safe and won't interact with any medications you take.
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Asthma in children Pediatric asthma Asthma - pediatric Wheezing - asthma - children Summary Asthma is a disease that causes the airways to swell and get narrow. It leads to wheezing, shortness of breath, chest tightness, and coughing. Causes Asthma is caused by swelling (inflammation) in the airways. During an asthma attack, the muscles surrounding the airways tighten. The lining of the air passages swells. As a result, less air is able to pass through. Asthma is often seen in children. It is a leading cause of missed school days and hospital visits for children. An allergic reaction is a key part of asthma in children. Asthma and allergies often occur together. In children who have sensitive airways, asthma symptoms can be triggered by breathing in substances called allergens, or triggers. Common asthma triggers include: Animals (hair or dander) Dust, mold, and pollen Aspirin and other medicines Changes in weather (most often cold weather) Chemicals in the air or in food Tobacco smoke Exercise Strong emotions Viral infections, such as the common cold Symptoms Breathing problems are common. They can include: Shortness of breath Feeling out of breath Gasping for air Trouble breathing out (exhaling) Breathing faster than normal When the child is having a hard time breathing, the skin of the chest and neck may suck inward. Other symptoms of asthma in children include: Coughing that sometimes wakes the child up at night (it may be the only symptom). Dark bags under the eyes. Feeling tired. Irritability. Tightness in the chest. A whistling sound made when breathing (wheezing). You may notice it more when the child breathes out. Your child's asthma symptoms may vary. Symptoms may appear often or develop only when triggers are present. Some children are more likely to have asthma symptoms at night. Exams and Tests The health care provider will use a stethoscope to listen to the child's lungs. The provider may be able to hear asthma sounds. However, lung sounds are often normal when the child is not having an asthma attack. The provider will have the child breathe into a device called a peak flow meter. Peak flow meters can tell how well the child can blow air out of the lungs. If the airways are narrow due to asthma, peak flow values drop. You and your child will learn to measure peak flow at home. Your child's provider may order the following tests: Allergy testing on the skin, or a blood test to see if your child is allergic to certain substances Chest x-ray Lung function tests Treatment You and your child's providers should work together as a team to create and carry out an asthma action plan. This plan will tell you how to: Avoid asthma triggers Monitor symptoms Measure peak flow Take medicines The plan should also tell you when to call the provider. It is important to know what questions to ask your child's provider. Children with asthma need a lot of support at school. Give the school staff your asthma action plan so they know how to take care of your child's asthma. Find out how to let your child take medicine during school hours. (You may need to sign a consent form.) Having asthma does not mean your child cannot exercise. Coaches, gym teachers, and your child should know what to do if your child has asthma symptoms caused by exercise. ASTHMA MEDICINES There are two basic kinds of medicine used to treat asthma. Long-term control drugs are taken every day to prevent asthma symptoms. Your child should take these medicines even if no symptoms are present. Some children may need more than one long-term control medicine. Types of long-term control medicines include: Inhaled steroids (these are usually the first choice of treatment) Long-acting bronchodilators (these are almost always used with inhaled steroids) Leukotriene inhibitors Cromolyn sodium Quick relief or rescue asthma drugs work fast to control asthma symptoms. Children take them when they are coughing, wheezing, having trouble breathing, or having an asthma attack. Some of your child's asthma medicines can be taken using an inhaler. Children who use an inhaler should use a spacer device. This helps them get the medicine into the lungs properly. If your child uses the inhaler the wrong way, less medicine gets into the lungs. Have your provider show your child how to correctly use an inhaler. Younger children can use a nebulizer instead of an inhaler to take their medicine. A nebulizer turns asthma medicine into a mist. GETTING RID OF TRIGGERS It is important to know your child's asthma triggers. Avoiding them is the first step toward helping your child feel better. Keep pets outdoor, or at least away from the child's bedroom. No one should smoke in a house or around a child with asthma. Getting rid of tobacco smoke in the home is the single most important thing a family can do to help a child with asthma. Smoking outside the house is not enough. Family members and visitors who smoke carry the smoke inside on their clothes and hair. This can trigger asthma symptoms. DO NOT use indoor fireplaces. Keep the house clean. Keep food in containers and out of bedrooms. This helps reduce the possibility of cockroaches, which can trigger asthma attacks. Cleaning products in the home should be unscented. MONITOR YOUR CHILD'S ASTHMA Checking peak flow is one of the best ways to control asthma. It can help you keep your child's asthma from getting worse. Asthma attacks usually DO NOT happen without warning. Children under age 5 may not be able to use a peak flow meter well enough for it to be helpful. However, a child should start using the peak flow meter at a young age to get used to it. An adult should always watch for a child's asthma symptoms. Outlook (Prognosis) With proper treatment, most children with asthma can live a normal life. When asthma is not well controlled, it can lead to missed school, problems playing sports, missed work for parents, and many visits to the provider's office and emergency room. Asthma symptoms often lessen or go away completely as the child gets older. Asthma that is not well controlled can lead to lasting lung problems. In rare cases, asthma is a life-threatening disease. Families need to work closely with their providers to develop a plan to care for a child with asthma. When to Contact a Medical Professional Call your child's provider if you think your child has new symptoms of asthma. If your child has been diagnosed with asthma, call the provider: After an emergency room visit When peak flow numbers have been getting lower When symptoms get more frequent and more severe, even though your child is following the asthma action plan If your child is having trouble breathing or having an asthma attack, get medical help right away. Emergency symptoms include: Difficulty breathing Bluish color to the lips and face Severe anxiety due to shortness of breath Rapid pulse Sweating Decreased level of alertness, such as severe drowsiness or confusion A child who is having a severe asthma attack may need to stay in the hospital and get oxygen and medicines through a vein (intravenous line or IV). Review Date 5/20/2018 Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Glaucoma Open-angle glaucoma Chronic glaucoma Chronic open-angle glaucoma Primary open-angle glaucoma Closed-angle glaucoma Narrow-angle glaucoma Angle-closure glaucoma Acute glaucoma Secondary glaucoma Congenital glaucoma Vision loss - glaucoma Summary Glaucoma is a group of eye conditions that can damage the optic nerve. This nerve sends the images you see to your brain. Most often, optic nerve damage is caused by increased pressure in the eye. This is called intraocular pressure. Watch this video about: Glaucoma </div> </div> Causes Glaucoma is the second most common cause of blindness in the United States. There are four major types of glaucoma: Open-angle glaucoma Angle-closure glaucoma, also called closed-angle glaucoma Congenital glaucoma Secondary glaucoma The front part of the eye is filled with a clear fluid called aqueous humor. This fluid is made in an area behind the colored part of the eye (iris). It leaves the eye through channels where the iris and cornea meet. This area is called the anterior chamber angle, or the angle. The cornea is the clear covering on the front of the eye that covers the iris, pupil, and angle. Anything that slows or blocks the flow of this fluid will cause pressure to build up in the eye. In open-angle glaucoma, the increase in pressure is often small and slow. In closed-angle glaucoma, the increase is often high and sudden. Either type can damage the optic nerve. <strong>Open-angle glaucoma</strong> is the most common type of glaucoma. The cause is unknown. The increase in eye pressure happens slowly over time. You cannot feel it. The increased pressure pushes on the optic nerve. Damage to the optic nerve causes blind spots in your vision. Open-angle glaucoma tends to run in families. Your risk is higher if you have a parent or grandparent with open-angle glaucoma. People of African descent are also at higher risk for this disease. <strong>Closed-angle glaucoma</strong> occurs when the fluid is suddenly blocked and cannot flow out of the eye. This causes a quick, severe rise in eye pressure. Dilating eye drops and certain medicines may trigger an acute glaucoma attack. Closed-angle glaucoma is an emergency. If you have had acute glaucoma in one eye, you are at risk for it in the second eye. Your health care provider is likely to treat your second eye to prevent a first attack in that eye. <strong>Secondary glaucoma</strong> occurs due to a known cause. Both open- and closed-angle glaucoma can be secondary when caused by something known. Causes include: Drugs such as corticosteroids Eye diseases such as uveitis (an infection of the middle layer of the eye) Diseases such as diabetes Eye injury <strong>Congenital glaucoma</strong> occurs in babies. It often runs in families. It is present at birth. It is caused when the eye does not develop normally. Symptoms OPEN-ANGLE GLAUCOMA Most people have no symptoms. Once you are aware of vision loss, the damage is already severe. Slow loss of side (peripheral) vision (also called tunnel vision). Advanced glaucoma can lead to blindness. ANGLE-CLOSURE GLAUCOMA Symptoms may come and go at first, or steadily become worse. You may notice: Sudden, severe pain in one eye Decreased or cloudy vision, often called "steamy" vision Nausea and vomiting Rainbow-like halos around lights Red eye Eye feels swollen CONGENITAL GLAUCOMA Symptoms are most often noticed when the child is a few months old. Cloudiness of the front of the eye Enlargement of one eye or both eyes Red eye Sensitivity to light Tearing SECONDARY GLAUCOMA Symptoms are most often related to the underlying problem causing the glaucoma. Depending on the cause, symptoms may either be like open-angle glaucoma or angle-closure glaucoma. Exams and Tests The only way to diagnose glaucoma is by having a complete eye exam. You will be given a test to check your eye pressure. This is called tonometry. In most cases, you will be given eye drops to widen (dilate) your pupil. When your pupil is dilated, your eye doctor will look at the inside of your eye and the optic nerve. Eye pressure is different at different times of the day. Eye pressure can even be normal in some people with glaucoma. So you will need other tests to confirm glaucoma. They may include: Using a special lens to look at the angle of the eye (gonioscopy). Photographs or laser scanning images of the inside of your eye (optic nerve imaging). Laser scanning images of the angle of the eye. Checking your retina -- The retina is the light-sensitive tissue at the back of your eye. Checking how your pupil responds to light (pupillary reflex response). 3-D view of your eye (slit lamp examination). Testing the clearness of your vision (visual acuity). Testing your field of vision (visual field measurement). Treatment The goal of treatment is to reduce your eye pressure. Treatment depends on the type of glaucoma that you have. OPEN-ANGLE GLAUCOMA If you have open-angle glaucoma, you will probably be given eye drops. You may need more than one type. Most people can be treated with eye drops. Most of the eye drops used today have fewer side effects than those used in the past. You also may be given pills to lower pressure in the eye. If drops alone do not work, you may need other treatment: Laser treatment uses a painless laser to open the channels where fluid flows out. If drops and laser treatment do not work, you may need surgery. The doctor will open a new channel so fluid can escape. This will help lower your pressure. Recently, new implants have been developed that can help treat glaucoma in people having cataract surgery. ACUTE ANGLE GLAUCOMA An acute angle-closure attack is a medical emergency. You can become blind in a few days if you are not treated. You may be given drops, pills, and medicine given through a vein (by IV) to lower your eye pressure. Some people also need an emergency operation, called an iridotomy. The doctor uses a laser to open a new channel in the iris. Sometimes this is done with surgery. The new channel relieves the attack and will prevent another attack. To help prevent an attack in the other eye, the procedure will often be performed on the other eye. This may be done even if it has never had an attack. CONGENITAL GLAUCOMA Congenital glaucoma is almost always treated with surgery. This is done using general anesthesia. This means the child is asleep and feels no pain. SECONDARY GLAUCOMA If you have secondary glaucoma, treating the cause may help your symptoms go away. Other treatments also may be needed. Outlook (Prognosis) Open-angle glaucoma cannot be cured. You can manage it and keep your sight by following your provider's directions. Closed-angle glaucoma is a medical emergency. You need treatment right away to save your vision. Babies with congenital glaucoma usually do well when surgery is done early. How you do with secondary glaucoma depends on what is causing the condition. When to Contact a Medical Professional If you have severe eye pain or a sudden loss of vision, get immediate medical help. These may be signs of closed-angle glaucoma. Prevention You cannot prevent open-angle glaucoma. Most people have no symptoms. But you can help prevent vision loss. A complete eye exam can help find open-angle glaucoma early, when it is easier to treat. All adults should have a complete eye exam by the age of 40. If you are at risk for glaucoma, you should have a complete eye exam sooner than age 40. You should have regular eye exams as recommended by your provider. If you are at risk for closed-angle glaucoma, your provider may recommend treatment before you have an attack to help prevent eye damage and vision loss. Review Date 2/19/2018 Updated by: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Ibuprofen IMPORTANT WARNING: People who take nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as ibuprofen may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning and may cause death. This risk may be higher for people who take NSAIDs for a long time. Do not take an NSAID such as ibuprofen if you have recently had a heart attack, unless directed to do so by your doctor. Tell your doctor if you or anyone in your family has or has ever had heart disease, a heart attack, or a stroke; if you smoke; and if you have or have ever had high cholesterol, high blood pressure, or diabetes. Get emergency medical help right away if you experience any of the following symptoms: chest pain, shortness of breath, weakness in one part or side of the body, or slurred speech. If you will be undergoing a coronary artery bypass graft (CABG; a type of heart surgery), you should not take ibuprofen right before or right after the surgery. NSAIDs such as ibuprofen may cause ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. The risk may be higher for people who take NSAIDs for a long time, are older in age, have poor health, or who drink three or more alcoholic drinks per day while taking ibuprofen. Tell your doctor if you take any of the following medications: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); aspirin; other NSAIDs such as ketoprofen and naproxen (Aleve, Naprosyn); oral steroids such as dexamethasone, methylprednisolone (Medrol), and prednisone (Rayos); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft); or serotonin norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor XR). Also tell your doctor if you have or have ever had ulcers, bleeding in your stomach or intestines, or other bleeding disorders. If you experience any of the following symptoms, stop taking ibuprofen and call your doctor: stomach pain, heartburn, vomit that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools. Keep all appointments with your doctor and the laboratory. Your doctor will monitor your symptoms carefully and will probably order certain tests to check your body's response to ibuprofen. Be sure to tell your doctor how you are feeling so that your doctor can prescribe the right amount of medication to treat your condition with the lowest risk of serious side effects. Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with prescription ibuprofen and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide. Why is this medication prescribed? Prescription ibuprofen is used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints) and rheumatoid arthritis (arthritis caused by swelling of the lining of the joints). It is also used to relieve mild to moderate pain, including menstrual pain (pain that happens before or during a menstrual period). Nonprescription ibuprofen is used to reduce fever and to relieve minor aches and pain from headaches, muscle aches, arthritis, menstrual periods, the common cold, toothaches, and backaches. Ibuprofen is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation. How should this medicine be used? Prescription ibuprofen comes as a tablet to take by mouth. It is usually taken three or four times a day for arthritis or every 4 to 6 hours as needed for pain. Nonprescription ibuprofen comes as a tablet, chewable tablet, suspension (liquid), and drops (concentrated liquid). Adults and children older than 12 years of age may usually take nonprescription ibuprofen every 4 to 6 hours as needed for pain or fever. Children and infants may usually be given nonprescription ibuprofen every 6 to 8 hours as needed for pain or fever, but should not be given more than 4 doses in 24 hours. Ibuprofen may be taken with food or milk to prevent stomach upset. If you are taking ibuprofen on a regular basis, you should take it at the same time(s) every day. Follow the directions on the package or prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ibuprofen exactly as directed. Do not take more or less of it or take it more often than directed by the package label or prescribed by your doctor. Ibuprofen comes alone and in combination with other medications. Some of these combination products are available by prescription only, and some of these combination products are available without a prescription and are used to treat cough and cold symptoms and other conditions. If your doctor has prescribed a medication that contains ibuprofen, you should be careful not to take any nonprescription medications that also contain ibuprofen. If you are selecting a product to treat cough or cold symptoms, ask your doctor or pharmacist for advice on which product is best for you. Check nonprescription product labels carefully before using two or more products at the same time. These products may contain the same active ingredient(s) and taking them together could cause you to receive an overdose. This is especially important if you will be giving cough and cold medications to a child. Nonprescription cough and cold combination products, including products that contain ibuprofen, can cause serious side effects or death in young children. Do not give these products to children younger than 4 years of age. If you give these products to children 4 to 11 years of age, use caution and follow the package directions carefully. If you are giving ibuprofen or a combination product that contains ibuprofen to a child, read the package label carefully to be sure that it is the right product for a child of that age. Do not give ibuprofen products that are made for adults to children. Before you give an ibuprofen product to a child, check the package label to find out how much medication the child should receive. Give the dose that matches the child's age on the chart. Ask the child's doctor if you don't know how much medication to give the child. Shake the suspension and drops well before each use to mix the medication evenly. Use the measuring cup provided to measure each dose of the suspension, and use the dosing device provided to measure each dose of the drops. The chewable tablets may cause a burning feeling in the mouth or throat. Take the chewable tablets with food or water. Stop taking nonprescription ibuprofen and call your doctor if your symptoms get worse, you develop new or unexpected symptoms, the part of your body that was painful becomes red or swollen, your pain lasts for more than 10 days, or your fever lasts more than 3 days. Stop giving nonprescription ibuprofen to your child and call your child's doctor if your child does not start to feel better during the first 24 hours of treatment. Also stop giving nonprescription ibuprofen to your child and call your child's doctor if your child develops new symptoms, including redness or swelling on the painful part of his body, or if your child's pain or fever get worse or lasts longer than 3 days. Do not give nonprescription ibuprofen to a child who has a sore throat that is severe or does not go away, or that comes along with fever, headache, nausea, or vomiting. Call the child's doctor right away, because these symptoms may be signs of a more serious condition. Other uses for this medicine Ibuprofen is also sometimes used to treat ankylosing spondylitis (arthritis that mainly affects the spine), gouty arthritis (joint pain caused by a build-up of certain substances in the joints), and psoriatic arthritis (arthritis that occurs with a long-lasting skin disease that causes scaling and swelling). Talk to your doctor about the risks of using this drug for your condition. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? <h3>Before taking ibuprofen,</h3> /h3> tell your doctor and pharmacist if you are allergic to ibuprofen, aspirin or other NSAIDs such as ketoprofen and naproxen (Aleve, Naprosyn), any other medications, or any of the inactive ingredients in the type of ibuprofen you plan to take. Ask your pharmacist or check the label on the package for a list of the inactive ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin, in Lotrel), captopril, enalapril (Vasotec, in Vaseretic), fosinopril, lisinopril (in Zestoretic), moexipril (Univasc), perindopril (Aceon, in Prestalia), quinapril (Accupril, in Quinaretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); angiotensin receptor blockers such as candesartan (Atacand, in Atacand HCT), eprosartan (Teveten), irbesartan (Avapro, in Avalide), losartan (Cozaar, in Hyzaar), olmesartan (Benicar, in Azor, in Benicar HCT, in Tribenzor), telmisartan (Micardis, in Micardis HCT, in Twynsta), and valsartan (in Exforge HCT); beta blockers such as atenolol (Tenormin, in Tenoretic), labetalol (Trandate), metoprolol (Lopressor, Toprol XL, in Dutoprol), nadolol (Corgard, in Corzide), and propranolol (Hemangeol, Inderal, Innopran); diuretics ('water pills'); lithium (Lithobid); and methotrexate (Otrexup, Rasuvo, Trexall). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects. do not take nonprescription ibuprofen with any other medication for pain unless your doctor tells you that you should. tell your doctor if you have or have ever had any of the conditions mentioned in the IMPORTANT WARNING section or asthma, especially if you also have frequent stuffed or runny nose or nasal polyps (swelling of the inside of the nose); heart failure; swelling of the hands, arms, feet, ankles, or lower legs; lupus (a condition in which the body attacks many of its own tissues and organs, often including the skin, joints, blood, and kidneys); or liver or kidney disease. If you are giving ibuprofen to a child, tell the child's doctor if the child has not been drinking fluids or has lost a large amount of fluid from repeated vomiting or diarrhea. tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy; you plan to become pregnant; or you are breast-feeding. If you become pregnant while taking ibuprofen, call your doctor. if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking ibuprofen. if you have phenylketonuria (PKU, an inborn disease in which mental retardation develops if a specific diet is not followed), read the package label carefully before taking nonprescription ibuprofen. Some types of nonprescription ibuprofen may be sweetened with aspartame, a source of phenylalanine. What special dietary instructions should I follow? Unless your doctor tells you otherwise, continue your normal diet. What should I do if I forget a dose? If you are taking ibuprofen on a regular basis, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? <h3>Ibuprofen may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: </h3> /h3> constipation diarrhea gas or bloating dizziness nervousness ringing in the ears <h3>Some side effects can be serious. If you experience any of the following symptoms, or those mentioned in the IMPORTANT WARNING section, call your doctor immediately. Do not take any more ibuprofen until you speak to your doctor. </h3> /h3> unexplained weight gain shortness of breath or difficulty breathing swelling of the abdomen, feet, ankles, or lower legs fever blisters rash itching hives swelling of the eyes, face, throat, arms, or hands difficulty breathing or swallowing hoarseness excessive tiredness pain in the upper right part of the stomach nausea loss of appetite yellowing of the skin or eyes flu-like symptoms pale skin fast heartbeat cloudy, discolored, or bloody urine back pain difficult or painful urination blurred vision, changes in color vision, or other vision problems red or painful eyes stiff neck headache confusion aggression Ibuprofen may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). What should I know about storage and disposal of this medication? Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location - one that is up and away and out of their sight and reach. http://www.upandaway.org In case of emergency/overdose In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911. <h3>Symptoms of overdosage may include: </h3> /h3> dizziness fast eye movements that you cannot control slow breathing or short periods of time without breathing blue color around the lips, mouth, and nose What other information should I know? If you are taking prescription ibuprofen, do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. Brand names Addaprin Advil Cedaprin I-Prin Midol Motrin Motrin IB NeoProfen Profen IB Proprinal Ultraprin Brand names of combination products Advil PM (containing Diphenhydramine, Ibuprofen) Combunox (containing Ibuprofen, Oxycodone) Duexis (containing Famotidine, Ibuprofen) Ibudone (containing Hydrocodone, Ibuprofen) Reprexain (containing Hydrocodone, Ibuprofen) Vicoprofen (containing Hydrocodone, Ibuprofen)
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Celiac Disease Definition and Facts Celiac disease is a digestive disorder that damages the small intestine. People with celiac disease cannot eat gluten, a protein found in wheat, barley, and rye. The disease can cause long-term digestive problems and keep you from getting nutrients you need. What is celiac disease? Celiac disease is a digestive disorder that damages the small intestine. The disease is triggered by eating foods containing gluten. Gluten is a protein found naturally in wheat, barley, and rye, and is common in foods such as bread, pasta, cookies, and cakes. Many pre-packaged foods, lip balms and lipsticks, hair and skin products, toothpastes, vitamin and nutrient supplements, and, rarely, medicines, contain gluten.Celiac disease can be very serious. The disease can cause long-lasting digestive problems and keep your body from getting all the nutrients it needs. Celiac disease can also affect the body outside the intestine.Celiac disease is different from gluten sensitivity or wheat intolerance. If you have gluten sensitivity, you may have symptoms similar to those of celiac disease, such as abdominal pain and tiredness. Unlike celiac disease, gluten sensitivity does not damage the small intestine.Celiac disease is also different from a wheat allergy. In both cases, your body's immune system reacts to wheat. However, some symptoms in wheat allergies, such as having itchy eyes or a hard time breathing, are different from celiac disease. Wheat allergies also do not cause long-term damage to the small intestine.1 How common is celiac disease? As many as one in 141 Americans has celiac disease, although most don't know it.2 Who is more likely to develop celiac disease? Although celiac disease affects children and adults in all parts of the world, the disease is more common in Caucasians and more often diagnosed in females. You are more likely to develop celiac disease if someone in your family has the disease. Celiac disease also is more common among people with certain other diseases, such as Down syndrome, Turner syndrome, and type 1 diabetes. What other health problems do people with celiac disease have? If you have celiac disease, you also may be at risk forAddison's disease Hashimoto's disease primary biliary cirrhosis type 1 diabetes What are the complications of celiac disease? Long-term complications of celiac disease includemalnutrition, a condition in which you don't get enough vitamins, minerals, and other nutrients you need to be healthy accelerated osteoporosis or bone softening, known as osteomalacia nervous system problems problems related to reproductionRare complications can includeintestinal cancer liver diseases lymphoma, a cancer of part of the immune system called the lymph system that includes the gutIn rare cases, you may continue to have trouble absorbing nutrients even though you have been following a strict gluten-free diet. If you have this condition, called refractory celiac disease, your intestines are severely damaged and can't heal. You may need to receive nutrients through an IV. Definition & Facts Symptoms and Causes If you have celiac disease, you may experience digestive symptoms or symptoms in other parts of your body. Digestive symptoms are more common in children than adults. Some people with celiac disease have no symptoms. What are the symptoms of celiac disease? Most people with celiac disease have one or more symptoms. However, some people with the disease may not have symptoms or feel sick. Sometimes health issues such as surgery, a pregnancy, childbirth, bacterial gastroenteritis, a viral infection, or severe mental stress can trigger celiac disease symptoms.If you have celiac disease, you may have digestive problems or other symptoms. Digestive symptoms are more common in children and can includebloating, or a feeling of fullness or swelling in the abdomen chronic diarrhea constipation gas nausea pale, foul-smelling, or fatty stools that float stomach pain vomitingFor children with celiac disease, being unable to absorb nutrients when they are so important to normal growth and development can lead todamage to the permanent teeth's enamel delayed puberty failure to thrive in infants mood changes or feeling annoyed or impatient slowed growth and short height weight lossAdults are less likely to have digestive symptoms and, instead, may have one or more of the following:anemia a red, smooth, shiny tongue bone or joint pain depression or anxiety dermatitis herpetiformis headaches infertility or repeated miscarriage missed menstrual periods mouth problems such a canker sores or dry mouth seizures tingling numbness in the hands and feet tiredness weak and brittle bonesAdults who have digestive symptoms with celiac disease may haveabdominal pain and bloating intestinal blockages tiredness that lasts for long periods of time ulcers, or sores on the stomach or lining of the intestineCeliac disease also can produce a reaction in which your immune system, or your body's natural defense system, attacks healthy cells in your body. This reaction can spread outside your digestive tract to other areas of your body, including yourbones joints nervous system skin spleenDepending on how old you are when a doctor diagnoses your celiac disease, some symptoms, such as short height and tooth defects, will not improve.Dermatitis herpetiformis is an itchy, blistering skin rash that usually appears on the elbows, knees, buttocks, back, or scalp. The rash affects about 10 percent of people with celiac disease. The rash can affect people of all ages but is most likely to appear for the first time between the ages of 30 and 40. Men who have the rash also may have oral or, rarely, genital sores. Some people with celiac disease may have the rash and no other symptoms. Why are celiac disease symptoms so varied? Symptoms of celiac disease vary from person to person. Your symptoms may depend onhow long you were breastfed as an infant; some studies have shown that the longer you were breastfed, the later celiac disease symptoms appear how much gluten you eat how old you were when you started eating gluten the amount of damage to your small intestine your age-symptoms can vary between young children and adultsPeople with celiac disease who have no symptoms can still develop complications from the disease over time if they do not get treatment. What causes celiac disease? Research suggests that celiac disease only happens to individuals who have particular genes. These genes are common and are carried by about one-third of the population. Individuals also have to be eating food that contains gluten to get celiac disease. Researchers do not know exactly what triggers celiac disease in people at risk who eat gluten over a long period of time. Sometimes the disease runs in families. About 10 to 20 percent of close relatives of people with celiac disease also are affected.3Your chances of developing celiac disease increase when you have changes in your genes, or variants. Certain gene variants and other factors, such as things in your environment, can lead to celiac disease. Symptoms & Causes Diagnosis Your doctor may diagnose celiac disease with a medical and family history, a physical exam, blood tests, an intestinal biopsy, a skin biopsy, and genetic tests. Doctors in the United Stated do not routinely screen people for celiac disease. How do doctors diagnose celiac disease? Celiac disease can be hard to diagnose because some of the symptoms are like symptoms of other diseases, such as irritable bowel syndrome (IBS) and lactose intolerance. Your doctor may diagnose celiac disease with a medical and family history, physical exam, and tests. Tests may include blood tests, genetic tests, and biopsy.Your doctor will ask you for information about your family's health-specifically, if anyone in your family has a history of celiac disease.During a physical exam, a doctor most oftenchecks your body for a rash or malnutrition, a condition that arises when you don't get enough vitamins, minerals, and other nutrients you need to be healthy listens to sounds in your abdomen using a stethoscope taps on your abdomen to check for pain and fullness or swellingFor some people, a dental visit can be the first step toward discovering celiac disease. Dental enamel defects, such as white, yellow, or brown spots on the teeth, are a pretty common problem in people with celiac disease, especially children. These defects can help dentists and other health care professionals identify celiac disease. What tests do doctors use to diagnose celiac disease? A health care professional may take a blood sample from you and send the sample to a lab to test for antibodies common in celiac disease. If blood test results are negative and your doctor still suspects celiac disease, he or she may order more blood tests.If a biopsy and other blood tests do not clearly confirm celiac disease, your doctor may order genetic blood tests to check for certain gene changes, or variants.4 You are very unlikely to have celiac disease if these gene variants are not present. Having these variants alone is not enough to diagnose celiac disease because they also are common in people without the disease. In fact, most people with these genes will never get celiac disease.If blood tests suggest you have celiac disease, your doctor will perform a biopsy to be sure. During a biopsy, the doctor takes a small piece of tissue from your small intestine during a procedure called an upper GI endoscopy.If a doctor suspects you have dermatitis herpetiformis, he or she will perform a skin biopsy. For a skin biopsy, the doctor removes tiny pieces of skin tissue to examine with a microscope.A doctor examines the skin tissue and checks the tissue for antibodies common in celiac disease. If the skin tissue has the antibodies, a doctor will perform blood tests to confirm celiac disease. If the skin biopsy and blood tests both suggest celiac disease, you may not need an intestinal biopsy. Do doctors screen for celiac disease? Screening is testing for diseases when you have no symptoms. Doctors in the United States do not routinely screen people for celiac disease. However, blood relatives of people with celiac disease and those with type 1 diabetes should talk with their doctor about their chances of getting the disease.Many researchers recommend routine screening of all family members, such as parents and siblings, for celiac disease.5 However, routine genetic screening for celiac disease is not usually helpful when diagnosing the disease. Diagnosis Treatment Doctors treat celiac disease by prescribing a gluten-free diet. Symptoms significantly improve for most people with celiac disease who follow a gluten-free diet. A dietitian can teach you how to avoid gluten while following a healthy and nutritious diet. How do doctors treat celiac disease? Doctors treat celiac disease with a gluten-free diet. Gluten is a protein found naturally in wheat, barley, and rye that triggers a reaction if you have celiac disease. Symptoms greatly improve for most people with celiac disease who stick to a gluten-free diet. In recent years, grocery stores and restaurants have added many more gluten-free foods and products, making it easier to stay gluten free.Your doctor may refer you to a dietitian who specializes in treating people with celiac disease. The dietitian will teach you how to avoid gluten while following a healthy diet. He or she will help youcheck food and product labels for gluten design everyday meal plans make healthy choices about the types of foods to eatFor most people, following a gluten-free diet will heal damage in the small intestine and prevent more damage. You may see symptoms improve within days to weeks of starting the diet. The small intestine usually heals in 3 to 6 months in children. Complete healing can take several years in adults. Once the intestine heals, the villi, which were damaged by the disease, regrow and will absorb nutrients from food into the bloodstream normally.If you have dermatitis herpetiformis-an itchy, blistering skin rash-skin symptoms generally respond to a gluten-free diet. However, skin symptoms may return if you add gluten back into your diet. Medicines such as dapsone, taken by mouth, can control the skin symptoms. People who take dapsone need to have regular blood tests to check for side effects from the medicine.Dapsone does not treat intestinal symptoms or damage, which is why you should stay on a gluten-free diet if you have the rash. Even when you follow a gluten-free diet, the rash may take months or even years to fully heal-and often comes back over the years. Avoiding medicines and nonfood products that may contain gluten In addition to prescribing a gluten-free diet, your doctor will want you to avoid all hidden sources of gluten. If you have celiac disease, ask a pharmacist about ingredients inherbal and nutritional supplements prescription and over-the-counter medicines vitamin and mineral supplementsYou also could take in or transfer from your hands to your mouth other products that contain gluten without knowing it. Products that may contain gluten includechildren's modeling dough, such as Play-Doh cosmetics lipstick, lip gloss, and lip balm skin and hair products toothpaste and mouthwash communion wafersMedications are rare sources of gluten. Even if gluten is present in a medicine, it is likely to be in such small quantities that it would not cause any symptoms.Reading product labels can sometimes help you avoid gluten. Some product makers label their products as being gluten-free. If a product label doesn't list the product's ingredients, ask the maker of the product for an ingredients list. Treatment If you don't improve after starting a gluten-free diet, you may still be eating or using small amounts of gluten. You probably will start responding to the gluten-free diet once you find and cut out all hidden sources of gluten. Hidden sources of gluten include additives made with wheat, such asmodified food starch malt flavoring preservatives stabilizersIf you still have symptoms even after changing your diet, you may have other conditions or disorders that are more common with celiac disease, such as irritable bowel syndrome (IBS), lactose intolerance, microscopic colitis, dysfunction of the pancreas, and small intestinal bacterial overgrowth. Eating, Diet, and Nutrition Eating, diet, and nutrition play a major role in treating celiac disease. You should maintain a gluten-free diet by avoiding all products that contain gluten. You can maintain a well-balanced diet with a variety of foods that do not include gluten. What should I avoid eating if I have celiac disease? Avoiding foods with gluten, a protein found naturally in wheat, rye, and barley, is critical in treating celiac disease. Removing gluten from your diet will improve symptoms, heal damage to your small intestine, and prevent further damage over time. While you may need to avoid certain foods, the good news is that many healthy, gluten-free foods and products are available.You should avoid all products that contain gluten, such as most cereal, grains, and pasta, and many processed foods. Be sure to always read food ingredient lists carefully to make sure the food you want to eat doesn't have gluten. In addition, discuss gluten-free food choices with a dietitian or health care professional who specializes in celiac disease. What should I eat if I have celiac disease? Foods such as meat, fish, fruits, vegetables, rice, and potatoes without additives or seasonings do not contain gluten and are part of a well-balanced diet. You can eat gluten-free types of bread, pasta, and other foods that are now easier to find in stores, restaurants, and at special food companies. You also can eat potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour.In the past, doctors and dietitians advised against eating oats if you have celiac disease. Evidence suggests that most people with the disease can safely eat moderate amounts of oats, as long as they did not come in contact with wheat gluten during processing. You should talk with your health care team about whether to include oats in your diet.When shopping and eating out, remember toread food labels-especially on canned, frozen, and processed foods-for ingredients that contain gluten identify foods labelled "gluten-free;" by law, these foods must contain less than 20 parts per million, well below the threshold to cause problems in the great majority of patients with celiac disease ask restaurant servers and chefs about how they prepare the food and what is in it find out whether a gluten-free menu is available ask a dinner or party host about gluten-free options before attending a social gatheringFoods labeled gluten-free tend to cost more than the same foods that have gluten. You may find that naturally gluten-free foods are less expensive. With practice, looking for gluten can become second nature.If you have just been diagnosed with celiac disease, you and your family members may find support groups helpful as you adjust to a new approach to eating. Is a gluten-free diet safe if I don't have celiac disease? In recent years, more people without celiac disease have adopted a gluten-free diet, believing that avoiding gluten is healthier or could help them lose weight. No current data suggests that the general public should maintain a gluten-free diet for weight loss or better health. 6, 7A gluten-free diet isn't always a healthy diet. For instance, a gluten-free diet may not provide enough of the nutrients, vitamins, and minerals the body needs, such as fiber, iron, and calcium. Some gluten-free products can be high in calories and sugar.If you think you might have celiac disease, don't start avoiding gluten without first speaking with your doctor. If your doctor diagnoses you with celiac disease, he or she will put you on a gluten-free diet. Gluten-free food labeling requirements The U.S. Food and Drug Administration (FDA) published a rule defining what "gluten-free" means on food labels. The "gluten-free" for food labeling rule requires that any food with the terms "gluten-free," "no gluten," "free of gluten," and "without gluten" on the label must meet all of the definition's requirements.While the FDA rule does not apply to foods regulated by the U.S. Department of Agriculture, including meat and egg products, it is often still observed. Eating, Diet, & Nutrition
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Congenital Heart Defects What Are... Congenital (kon-JEN-ih-tal) heart defects are problems with the heart's structure that are present at birth. These defects can involve: The interior walls of the heart The valves inside the heart The arteries and veins that carry blood to the heart or the body Congenital heart defects change the normal flow of blood through the heart. There are many types of congenital heart defects. They range from simple defects with no symptoms to complex defects with severe, life-threatening symptoms. Congenital heart defects are the most common type of birth defect. They affect 8 out of every 1,000 newborns. Each year, more than 35,000 babies in the United States are born with congenital heart defects. Many of these defects are simple conditions. They need no treatment or are easily fixed. Some babies are born with complex congenital heart defects. These defects require special medical care soon after birth. The diagnosis and treatment of complex heart defects has greatly improved over the past few decades. As a result, almost all children who have complex heart defects survive to adulthood and can live active, productive lives. Most people who have complex heart defects continue to need special heart care throughout their lives. They may need to pay special attention to how their condition affects issues such as health insurance, employment, birth control and pregnancy, and other health issues. In the United States, more than 1 million adults are living with congenital heart defects. HOW THE HEART WORKS To understand congenital heart defects, it's helpful to know how a healthy heart works. Your child's heart is a muscle about the size of his or her fist. The heart works like a pump and beats 100,000 times a day. The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it to the body. The heart has four chambers and four valves and is connected to various blood vessels. Veins are blood vessels that carry blood from the body to the heart. Arteries are blood vessels that carry blood away from the heart to the body. A Healthy Heart Cross-Section Heart Chambers The heart has four chambers or "rooms." The atria (AY-tree-uh) are the two upper chambers that collect blood as it flows into the heart. The ventricles (VEN-trih-kuhls) are the two lower chambers that pump blood out of the heart to the lungs or other parts of the body. Heart Valves Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart. The tricuspid (tri-CUSS-pid) valve is in the right side of the heart, between the right atrium and the right ventricle. The pulmonary (PULL-mun-ary) valve is in the right side of the heart, between the right ventricle and the entrance to the pulmonary artery. This artery carries blood from the heart to the lungs. The mitral (MI-trul) valve is in the left side of the heart, between the left atrium and the left ventricle. The aortic (ay-OR-tik) valve is in the left side of the heart, between the left ventricle and the entrance to the aorta. This artery carries blood from the heart to the body. Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries. Then they shut to keep blood from flowing backward. When the heart's valves open and close, they make a "lub-DUB" sound that a doctor can hear using a stethoscope. The first sound—the "lub"—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the ventricles contract, or squeeze, and pump blood out of the heart. The second sound—the "DUB"—is made by the aortic and pulmonary valves closing at the beginning of diastole (di-AS-toe-lee). Diastole is when the ventricles relax and fill with blood pumped into them by the atria. Arteries The arteries are major blood vessels connected to your heart. The pulmonary artery carries blood from the right side of the heart to the lungs to pick up a fresh supply of oxygen. The aorta is the main artery that carries oxygen-rich blood from the left side of the heart to the body. The coronary arteries are the other important arteries attached to the heart. They carry oxygen-rich blood from the aorta to the heart muscle, which must have its own blood supply to function. Veins The veins also are major blood vessels connected to your heart. The pulmonary veins carry oxygen-rich blood from the lungs to the left side of the heart so it can be pumped to the body. The superior and inferior vena cavae are large veins that carry oxygen-poor blood from the body back to the heart. For more information about how a healthy heart works, go to the Health Topics How the Heart Works article. This article contains animations that show how your heart pumps blood and how your heart's electrical system works. TYPES With congenital heart defects, some part of the heart doesn’t form properly before birth. This changes the normal flow of blood through the heart. There are many types of congenital heart defects. Some are simple, such as a hole in the septum. The hole allows blood from the left and right sides of the heart to mix. Another example of a simple defect is a narrowed valve that blocks blood flow to the lungs or other parts of the body. Other heart defects are more complex. They include combinations of simple defects, problems with the location of blood vessels leading to and from the heart, and more serious problems with how the heart develops. Examples of Simple Congenital Heart Defects Holes in the Heart (Septal Defects) The septum is the wall that separates the chambers on left and right sides of the heart. The wall prevents blood from mixing between the two sides of the heart. Some babies are born with holes in the septum. These holes allow blood to mix between the two sides of the heart. Atrial septal defect (ASD). An ASD is a hole in the part of the septum that separates the atria—the upper chambers of the heart. The hole allows oxygen-rich blood from the left atrium to flow into the right atrium, instead of flowing into the left ventricle as it should. Many children who have ASDs have few, if any, symptoms. Cross-Section of a Normal Heart and a Heart With an Atrial Septal Defect ASDs can be small, medium, or large. Small ASDs allow only a little blood to leak from one atrium to the other. They don't affect how the heart works and don't need any special treatment. Many small ASDs close on their own as the heart grows during childhood. Medium and large ASDs allow more blood to leak from one atrium to the other. They’re less likely to close on their own. About half of all ASDs close on their own over time. Medium and large ASDs that need treatment can be repaired using a catheter procedure or open-heart surgery. Ventricular septal defect (VSD). A VSD is a hole in the part of the septum that separates the ventricles—the lower chambers of the heart. The hole allows oxygen-rich blood to flow from the left ventricle into the right ventricle, instead of flowing into the aorta and out to the body as it should. Cross-Section of a Normal Heart and a Heart With a Ventricular Septal Defect VSDs can be small, medium, or large. Small VSDs don't cause problems and may close on their own. Medium VSDs are less likely to close on their own and may require treatment. Large VSDs allow a lot of blood to flow from the left ventricle to the right ventricle. As a result, the left side of the heart must work harder than normal. Extra blood flow increases blood pressure in the right side of the heart and the lungs. The heart’s extra workload can cause heart failure and poor growth. If the hole isn't closed, high blood pressure can scar the arteries in the lungs. Doctors use open-heart surgery to repair VSDs. Patent Ductus Arteriosus Patent ductus arteriosus (PDA) is a fairly common heart defect that can occur soon after birth. In PDA, abnormal blood flow occurs between the aorta and the pulmonary artery. Before birth, these arteries are connected by a blood vessel called the ductus arteriosus. This blood vessel is an essential part of fetal blood circulation. Within minutes or up to a few days after birth, the ductus arteriosus closes. In some babies, however, the ductus arteriosus remains open (patent). The opening allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can strain the heart and increase blood pressure in the lung arteries. A heart murmur might be the only sign of PDA. (A heart murmur is an extra or unusual sound heard during a heartbeat.) Other signs and symptoms can include shortness of breath, poor feeding and growth, tiring easily, and sweating with exertion. PDA is treated with medicines, catheter-based procedures, and surgery. Small PDAs often close without treatment. Narrowed Valves Simple congenital heart defects also can involve the heart's valves. These valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart (the aorta and the pulmonary artery). Valves can have the following types of defects: Stenosis (steh-NO-sis). This defect occurs if the flaps of a valve thicken, stiffen, or fuse together. As a result, the valve cannot fully open. Thus, the heart has to work harder to pump blood through the valve. Atresia (ah-TRE-ze-AH). This defect occurs if a valve doesn't form correctly and lacks a hole for blood to pass through. Atresia of a valve generally results in more complex congenital heart disease. Regurgitation (re-GUR-jih-TA-shun). This defect occurs if a valve doesn't close tightly. As a result, blood leaks back through the valve. The most common valve defect is pulmonary valve stenosis, which is a narrowing of the pulmonary valve. This valve allows blood to flow from the right ventricle into the pulmonary artery. The blood then travels to the lungs to pick up oxygen. Pulmonary valve stenosis can range from mild to severe. Most children who have this defect have no signs or symptoms other than a heart murmur. Treatment isn't needed if the stenosis is mild. In babies who have severe pulmonary valve stenosis, the right ventricle can get very overworked trying to pump blood to the pulmonary artery. These infants may have signs and symptoms such as rapid or heavy breathing, fatigue (tiredness), and poor feeding. Older children who have severe pulmonary valve stenosis may have symptoms such as fatigue while exercising. Some babies may have pulmonary valve stenosis and PDA or ASDs. If this happens, oxygen-poor blood can flow from the right side of the heart to the left side. This can cause cyanosis (si-ah-NO-sis). Cyanosis is a bluish tint to the skin, lips, and fingernails. It occurs because the oxygen level in the blood leaving the heart is below normal. Severe pulmonary valve stenosis is treated with a catheter procedure. Example of a Complex Congenital Heart Defect Complex congenital heart defects need to be repaired with surgery. Advances in treatment now allow doctors to successfully repair even very complex congenital heart defects. The most common complex heart defect is tetralogy of Fallot (teh-TRAL-o-je of fah-LO), which is a combination of four defects: Pulmonary valve stenosis. A large VSD. An overriding aorta. In this defect, the aorta is located between the left and right ventricles, directly over the VSD. As a result, oxygen-poor blood from the right ventricle can flow directly into the aorta instead of into the pulmonary artery. Right ventricular hypertrophy (hi-PER-tro-fe). In this defect, the muscle of the right ventricle is thicker than usual because it has to work harder than normal. In tetralogy of Fallot, not enough blood is able to reach the lungs to get oxygen, and oxygen-poor blood flows to the body. Cross-Section of a Normal Heart and a Heart With Tetralogy of Fallot Babies and children who have tetralogy of Fallot have episodes of cyanosis, which can be severe. In the past, when this condition wasn't treated in infancy, older children would get very tired during exercise and might faint. Tetralogy of Fallot is repaired in infancy now to prevent these problems. Babies and children who have tetralogy of Fallot have episodes of cyanosis, which can be severe. In the past, when this condition wasn't treated in infancy, older children would get very tired during exercise and might faint. Tetralogy of Fallot is repaired in infancy now to prevent these problems. Tetralogy of Fallot must be repaired with open-heart surgery, either soon after birth or later in infancy. The timing of the surgery will depend on how narrow the pulmonary artery is. Children who have had this heart defect repaired need lifelong medical care from a specialist to make sure they stay as healthy as possible. OTHER NAMES Congenital heart disease Heart defects Congenital cardiovascular malformations CAUSES If your child has a congenital heart defect, you may think you did something wrong during your pregnancy to cause the problem. However, doctors often don't know why congenital heart defects occur. Heredity may play a role in some heart defects. For example, a parent who has a congenital heart defect may be more likely than other people to have a child with the defect. Rarely, more than one child in a family is born with a heart defect. Children who have genetic disorders, such as Down syndrome, often have congenital heart defects. In fact, half of all babies who have Down syndrome have congenital heart defects. Smoking during pregnancy also has been linked to several congenital heart defects, including septal defects. Researchers continue to search for the causes of congenital heart defects. SIGNS & SYMPTOMS Many congenital heart defects cause few or no signs and symptoms. A doctor may not even detect signs of a heart defect during a physical exam. Some heart defects do cause signs and symptoms. They depend on the number, type, and severity of the defects. Severe defects can cause signs and symptoms, usually in newborns. These signs and symptoms may include: Rapid breathing Cyanosis (a bluish tint to the skin, lips, and fingernails) Fatigue (tiredness) Poor blood circulation Congenital heart defects don't cause chest pain or other painful symptoms. Heart defects can cause heart murmurs (extra or unusual sounds heard during a heartbeat). Doctors can hear heart murmurs using a stethoscope. However, not all murmurs are signs of congenital heart defects. Many healthy children have heart murmurs. Normal growth and development depend on a normal workload for the heart and normal flow of oxygen-rich blood to all parts of the body. Babies who have congenital heart defects may have cyanosis and tire easily while feeding. As a result, they may not gain weight or grow as they should. Older children who have congenital heart defects may get tired easily or short of breath during physical activity. Many types of congenital heart defects cause the heart to work harder than it should. With severe defects, this can lead to heart failure. Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Symptoms of heart failure include: Shortness of breath or trouble breathing Fatigue with physical activity A buildup of blood and fluid in the lungs Swelling in the ankles, feet, legs, abdomen, and veins in the neck DIAGNOSIS Severe congenital heart defects generally are diagnosed during pregnancy or soon after birth. Less severe defects often aren't diagnosed until children are older. Minor defects often have no signs or symptoms. Doctors may diagnose them based on results from a physical exam and tests done for another reason. Specialists Involved Pediatric cardiologists are doctors who specialize in the care of babies and children who have heart problems. Cardiac surgeons are specialists who repair heart defects using surgery. Physical Exam During a physical exam, the doctor will: Listen to your child's heart and lungs with a stethoscope Look for signs of a heart defect, such as cyanosis (a bluish tint to the skin, lips, or fingernails), shortness of breath, rapid breathing, delayed growth, or signs of heart failure Diagnostic Tests Echocardiography Echocardiography (echo) is a painless test that uses sound waves to create a moving picture of the heart. During the test, the sound waves (called ultrasound) bounce off the structures of the heart. A computer converts the sound waves into pictures on a screen. Echo allows the doctor to clearly see any problem with the way the heart is formed or the way it's working. Echo is an important test for both diagnosing a heart problem and following the problem over time. The test can show problems with the heart's structure and how the heart is reacting to those problems. Echo will help your child's cardiologist decide if and when treatment is needed. During pregnancy, if your doctor suspects that your baby has a congenital heart defect, fetal echo can be done. This test uses sound waves to create a picture of the baby's heart while the baby is still in the womb. Fetal echo usually is done at about 18 to 22 weeks of pregnancy. If your child is diagnosed with a congenital heart defect before birth, your doctor can plan treatment before the baby is born. EKG (Electrocardiogram) An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart. An EKG can detect if one of the heart's chambers is enlarged, which can help diagnose a heart problem. Chest X Ray A chest x ray is a painless test that creates pictures of the structures in the chest, such as the heart and lungs. This test can show whether the heart is enlarged. It also can show whether the lungs have extra blood flow or extra fluid, a sign of heart failure. Pulse Oximetry For this test, a small sensor is attached to a finger or toe (like an adhesive bandage). The sensor gives an estimate of how much oxygen is in the blood. Cardiac Catheterization During cardiac catheterization (KATH-e-ter-ih-ZA-shun), a thin, flexible tube called a catheter is put into a vein in the arm, groin (upper thigh), or neck. The tube is threaded to the heart. Special dye is injected through the catheter into a blood vessel or one of the heart’s chambers. The dye allows the doctor to see blood flowing through the heart and blood vessels on an x-ray image. The doctor also can use cardiac catheterization to measure the pressure and oxygen level inside the heart chambers and blood vessels. This can help the doctor figure out whether blood is mixing between the two sides of the heart. Cardiac catheterization also is used to repair some heart defects. TREATMENTS Although many children who have congenital heart defects don't need treatment, some do. Doctors repair congenital heart defects with catheter procedures or surgery. Sometimes doctors combine catheter and surgical procedures to repair complex heart defects, which may involve several kinds of defects. The treatment your child receives depends on the type and severity of his or her heart defect. Other factors include your child's age, size, and general health. Some children who have complex congenital heart defects may need several catheter or surgical procedures over a period of years, or they may need to take medicines for years. Catheter Procedures Catheter procedures are much easier on patients than surgery. They involve only a needle puncture in the skin where the catheter (thin, flexible tube) is inserted into a vein or an artery. Doctors don't have to surgically open the chest or operate directly on the heart to repair the defect(s). This means that recovery may be easier and quicker. The use of catheter procedures has increased a lot in the past 20 years. They have become the preferred way to repair many simple heart defects, such as atrial septal defect (ASD) and pulmonary valve stenosis. For ASD repair, the doctor inserts a catheter into a vein in the groin (upper thigh). He or she threads the tube to the heart's septum. A device made up of two small disks or an umbrella-like device is attached to the catheter. When the catheter reaches the septum, the device is pushed out of the catheter. The device is placed so that it plugs the hole between the atria. It’s secured in place and the catheter is withdrawn from the body. Within 6 months, normal tissue grows in and over the device. The closure device does not need to be replaced as the child grows. For pulmonary valve stenosis, the doctor inserts a catheter into a vein and threads it to the heart’s pulmonary valve. A tiny balloon at the end of the catheter is quickly inflated to push apart the leaflets, or "doors," of the valve. Then, the balloon is deflated and the catheter and ballon are withdrawn. This procedure can be used to repair any narrowed valve in the heart. To help guide the catheter, doctors often use echocardiography (echo), transesophageal (tranz-ih-sof-uh-JEE-ul) echo (TEE), and coronary angiography (an-jee-OG-rah-fee). TEE is a special type of echo that takes pictures of the heart through the esophagus. The esophagus is the passage leading from the mouth to the stomach. Doctors also use TEE to examine complex heart defects. Surgery A child may need open-heart surgery if his or her heart defect can't be fixed using a catheter procedure. Sometimes one surgery can repair the defect completely. If that's not possible, the child may need more surgeries over months or years to fix the problem. Cardiac surgeons may use open-heart surgery to: Close holes in the heart with stitches or a patch Repair or replace heart valves Widen arteries or openings to heart valves Repair complex defects, such as problems with the location of blood vessels near the heart or how they are formed Rarely, babies are born with multiple defects that are too complex to repair. These babies may need heart transplants. In this procedure, the child's heart is replaced with a healthy heart from a deceased child. The heart has been donated by the deceased child’s family. LIVING WITH The outlook for children who have congenital heart defects is much better today than in the past. Advances in testing and treatment allow most of these children to survive to adulthood. They’re able to live active, productive lives. Many of these children need only occasional checkups with a cardiologist (heart specialist) as they grow up and go through adult life. Children who have complex heart defects need long-term care from trained specialists. This will help them stay as healthy as possible and maintain a good quality of life. Children and Teens Ongoing Medical Care Ongoing medical care is important for your child's health. This includes: Having checkups with your child's heart specialist as directed Seeing your child’s pediatrician or family doctor for routine exams Taking medicines as prescribed Children who have severe heart defects may be at slightly increased risk for infective endocarditis (IE). IE is a serious infection of the inner lining of the heart chambers and valves. Your child's doctor or dentist may give your child antibiotics before some medical or dental procedures (such as surgery or dental cleanings) that can allow bacteria into the bloodstream. Your child's doctor will tell you whether your child needs antibiotics before such procedures. To reduce the risk of IE, gently brush your young child's teeth every day as soon as they begin to come in. As your child gets older, make sure he or she brushes every day and sees a dentist regularly. Talk with your child's doctor and dentist about how to keep your child's mouth and teeth healthy. As children who have heart defects grow up and become teens, they should learn how their hearts differ from normal hearts. They also should know what kind of defect they have, how it was treated, and what kind of care is still needed. They should be able to recognize signs and symptoms and know how to respond. Work with your child’s health care providers to compile a packet of medical records and information that covers all aspects of your child's heart defect, including: Diagnosis Procedures or surgeries Prescribed medicines Recommendations about medical followup and how to prevent complications Health insurance Review your current health insurance plan so you understand your coverage. Keeping your health insurance current is important. If you plan to change jobs, find out whether your new health insurance will cover care for your child's congenital heart defect. Feeding and Nutrition Some babies and children who have congenital heart defects don't grow and develop as fast as other children. If your child's heart has to pump harder than normal because of a heart defect, he or she may tire quickly while feeding. As a result, your child may not be able to eat enough. Poor feeding may cause your child to be smaller and thinner than other children. Your child also may start certain activities—such as rolling over, sitting, and walking—later than other children. After treatments and surgery, growth and development often improve. To help your baby get enough calories, ask his or her doctor about the best feeding schedule. Also, ask whether your baby needs any nutritional supplements. Make sure your child has nutritious meals and snacks as he or she grows. This will help with growth and development. Physical Activity Physical activity helps children strengthen their muscles and stay healthy. Ask your child's doctor how much and what kinds of physical activity are best for your child. Some children and teens who have congenital heart defects may need to limit the amount or type of activity they do. Remember to ask the doctor for a note that describes any limits on your child's physical activities. Schools and other groups may need this information. Emotional Issues Children and teens who have serious conditions or illnesses may have emotional issues. For example, they may feel isolated if they have to be in the hospital a lot. Some may feel sad or frustrated with their body image and their inability to be a "normal" kid. Sometimes brothers or sisters are jealous of a child who needs a lot of attention for medical problems. If you have concerns about your child's emotional health, talk with his or her doctor. Transition of Care The move from pediatric care to adult care is an important step in treatment. Talk with your teen’s health care team about creating a plan to help your teen transition to adult care. Start planning as soon as your teen is able and willing to fully take part in this process. Following a transition plan has many benefits. It will help your teen: Get used to talking with health care providers Learn about the adult health care system Understand the importance of having health insurance and learn what his or her insurance covers Take responsibility for his or her medical care A transition plan also can help your teen think about other important issues, such as future education and employment, birth control and pregnancy planning, and making healthy choices about nutrition, physical activity, and other lifestyle habits. Adults Adults who needed regular medical checkups for congenital heart defects in their youth may need to keep seeing specialists into adulthood. These adults should pay attention to the following issues. Medical History Some people think that the surgery they had in childhood for their congenital heart defects was a cure. They don't realize they may need regular medical followup in adulthood to maintain good health. Some adults may not know what kind of heart defect they had (or still have) or how it was repaired. They should learn about their medical history and know as much as possible about any medicines they're taking. Preventing Infective Endocarditis People who have congenital heart defects may need antibiotics before some medical or dental procedures that can allow bacteria to enter the bloodstream. These bacteria can cause infective endocarditis (IE). IE is a serious infection of the inner lining of the heart chambers and valves. Your doctor will tell you whether you need to take antibiotics before medical or dental procedures. Regular brushing, flossing, and visits to the dentist also can help prevent IE. Birth Control and Pregnancy Women who have heart defects should talk with their doctors about the safest type of birth control for them. Many of these women can safely use most methods. However, some women should avoid certain types of birth control, such as birth control pills or intrauterine devices (IUDs). Many women who have simple heart defects can have normal pregnancies and deliveries. Women with congenital heart defects who want to become pregnant (or who are pregnant) should talk with their doctors about the health risks. They also should consult with doctors who specialize in treating pregnant women who have congenital heart defects. Women who have congenital heart defects may be at higher risk than other women of having babies who have congenital heart defects. Pregnant women who have congenital heart defects should talk with their doctors about whether to have fetal echocardiography (echo). This test uses sound waves to create images of the baby's heart. Fetal echo gives the doctor information about the size and shape of the baby's heart. This test also shows how well the heart’s chambers and valves are working. Health Insurance and Employment Adults who have congenital heart defects should carefully consider how changing jobs will affect their health insurance coverage. Some health plans have waiting periods or clauses to exclude some kinds of coverage. Before making any job changes, find out whether the change will affect your insurance coverage. Several laws protect the employment rights of people who have health conditions, such as congenital heart defects. The Americans with Disabilities Act and the Work Incentives Improvement Act try to ensure fairness in hiring for all people, including those who have health conditions.
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Congenital heart defects in children Overview If your child has a congenital heart defect, it means that your child was born with a problem in the structure of his or her heart. Some congenital heart defects in children are simple and don't need treatment. Other congenital heart defects in children are more complex and may require several surgeries performed over a period of several years. Learning about your child's congenital heart defect can help you understand the condition and know what you can expect in the coming months and years. Congenital heart defect care at Mayo Clinic Symptoms Serious congenital heart defects usually become evident soon after birth or during the first few months of life. Signs and symptoms could include: - Pale gray or blue skin color (cyanosis) - Rapid breathing - Swelling in the legs, abdomen or areas around the eyes - Shortness of breath during feedings, leading to poor weight gain Less serious congenital heart defects may not be diagnosed until later in childhood, because your child may not have any noticeable signs of a problem. If signs and symptoms are evident in older children, they may include: - Easily becoming short of breath during exercise or activity - Easily tiring during exercise or activity - Fainting during exercise or activity - Swelling in the hands, ankles or feet Serious congenital heart defects are often diagnosed before or soon after your child is born. If you notice that your baby has any of the signs or symptoms above, call your child's doctor. If your child has any of the signs or symptoms of less serious heart defects as he or she grows, call your child's doctor. Your child's doctor can let you know if your child's symptoms are due to a heart defect or another medical condition. Causes The heart is divided into four hollow chambers, two on the right and two on the left. To pump blood throughout the body, the heart uses its left and right sides for different tasks. The right side of the heart moves blood to the lungs through vessels called pulmonary arteries. In the lungs, blood picks up oxygen then returns to the heart's left side through the pulmonary veins. The left side of the heart then pumps the blood through the aorta and out to the rest of the body. During the first six weeks of pregnancy, the heart begins taking shape and starts beating. The major blood vessels that run to and from the heart also begin to form during this critical time during gestation. It's at this point in your baby's development that heart defects may begin to develop. Researchers aren't sure exactly what causes most of these defects, but they think genetics, certain medical conditions, some medications and environmental factors, such as smoking, may play a role. There are many different types of congenital heart defects, falling mainly into these categories: - Holes in the heart. Holes can form in the walls between heart chambers or between major blood vessels leaving the heart. In certain situations, these holes allow oxygen-poor blood to mix with oxygen-rich blood, resulting in less oxygen being carried to your child's body. Depending on the size of the hole, this lack of sufficient oxygen can cause your child's skin or fingernails to appear blue or possibly lead to congestive heart failure. A ventricular septal defect is a hole in the wall between the right and left chambers on the lower half of the heart (ventricles). An atrial septal defect occurs when there's a hole between the upper heart chambers (atria). Patent ductus arteriosus (PAY-tunt DUK-tus ahr-teer-e-O-sus) is a connection between the pulmonary artery (containing deoxygenated blood) and the aorta (containing oxygenated blood). A complete atrioventricular canal defect is a condition that causes a hole in the center of the heart. - Obstructed blood flow. When blood vessels or heart valves are narrow because of a heart defect, the heart must work harder to pump blood through them. Eventually, this leads to enlarging of the heart and thickening of the heart muscle. Examples of this type of defect are pulmonary stenosis or aortic stenosis (stuh-NO-sis). - Abnormal blood vessels. Several congenital heart defects happen when blood vessels going to and from the heart don't form correctly, or they're not positioned the way they're supposed to be. A defect called transposition of the great arteries occurs when the pulmonary artery and the aorta are on the wrong sides of the heart. A condition called coarctation of the aorta happens when the main blood vessel supplying blood to the body is too narrow. Total anomalous pulmonary venous connection is a defect that occurs when blood vessels from the lungs attach to wrong area of the heart. - Heart valve abnormalities. If the heart valves can't open and close correctly, blood can't flow smoothly. One example of this type of defect is called Ebstein's anomaly. In Ebstein's anomaly, the tricuspid valve - which is located between the right atrium and the right ventricle - is malformed and often leaks. Another example is pulmonary atresia, in which the pulmonary valve is missing, causing abnormal blood flow to the lungs. - An underdeveloped heart. Sometimes, a major portion of the heart fails to develop properly. For example, in hypoplastic left heart syndrome, the left side of the heart hasn't developed enough to effectively pump enough blood to the body. - A combination of defects. Some infants are born with several heart defects. Tetralogy of Fallot (teh-TRAL-uh-jee of fuh-LOW) is a combination of four defects: a hole in the wall between the heart's ventricles, a narrowed passage between the right ventricle and pulmonary artery, a shift in the connection of the aorta to the heart, and thickened muscle in the right ventricle. Risk factors Most congenital heart defects result from problems early in your child's heart development, the cause of which is unknown. However, certain environmental and genetic risk factors may play a role. They include: - Rubella (German measles). Having rubella during pregnancy can cause problems in your baby's heart development. Your doctor can test you for immunity to this viral disease before pregnancy and vaccinate you against it if you aren't immune. - Diabetes. You can reduce the risk of congenital heart defects by carefully controlling your diabetes before attempting to conceive and during pregnancy. Gestational diabetes generally doesn't increase your baby's risk of developing a heart defect. - Medications. Certain medications taken during pregnancy may cause birth defects, including congenital heart defects. Give your doctor a complete list of medications you take before attempting to become pregnant. Medications known to increase the risk of congenital heart defects include thalidomide (Thalomid), angiotensin-converting enzyme (ACE) inhibitors, statins, the acne medication isotretinoin (Absorica, Amnesteem, Claravis) and lithium. - Drinking alcohol during pregnancy. Avoid alcohol during pregnancy because it increases the risk of congenital heart defects. - Smoking. Smoking during pregnancy increases the likelihood of a congenital heart defect in the baby. - Heredity. Congenital heart defects sometimes run in families and may be associated with a genetic syndrome. Many children with Down syndrome - which is caused by an extra 21st chromosome (trisomy 21) - have heart defects. A missing piece (deletion) of genetic material on chromosome 22 also causes heart defects. Genetic testing can detect such disorders during fetal development. If you already have a child with a congenital heart defect, a genetic counselor can estimate the odds that your next child will have one. Complications Some potential complications that can occur with a congenital heart defect include: - Congestive heart failure. This serious complication may develop in babies who have a significant heart defect. Signs of congestive heart failure include rapid breathing, often with gasping breaths, and poor weight gain. - Slower growth and development. Children with more-serious congenital heart defects often develop and grow more slowly than do children who don't have heart defects. They may be smaller than other children of the same age and, if the nervous system has been affected, may learn to walk and talk later than other children. - Heart rhythm problems. Heart rhythm problems (arrhythmias) can be caused by a congenital heart defect or from scarring that forms after surgery to correct a congenital heart defect. - Cyanosis. If your child's heart defect causes oxygen-poor blood to mix with oxygen-rich blood in his or her heart, your child may develop a grayish-blue skin color, a condition called cyanosis. - Stroke. Although uncommon, some children with congenital heart defects are at increased risk of stroke due to blood clots traveling through a hole in the heart and on to the brain. - Emotional issues. Some children with congenital heart defects may feel insecure or develop emotional problems because of their size, activity restrictions or learning difficulties. Talk to your child's doctor if you're concerned about your child's moods. - A need for lifelong follow-up. Children who have heart defects should be mindful of their heart problems their entire lives, as their defect could lead to an increased risk of heart tissue infection (endocarditis), heart failure or heart valve problems. Most children with congenital heart defects will need to be seen regularly by a cardiologist throughout life. Diagnosis Your child's doctor may initially suspect a problem because he or she hears a heart murmur during a routine exam. A heart murmur is a sound that occurs when blood flows through the heart or blood vessels fast enough to make a sound that a doctor can hear with a stethoscope. Most heart murmurs are innocent, meaning that there is no heart defect and the murmur isn't dangerous to your child's health. Some murmurs, however, may mean blood is flowing through your child's heart abnormally because he or she has a heart defect. Tests to diagnose a congenital heart defect If it's possible your child has a heart defect, your doctor or your child's doctor may order several tests to see if your child has a heart problem. In addition to a regular physical exam, these could include: - Fetal echocardiogram. This test allows your doctor to see if your child has a heart defect before he or she is born, allowing your doctor to better plan treatment. In this test, your doctor performs an ultrasound. The sound waves from the ultrasound are used to create a picture of your baby's heart. - Echocardiogram. Your child's doctor may use a regular echocardiogram to diagnose a congenital heart defect after your child has been born. In this noninvasive test, your child's doctor performs an ultrasound to produce images of the heart. An echocardiogram allows the doctor to see your child's heart in motion and to identify abnormalities in the heart muscle and valves. - Electrocardiogram. This noninvasive test records the electrical activity of your child's heart and can help diagnose heart defects or rhythm problems. Electrodes connected to a computer and printer are placed on your baby's chest and show waves that indicate how your child's heart is beating. - Chest X-ray. Your child may have a chest X-ray to see if the heart is enlarged, or if the lungs have extra blood or other fluid in them. These could be signs of heart failure. - Pulse oximetry. This test measures how much oxygen is in your child's blood. A sensor is placed over the end of your child's finger to record the amount of oxygen in your child's blood. Too little oxygen could suggest your child has a heart problem. - Cardiac catheterization. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at your baby's groin and guided through it into the heart. Catheterization is sometimes necessary because it may give your child's doctor a much more detailed view of your child's heart defect than an echocardiogram. In addition, some treatment procedures can be done during cardiac catheterization. - Cardiovascular magnetic resonance imaging (MRI). This type of imaging is becoming increasingly used to diagnose and evaluate congenital heart defects in adolescents and adults. Newer MRI technology provides faster imaging and higher resolution than other methods, such as echocardiography. Treatment A congenital heart defect may have no long-term effect on your child's health - in some instances, such defects can safely go untreated. Certain defects, such as small holes, may even correct themselves as your child ages. Some heart defects, however, are serious and require treatment soon after they're found. Depending on the type of heart defect your child has, doctors treat congenital heart defects with: - Procedures using catheterization. Some children and adults now have their congenital heart defects repaired using catheterization techniques, which allow the repair to be done without surgically opening the chest and heart. Catheter procedures can often be used to fix holes or areas of narrowing. In procedures that can be done using catheterization, the doctor inserts a thin tube (catheter) into a leg vein and guides it to the heart with the help of X-ray images. Once the catheter is positioned at the site of the defect, tiny tools are threaded through the catheter to the heart to repair the defect. - Open-heart surgery. Depending on your child's condition, he or she may need surgery to repair the defect. Many congenital heart defects are corrected using open-heart surgery. In open-heart surgery, the chest has to be opened. In some cases, minimally invasive heart surgery may be an option. This type of surgery involves making small incisions between the ribs and inserting instruments through them to repair the defect. - Heart transplant. If a serious heart defect can't be repaired, a heart transplant may be an option. - Medications. Some mild congenital heart defects, especially those found later in childhood or adulthood, can be treated with medications that help the heart work more efficiently. Drugs known as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) and beta blockers and medications that cause fluid loss (diuretics) can help ease stress on the heart by lowering blood pressure, heart rate and the amount of fluid in the chest. Certain medications can also be prescribed to help irregular heartbeats (arrhythmias). Sometimes, a combination of treatments is necessary. In addition, some catheter or surgical procedures have to be done in steps, over a period of years. Others may need to be repeated as a child grows. Long-term treatment Some children with congenital heart defects require multiple procedures and surgeries throughout life. Although the outcomes for children with heart defects have improved dramatically, most people, except those with very simple defects, will require ongoing care, even after corrective surgery. - Lifelong monitoring and treatment. Even if your child has surgery to treat a heart defect, your child's condition will need to be monitored for the rest of his or her life. Initially, your child with a congenital heart defect will be monitored and have regular follow-up appointments with a pediatric cardiologist. As your child grows older, his or her care will transition to an adult congenital cardiologist, who can monitor his or her condition over time. A congenital heart defect can affect your child's adult life, as it can contribute to other health problems. Adults who have congenital heart defects may need other treatments for their condition. As your child ages, it's important to remind him or her of the heart condition that was corrected and the need for ongoing, lifelong care by doctors experienced in evaluating and treating congenital heart disease. Encourage your child to keep his or her doctor informed about the heart defect and the procedures performed to treat the problem. - Exercise restrictions. Parents of children with congenital heart defects may worry about the risks of rough play and activity even after treatment. Although some children may need to limit the amount or type of exercise, many can participate in normal or near-normal activity. Your child's doctor can tell you which activities are safe for your child. If some activities do pose distinct dangers, encourage your child to participate in other activities instead of focusing on what he or she can't do. Although every child is different, most children with congenital heart defects grow up to lead healthy, productive lives. - Infection prevention. Depending on the type of congenital heart defect your child had, and the surgery used to correct it, your child may need to take extra steps to prevent infection. Sometimes, a congenital heart defect can increase the risk of infections - either in the lining of the heart or heart valves (infective endocarditis). Because of this risk, your child may need to take antibiotics to prevent infection before additional surgeries or dental procedures. Children who are most likely to have a higher risk of infection include those whose defect was repaired with a prosthetic material or device, such as an artificial heart valve. Ask your child's cardiologist if preventive antibiotics are necessary for your child.
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Diverticulitis Overview Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are found most often in the lower part of the large intestine (colon). Diverticula are common, especially after age 40, and seldom cause problems. Sometimes, however, one or more of the pouches become inflamed or infected. That condition is known as diverticulitis (die-vur-tik-yoo-LIE-tis). Diverticulitis can cause severe abdominal pain, fever, nausea and a marked change in your bowel habits. Mild diverticulitis can be treated with rest, changes in your diet and antibiotics. Severe or recurring diverticulitis may require surgery. Symptoms The signs and symptoms of diverticulitis include: - Pain, which may be constant and persist for several days. Pain is usually felt in the lower left side of the abdomen, but may occur on the right, especially in people of Asian descent. - Nausea and vomiting. - Fever. - Abdominal tenderness. - Constipation or, less commonly, diarrhea. Causes Diverticula usually develop when naturally weak places in your colon give way under pressure. This causes marble-sized pouches to protrude through the colon wall. Diverticulitis occurs when diverticula tear, resulting in inflammation or infection or both. Risk factors Several factors may increase your risk of developing diverticulitis: - Aging. The incidence of diverticulitis increases with age. - Obesity. Being seriously overweight increases your odds of developing diverticulitis. Morbid obesity may increase your risk of needing more-invasive treatments for diverticulitis. - Smoking. People who smoke cigarettes are more likely than nonsmokers to experience diverticulitis. - Lack of exercise. Vigorous exercise appears to lower your risk of diverticulitis. - Diet high in animal fat and low in fiber, although the role of low fiber alone isn't clear. - Certain medications. Several drugs are associated with an increased risk of diverticulitis, including steroids, opiates and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). Diagnosis Diverticulitis is usually diagnosed during an acute attack. Because abdominal pain can indicate a number of problems, your doctor will need to rule out other causes for your symptoms. Your doctor will likely start with a physical examination, including checking your abdomen for tenderness. Women, in addition, generally have a pelvic examination to rule out pelvic disease. After that, your doctor will likely recommend: - Blood and urine tests, to check for signs of infection. - Pregnancy test for women of childbearing age, to rule out pregnancy as a cause of abdominal pain. - Liver function tests, to rule out other causes of abdominal pain. - Stool test, to rule out infection in people who have diarrhea. - CT scan, which can indicate inflamed or infected pouches and confirm a diagnosis of diverticulitis. CT can also indicate the severity of diverticulitis and guide treatment. Diagnosis at Mayo Clinic Diverticulitis can be difficult to diagnose because abdominal pain is a symptom of many digestive disorders. Mayo Clinic has radiologists who specialize in digestive disorders and have experience distinguishing diverticulitis from other conditions. Mayo's digestive disease specialists (gastroenterologists) have experience diagnosing the severity of diverticulitis. Precise diagnosis is important for appropriate treatment. Treatment Treatment depends on the severity of your signs and symptoms. Uncomplicated diverticulitis If your symptoms are mild, you may be treated at home. Your doctor is likely to recommend: - Antibiotics, to treat infection. - A liquid diet for a few days while your bowel heals. Once your symptoms improve, you can gradually add solid food to your diet. - An over-the-counter pain reliever, such as acetaminophen (Tylenol, others). This treatment is successful in 70 to 100 percent of people with uncomplicated diverticulitis. Complicated diverticulitis If you have a severe attack or have other health problems, you'll likely need to be hospitalized. Treatment generally involves: - Intravenous antibiotics - Insertion of a tube to drain an abscess, if one has formed Surgery You'll likely need surgery to treat diverticulitis if: - You have a complication, such as perforation, abscess, fistula or bowel obstruction - You have had multiple episodes of uncomplicated diverticulitis - You are immune compromised There are two main types of surgery: - Primary bowel resection. The surgeon removes diseased segments of your intestine and then reconnects the healthy segments (anastomosis). This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open surgery or a minimally invasive (laparoscopic) procedure. - Bowel resection with colostomy. If you have so much inflammation that it's not possible to rejoin your colon and rectum, the surgeon will perform a colostomy. An opening (stoma) in your abdominal wall is connected to the healthy part of your colon. Waste passes through the opening into a bag. Once the inflammation has eased, the colostomy may be reversed and the bowel reconnected. Follow-up care Your doctor may recommend colonoscopy six weeks after you recover from diverticulitis, especially if you haven't had the test in the previous year. There doesn't appear to be a direct link between diverticular disease and colon or rectal cancer. But colonoscopy - which isn't possible during a diverticulitis attack - can exclude colon cancer as a cause of your symptoms. Sometimes, surgery is recommended. But previous recommendations for surgery based on the number of attacks have been questioned, since most people do well even after two or more attacks. The decision on surgery is an individual one, and is often based on the frequency of attacks and whether complications have occurred. Treatment at Mayo Clinic Mayo Clinic specialists have experience treating both mild and severe diverticulitis. If you need surgery, Mayo surgeons can offer minimally invasive options - including laparoscopic, hand-assisted laparoscopic and robotic procedures - if appropriate. Lifestyle and home remedies To help prevent diverticulitis: - Exercise regularly. Exercise promotes normal bowel function and reduces pressure inside your colon. Try to exercise at least 30 minutes on most days. - Eat more fiber. High-fiber foods, such as fresh fruits and vegetables and whole grains, soften waste material and help it pass more quickly through your colon. This reduces pressure inside your digestive tract. However, it isn't clear whether a high-fiber diet decreases the risk of diverticulitis. Eating seeds and nuts isn't associated with developing diverticulitis. - Drink plenty of fluids. Fiber works by absorbing water and increasing the soft, bulky waste in your colon. But if you don't drink enough liquid to replace what's absorbed, fiber can be constipating. Alternative medicine Some experts suspect that people who develop diverticulitis may not have enough good bacteria in their colons. Probiotics - foods or supplements that contain beneficial bacteria - are sometimes suggested as a way to prevent diverticulitis. But that advice hasn't been scientifically validated.
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Cystic fibrosis Overview Cystic fibrosis is an inherited disorder that causes severe damage to the lungs, digestive system and other organs in the body. Cystic fibrosis affects the cells that produce mucus, sweat and digestive juices. These secreted fluids are normally thin and slippery. But in people with cystic fibrosis, a defective gene causes the secretions to become sticky and thick. Instead of acting as a lubricant, the secretions plug up tubes, ducts and passageways, especially in the lungs and pancreas. Although cystic fibrosis requires daily care, people with the condition are usually able to attend school and work, and often have a better quality of life than people with cystic fibrosis had in previous decades. Improvements in screening and treatments mean people with cystic fibrosis now may live into their mid- to late 30s, on average, and some are living into their 40s and 50s. Cystic fibrosis care at Mayo Clinic Symptoms Screening of newborns for cystic fibrosis is now performed in every state in the United States. As a result, the condition can be diagnosed within the first month of life, before symptoms develop. For people born before newborn screening was performed, it's important to be aware of the signs and symptoms of cystic fibrosis. Cystic fibrosis signs and symptoms vary, depending on the severity of the disease. Even in the same person, symptoms may worsen or improve as time passes. Some people may not experience symptoms until adolescence or adulthood. People with cystic fibrosis have a higher than normal level of salt in their sweat. Parents often can taste the salt when they kiss their children. Most of the other signs and symptoms of cystic fibrosis affect the respiratory system and digestive system. However, adults diagnosed with cystic fibrosis are more likely to have atypical symptoms, such as recurring bouts of inflamed pancreas (pancreatitis), infertility and recurring pneumonia. The thick and sticky mucus associated with cystic fibrosis clogs the tubes that carry air in and out of your lungs. This can cause signs and symptoms such as: - A persistent cough that produces thick mucus (sputum) - Wheezing - Breathlessness - Exercise intolerance - Repeated lung infections - Inflamed nasal passages or a stuffy nose The thick mucus can also block tubes that carry digestive enzymes from your pancreas to your small intestine. Without these digestive enzymes, your intestines aren't able to completely absorb the nutrients in the food you eat. The result is often: - Foul-smelling, greasy stools - Poor weight gain and growth - Intestinal blockage, particularly in newborns (meconium ileus) - Severe constipation Frequent straining while passing stool can cause part of the rectum - the end of the large intestine - to protrude outside the anus (rectal prolapse). When this occurs in children, it may be a sign of cystic fibrosis. Parents should consult a physician knowledgeable about cystic fibrosis. Rectal prolapse in children may sometimes require surgery. Rectal prolapse in children with cystic fibrosis is less common than it was in the past, which may be due to earlier testing, diagnosis and treatment of cystic fibrosis. If you or your child has symptoms of cystic fibrosis - or if someone in your family has cystic fibrosis - talk with your doctor about testing for the disease. Seek immediate medical care if you or your child has difficulty breathing. Causes In cystic fibrosis, a defect (mutation) in a gene changes a protein that regulates the movement of salt in and out of cells. The result is thick, sticky mucus in the respiratory, digestive and reproductive systems, as well as increased salt in sweat. Many different defects can occur in the gene. The type of gene mutation is associated with the severity of the condition. Children need to inherit one copy of the gene from each parent in order to have the disease. If children inherit only one copy, they won't develop cystic fibrosis. However, they will be carriers and possibly pass the gene to their own children. Risk factors - Family history. Because cystic fibrosis is an inherited disorder, it runs in families. - Race. Although cystic fibrosis occurs in all races, it is most common in white people of Northern European ancestry. Complications - Damaged airways (bronchiectasis). Cystic fibrosis is one of the leading causes of bronchiectasis, a condition that damages the airways. This makes it harder to move air in and out of the lungs and clear mucus from the airways (bronchial tubes). - Chronic infections. Thick mucus in the lungs and sinuses provides an ideal breeding ground for bacteria and fungi. People with cystic fibrosis may often have sinus infections, bronchitis or pneumonia. - Growths in the nose (nasal polyps). Because the lining inside the nose is inflamed and swollen, it can develop soft, fleshy growths (polyps). - Coughing up blood (hemoptysis). Over time, cystic fibrosis can cause thinning of the airway walls. As a result, teenagers and adults with cystic fibrosis may cough up blood. - Pneumothorax. This condition, in which air collects in the space that separates the lungs from the chest wall, also is more common in older people with cystic fibrosis. Pneumothorax can cause chest pain and breathlessness. - Respiratory failure. Over time, cystic fibrosis can damage lung tissue so badly that it no longer works. Lung function usually worsens gradually, and it eventually can become life-threatening. - Acute exacerbations. People with cystic fibrosis may experience worsening of their respiratory symptoms, such as coughing and shortness of breath, for several days to weeks. This is called an acute exacerbation and requires treatment in the hospital. - Nutritional deficiencies. Thick mucus can block the tubes that carry digestive enzymes from your pancreas to your intestines. Without these enzymes, your body can't absorb protein, fats or fat-soluble vitamins. - Diabetes. The pancreas produces insulin, which your body needs to use sugar. Cystic fibrosis increases the risk of diabetes. Around 30 percent of people with cystic fibrosis develop diabetes by age 30. - Blocked bile duct. The tube that carries bile from your liver and gallbladder to your small intestine may become blocked and inflamed, leading to liver problems and sometimes gallstones. - Intestinal obstruction. Intestinal obstruction can happen to people with cystic fibrosis at all ages. Children and adults with cystic fibrosis are more likely than are infants to develop intussusception, a condition in which a section of the intestines folds in on itself like an accordion. - Distal intestinal obstruction syndrome (DIOS). DIOS is partial or complete obstruction where the small intestine meets the large intestine. Almost all men with cystic fibrosis are infertile because the tube that connects the testes and prostate gland (vas deferens) is either blocked with mucus or missing entirely. Certain fertility treatments and surgical procedures sometimes make it possible for men with cystic fibrosis to become biological fathers. Although women with cystic fibrosis may be less fertile than other women, it's possible for them to conceive and to have successful pregnancies. Still, pregnancy can worsen the signs and symptoms of cystic fibrosis, so be sure to discuss the possible risks with your doctor. - Thinning of the bones (osteoporosis). People with cystic fibrosis are at higher risk of developing a dangerous thinning of bones. - Electrolyte imbalances and dehydration. Because people with cystic fibrosis have saltier sweat, the balance of minerals in their blood may be upset. Signs and symptoms include increased heart rate, fatigue, weakness and low blood pressure. Diagnosis To diagnose cystic fibrosis, doctors may conduct several tests. Newborn screening and diagnosis Every state in the U.S. now routinely screens newborns for cystic fibrosis. Early diagnosis means treatment can begin immediately. In one screening test, a blood sample is checked for higher than normal levels of a chemical (immunoreactive trypsinogen, or IRT) released by the pancreas. A newborn's IRT levels may be high because of premature birth or a stressful delivery. For that reason other tests may be needed to confirm a diagnosis of cystic fibrosis. Genetic tests may be used in addition to checking the IRT levels to confirm the diagnosis. Doctors may also conduct genetic tests to test for specific defects on the gene responsible for cystic fibrosis. To evaluate if an infant has cystic fibrosis, doctors may also conduct a sweat test when the infant is at least 2 weeks old. In a sweat test, doctors apply a sweat-producing chemical to a small area of skin. They then collect the sweat to test it and see if it's saltier than normal. Testing may be done at a center specializing in cystic fibrosis. Testing of older children and adults Cystic fibrosis tests may be recommended for older children and adults who weren't screened at birth. Your doctor may suggest genetic and sweat tests for cystic fibrosis if you have recurring bouts of inflamed pancreas (pancreatitis), nasal polyps, chronic sinus or lung infections, bronchiectasis, or male infertility. Treatment There is no cure for cystic fibrosis, but treatment can ease symptoms and reduce complications. Close monitoring and early, aggressive intervention is recommended. Managing cystic fibrosis is complex, so consider obtaining treatment at a center staffed by doctors and other staff trained in cystic fibrosis. Doctors may work with a multidisciplinary team of doctors and medical professionals trained in cystic fibrosis to evaluate and treat your condition. The goals of treatment include: - Preventing and controlling infections that occur in the lungs - Removing and loosening mucus from the lungs - Treating and preventing intestinal blockage - Providing adequate nutrition Medications The options may include: - Antibiotics to treat and prevent lung infections - Anti-inflammatory medications to lessen swelling in the airways in your lungs - Mucus-thinning drugs to help you cough up the mucus, which can improve lung function - Inhaled medications called bronchodilators that can help keep your airways open by relaxing the muscles around your bronchial tubes - Oral pancreatic enzymes to help your digestive tract absorb nutrients For those with cystic fibrosis who have certain gene mutations, doctors may recommend a newer medication called ivacaftor (Kalydeco). This medication may improve lung function and weight, and reduce the amount of salt in sweat. It has been approved by the Food and Drug Administration for people with cystic fibrosis who are age 6 and older. The dose depends on your weight and age. Doctors may conduct liver function tests and eye examinations before prescribing ivacaftor and on a regular basis while you're taking it to check for side effects such as liver function abnormalities and cataracts. For people with a certain gene mutation who are age 12 and older, another drug (Orkambi) is available that combines ivacaftor with a medication called lumacaftor. The combination of these medications may improve lung function and reduce the risk of exacerbations. However, some people may experience side effects such as chest discomfort and shortness of breath soon after starting the medication. Some people may also have high blood pressure while taking the medication. Doctors may monitor you for any side effects. Chest physical therapy Loosening the thick mucus in the lungs makes it easier to cough up. Chest physical therapy helps loosen mucus. It is usually done from one to four times a day. A common technique is clapping with cupped hands on the front and back of the chest. Certain breathing techniques also may be used to help loosen the mucus. Your doctor will instruct you about the type of chest physical therapy he or she recommends for you. Mechanical devices also can help loosen lung mucus. These include a vibrating vest or a tube or mask you breathe into. Pulmonary rehabilitation Your doctor may recommend a long-term program that may improve your lung function and overall well-being. Pulmonary rehabilitation is usually done on an outpatient basis and may include: - Physical exercise that may improve your condition - Breathing techniques that may help loosen mucus and improve breathing - Nutritional counseling - Counseling and support - Education about your condition Surgical and other procedures - Nasal polyp removal. Your doctor may recommend surgery to remove nasal polyps that obstruct breathing. - Oxygen therapy. If your blood oxygen level declines, your doctor may recommend that you breathe pure oxygen to prevent high blood pressure in the lungs (pulmonary hypertension). - Endoscopy and lavage. Mucus may be suctioned from obstructed airways through an endoscope. - Feeding tube. Cystic fibrosis interferes with digestion, so you can't absorb nutrients from food very well. Your doctor may suggest temporarily using a feeding tube to deliver extra nutrition while you sleep. This tube may be inserted in your nose and guided to your stomach, or it may be surgically implanted into the abdomen. - Bowel surgery. If a blockage develops in your bowel, you may need surgery to remove it. Intussusception, where a section of bowel has folded in on itself, also may require surgical repair. - Lung transplant. If you have severe breathing problems, life-threatening lung complications or increasing resistance to antibiotics used to treat lung infections, lung transplantation may be an option. Because bacteria line the airways in diseases that cause permanent widening of the large airways (bronchiectasis), such as cystic fibrosis, both lungs need to be replaced. Cystic fibrosis does not recur in transplanted lungs. However, other complications associated with cystic fibrosis - such as sinus infections, diabetes, pancreas problems and osteoporosis - can still occur after a lung transplant. Lifestyle and home remedies You can manage your condition and minimize complications in several ways. Always talk to your doctor before starting home remedies. Cystic fibrosis can cause malnourishment because the enzymes needed for digestion can't reach your small intestine, preventing food from being absorbed. People with cystic fibrosis may need a significantly higher number of calories daily than do people without the condition. A healthy diet is important to maintain good lung function. It's also important to drink lots of fluids, which can help thin the mucus in your lungs. You may work with a dietitian to develop a nutrition plan. Most people with cystic fibrosis need to take pancreatic enzyme capsules with every meal and snack. In addition, your doctor may recommend: - Antacids - Supplemental high-calorie nutrition - Special fat-soluble vitamins - Extra fiber to prevent intestinal blockage - Extra salt, especially during hot weather or before exercising - Adequate water during hot weather In addition to other usual childhood vaccines, people with cystic fibrosis should have the annual flu vaccine and any other vaccines their doctor recommends. Cystic fibrosis doesn't affect the immune system, but children with cystic fibrosis are more likely to develop complications when they become sick. Regular exercise helps loosen mucus in your airways, and strengthens your heart. For many people with cystic fibrosis, participating in sports can improve confidence and self-esteem. Anything that gets you moving, including walking and biking, can help. Don't smoke in your home or car, and don't allow other people to smoke around you or your child. Secondhand smoke is harmful for everyone, but especially for people with cystic fibrosis. Teach all the members of your family to wash their hands thoroughly before eating, after using the bathroom, when coming home from work or school, and after being around a person who is sick. Hand-washing is the best way to protect against infection. You'll have ongoing care from your doctor and other medical professionals. Make sure to attend your regular follow-up appointments. Take your medications as prescribed and follow therapies as instructed. Contact your doctor if you experience any signs or symptoms such as severe constipation, more mucus than usual, blood in your mucus or reduced energy.
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Asthma Bronchial asthma Wheezing - asthma - adults Summary Asthma is a disease that causes the airways of the lungs to swell and narrow. It leads to wheezing, shortness of breath, chest tightness, and coughing. Causes Asthma is caused by swelling (inflammation) in the airways. When an asthma attack occurs, the lining of the air passages swells and the muscles surrounding the airways become tight. This reduces the amount of air that can pass through the airway. In people who have sensitive airways, asthma symptoms can be triggered by breathing in substances called allergens or triggers. Common asthma triggers include: Animals (pet hair or dander) Dust mites Certain medicines (aspirin and other NSAIDS) Changes in weather (most often cold weather) Chemicals in the air or in food Exercise Mold Pollen Respiratory infections, such as the common cold Strong emotions (stress) Tobacco smoke Substances in some workplaces can also trigger asthma symptoms, leading to occupational asthma. The most common triggers are wood dust, grain dust, animal dander, fungi, or chemicals. Many people with asthma have a personal or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies. Symptoms Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom. Asthma attacks can last for minutes to days. Attacks can become dangerous if airflow is severely blocked. Symptoms of asthma include: Cough with or without sputum (phlegm) production Pulling in of the skin between the ribs when breathing (intercostal retractions) Shortness of breath that gets worse with exercise or activity Wheezing Emergency symptoms that need prompt medical help include: Bluish color to the lips and face Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack Extreme difficulty breathing Rapid pulse Severe anxiety due to shortness of breath Sweating Other symptoms that may occur: Abnormal breathing pattern -- breathing out takes more than twice as long as breathing in Breathing temporarily stops Chest pain Tightness in the chest Exams and Tests The health care provider will use a stethoscope to listen to your lungs. Wheezing or other asthma-related sounds may be heard. Tests that may be ordered include: Allergy testing -- skin or a blood test to see if a person with asthma is allergic to certain substances Arterial blood gas (usually only done with people who are having a severe asthma attack) Chest x-ray Lung function tests, including peak flow measurements Treatment The goals of treatment are: Control airway swelling Stay away from substances that trigger your symptoms Help you to be able to do normal activities without asthma symptoms You and your doctor should work as a team to manage your asthma. Follow your doctor's instructions on taking medicines, eliminating asthma triggers, and monitoring symptoms. MEDICINES FOR ASTHMA There are two kinds of medicines for treating asthma: Control medicines to help prevent attacks Quick-relief (rescue) medicines for use during attacks LONG-TERM MEDICINES These are also called maintenance or control medicines. They are used to prevent symptoms in people with moderate to severe asthma. You must take them every day for them to work. Take them even when you feel OK. Some long-term medicines are breathed in (inhaled), such as steroids and long-acting beta-agonists. Others are taken by mouth (orally). Your doctor will prescribe the right medicine for you. QUICK-RELIEF MEDICINES These are also called rescue medicines. They are taken: For coughing, wheezing, trouble breathing, or an asthma attack Just before exercising to help prevent asthma symptoms caused by exercise Tell your doctor if you are using quick-relief medicines twice a week or more. If so, your asthma may not be under control and your doctor may need to change your dose of daily control drugs. Quick-relief medicines include: Short-acting inhaled bronchodilators Oral corticosteroids for when you have an asthma attack that is not going away A severe asthma attack requires a checkup by a doctor. You may also need a hospital stay. There, you will likely be given oxygen, breathing assistance, and medicines given through a vein (IV). ASTHMA CARE AT HOME Know the asthma symptoms to watch for. Know how to take your peak flow reading and what it means. Know which triggers make your asthma worse and what to do when this happens. Know how to care for your asthma when you exercise. Asthma action plans are written documents for managing asthma. An asthma action plan should include: Instructions for taking asthma medicines when your condition is stable A list of asthma triggers and how to avoid them How to recognize when your asthma is getting worse, and when to call your provider A peak flow meter is a simple device to measure how quickly you can move air out of your lungs. It can help you see if an attack is coming, sometimes even before symptoms appear. Peak flow measurements help let you know when you need to take medicine or other action. Peak flow values of 50% to 80% of your best results are a sign of a moderate asthma attack. Numbers below 50% are a sign of a severe attack. Outlook (Prognosis) There is no cure for asthma, although symptoms sometimes improve over time. With proper self-management and medical treatment, most people with asthma can lead a normal life. Possible Complications The complications of asthma can be severe, and may include: Death Decreased ability to exercise and take part in other activities Lack of sleep due to nighttime symptoms Permanent changes in the function of the lungs Persistent cough Trouble breathing that requires breathing assistance (ventilator) When to Contact a Medical Professional Call for an appointment with your provider if asthma symptoms develop. Call your provider or go to the emergency room if: An asthma attack requires more medicine than recommended Symptoms get worse or do not improve with treatment You have shortness of breath while talking Your peak flow measurement is 50% to 80% of your personal best Go to the emergency room if these symptoms occur: Drowsiness or confusion Severe shortness of breath at rest A peak flow measurement of less than 50% of your personal best Severe chest pain Bluish color to the lips and face Extreme difficulty breathing Rapid pulse Severe anxiety due to shortness of breath Prevention You can reduce asthma symptoms by avoiding triggers and substances that irritate the airways. Cover bedding with allergy-proof casings to reduce exposure to dust mites. Remove carpets from bedrooms and vacuum regularly. Use only unscented detergents and cleaning materials in the home. Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold. Keep the house clean and keep food in containers and out of bedrooms. This helps reduce the possibility of cockroaches. Body parts and droppings from cockroaches can trigger asthma attacks in some people. If someone is allergic to an animal that cannot be removed from the home, the animal should be kept out of the bedroom. Place filtering material over the heating outlets to trap animal dander. Change the filter in furnaces and air conditioners often. Eliminate tobacco smoke from the home. This is the single most important thing a family can do to help someone with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair. This can trigger asthma symptoms. If you smoke, now is a good time to quit. Avoid air pollution, industrial dust, and irritating fumes as much as possible. Review Date 2/19/2018 Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Diabetes Overview Diabetes is a disease in which blood sugar (glucose) levels in your body are too high. Diabetes can cause serious health problems, including heart attack or stroke, blindness, problems during pregnancy, and kidney failure. More than 13 million women have diabetes, or about one in 10 women ages 20 and older.1 What is diabetes? Diabetes is a disease caused by high levels of blood sugar (glucose) in your body. This can happen when your body does not make insulin or does not use insulin correctly. Insulin is a hormone made in the pancreas, an organ near your stomach. Insulin helps the glucose from food get into your body's cells for energy. If your body does not make enough insulin, or your body does not use the insulin correctly, the glucose stays and builds up in your blood. Over time, this extra glucose can lead to prediabetes or diabetes. Diabetes puts you at risk for other serious and life-threatening health problems, such as heart disease, stroke, blindness, and kidney damage. What are the different types of diabetes? The three main types of diabetes are: Am I at risk for diabetes? A risk factor is something that puts you at a higher risk for a disease compared with an average person. Risk factors for type 1 diabetes in women and girls include: Risk factors for type 2 diabetes in women and girls include:4 If you have any of these risk factors, talk to your doctor about ways to lower your risk for diabetes. You can also take the Diabetes Risk Test and talk about the results with your doctor. Who gets diabetes? Type 1 diabetes usually develops in childhood, but it can happen at any age. It is more common in whites than in other racial or ethnic groups. About 5% of adults with diabetes have type 1 diabetes.1 Genes you inherit from your parents play an important role in the development of type 1 diabetes. However, where you live may also affect your risk. Type 1 diabetes develops more often in winter and in people who live in colder climates. Type 2 diabetes is more common in adults, especially in people who are overweight and have a family history of diabetes. About 95% of adults with diabetes have type 2 diabetes.1 Type 2 diabetes is becoming more common in children and teens as more of them become overweight and obese.5 Do women of color need to worry about diabetes? Yes. Certain racial and ethnic groups have a higher risk for type 2 diabetes. These groups include: How does diabetes affect women differently than men? Diabetes affects women and men in almost equal numbers. However, diabetes affects women differently than men. Compared with men with diabetes, women with diabetes have:9 Does diabetes raise my risk for other health problems? Yes. The longer you have type 2 diabetes, the higher your risk for developing serious medical problems from diabetes. Also, if you smoke and have diabetes, you are even more likely to develop serious medical problems from diabetes, compared with people who have diabetes and do not smoke.11 The extra glucose in the blood that leads to diabetes can damage your nerves and blood vessels. Nerve damage from diabetes can lead to pain or a permanent loss of feeling in your hands, feet, and other parts of your body.12 Blood vessel damage from diabetes can also lead to: Women with diabetes are also at higher risk for: What causes diabetes? Researchers do not know the exact causes of type 1 and type 2 diabetes. Researchers do know that inheriting certain genes from your family can raise your risk for developing diabetes. Obesity is also a major risk factor for type 2 diabetes. Smoking can also cause type 2 diabetes. And the more you smoke the higher your risk for type 2 diabetes and other serious health problems if you already have diabetes.13 Weight loss can help control type 2 diabetes so that you are healthier. Quitting smoking can also help you control your blood sugar levels. Being a healthy weight and not smoking can help all women be healthier. But, obesity and smoking do not always cause diabetes. Some women who are overweight or obese or smoke never develop diabetes. Also, women who are a normal weight or only slightly overweight can develop diabetes if they have other risk factors, such as a family history of diabetes. What are the signs and symptoms of diabetes? Type 1 diabetes symptoms are usually more severe and may develop suddenly. Type 2 diabetes may not cause any signs or symptoms at first. Symptoms can develop slowly over time. You may not notice them right away. Common signs and symptoms of type 1 and type 2 diabetes include: Do I need to be tested for diabetes? Maybe. You should be tested for diabetes if you are between 40 and 70 years old and are overweight or obese. Your doctor may recommend testing earlier than age 40 if you also have other risk factors for diabetes. Also, talk to your doctor about diabetes testing if you have signs or symptoms of diabetes. Your doctor will use a blood test to see if you have diabetes. If the testing shows that your blood sugar levels are high, you can begin making healthy changes to your eating habits and getting more physical activity to help prevent diabetes. What is prediabetes? Prediabetes means your blood sugar (glucose) level is higher than normal, but it is lower than the diabetes range. It also means you are at higher risk of getting type 2 diabetes and heart disease. As many as 27 million American women have prediabetes.14 If you have prediabetes, you can make healthy changes, such as doing some type of physical activity on most days, to lower your risk of getting diabetes and return to normal blood sugar levels. Losing 7% of your body weight (or 14 pounds if you weigh 200 pounds) can lower your risk for type 2 diabetes by more than half. If you have prediabetes, get your blood glucose checked every year by a doctor or nurse.15 How is diabetes treated? Diabetes treatment includes managing your blood sugar levels to control your symptoms. You can help control your blood sugar levels by eating healthy and getting regular physical activity. With type 1 diabetes, you also will need to take insulin through shots or an insulin pump. Insulin cannot be taken as a pill. Type 2 diabetes treatment also may include taking medicine to control your blood sugar. Over time, people with type 2 diabetes make less and less of their own insulin. This may mean that you will need to increase your medicines or start taking insulin shots to keep your diabetes in control. Learn more about controlling diabetes at the National Diabetes Education Program website. Is there anything I can do to prevent type 1 diabetes? Researchers do not know how to prevent type 1 diabetes. Researchers are still looking for ways to prevent type 1 diabetes in women and girls by studying their close relatives who have diabetes. Is there anything I can do to prevent type 2 diabetes? Yes. Many studies, including the large Diabetes Prevention Program study, have proven that you can prevent diabetes by losing weight. Weight loss through healthy eating and more physical activity improves the way your body uses insulin and glucose. Learn how to eat healthier and get more physical activity. Is it safe for women with diabetes to get pregnant? Yes. If you have type 1 or type 2 diabetes, you can have a healthy pregnancy. If you have diabetes and you want to have a baby, you need to plan ahead, before you get pregnant. Talk to your doctor before you get pregnant. He or she can talk to you about steps you can take to keep your baby healthy. This may include a diabetes education program to help you better understand your diabetes and how to control it during pregnancy. Did we answer your question about diabetes? For more information about diabetes, call the OWH Helpline at 1-800-994-9662 or contact the following organizations: Sources
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Rasagiline: Rasagiline is used alone or in combination with another medication to treat the symptoms of Parkinson's disease (a slowly progressing disease of the nervous system causing a fixed face without expression, tremor at rest, slowing of movements, walking with shuffling steps, stooped posture and muscle weakness). Rasagiline is in a class of medications called monoamine oxidase (MAO) type B inhibitors. It works by increasing the amounts of certain natural substances in the brain. Rasagiline comes as a tablet to take by mouth. It is usually taken once a day with or without food. Take rasagiline at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take rasagiline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor may start you on a low dose of rasagiline and may increase your dose based upon your body's response to this medication. Do not stop taking rasagiline without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop taking rasagiline, you may experience withdrawal symptoms such as a fever; muscle stiffness; unsteadiness, wobbliness, or lack of coordination; or changes in consciousness. Tell your doctor if you experience any of these symptoms when your dose of rasagiline is decreased. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking rasagiline, - tell your doctor and pharmacist if you are allergic to rasagiline, any other medications, or any of the ingredients in rasagiline tablets. Ask your pharmacist for a list of the ingredients. - tell your doctor if you are taking cough and cold products containing dextromethorphan (DM; Delsym, Hold, Robitussin CoughGels, Vicks 44 Cough Relief, in Robitussin DM, others), cyclobenzaprine (Flexeril), meperidine (Demerol), methadone (Dolophine, Methadose), propoxyphene (Darvon, in Darvocet-N, others), St. John's wort, or tramadol (Ultram, in Ultracet). Also tell your doctor if you are taking MAO inhibitors such as phenelzine (Nardil), selegiline (Eldepryl), or tranylcypromine (Parnate) or have stopped taking them within the past two weeks. Your doctor may tell you not to take rasagiline if you are taking one or more of these medications. - tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amphetamines (Adderall, Dexedrine, DextroStat); antidepressants; cimetidine (Tagamet); decongestants placed in the eye or nose; diet or weight-control products containing ephedrine; fluoroquinolone antibiotics including ciprofloxacin (Cipro), gatifloxacin (Tequin), levofloxacin (Levaquin), norfloxacin (Noroxin), and ofloxacin (Floxin); fluvoxamine (Luvox); medications to treat asthma; medications to treat high blood pressure; medications to treat mental illness; medications to treat pain; phenylpropanolamine (not available in the U.S.); pseudoephedrine (PediaCare, Sudafed, Suphedrine, others); and ticlopidine (Ticlid). Tell your doctor if you are taking fluoxetine (Prozac, Sarafem) or have stopped taking it within the past 5 weeks. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have or have ever had high blood pressure, mental illness or psychosis;kidney, or liver disease. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking rasagiline, call your doctor. - you should know that rasagiline may cause dizziness, lightheadedness, nausea, sweating, and fainting when you get up too quickly from a lying position. This is more common during the first 2 months of taking rasagiline. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up. - you should know that rasagiline may cause serious, life-threatening high blood pressure when taken with certain medications or foods. Carefully follow your doctor's instructions about medications and foods to be avoided. Call your doctor right away if you have a severe headache, blurred vision, or any of the other symptoms listed below as serious side effects. - you should know that people who have Parkinson's disease have a higher risk of melanoma (a type of skin cancer) than people who do not have Parkinson's disease. It is not known whether this increased risk is caused by Parkinson's disease, medications used for Parkinson's disease such as rasagiline, or other factors. You should have regular visits with a dermatologist to examine your skin for melanoma. - you should know that some people who took rasagiline or similar medications to treat Parkinson's disease experienced intense urges to gamble, increased sexual urges, and other urges that they were unable to control. Tell your doctor if you experience new or increased gambling urges, increased sexual urges, or other intense urges while taking rasagiline. You will need to avoid eating foods that contain very high amounts of tyramine, such as aged cheeses (e.g., Stilton or blue cheese) during your treatment with rasagiline. Talk to your doctor or dietitian about which foods you should avoid during your treatment or if you do not feel well after eating or drinking certain foods while taking rasagiline. Do not take a double dose to make up for a missed one. Skip the missed dose and take your next dose at the usual time the next day. Rasagiline may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - mild headache - joint or neck pain - heartburn - nausea - vomiting - stomach pain - constipation - diarrhea - loss of appetite - weight loss - flu-like symptoms - fever - sweating - red, swollen, and/or itchy eyes - dry mouth - swollen gums - unsteadiness, wobbliness, or lack of coordination - involuntary, repeated body movements - lack of energy - sleepiness - abnormal dreams - depression - pain, burning, numbness, or tingling in the hands or feet - rash - bruising or purple discoloration on skin Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately: - severe headache - blurred vision - seizures - chest pain - shortness of breath or difficulty breathing - confusion - unconsciousness - slow or difficult speech - dizziness or faintness - weakness or numbness of an arm or leg - hallucinating (seeing things or hearing voices that do not exist) - extreme restlessness - difficulty thinking clearly or understanding reality Rasagiline may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of rasagiline overdose may occur as late as 1 to 2 days after the overdose. Symptoms of overdose may include the following: - drowsiness - dizziness - faintness - irritability - hyperactivity - agitation or restlessness - severe headache - hallucinating - confusion - loss of coordination - difficulty opening the mouth - rigid body spasm that may include an arched back - twitching muscles - seizures - loss of consciousness - fast or irregular heart beat - pain in the area between the stomach and chest - difficulty breathing or slowed breathing - diarrhea - fever - sweating - cool, clammy skin - shivering - increase in pupil size (black circle in middle of eye) Keep all appointments with your doctor. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Azilect®
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Oxazepam IMPORTANT WARNING: Oxazepam may increase the risk of serious or life-threatening breathing problems, sedation, or coma if used along with certain medications. Tell your doctor if you are taking or plan to take certain opiate medications for cough such as codeine (in Triacin-C, in Tuzistra XR) or hydrocodone (in Anexsia, in Norco, in Zyfrel) or for pain such as codeine (in Fiorinal), fentanyl (Actiq, Duragesic, Subsys, others), hydromorphone (Dilaudid, Exalgo), meperidine (Demerol), methadone (Dolophine, Methadose), morphine (Astramorph, Duramorph PF, Kadian), oxycodone (in Oxycet, in Percocet, in Roxicet, others), and tramadol (Conzip, Ultram, in Ultracet). Your doctor may need to change the dosages of your medications and will monitor you carefully. If you take oxazepam with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care immediately: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own. Drinking alcohol or using street drugs during your treatment with oxazepam also increases the risk that you will experience these serious, life-threatening side effects. Do not drink alcohol or use street drugs during your treatment. Why is this medication prescribed? Oxazepam is used to relieve anxiety, including anxiety caused by alcohol withdrawal (symptoms that may develop in people who stop drinking alcohol after drinking large amounts for a long time). Oxazepam is in a class of medications called benzodiazepines. It works by slowing activity in the brain to allow for relaxation. How should this medicine be used? Oxazepam comes as a capsule to take by mouth. It is usually taken three or four times a day and may be taken with or without food. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take oxazepam exactly as directed. Oxazepam can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer time than prescribed by your doctor. Oxazepam may not work as well if it is taken for a long time. Oxazepam may help control your symptoms but will not cure your condition. Continue to take oxazepam even if you feel well. Do not skip doses even if you feel that you do not need them. Do not stop taking this medication without talking to your doctor. If you suddenly stop taking oxazepam, you may experience withdrawal symptoms (anxiousness, sleeplessness, and irritability). Your doctor will probably decrease your dose gradually. Other uses for this medicine Oxazepam is also used to treat irritable bowel syndrome. Talk to your doctor about the possible risks of using this medication for your condition. This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. What special precautions should I follow? <h3>Before taking oxazepam,</h3> /h3> tell your doctor and pharmacist if you are allergic to oxazepam, any other medications, or any of the ingredients in oxazepam capsules. Ask your doctor or pharmacist for more information. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antihistamines; digoxin (Lanoxin); levodopa (in Ritary, in Sinemet, in Stalevo); medication for depression, seizures, Parkinson's disease, asthma, colds, or allergies; muscle relaxants; oral contraceptives; phenytoin (Dilantin, Phenytek); probenecid (Probalan, in Col-Probenecid); rifampin (Rifadin, Rimactane, in Rifamate, in Rifater); sedatives; sleeping pills; theophylline (Elixophyllin, Theo 24, Theochron); or tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have or have ever had glaucoma or seizures, or lung, heart, or liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking oxazepam, call your doctor immediately. talk to your doctor about the risks and benefits of taking oxazepam if you are 65 years of age or older. Older adults should take lower doses of oxazepam because higher doses may not be more effective and are more likely to cause serious side effects. if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking oxazepam. you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this medication. What special dietary instructions should I follow? Unless your doctor tells you otherwise, continue your normal diet. What should I do if I forget a dose? Take the missed dose as soon as you remember it. However, if it is almost time for your next dose skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? <h3>Oxazepam may cause side effects. Call your doctor if any of the symptoms are severe or do not go away: </h3> /h3> drowsiness dizziness tiredness weakness dry mouth diarrhea upset stomach changes in appetite restlessness or excitement constipation difficulty urinating frequent urination blurred vision changes in sex drive or ability <h3>Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately: </h3> /h3> shuffling walk persistent, fine tremor or inability to sit still fever difficulty breathing or swallowing severe skin rash yellowing of the skin or eyes irregular heartbeat Oxazepam may cause other side effects. Call your doctor if you experience any unusual problems during your treatment with oxazepam. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). What should I know about storage and disposal of this medication? Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location - one that is up and away and out of their sight and reach. http://www.upandaway.org In case of emergency/overdose In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911. What other information should I know? Keep all appointments with your doctor. Do not let anyone else take your medication. Oxazepam is a controlled substance. Prescriptions may be refilled only a limited number of times; ask your pharmacist if you have any questions. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. Brand names Serax
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Pancreatic Islet Transplantation What are pancreatic islets? Pancreatic islets, also called islets of Langerhans, are tiny clusters of cells scattered throughout the pancreas. The pancreas is an organ about the size of a hand located behind the lower part of the stomach.Pancreatic islets contain several types of cells, including beta cells, that produce the hormone insulin. The pancreas also makes enzymes that help the body digest and use food.Pancreatic islets contain several types of cells, including beta cells, that produce the hormone insulin.Pancreatic islets contain several types of cells, including beta cells, that produce the hormone insulin.Pancreatic islets contain several types of cells, including beta cells, that produce the hormone insulin.When the level of blood glucose, also called blood sugar, rises after a meal, the pancreas responds by releasing insulin into the bloodstream. Insulin helps cells throughout the body absorb glucose from the bloodstream and use it for energy.Diabetes develops when the pancreas does not make enough insulin, the body's cells do not use insulin effectively, or both. As a result, glucose builds up in the blood instead of being absorbed by cells in the body.In type 1 diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them. The immune system protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. A person who has type 1 diabetes must take insulin daily to live. Type 2 diabetes usually begins with a condition called insulin resistance, in which the body has trouble using insulin effectively. Over time, insulin production declines as well, so many people with type 2 diabetes eventually need to take insulin. What is pancreatic islet transplantation? The two types of pancreatic islet transplantation areallo-transplantation auto-transplantationallo-transplantationauto-transplantationPancreatic islet allo-transplantation is a procedure in which islets from the pancreas of a deceased organ donor are purified, processed, and transferred into another person. Pancreatic islet allo-transplantation is currently labeled an experimental procedure until the transplantation technology is considered successful enough to be labeled therapeutic. For more information, see the section "What are the obstacles to pancreatic islet allo-transplantation?"Pancreatic islet allo-transplantation"What are the obstacles to pancreatic islet allo-transplantation?"For each pancreatic islet allo-transplant infusion, researchers use specialized enzymes to remove islets from the pancreas of a single, deceased donor. The islets are purified and counted in a lab. Transplant patients typically receive two infusions with an average of 400,000 to 500,000 islets per infusion. Once implanted, the beta cells in these islets begin to make and release insulin.Pancreatic islet allo-transplantation is performed in certain patients with type 1 diabetes whose blood glucose levels are difficult to control. The goals of the transplant are to help these patients achieve normal blood glucose levels with or without daily injections of insulin and to reduce or eliminate hypoglycemia unawareness—a dangerous condition in which a person with diabetes cannot feel the symptoms of hypoglycemia, or low blood glucose. When a person feels the symptoms of hypoglycemia, steps can be taken to bring blood glucose levels back to normal.Pancreatic islet allo-transplants are only performed at hospitals that have received permission from the U.S. Food and Drug Administration (FDA) for clinical research on islet transplantation. The transplants are often performed by a radiologist—a doctor who specializes in medical imaging. The radiologist uses x rays and ultrasound to guide the placement of a thin, flexible tube called a catheter through a small incision in the upper abdomen—the area between the chest and hips—and into the portal vein of the liver. The portal vein is the major vein that supplies blood to the liver. The islets are then infused, or pushed, slowly into the liver through the catheter. Usually, the patient receives a local anesthetic and a sedative. In some cases, a surgeon performs the transplant using general anesthesia.Patients often need two or more transplants to get enough functioning islets to stop or reduce their need for insulin injections.Pancreatic islet allo-transplantation (above). In islet auto-transplantation, the islets are extracted from the patient's own pancreas.Pancreatic islet allo-transplantation (above). In islet auto-transplantation, the islets are extracted from the patient's own pancreas.Pancreatic islet allo-transplantation (above). In islet auto-transplantation, the islets are extracted from the patient's own pancreas.Pancreatic islet auto-transplantation is performed following total pancreatectomy—the surgical removal of the whole pancreas—in patients with severe and chronic, or long lasting, pancreatitis that cannot be managed by other treatments. This procedure is not considered experimental. Patients with type 1 diabetes cannot receive pancreatic islet auto-transplantation. The procedure is performed in a hospital, and the patient receives general anesthesia. The surgeon first removes the pancreas and then extracts and purifies islets from the pancreas. Within hours, the islets are infused through a catheter into the patient's liver. The goal is to give the body enough healthy islets to make insulin.Pancreatic islet auto-transplantation What happens after pancreatic islet transplantation? Pancreatic islets begin to release insulin soon after transplantation. However, full islet function and new blood vessel growth from the new islets take time. Transplant recipients usually take insulin injections until the islets are fully functional. They may also receive various medications before and after transplantation to promote successful implantation and long-term functioning of the islets. However, the autoimmune response that destroyed transplant recipients' own islets in the first place can happen again and attack the transplanted islets. Although the liver has been the traditional site for infusing the donor islets, researchers are investigating alternative sites, such as muscle tissue or another organ. What are the benefits and risks of pancreatic islet allo-transplantation? The benefits of pancreatic islet allo-transplantation include improved blood glucose control, reducing or eliminating the need for insulin injections to control diabetes, and preventing hypoglycemia. An alternative to islet transplantation is whole organ pancreas transplantation that is performed most often with kidney transplantation. The advantages of whole organ pancreas transplantation are less dependence on insulin and longer duration of organ function. The main disadvantage is that a whole organ transplant is a major surgery that involves a greater risk of complications and even death.Pancreatic islet allo-transplantation can also help reverse hypoglycemia unawareness. Research has shown that even partial islet function after a transplant can eliminate hypoglycemia unawareness.Improved blood glucose control from a successful allo-transplant may also slow or prevent the progression of diabetes problems, such as heart disease, kidney disease, and nerve or eye damage. Research to evaluate this possibility is ongoing.The risks of pancreatic islet allo-transplantation include the risks associated with the transplant procedure—particularly bleeding and blood clots. The transplanted islets may not function well or may stop functioning entirely. Other risks are the side effects from the immunosuppressive medications that transplant recipients must take to stop the immune system from rejecting the transplanted islets. When a patient has received a kidney transplant and is already taking immunosuppressive medications, the only additional risks are the islet infusion and the side effects from the immunosuppressive medications given at the time of allo-transplantation. Immunosuppressive medications are not needed in the case of an auto-transplant because the infused cells come from the patient's own body. Read more in the section "What is the role of immunosuppressive medications?""What is the role of immunosuppressive medications?"Collaborative Islet Transplant Registry Data In its 2010 annual report,1 the Collaborative Islet Transplant Registry presented data on 571 patients who received pancreatic islet allo-transplants between 1999 and 2009. Although most procedures were pancreatic islet allo-transplants alone, 90 procedures were done in conjunction with a kidney transplant. The majority of the islet transplant patients received one or two infusions of islets; at the end of the decade, the average number of islets received per infusion was 463,000. According to the report, about 60 percent of transplant recipients achieved insulin independence—defined as being able to stop insulin injections for at least 14 days—during the year following transplantation. By the end of the second year, 50 percent of recipients were able to stop taking insulin for at least 14 days. However, long-term insulin independence is difficult to maintain, and eventually most recipients needed to start taking insulin again. The report identified factors linked to better outcomes for recipients, including age—35 years or older lower pre-transplant triglyceride, or blood fat, levels lower pre-transplant insulin use The report noted that even partial function of the transplanted islets can improve blood glucose control and reduce the amount of insulin needed after loss of insulin independence. Collaborative Islet Transplant Registry Data In its 2010 annual report,1 the Collaborative Islet Transplant Registry presented data on 571 patients who received pancreatic islet allo-transplants between 1999 and 2009. Although most procedures were pancreatic islet allo-transplants alone, 90 procedures were done in conjunction with a kidney transplant. The majority of the islet transplant patients received one or two infusions of islets; at the end of the decade, the average number of islets received per infusion was 463,000.11According to the report, about 60 percent of transplant recipients achieved insulin independence—defined as being able to stop insulin injections for at least 14 days—during the year following transplantation.By the end of the second year, 50 percent of recipients were able to stop taking insulin for at least 14 days. However, long-term insulin independence is difficult to maintain, and eventually most recipients needed to start taking insulin again.The report identified factors linked to better outcomes for recipients, includingage—35 years or older lower pre-transplant triglyceride, or blood fat, levels lower pre-transplant insulin useage—35 years or olderlower pre-transplant triglyceride, or blood fat, levelslower pre-transplant insulin useThe report noted that even partial function of the transplanted islets can improve blood glucose control and reduce the amount of insulin needed after loss of insulin independence.1Collaborative Islet Transplant Registry seventh annual report. Collaborative Islet Transplant Registry website. https://web.emmes.com/study/isl//reports/01062012_7thAnnualReport.pdf (PDF, 8.2 MB) Updated December 30, 2011. Accessed July 23, 2013.1https://web.emmes.com/study/isl//reports/01062012_7thAnnualReport.pdf What is the role of immunosuppressive medications? Immunosuppressive medications are needed to prevent rejection—a common problem with any transplant.Scientists have made many advances in islet transplantation in recent years. In 2000, islet transplantation researchers at the University of Alberta in Edmonton, Canada, reported their findings in the New England Journal of Medicine. Their transplant protocol, known as the Edmonton protocol, has since been adapted by transplant centers around the world and continues to be refined.New England Journal of MedicineThe Edmonton protocol introduced the use of a new combination of immunosuppressive medications, also called anti-rejection medications, including daclizumab (Zenapax), sirolimus (Rapamune), and tacrolimus (Prograf). Researchers continue to develop and study modifications to the Edmonton protocol, including improved medication regimens that promote successful transplants. Medication regimens vary from one transplant center to another. Examples of other immunosuppressive medications used in islet transplantation include antithymocyte globulin (Thymoglobulin), alemtuzumab (Campath), basiliximab (Simulect), belatacept (Nulojix), etanercept (Enbrel), everolimus (Zortress), and mycophenolate mofetil (CellCept, Myfortic). Researchers are also evaluating nonimmunosuppresive medications, such as exenatide (Byetta) and sitagliptin (Januvia).Immunosuppressive medications have significant side effects, and their long-term effects are still not fully known. Immediate side effects may include mouth sores and gastrointestinal problems, such as upset stomach and diarrhea. Patients may also haveincreased blood cholesterol, or blood fat, levels high blood pressure anemia, a condition in which red blood cells are fewer or smaller than normal, which prevents the body's cells from getting enough oxygen fatigue decreased white blood cell counts decreased kidney function increased susceptibility to bacterial and viral infectionsincreased blood cholesterol, or blood fat, levelshigh blood pressureanemia, a condition in which red blood cells are fewer or smaller than normal, which prevents the body's cells from getting enough oxygenfatiguedecreased white blood cell countsdecreased kidney functionincreased susceptibility to bacterial and viral infectionsTaking immunosuppressive medications also increases the risk of developing certain tumors and cancers.Scientists are seeking ways to achieve immune tolerance of the transplanted islets, in which the patient's immune system no longer recognizes the islets as foreign. Immune tolerance would allow patients to maintain transplanted islets without long-term use of immunosuppressive medications. For example, one approach is to transplant islets encapsulated with a special coating, which may help to prevent rejection. What are the obstacles to pancreatic islet allo-transplantation? The shortage of islets from donors is a significant obstacle to widespread use of pancreatic islet allo-transplantation. According to the Organ Procurement and Transplantation Network, in 2011 there were about 8,000 deceased organ donors available in the United States.2 However, only 1,562 pancreases were recovered from donors in 2011.2 Also, many donated pancreases are not suitable for extracting islets for transplants because they do not meet the selection criteria, and islets are often damaged or destroyed during processing. Therefore, only a small number of islet transplants can be performed each year.2222Researchers are pursuing various approaches to solve this shortage of islets, such as transplanting islets from a single, donated pancreas, using only a portion of the pancreas from a living donor, or using islets from pigs. Researchers have transplanted pig islets into other animals, including monkeys, by encapsulating the islets with a special coating or by using medications to prevent rejection. Another approach is creating islets from other types of cells, such as stem cells. New technologies could then be employed to grow islets in the lab.Financial barriers also prevent the widespread use of islet allo-transplantation. Until the transplantation technology is considered successful enough to be labeled therapeutic rather than experimental, the costs of islet allo-transplants must be covered by research funds. Health insurance companies and Medicare generally do not cover experimental procedures. Federal law also does not allow health care providers or hospitals to charge patients or health insurance companies for research procedures. Some patient advocates and islet researchers feel that islet allo-transplantation is close to having a therapeutic label. The National Institutes of Health (NIH) currently supports studies that are working toward obtaining FDA licensure to reclassify islet allo-transplantation as therapeutic. In other countries, such as Canada and Scandinavia, islet allo-transplantation is no longer considered experimental and is an accepted therapy in certain patients.2National data. Organ Procurement and Transplantation Network website. https://optn.transplant.hrsa.gov/data/. Accessed July 23, 2013.2https://optn.transplant.hrsa.gov/data/ Eating, Diet, and Nutrition A person who receives a pancreatic islet transplant should follow a meal plan worked out with a health care provider and dietitian. Immunosuppressive medications taken after the transplant can cause changes in a person's body, such as weight gain. A healthy diet after the transplant is important to control weight gain, blood pressure, blood cholesterol, and blood glucose levels. Points to Remember Pancreatic islets, also called islets of Langerhans, are tiny clusters of cells scattered throughout the pancreas. Pancreatic islets contain several types of cells, including beta cells, that produce the hormone insulin. Insulin helps cells throughout the body absorb glucose from the bloodstream and use it for energy. Pancreatic islet allo-transplantation is a procedure in which islets from the pancreas of a deceased organ donor are purified, processed, and transferred into another person. Pancreatic islet allo-transplantation is performed in certain patients with type 1 diabetes whose blood glucose levels are difficult to control. The goals of the transplant are to help these patients achieve normal blood glucose levels with or without daily injections of insulin and to reduce or eliminate hypoglycemia unawareness. Pancreatic islet auto-transplantation is performed following total pancreatectomy in patients with severe and chronic pancreatitis that cannot be managed by other treatments. This procedure is not considered experimental. Patients with type 1 diabetes cannot receive pancreatic islet auto-transplantation. The shortage of islets from donors is a significant obstacle to widespread use of pancreatic islet allo-transplantation. Financial barriers also prevent the widespread use of islet allo-transplantation. Until the transplantation technology is considered successful enough to be labeled therapeutic rather than experimental, the costs of islet allo-transplants must be covered by research funds.Pancreatic islets, also called islets of Langerhans, are tiny clusters of cells scattered throughout the pancreas. Pancreatic islets contain several types of cells, including beta cells, that produce the hormone insulin. Insulin helps cells throughout the body absorb glucose from the bloodstream and use it for energy.Pancreatic islet allo-transplantation is a procedure in which islets from the pancreas of a deceased organ donor are purified, processed, and transferred into another person.Pancreatic islet allo-transplantation is performed in certain patients with type 1 diabetes whose blood glucose levels are difficult to control. The goals of the transplant are to help these patients achieve normal blood glucose levels with or without daily injections of insulin and to reduce or eliminate hypoglycemia unawareness.Pancreatic islet auto-transplantation is performed following total pancreatectomy in patients with severe and chronic pancreatitis that cannot be managed by other treatments. This procedure is not considered experimental. Patients with type 1 diabetes cannot receive pancreatic islet auto-transplantation.The shortage of islets from donors is a significant obstacle to widespread use of pancreatic islet allo-transplantation. Financial barriers also prevent the widespread use of islet allo-transplantation. Until the transplantation technology is considered successful enough to be labeled therapeutic rather than experimental, the costs of islet allo-transplants must be covered by research funds. Pancreatic Islet Transplantation The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.What are clinical trials, and are they right for you? Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.What are clinical trials, and are they right for you?Find out if clinical trials are right for youWhat clinical trials are open? Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.What clinical trials are open?www.ClinicalTrials.govWhat are pancreatic islets? Pancreatic islets, also called islets of Langerhans, are tiny clusters of cells scattered throughout the pancreas. The pancreas is an organ about the size of a hand located behind the lower part of the stomach. Pancreatic islets contain several types of cells, including beta cells, that produce the hormone insulin. The pancreas also makes enzymes that help the body digest and use food. Pancreatic islets contain several types of cells, including beta cells, that produce the hormone insulin. When the level of blood glucose, also called blood sugar, rises after a meal, the pancreas responds by releasing insulin into the bloodstream. Insulin helps cells throughout the body absorb glucose from the bloodstream and use it for energy. Diabetes develops when the pancreas does not make enough insulin, the body's cells do not use insulin effectively, or both. As a result, glucose builds up in the blood instead of being absorbed by cells in the body. In type 1 diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them. The immune system protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. A person who has type 1 diabetes must take insulin daily to live. Type 2 diabetes usually begins with a condition called insulin resistance, in which the body has trouble using insulin effectively. Over time, insulin production declines as well, so many people with type 2 diabetes eventually need to take insulin. What is pancreatic islet transplantation? The two types of pancreatic islet transplantation are allo-transplantation auto-transplantation Pancreatic islet allo-transplantation is a procedure in which islets from the pancreas of a deceased organ donor are purified, processed, and transferred into another person. Pancreatic islet allo-transplantation is currently labeled an experimental procedure until the transplantation technology is considered successful enough to be labeled therapeutic. For more information, see the section "What are the obstacles to pancreatic islet allo-transplantation?" For each pancreatic islet allo-transplant infusion, researchers use specialized enzymes to remove islets from the pancreas of a single, deceased donor. The islets are purified and counted in a lab. Transplant patients typically receive two infusions with an average of 400,000 to 500,000 islets per infusion. Once implanted, the beta cells in these islets begin to make and release insulin. Pancreatic islet allo-transplantation is performed in certain patients with type 1 diabetes whose blood glucose levels are difficult to control. The goals of the transplant are to help these patients achieve normal blood glucose levels with or without daily injections of insulin and to reduce or eliminate hypoglycemia unawareness—a dangerous condition in which a person with diabetes cannot feel the symptoms of hypoglycemia, or low blood glucose. When a person feels the symptoms of hypoglycemia, steps can be taken to bring blood glucose levels back to normal. Pancreatic islet allo-transplants are only performed at hospitals that have received permission from the U.S. Food and Drug Administration (FDA) for clinical research on islet transplantation. The transplants are often performed by a radiologist—a doctor who specializes in medical imaging. The radiologist uses x rays and ultrasound to guide the placement of a thin, flexible tube called a catheter through a small incision in the upper abdomen—the area between the chest and hips—and into the portal vein of the liver. The portal vein is the major vein that supplies blood to the liver. The islets are then infused, or pushed, slowly into the liver through the catheter. Usually, the patient receives a local anesthetic and a sedative. In some cases, a surgeon performs the transplant using general anesthesia. Patients often need two or more transplants to get enough functioning islets to stop or reduce their need for insulin injections. Pancreatic islet allo-transplantation (above). In islet auto-transplantation, the islets are extracted from the patient's own pancreas. Pancreatic islet auto-transplantation is performed following total pancreatectomy—the surgical removal of the whole pancreas—in patients with severe and chronic, or long lasting, pancreatitis that cannot be managed by other treatments. This procedure is not considered experimental. Patients with type 1 diabetes cannot receive pancreatic islet auto-transplantation. The procedure is performed in a hospital, and the patient receives general anesthesia. The surgeon first removes the pancreas and then extracts and purifies islets from the pancreas. Within hours, the islets are infused through a catheter into the patient's liver. The goal is to give the body enough healthy islets to make insulin. What happens after pancreatic islet transplantation? Pancreatic islets begin to release insulin soon after transplantation. However, full islet function and new blood vessel growth from the new islets take time. Transplant recipients usually take insulin injections until the islets are fully functional. They may also receive various medications before and after transplantation to promote successful implantation and long-term functioning of the islets. However, the autoimmune response that destroyed transplant recipients' own islets in the first place can happen again and attack the transplanted islets. Although the liver has been the traditional site for infusing the donor islets, researchers are investigating alternative sites, such as muscle tissue or another organ. What are the benefits and risks of pancreatic islet allo-transplantation? The benefits of pancreatic islet allo-transplantation include improved blood glucose control, reducing or eliminating the need for insulin injections to control diabetes, and preventing hypoglycemia. An alternative to islet transplantation is whole organ pancreas transplantation that is performed most often with kidney transplantation. The advantages of whole organ pancreas transplantation are less dependence on insulin and longer duration of organ function. The main disadvantage is that a whole organ transplant is a major surgery that involves a greater risk of complications and even death. Pancreatic islet allo-transplantation can also help reverse hypoglycemia unawareness. Research has shown that even partial islet function after a transplant can eliminate hypoglycemia unawareness. Improved blood glucose control from a successful allo-transplant may also slow or prevent the progression of diabetes problems, such as heart disease, kidney disease, and nerve or eye damage. Research to evaluate this possibility is ongoing. The risks of pancreatic islet allo-transplantation include the risks associated with the transplant procedure—particularly bleeding and blood clots. The transplanted islets may not function well or may stop functioning entirely. Other risks are the side effects from the immunosuppressive medications that transplant recipients must take to stop the immune system from rejecting the transplanted islets. When a patient has received a kidney transplant and is already taking immunosuppressive medications, the only additional risks are the islet infusion and the side effects from the immunosuppressive medications given at the time of allo-transplantation. Immunosuppressive medications are not needed in the case of an auto-transplant because the infused cells come from the patient's own body. Read more in the section "What is the role of immunosuppressive medications?" Collaborative Islet Transplant Registry Data In its 2010 annual report,1 the Collaborative Islet Transplant Registry presented data on 571 patients who received pancreatic islet allo-transplants between 1999 and 2009. Although most procedures were pancreatic islet allo-transplants alone, 90 procedures were done in conjunction with a kidney transplant. The majority of the islet transplant patients received one or two infusions of islets; at the end of the decade, the average number of islets received per infusion was 463,000. According to the report, about 60 percent of transplant recipients achieved insulin independence—defined as being able to stop insulin injections for at least 14 days—during the year following transplantation. By the end of the second year, 50 percent of recipients were able to stop taking insulin for at least 14 days. However, long-term insulin independence is difficult to maintain, and eventually most recipients needed to start taking insulin again. The report identified factors linked to better outcomes for recipients, including age—35 years or older lower pre-transplant triglyceride, or blood fat, levels lower pre-transplant insulin use The report noted that even partial function of the transplanted islets can improve blood glucose control and reduce the amount of insulin needed after loss of insulin independence. 1Collaborative Islet Transplant Registry seventh annual report. Collaborative Islet Transplant Registry website. https://web.emmes.com/study/isl//reports/01062012_7thAnnualReport.pdf (PDF, 8.2 MB) Updated December 30, 2011. Accessed July 23, 2013. What is the role of immunosuppressive medications? Immunosuppressive medications are needed to prevent rejection—a common problem with any transplant. Scientists have made many advances in islet transplantation in recent years. In 2000, islet transplantation researchers at the University of Alberta in Edmonton, Canada, reported their findings in the New England Journal of Medicine. Their transplant protocol, known as the Edmonton protocol, has since been adapted by transplant centers around the world and continues to be refined. The Edmonton protocol introduced the use of a new combination of immunosuppressive medications, also called anti-rejection medications, including daclizumab (Zenapax), sirolimus (Rapamune), and tacrolimus (Prograf). Researchers continue to develop and study modifications to the Edmonton protocol, including improved medication regimens that promote successful transplants. Medication regimens vary from one transplant center to another. Examples of other immunosuppressive medications used in islet transplantation include antithymocyte globulin (Thymoglobulin), alemtuzumab (Campath), basiliximab (Simulect), belatacept (Nulojix), etanercept (Enbrel), everolimus (Zortress), and mycophenolate mofetil (CellCept, Myfortic). Researchers are also evaluating nonimmunosuppresive medications, such as exenatide (Byetta) and sitagliptin (Januvia). Immunosuppressive medications have significant side effects, and their long-term effects are still not fully known. Immediate side effects may include mouth sores and gastrointestinal problems, such as upset stomach and diarrhea. Patients may also have increased blood cholesterol, or blood fat, levels high blood pressure anemia, a condition in which red blood cells are fewer or smaller than normal, which prevents the body's cells from getting enough oxygen fatigue decreased white blood cell counts decreased kidney function increased susceptibility to bacterial and viral infections Taking immunosuppressive medications also increases the risk of developing certain tumors and cancers. Scientists are seeking ways to achieve immune tolerance of the transplanted islets, in which the patient's immune system no longer recognizes the islets as foreign. Immune tolerance would allow patients to maintain transplanted islets without long-term use of immunosuppressive medications. For example, one approach is to transplant islets encapsulated with a special coating, which may help to prevent rejection. What are the obstacles to pancreatic islet allo-transplantation? The shortage of islets from donors is a significant obstacle to widespread use of pancreatic islet allo-transplantation. According to the Organ Procurement and Transplantation Network, in 2011 there were about 8,000 deceased organ donors available in the United States.2 However, only 1,562 pancreases were recovered from donors in 2011.2 Also, many donated pancreases are not suitable for extracting islets for transplants because they do not meet the selection criteria, and islets are often damaged or destroyed during processing. Therefore, only a small number of islet transplants can be performed each year. Researchers are pursuing various approaches to solve this shortage of islets, such as transplanting islets from a single, donated pancreas, using only a portion of the pancreas from a living donor, or using islets from pigs. Researchers have transplanted pig islets into other animals, including monkeys, by encapsulating the islets with a special coating or by using medications to prevent rejection. Another approach is creating islets from other types of cells, such as stem cells. New technologies could then be employed to grow islets in the lab. Financial barriers also prevent the widespread use of islet allo-transplantation. Until the transplantation technology is considered successful enough to be labeled therapeutic rather than experimental, the costs of islet allo-transplants must be covered by research funds. Health insurance companies and Medicare generally do not cover experimental procedures. Federal law also does not allow health care providers or hospitals to charge patients or health insurance companies for research procedures. Some patient advocates and islet researchers feel that islet allo-transplantation is close to having a therapeutic label. The National Institutes of Health (NIH) currently supports studies that are working toward obtaining FDA licensure to reclassify islet allo-transplantation as therapeutic. In other countries, such as Canada and Scandinavia, islet allo-transplantation is no longer considered experimental and is an accepted therapy in certain patients. 2National data. Organ Procurement and Transplantation Network website. https://optn.transplant.hrsa.gov/data/. Accessed July 23, 2013. Eating, Diet, and Nutrition A person who receives a pancreatic islet transplant should follow a meal plan worked out with a health care provider and dietitian. Immunosuppressive medications taken after the transplant can cause changes in a person's body, such as weight gain. A healthy diet after the transplant is important to control weight gain, blood pressure, blood cholesterol, and blood glucose levels. Points to Remember Pancreatic islets, also called islets of Langerhans, are tiny clusters of cells scattered throughout the pancreas. Pancreatic islets contain several types of cells, including beta cells, that produce the hormone insulin. Insulin helps cells throughout the body absorb glucose from the bloodstream and use it for energy. Pancreatic islet allo-transplantation is a procedure in which islets from the pancreas of a deceased organ donor are purified, processed, and transferred into another person. Pancreatic islet allo-transplantation is performed in certain patients with type 1 diabetes whose blood glucose levels are difficult to control. The goals of the transplant are to help these patients achieve normal blood glucose levels with or without daily injections of insulin and to reduce or eliminate hypoglycemia unawareness. Pancreatic islet auto-transplantation is performed following total pancreatectomy in patients with severe and chronic pancreatitis that cannot be managed by other treatments. This procedure is not considered experimental. Patients with type 1 diabetes cannot receive pancreatic islet auto-transplantation. The shortage of islets from donors is a significant obstacle to widespread use of pancreatic islet allo-transplantation. Financial barriers also prevent the widespread use of islet allo-transplantation. Until the transplantation technology is considered successful enough to be labeled therapeutic rather than experimental, the costs of islet allo-transplants must be covered by research funds. Clinical Trials The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. What are clinical trials, and are they right for you? Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you. What clinical trials are open? Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.
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