In Case of Emergency

DIABETIC CURE

2009-04-28T22:24:00.001-07:00

Dear All,

A woman (65) was diabetic for the last 2+ years and was taking insulin twice a day, she used the enclosed homemade medicine for a fortnight and now
she is absolutely free of diabetes and taking all her food as normal including sweets ............. ......... .

The doctors have advised her to stop insulin and any other blood sugar controlling drugs. Please circulate the email below to as many people as you can and let them take the maximum benefit from it.

AS RECEIVED :

Sheikh Saleh Mohammed Tuwaijiri, the Supreme judge of Tabuk Court has made the extensive experiments with perseverance and patience and discovered a successful treatment for diabetes. Now a days a lot of people, old men & women in particular suffer a lot due to Diabetes.

Ingredients:
1 – Wheat flour 100 gm
2 – Gum(of tree) (gondh) 100 gm
3 – Barley 100 gm
4 – Black Seeds (kalunji) 100 gm

Method of Preparation Put all the above ingredients in 5 cups of water.
Boil it for 10 minutes and put off the fire. Allow it to cool down by itself.
When it has become cold, filter out the seeds and preserve the water in a glass
jug or bottle.

How to use it? Take one small cup of this water every early morning when your stomach is empty. Continue this for 7 days. Next week repeat the same but in alternate days with these 2 weeks of treatment you will wonder to see that you have become normal to eat normal food without problem.

Note: A request is to spread this to as many as possible so that others can also take benefit out of it.

Cushing's Syndrome

2009-02-14T00:33:00.000-08:00

Cushing's Syndrome

What is Cushing's Syndrome?

Cushing’s syndrome is a condition that occurs when a person’s body is exposed to too much of the hormone cortisol.

What causes Cushing's Syndrome?

Cushing’s syndrome happens for two reasons:

Medication either causes the body to make too much cortisol, or the medication itself contains extra cortisol and taking it pushes the level above normal.
A person’s body makes more cortisol than it needs

Normally, the hypothalamus in the brain triggers a chain of events that causes the adrenal glands to release cortisol into the bloodstream. When everything is working correctly, the body is balanced, releasing the right amount of cortisol for daily needs. But problems with the adrenal glands, pituitary gland, or hypothalamus can cause the glands to make too much cortisol.

Conditions that might cause the body to make too much cortisol include:

Pituitary tumors
Ectopic ACTH syndrome
Adrenal tumors
Familial (genetic) Cushing's syndrome

What are the symptoms of Cushing's Syndrome?

Common symptoms of Cushing’s syndrome can include:

Upper body obesity, round face and neck, and thinning arms and legs
Slow growth rates in children
Skin problems, such as acne or reddish-blue streaks in the skin
High blood pressure
Muscle and bone weakness
Moodiness, irritability, or depression
High blood sugar

Women may also have increased growth of hair on their face and body and experience menstrual irregularities. Men may become less fertile and have a reduced or absent sex drive.

What are the treatments for Cushing's Syndrome?

Treatment for Cushing’s syndrome depends on the reason for the extra cortisol in the body. If it is caused by the use of medicine to treat another disorder, a health care provider can reduce the dose or change the medicine.

If the body is making too much cortisol, treatments may include oral medication, surgery, radiation, or a combination of these treatments.

In most cases Cushing’s syndrome can be cured.

Computed Tomography (CT): Questions and Answers

2009-02-13T01:08:00.000-08:00

What is computed tomography?

Computed tomography (CT) is a diagnostic procedure that uses special x-ray equipment to obtain cross-sectional pictures of the body. The CT computer displays these pictures as detailed images of organs, bones, and other tissues. This procedure is also called CT scanning, computerized tomography, or computerized axial tomography (CAT).

How is CT used in cancer?

Computed tomography is used in several ways:

To detect or confirm the presence of a tumor;
To provide information about the size and location of the tumor and whether it has spread;
To guide a biopsy (the removal of cells or tissues for examination under a microscope);
To help plan radiation therapy or surgery; and
To determine whether the cancer is responding to treatment.

What can a person expect during the CT procedure?

During a CT scan, the person lies very still on a table. The table slowly passes through the center of a large x-ray machine. The person might hear whirring sounds during the procedure. People may be asked to hold their breath at times, to prevent blurring of the pictures.

Often, a contrast agent, or “dye,” may be given by mouth, injected into a vein, given by enema, or given in all three ways before the CT scan is done. The contrast dye can highlight specific areas inside the body, resulting in a clearer picture.

Computed tomography scans do not cause any pain. However, lying in one position during the procedure may be slightly uncomfortable. The length of the procedure depends on the size of the area being x-rayed; CT scans take from 15 minutes to 1 hour to complete. For most people, the CT scan is performed on an outpatient basis at a hospital or a doctor’s office, without an overnight hospital stay.

Are there risks associated with a CT scan?

Some people may be concerned about the amount of radiation they receive during a CT scan. It is true that the radiation exposure from a CT scan can be higher than from a regular x-ray. However, not having the procedure can be more risky than having it, especially if cancer is suspected. People considering CT must weigh the risks and benefits.

In very rare cases, contrast agents can cause allergic reactions. Some people experience mild itching or hives (small bumps on the skin). Symptoms of a more serious allergic reaction include shortness of breath and swelling of the throat or other parts of the body. People should tell the technologist immediately if they experience any of these symptoms, so they can be treated promptly.

What is spiral CT?

A spiral (or helical) CT scan is a new kind of CT. During a spiral CT, the x-ray machine rotates continuously around the body, following a spiral path to make cross-sectional pictures of the body. Benefits of spiral CT include:

It can be used to make 3–dimensional pictures of areas inside the body;
It may detect small abnormal areas better than conventional CT; and
It is faster, so the test takes less time than a conventional CT.

What is total or whole body CT? Should a person have one?

A total or whole body CT scan creates images of nearly the entire body—from the chin to below the hips. This test has not been shown to have any value as a screening tool. (“Screening” means checking for signs of a disease when a person has no symptoms.)

The American College of Radiology (as well as most doctors) does not recommend scanning a person’s body on the chance of finding signs of any sort of disease. In most cases abnormal findings do not indicate a serious health problem; however, a person must often undergo more tests to find this out. The additional tests can be expensive, inconvenient, and uncomfortable. The disadvantages of total body CT almost always outweigh the benefits.

For more information about whole body scanning, please visit the U.S. Food and Drug Administration’s Web site at http://www.fda.gov/cdrh/ct/screening.html on the Internet.

What is virtual endoscopy?

Virtual endoscopy is a new technique that uses spiral CT. It allows doctors to see inside organs and other structures without surgery or special instruments. One type of virtual endoscopy, known as CT colonography or virtual colonoscopy, is under study as a screening technique for colon cancer.

What is combined PET/CT scanning?

Combined PET/CT scanning joins two imaging tests, CT and positron emission tomography (PET), into one procedure. A PET scan creates colored pictures of chemical changes (metabolic activity) in tissues. Because cancerous tumors usually are more active than normal tissue, they appear different on a PET scan.

Combining CT with PET scanning may provide a more complete picture of a tumor’s location and growth or spread than either test alone. Researchers hope that the combined procedure will improve health care professionals’ ability to diagnose cancer, determine how far it has spread, and follow patients’ responses to treatment. The combined PET/CT scan may also reduce the number of additional imaging tests and other procedures a patient needs. However, this new technology is currently available only at some facilities.

Where can people get more information about CT?

Additional information about CT is available from the CT Accreditation Department of the American College of Radiology, 1891 Preston White Drive, Reston, VA 20191–4397. The toll-free telephone number is 1–800–227–5463 (1–800–ACR–LINE). The CT Accreditation Department can be reached by e-mail at ctaccred@acr.org. The American College of Radiology Web site is located at http://www.acr.org on the Internet.

Information about diagnostic radiology, including CT, is also available on the Radiology Info Web site at http://www.radiologyinfo.org on the Internet. Radiology Info is the public information Web site of the Radiological Society of North America and the American College of Radiology.

Infant Health

2009-02-10T04:06:00.000-08:00

Infant Health

What is infancy?

Infancy is generally the period from birth until age two years. It is a time of a lot of growth and change for children and families.

This health topic covers some of the many issues related to infant care, including: [jump to sections on feeding, sleeping, safety and childcare below]

This information is provided with full-term infants specifically in mind. It is not meant to provide all the information you need to care for your infant; for more information, please visit the Infant Care Resource Web sites.

Preterm infants (those born before the mother has been pregnant about 38 weeks) often have special needs. See the section below for more details on preterm infants. [jump to preterm section below]

What are the best strategies for feeding my baby?

Breastfeeding, also called nursing, is often the ideal source of nutrition for newborns and can be an easy, healthy, and inexpensive way for a mother to feed her child.

Why is breastfeeding recommended?

Breast milk contains a wide range of nutrients important for baby’s growth and health. In addition, recent NICHD-supported research also suggests that some of the specific fatty acids contained in breast milk play important roles in helping brain development. For example, two specific fatty acids, known as DHA and AA, may help increase infants’ cognitive skills.

Breastfeeding is beneficial to the mother, too:

Nursing helps a woman’s body secrete hormones, causing her uterus to contract and heal. These hormones also postpone the restarting of menstruation.
Breastfeeding reduces the chance of postpartum depression, enhances mother-infant bonding, and can create a sense of accomplishment and satisfaction.
Some authorities believe that breastfeeding women have lower risks of developing breast and uterine cancers.

How long should a mother breastfeed?

According to the American Academy of Pediatrics (AAP) Policy Statement on Breastfeeding, women who don’t have health problems should feed their infants only breast milk for at least the first six months of life. After this time, the AAP suggests that women try to continue to breastfeed for the first 12 months of life because of the benefits to both the mother and baby.

The AAP recommends that infants who are weaned (meaning they are no longer breastfed) before 12 months of age should drink iron-fortified infant formula and not cow’s milk. Many types of infant formulas available in the United States are fortified with DHA and AA, and all formula available for preterm infants is fortified with these fatty acids.

The AAP also suggests introducing solid foods at six months of age. The Academy recommends introducing single-ingredient foods one at a time for a several-day trial before adding a new food.

During the first six months, water, juice, and other foods are generally unnecessary for breastfed infants. Infants should not have anything with fluoride, such as adult toothpaste, during their first six months, whether they are breast- or formula-fed.

What is jaundice?

Jaundice (jawn-DISS) is an illness that can cause a baby's skin, eyes, and mouth to turn a yellowish color. The yellow color is caused by a buildup of bilirubin, a substance that is produced in body during the normal process of breaking down old red blood cells and forming new ones.

What causes jaundice?

Normally the liver removes bilirubin from the body. But for many babies, in the first few days after birth the liver is not yet working at its full power. As a result, bilirubin level in the blood gets too high, causing the baby’s color to become slightly yellow. This is called jaundice.

If your baby has jaundice, it usually does not mean that your baby has liver problems or a “bad liver.” In most cases, it just means that the baby’s liver is slower in removing bilirubin from the blood during the first few days after birth.

How is jaundice treated?

Although jaundice is common and is often not serious, all babies with jaundice need to be seen by a health care provider.

Many babies need no treatment for jaundice. Their livers start to catch up quickly, usually within a few days after birth, and begin to remove bilirubin normally.

For some babies, however, doctors prescribe photo-therapy—treatment using a special lamp—to help break down the bilirubin in their bodies. In some cases, high levels of bilirubin could cause brain injury.

If your baby has jaundice, ask your health care provider how long his or her jaundice will last after leaving the hospital, and schedule a followup appointment as directed. If your baby’s jaundice lasts longer than expected, or an infant who did not have jaundice before starts to turn yellowish after going home, contact your health care provider right away.

How can I help my child with sleep?

Helping a child learn to fall asleep and stay asleep is one of the more challenging parts of infant care. Newborns tend to sleep or drowse for 16 to 20 hours a day. Their “internal clocks” are not yet set, so they sleep a lot both during the day and night. Newborns also have small stomachs, so they need to be awake for regular feedings.

After a few months, babies usually begin to sleep in longer stretches at night and are awake for longer periods during the day. Practicing bedtime routines and putting your baby into the crib before he or she falls asleep can help build better sleep patterns.

For more information on sleep, see the item All About Sleep published by the American Academy of Family Physicians.

What is Sudden Infant Death Syndrome (SIDS)?

SIDS is the sudden, unexplained death of an infant younger than one year old. It is the leading cause of death in children between one month and one year of age. Health care providers don’t know exactly what causes SIDS, but they do know certain things can help reduce the risk of SIDS.

How can parents reduce the risk of SIDS?

The best way to reduce the risk of SIDS is to always place babies on their backs to sleep for naps and at night. Babies who sleep on their backs are less likely to die of SIDS than babies who sleep on their stomachs or sides. Placing your baby on his or her back to sleep, for naps and at night, is the number one way to reduce the risk of SIDS.

Visit the Sudden Infant Death Syndrome (SIDS) health topic to learn more about SIDS and ways to reduce the risk of SIDS.

What are some ways to keep my baby safe?

Keeping your baby safe is one of the most important jobs for parents. The U.S. Consumer Product Safety Commission publishes a booklet called The Safe Nursery that provides information on a variety of potential hazards and ways to help keep your infant safe.

What about safety for my infant in the car?

In addition to safety at home, car seat safety is an important part of taking care of your child. The AAP publishes Car Safety Seats: A Guide for Families, which discusses what type of car seats are best at what ages and other important aspects of car seat safety. Each car seat is different so it is important to carefully review and follow the manufacturer’s instructions.

The AAP also has a section on its Web site dedicated to Safety and First Aid.

What is hyperthermia and how can I prevent it in my child?

The term hyperthermia (pronounced high-purr-THER-mee-yah) refers to heat-related illnesses—or those associated with exposure to high temperature in the environment, causing high body temperature. When the body is exposed to high temperatures, like on a hot day, the body normally cools itself using different mechanisms, such as heavy sweating and losing heat through the skin. But in certain situations, such as when inside a parked car when it is warm or humid, or in a desert climate where it is can be very hot and dry, sweating and other mechanisms may not be enough to cool high body heat. As a result, the body’s temperature rises quickly and may damage the brain and other organs in the body. Normal body temperature is 98.6 degrees Fahrenheit—Hyperthermia occurs when the body heats up to 104 degrees Fahrenheit. Body temperature of 107 degrees is usually fatal.

Heat illnesses typically progress from “heat stress”—Physical and emotional stress at being in a hot environment; to “heat exhaustion”—characterized by dehydration, extreme thirst, and weakness/dizziness; to “heat stroke”—which may cause delirium, convulsions, coma, and death.

In the last decade, deaths from hyperthermia have increased, especially among children and pets, mainly as a result of them being left alone in a car for even short periods of time. A child’s body is less effective at cooling itself than an adult body is, and adults can alter their environment by taking off clothes. Even when the outside temperature is at “room temperature” (about 72 degrees Fahrenheit), the temperature inside a car can increase to more than 100 degrees Fahrenheit in just 30 minutes. So, even when the weather is comfortable outside, children are at high risk for heat stroke and death from being left alone in a car.

Parents and caregivers should never leave a child alone in a car, not even with the windows down, and not even for a minute. Parents and caregivers should also develop plans for leaving their car to ensure that everyone exits the car safely and no one is left in the car accidentally. If you see a child left alone in a parked car, you should call 911 to request emergency help—It could mean the difference between life and death for that child.

Visit the Infant Care Resource Web sites for more information about preventing heat-related illnesses.

What about child care for infants?

For many parents and families, child care comes from someone other than the child’s mother. To understand how this type of care influences child development, the NICHD started the Study of Early Child Care and Youth Development (SECCYD) in 1991.

The major goal of the study was to examine how differences in child care experiences relate to children’s social, emotional, intellectual, and language development, and to their physical growth and health. The study examined how quality, quantity, and type of child care setting affect children’s development.

Specific findings from the Study include the following:

Higher quality care was associated with better child outcomes.
The number of hours in care mattered in terms of child outcomes to some degree.
The child care type or setting (child care home, child care center, etc.) had different effects on children at different ages.
Parent and family characteristics were more strongly linked to child development and child outcomes than any aspect of child care.

The Study also developed a Positive Caregiving Checklist that parents can use to examine the quality of care their child is receiving.

For more information on the Study, check out the publication NICHD Study of Early Child Care and Youth Development (SECCYD): Findings for Children from Birth to Age 4 ½ Years.

Do preterm infants have special care needs?

Preterm infants, also known as preemies, are babies born before the mother has completed 37 weeks of pregnancy (or on or before 259 days from the first day of the last menstrual period). Preterm infants often have special needs, even after they leave the hospital. Infants born only a few weeks preterm (between 34 and 37 weeks, or “late preterm”) often have special needs during the first two years of age.

Preterm infants may need to spend time in a Neonatal Intensive Care Unit (NICU) at the hospital until they are big and strong enough to go home. Preterm babies may also need special care even after leaving the NICU.

You should talk to your health care provider about your infant’s specific care needs.

The NICHD provides more information at its Preterm Labor and Delivery Health and Human Development topic. The National Library of Medicine's MedlinePlus Web site also provides more information on Preterm (or Premature) Infants.

Common cold

2009-02-09T01:52:00.001-08:00

Common cold

Definition

The common cold is a viral infection of your upper respiratory tract — your nose and throat. A common cold is usually harmless, although it may not feel that way. If it's not a runny nose, sore throat and cough, it's the watery eyes, sneezing and congestion — or maybe all of the above. In fact, because any one of more than 200 viruses can cause a common cold, symptoms tend to vary greatly.

Most adults are likely to have a common cold two to four times a year. Children, especially preschoolers, may have a common cold as many as six to 10 times annually.

Most people recover from a common cold in about a week or two. If symptoms don't improve, see your doctor.

Symptoms

Symptoms of a common cold usually appear about one to three days after exposure to a cold virus. Signs and symptoms of a common cold may include:

Runny or stuffy nose
Itchy or sore throat
Cough
Congestion
Slight body aches or a mild headache
Sneezing
Watery eyes
Low-grade fever (up to 102 F, or 39 C)
Mild fatigue

The discharge from your nose may become thicker and yellow or green in color as a common cold runs its course. What makes a cold different from other viral infections is that you generally won't have a high fever. You're also unlikely to experience significant fatigue from a common cold.

When to see a doctor
For adults — Seek medical attention if you have:

Fever of 102 F (39 C) or higher
High fever accompanied by achiness and fatigue
Fever accompanied by sweating, chills and a cough with colored phlegm
Significantly swollen glands
Severe sinus pain

For children — In general, children are sicker with a common cold than adults are and often develop complications, such as ear infections. Your child doesn't need to see the doctor for a routine common cold. But seek medical attention right away if your child has any of the following signs or symptoms:

Fever of 103 F (39.5 C) or higher, chills or sweating
Fever that lasts more than three days
Vomiting or abdominal pain
Unusual sleepiness
Severe headache
Difficulty breathing
Persistent crying
Ear pain
Persistent cough

Causes

Although more than 200 viruses can cause a common cold, the rhinovirus is the most common culprit, and it's highly contagious.

A cold virus enters your body through your mouth or nose. The virus can spread through droplets in the air when someone who is sick coughs, sneezes or talks. But it also spreads by hand-to-hand contact with someone who has a cold or by using shared objects, such as utensils, towels, toys or telephones. Touch your eyes, nose or mouth after such contact or exposure, and you're likely to "catch" a cold.

Risk factors

Cold viruses are almost always present in the environment. But the following factors can increase your chances of getting a cold:

Age. Infants and preschool children are especially susceptible to common colds because they haven't yet developed resistance to most of the viruses that cause them. But an immature immune system isn't the only thing that makes kids vulnerable. They also tend to spend lots of time with other children and frequently aren't careful about washing their hands and covering their coughs and sneezes. Colds in newborns can be problematic if they interfere with nursing or breathing through the nose.

Immunity. As you age, you develop immunity to many of the viruses that cause common colds. You'll have colds less frequently than you did as a child. However, you can still come down with a cold when you are exposed to cold viruses, have an allergic reaction that affects your nasal passages or have a weakened immune system. All of these factors increase your risk of a cold.

Time of year. Both children and adults are more susceptible to colds in fall and winter. That's because children are in school, and most people are spending a lot of time indoors. In places where there is no winter season, colds are more frequent in the rainy season.

Complications

Acute ear infection (otitis media). Ear infection occurs when bacteria or viruses infiltrate the space behind the eardrum. It's a frequent complication of common colds in children. Typical signs and symptoms include earaches and, in some cases, a green or yellow discharge from the nose or the return of a fever following a common cold. Children who are too young to verbalize their distress may simply cry or sleep restlessly. Ear pulling is not a reliable sign.
Wheezing. A cold can trigger wheezing in children with asthma.
Sinusitis. In adults or children, a common cold that doesn't resolve may lead to sinusitis — inflammation and infection of the sinuses.
Other secondary infections. These include strep throat (streptococcal pharyngitis), pneumonia, bronchitis in adults and croup in children. These infections need to be treated by a doctor.

Preparing for your appointment

If you have a cold, you're likely to start by first seeing your family doctor, a general practitioner or your child's pediatrician.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

Write down the symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including any major stresses or recent life changes.
Make a list of all medications, as well as any vitamins or supplements and over-the-counter (OTC) cold remedies that you're taking.
Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For common cold, some basic questions to ask your doctor include:

What is likely causing my symptoms or condition?
Other than the most likely cause, what are other possible causes for my symptoms or condition?
What kinds of tests do I need?
Is my condition likely temporary or chronic?
What is the best course of action?
What are the alternatives to the primary approach that you're suggesting?
I have these other health conditions. How can I best manage them together?
Are there any restrictions that I need to follow?
Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
Is there a generic alternative to the medicine you're prescribing me?
Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?
What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:

When did you first begin experiencing symptoms?
Have your symptoms been continuous, or occasional?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?

What you can do in the meantime
While you're waiting for your appointment, you may consider taking OTC pain medications and decongestants to ease symptoms. Get plenty of rest and drink lots of fluids.

Treatments and drugs

There's no cure for the common cold. Antibiotics are of no use against cold viruses. Over-the-counter cold preparations won't cure a common cold or make it go away any sooner, and most have side effects. Here's a look at the pros and cons of some common cold remedies.

Pain relievers. For fever, sore throat and headache, many people turn to acetaminophen (Tylenol, others) or other mild pain relievers. Keep in mind that acetaminophen can cause liver damage, especially if taken frequently or in larger than recommended doses. Be especially careful when giving acetaminophen to children because the dosing guidelines can be confusing. For instance, the infant-drop formulation is much more concentrated than the syrup commonly used in older children. Never give aspirin to children. It has been associated with Reye's syndrome — a rare but potentially fatal illness.
Decongestant nasal sprays. Adults shouldn't use decongestant drops or sprays for more than a few days because prolonged use can cause chronic inflammation of mucous membranes. And children shouldn't use decongestant drops or sprays at all. There's little evidence that they work in young children, and they may cause side effects.
Cough syrups. In winter, nonprescription cough syrups practically fly off the drugstore shelves. But the American College of Chest Physicians strongly discourages the use of these medications because they're not effective at treating the underlying cause of cough due to colds. Some contain ingredients that may alleviate coughing, but the amounts are too small to do much good and may actually be harmful for children. In fact, the college recommends against using OTC cough syrups or cold medicines for anyone younger than age 14. The Food and Drug Administration (FDA) strongly recommends against giving OTC cough and cold medicines to children younger than age 2. Meantime, under an agreement announced by manufacturers in late 2008, several brands of OTC cold and cough medications began carrying a warning that these products should not be used in children under 4. For young children, an accidental overdose could be fatal. Coughs associated with a cold usually last less than two to three weeks. If a cough lingers longer than that, see your doctor.

Lifestyle and home remedies

You may not be able to cure your common cold, but you can make yourself as comfortable as possible. These tips may help:

Drink lots of fluids. Water, juice, tea and warm soup are all good choices. They help replace fluids lost during mucus production or fever. Avoid alcohol and caffeine, which can cause dehydration, and cigarette smoke, which can aggravate your symptoms.
Try chicken soup. Generations of parents have spooned chicken soup into their sick children. Now scientists have put chicken soup to the test, discovering that it does seem to help relieve cold and flu symptoms in two ways. First, it acts as an anti-inflammatory by inhibiting the movement of neutrophils — immune system cells that help the body's response to inflammation. Second, it temporarily speeds up the movement of mucus through the nose, helping relieve congestion and limiting the time viruses are in contact with the nasal lining.
Get some rest. If possible, stay home from work if you have a fever or a bad cough, or are drowsy from medications. This will give you a chance to rest as well as reduce the chances that you'll infect others. Wear a mask when you have a cold if you live or work with someone with a chronic disease or compromised immune system.
Adjust your room's temperature and humidity. Keep your room warm, but not overheated. If the air is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing. Be sure to keep the humidifier clean to prevent the growth of bacteria and molds.
Soothe your throat. Gargling with warm salt water several times a day or drinking warm lemon water with honey may help soothe a sore throat and relieve a cough.
Use saline nasal drops. To help relieve nasal congestion, try saline nasal drops. You can buy these drops over-the-counter, and they're effective, safe and nonirritating, even for children. To use in babies, put several drops into one nostril, then immediately bulb suction that nostril. Repeat the process in the opposite nostril. Doing this before feeding your baby can improve your child's ability to nurse or take a bottle, and before bedtime it may improve sleep.

Alternative medicine

Alternative therapies probably won't cure your cold, but they may help make you more comfortable by easing your symptoms.

Echinacea. Whether taking preparations of the herb echinacea protects you from getting a cold or relieves cold symptoms continues to be debated. While no studies have shown that taking echinacea can prevent you from getting a cold, there is some evidence that it can modestly relieve cold symptoms or shorten the duration of a cold. Echinacea seems most effective when taken soon after cold symptoms are first experienced.

Vitamin C. There's no evidence that taking large doses of vitamin C reduces your risk of catching cold. However, there is some evidence that high doses of vitamin C — up to 6 grams a day — may have a small effect in reducing the duration of cold symptoms.

Zinc. There's evidence that zinc nasal sprays or lozenges taken at the beginning of a cold may help reduce symptoms. While some studies also suggest zinc nasal sprays can be helpful, many users experienced permanent loss of smell and therefore the use of these sprays is discouraged.

Prevention

No vaccine has been developed for the common cold, which can be caused by many different viruses. But you can take some common-sense precautions to slow the spread of cold viruses:

Wash your hands. Clean your hands thoroughly and often, and teach your children the importance of hand washing. Carry a bottle of alcohol-based hand rub containing at least 60 percent alcohol for times when soap and water aren't available. These gels kill most germs, and are safe for older children to use themselves.
Scrub your stuff. Keep kitchen and bathroom countertops clean, especially when someone in your family has a common cold. Wash children's toys after play.
Use tissues. Always sneeze and cough into tissues. Discard used tissues right away, and then wash your hands carefully. Teach children to sneeze or cough into the bend of their elbow when they don't have a tissue. That way they cover their mouth without using their hands.
Don't share. Don't share drinking glasses or utensils with other family members. Use your own glass or disposable cups when you or someone else is sick. Label the cup or glass with the name of the person with the cold.
Steer clear of colds. Avoid close, prolonged contact with anyone who has a cold.
Choose your child care center wisely. Look for a child care setting with good hygiene practices and clear policies about keeping sick children at home. The number of children in the center directly relates to the number of colds to which your child will be exposed.

Carbon Monoxide (CO)

2009-02-04T02:58:00.000-08:00

Carbon Monoxide (CO)

Carbon monoxide is an odorless, colorless and toxic gas. Because it is impossible to see, taste or smell the toxic fumes, CO can kill you before you are aware it is in your home. At lower levels of exposure, CO causes mild effects that are often mistaken for the flu. These symptoms include headaches, dizziness, disorientation, nausea and fatigue. The effects of CO exposure can vary greatly from person to person depending on age, overall health and the concentration and length of exposure.

Contents

Sources of Carbon Monoxide

Unvented kerosene and gas space heaters; leaking chimneys and furnaces; back-drafting from furnaces, gas water heaters, wood stoves, and fireplaces; gas stoves; generators and other gasoline powered equipment; automobile exhaust from attached garages; and tobacco smoke. Incomplete oxidation during combustion in gas ranges and unvented gas or kerosene heaters may cause high concentrations of CO in indoor air. Worn or poorly adjusted and maintained combustion devices (e.g., boilers, furnaces) can be significant sources, or if the flue is improperly sized, blocked, disconnected, or is leaking. Auto, truck, or bus exhaust from attached garages, nearby roads, or parking areas can also be a source.

Health Effects Associated with Carbon Monoxide

At low concentrations, fatigue in healthy people and chest pain in people with heart disease. At higher concentrations, impaired vision and coordination; headaches; dizziness; confusion; nausea. Can cause flu-like symptoms that clear up after leaving home. Fatal at very high concentrations. Acute effects are due to the formation of carboxyhemoglobin in the blood, which inhibits oxygen intake. At moderate concentrations, angina, impaired vision, and reduced brain function may result. At higher concentrations, CO exposure can be fatal.

Levels in Homes

Average levels in homes without gas stoves vary from 0.5 to 5 parts per million (ppm). Levels near properly adjusted gas stoves are often 5 to 15 ppm and those near poorly adjusted stoves may be 30 ppm or higher.

ALERT: Put generators outside.

Never use a generator inside homes, garages, crawlspaces, sheds, or similar areas. Deadly levels of carbon monoxide can quickly build up in these areas and can linger for hours, even after the generator has shut off.

Steps to Reduce Exposure to Carbon Monoxide

It is most important to be sure combustion equipment is maintained and properly adjusted. Vehicular use should be carefully managed adjacent to buildings and in vocational programs. Additional ventilation can be used as a temporary measure when high levels of CO are expected for short periods of time.

Keep gas appliances properly adjusted.
Consider purchasing a vented space heater when replacing an unvented one.
Use proper fuel in kerosene space heaters.
Install and use an exhaust fan vented to outdoors over gas stoves.
Open flues when fireplaces are in use.
Choose properly sized wood stoves that are certified to meet EPA emission standards. Make certain that doors on all wood stoves fit tightly.
Have a trained professional inspect, clean, and tune-up central heating system (furnaces, flues, and chimneys) annually. Repair any leaks promptly.
Do not idle the car inside garage.

What is Child Pornography?

2009-01-29T04:14:00.000-08:00

What is Child Pornography?

Under federal law, child pornography¹ is defined as a visual depiction of any kind, including a drawing, cartoon, sculpture, or painting, photograph, film, video, or computer-generated image or picture, whether made or produced by electronic, mechanical, or other means, of sexually explicit conduct, where it

depicts a minor engaging in sexually explicit conduct and is obscene, or
depicts an image that is, or appears to be, of a minor engaging in graphic bestiality, sadistic or masochistic abuse, or sexual intercourse, including genital-genital, oral-genital, anal-genital, or oral-anal, whether between persons of the same or opposite sex, and such depiction lacks serious literary, artistic, political, or scientific value.²

Sexually explicit conduct includes various forms of sexual activity such as intercourse, bestiality, masturbation, sadistic or masochistic abuse, and lascivious exhibition of the genitals.³ It is illegal to possess, distribute, or manufacture these images.

These illegal images can be presented in various forms including print media; videotape; film; compact disc, read-only memory (CD-ROM); or digital versatile technology (DVD)⁴ and can be transmitted through computer bulletin-board systems (BBS), USENET Newsgroups, Internet Relay Chat, web-based groups, peer-to-peer technology, and an array of constantly changing world wide web sites.⁵

All states and the District of Columbia have laws concerning child pornography. As a result a person who violates federal laws concerning these images may also face additional state charges.

Who Is a Minor?
Federal statute defines “minor” as any person younger than 18.⁶ “While a majority of states follow the federal statute, some state laws define ‘minor’ or ‘child’ as a youth younger than 14, 16, or 17.⁷ Delaware law includes any person 18 years of age and younger in its definition of a ‘child.’”⁸

Is Child Pornography a Crime?
Yes, the possession or distribution of child pornography is illegal under federal laws and laws in all 50 states; however, researchers and law-enforcement officials believe this crime is increasing and the increase is related to growing Internet use.⁹

In response to this growing crime, the U.S. Department of Justice (USDoJ) has responded in several ways including funding the National Center for Missing & Exploited Children’s CyberTipline, www.cybertipline.com, acting as the national clearinghouse for reports of Internet-related child pornography and other Internet-related sex crimes committed against children. The USDoJ also created regional Internet Crimes Against Children (ICAC) Task Forces to assist state and local law enforcement in handling these crimes and funded specialized Internet child exploitation units in federal law-enforcement agencies.¹⁰

Where Is Child Pornography Predominantly Found?
The Internet has created an exciting new world of information and communication for anyone with access to online services. While this technology offers unparalleled opportunities for children and adults to learn about the universe we live in, it has also had an immeasurable impact on the sexual exploitation of children, specifically the distribution of sexually exploitive images of children.

The development, increasing accessibility, and use of home-computer technology has revolutionized the distribution of these images by increasing the ease and decreasing the cost of production and distribution especially across international borders. Computer technology is transforming the production of these images into a “sophisticated global cottage industry.”¹¹

It is not unusual to encounter illegal images while exploring legitimate areas of the Internet. A current study has estimated that “as much as 20 percent of all pornographic activity on the Internet may involve children”;¹² however, accurate estimates are difficult to produce since a reliable methodology to measure the actual extent of these images online has yet to be devised.¹³ Nonetheless parents and guardians should closely monitor the online activities of their children and always maintain access to their children’s online accounts.

What Motivates People Who Possess Child Pornography?
There is not much research about the motivations of people who possess child pornography. But, from the little information that exists, it suggests these people are a diverse group who use sexually abusive images of children for a variety of reasons.¹⁴ Those who possess child pornography include people who are

• sexually interested in prepubescent children (pedophiles) or young adolescents (hebephiles), who use child pornography for sexual fantasy and gratification
• sexually “indiscriminate,” meaning they are constantly looking for new and different sexual stimuli
• sexually curious, downloading a few images to satisfy that curiosity
• interested in profiting financially by selling images or setting up web sites requiring payment for access¹⁵

Who Possesses Child Pornography?
The diversity of these possessors is exemplified by many factors including wide age ranges; incomes ranging from poverty to wealth; levels of education running the gamut from some not finishing high school to others having post college degrees; and those who come from cities, suburbs, small towns, and rural areas. Some are well known, well thought of in their communities, and/or have high-profile jobs. Others seem isolated, seem to be obsessed with the Internet, and/or have long criminal histories.¹⁶

Almost all child-pornography possessors (estimated 1,713) arrested between July 1, 2000, and June 30, 2001, were male, 91% were white, and 86% were older than 25. Only 3% were younger than 18. Most were unmarried at the time of their crime, either because they had never married (41%) or because they were separated, divorced, or widowed (21%). Thirty-eight (38%) percent were either married or living with partners.¹⁷

Of those estimated arrestees, most had sexually abusive images of prepubescent children (83%) and images graphically depicting sexual penetration (80%). Approximately 1 in 5 people arrested (21%) had images depicting sexual violence to children such as bondage, rape, and torture. More than 1 in 3 (39%) had child-pornography videos with motion and sound.¹⁸

Of those estimated arrestees, law enforcement found about half (48%) had more than 100 graphic still images, and 14% had 1,000 or more graphic images.¹⁹

Forty percent (40%) of those estimated arrestees were “dual offenders,” who sexually victimized children and possessed child pornography, with both crimes discovered in the same investigation. An additional 15% were dual offenders who attempted to sexually victimize children by soliciting undercover investigators who posed online as minors.²⁰

How Old Were the Children Found in These Images?
According to investigators who handled the cases of estimated arrestees, most had images of children who had not yet reached puberty. Specifically 83% had images of children between ages 6 and 12; 39% had images of 3- to 5-year-old children; and 19% had images of toddlers or infants younger than age 3.²¹

Are the Children in the Images Boys or Girls?
According to investigators who handled the cases of estimated arrestees, 62% had pictures of mostly girls. Fourteen percent (14%) had pictures of mostly boys. Fifteen percent (15%) had pictures showing boys and girls in about equal numbers.²²

How Graphic Are the Images?
According to investigators who handled the cases of estimated arrestees, most had graphic images explicitly showing sexual acts by or on children. Specifically 92% had images of minors focusing on genitals or showing explicit sexual activity; 80% had pictures showing the sexual penetration of a child, including oral sex; 71% possessed images showing sexual contact between an adult and a minor, defined as an adult touching the genitals or breasts of a minor or vice-versa; 21% had child pornography depicting violence such as bondage, rape, or torture and most of those involved images of children who were gagged, bound, blindfolded, or otherwise enduring sadistic sex; and 79% also had what might be termed “softcore” images of nude or semi-nude minors, but only 1% possessed such images alone.²³

What Are the Effects of Child Pornography?
It is important to realize these images can have a devastating and lasting effect on children. In addition to any physical injuries they might suffer in the course of their molestation, such as genital bruising, lacerations, or exposure to sexually transmitted diseases, child victims may also experience depression, withdrawal, anger, and other psychological disorders.²⁴ Such effects may continue into adulthood. For instance women abused as children have statistically significant higher rates of nightmares, back pain, headaches, pelvic pain, eating binges, and other similar symptoms.²⁵ Child victims also frequently experience feelings of guilt and responsibility for the abuse and betrayal, a sense of powerlessness, and feelings of worthlessness and low self-esteem.²⁶ These feelings are often expressed through increased fearfulness and changes in sleep patterns including re-occurring memories, flashbacks, dreams, and nightmares associated with posttraumatic stress.²⁷ Younger children tend to externalize stress by re-enacting sexual activities through play, while adolescents may experience negative effects on their growing sexuality as a result of inappropriate early sexual experiences.²⁸

The lives of children featured in these illegal images are forever altered, not only by the molestation but by the permanent record of the exploitation. Once sexual exploitation takes place, the molester may document these encounters on film or video. This documentation can then become the “ammunition” needed to blackmail the child into further submission, which is necessary to continue the relationship and maintain its secrecy. In addition these documented images allow molesters to “relive” their sexual fantasies with children long after the exploitation has stopped.

A greater number of child molesters are now using computer technology to organize and maintain their collections of these illegal images. They are also using the Internet to increase the size of these collections. Personally manufactured illegal images of children are especially valuable on the Internet, which provide the molester with a respected status among fellow exploiters and traders of this material. Once this status is achieved, molesters will often begin to trade images of their own sexual exploits with children.

When these images reach cyberspace, they are irretrievable and can continue to circulate forever. Thus the child is revictimized as the images are viewed again and again.

How Do Online Exploiters Find Children?
Individuals looking for potential child victims online have no difficulty finding them. It is quite common for these individuals to frequent “kids only” chatrooms and communicate with children who unwittingly divulge personal information about themselves. A more recent phenomenon is the solicitation of sex over the Internet.

After this initial meeting, these individuals will often continue to communicate with the child electronically or through other means. Some of these individuals may then attempt to lower the child’s inhibitions by gradually introducing sexual content into their online conversations and even send the child sexually abusive images of other children. When children are shown images of peers engaged in sexual activities, they are led to believe this behavior is acceptable. This lowers their inhibitions and makes it easier for the molester to take advantage of the child sexually.

Parents and guardians are strongly encouraged to speak openly with their children about online risks and monitor their online activities.

Chewing tobacco: Not a risk-free alternative to cigarettes

2009-01-27T04:46:00.001-08:00

Chewing tobacco: Not a risk-free alternative to cigarettes

You can call it what you want — smokeless tobacco, spit tobacco, snus, chew, snuff, pinch, plug or dip — but don't call it harmless. If you're considering making the switch from cigarettes to chewing tobacco because you think the smokeless version of tobacco won't hurt you, be forewarned — chewing tobacco also causes serious health problems. Find out why chewing tobacco is not a healthy option.

Chewing tobacco: Just one form of smokeless tobacco

Smokeless tobacco products consist of tobacco or a tobacco blend that's chewed, inhaled or sucked on rather than smoked. It's available in three main forms:

Chewing tobacco. This type of smokeless tobacco comes in loose leaf, plugs or twists. As the name suggests, it's chewed.
Snuff. This product is available dry or moist, in loose leaf or in pouches that look like small tea bags. A pinch of snuff may be placed between the cheek and the gum or inhaled into the nostrils.
Betel quid. A product of India, Africa and Asia, betel quid is produced commercially or made at home. It consists of a dried paste that often includes tobacco, areca nuts, catechu, and scent or flavoring. Catechu is a plant-based product used to treat diarrhea and sometimes used for birth control in some parts of the world. Areca nuts are a plant-based product often used as a recreational drug. Betel is placed in the mouth, usually between the gum and cheek, and gently sucked and chewed.

Though the concept of chewing tobacco might conjure up images of spittoons and messy brown liquid, not all smokeless tobacco needs to be spit out during use. Tobacco companies have developed a friendlier version of chewing tobacco — a spitless tobacco — in an effort to convince more smokers to consider using smokeless products in places where smoking is prohibited.

Health risks of chewing tobacco and other forms of smokeless tobacco

CLICK TO ENLARGE

Leukoplakia

Using chewing tobacco and other smokeless tobacco products can cause serious health problems, from gum irritation to oral cancer.

Addiction
Chewing tobacco gets you hooked on nicotine, similar to the way cigarettes do. And once you're addicted, it becomes difficult to stop using chewing tobacco. Just as with smoking, withdrawal from chewing tobacco causes signs and symptoms such as intense cravings, increased appetite, irritability and depressed mood.

People who use chewing tobacco eventually develop a tolerance for nicotine and need more tobacco to feel the desired effects of the nicotine. Some people switch to brands with higher nicotine content and tend to use chewing tobacco more frequently the longer they've been using smokeless products. More severely addicted users may leave the chew in their mouths overnight and swallow the tobacco juices.

Cavities
Chewing tobacco and other forms of smokeless tobacco cause tooth decay. That's because chewing tobacco contains high amounts of sugar, which contributes to cavities. Chewing tobacco also contains coarse particles that can irritate your gums and scratch away at the enamel on your teeth, making your teeth more vulnerable to cavities.

Gum disease
The sugar and irritants in chewing tobacco and other forms of smokeless tobacco can cause your gums to pull away from your teeth in the area of your mouth where you place the chew. Over time you can develop gum disease (gingivitis) and possibly tooth loss.

Heart problems and non-oral cancer
Smokeless tobacco increases your heart rate and blood pressure. Some evidence suggests that it may put you at an increased risk of heart attack. People who use smokeless tobacco also have higher cholesterol levels than those who don't use tobacco. And a study published in June 2007 in the medical journal The Lancet showed a connection between the use of one form of smokeless tobacco (snus) and an increased risk of pancreatic cancer.

Precancerous mouth lesions
People who use smokeless tobacco are more likely to develop small white patches called leukoplakia (loo-ko-PLA-ke-uh) inside their mouths where the chew is most often placed. These mouth lesions are precancerous — meaning that the sores could one day develop into cancer. After stopping tobacco usage, the lesions usually go away in a few weeks or a few months.

Oral cancer
Your risk of oral cancer is increased if you use smokeless tobacco. Oral cancer includes cancers of the mouth, throat, cheek, gums, lips and tongue. Surgery to remove cancer from any of these areas can leave your jaw, chin, neck or face disfigured.

Smokeless doesn't mean harmless

If you aren't convinced that chewing tobacco, spit tobacco and other forms of smokeless tobacco aren't risk-free, consider the words of someone who's seen the damage tobacco can do. Joe Garagiola, a former spit tobacco user, played major league baseball and later worked in broadcasting. After retiring from baseball he became a crusader against spit tobacco — the term he prefers since "smokeless" makes tobacco sound harmless.

Joe Garagiola

"I chewed tobacco because it seemed to be the thing to do if you were playing baseball," says Garagiola. "Everybody chewed when I was playing, and nobody knew the dangers of it." But he's seen the dangers since, losing three close friends to oral cancer and seeing the harmful effects of spit tobacco on other people.

"You won't die of gum disease or yellow teeth, but develop oral cancer and it's a terrible way to go," Garagiola says. "Here you are with oral cancer from using spit tobacco, your jaw has been removed and you have to eat through a tube. You die one piece at a time. Spit tobacco is a horrible, horrible thing. I just wish I could get this message across to everyone."

It's never too late to quit

If you're using smokeless tobacco, quit. Now that you know the dangers associated with it, you have extra motivation to give it up. Here's what to do:

Set a quit date. Mark your quit day on your calendar and commit to it. Select a day at least one week away so that you have time to prepare for your life as a former tobacco user.
Talk to your doctor. Tell your doctor about your goal to quit using smokeless tobacco and ask for advice. Smokeless tobacco users have more success with quitting if they talk to a doctor or dentist about strategies for quitting.
Consider medications. Ask your doctor about medications that can help you quit, such as over-the-counter nicotine replacement products, including patches, gum, inhalers and lozenges. There are also non-nicotine prescription medications such as bupropion (Zyban) and varenicline (Chantix) that can ease nicotine withdrawal symptoms when you quit.
Get support. Join a support group in your area. Go online. Get help and support from people who understand what you're going through. Free resources are available, so don't worry about a financial cost.

Devise a plan to deal with cravings and know that cravings typically last only a few minutes. Eating licorice, chewing gum, going for a walk or calling a friend can help you get through them. And the interval between cravings increases the longer you've stopped using tobacco and eventually the cravings will go away.

Facts and Fallacies About Digestive Diseases

2009-01-22T01:45:00.000-08:00

Facts and Fallacies About Digestive Diseases

On this page:

The digestive system

Researchers have only recently begun to understand the many, often complex diseases that affect the digestive system. Accordingly, people are gradually replacing folklore, old wives' tales, and rumors about the causes and treatments of digestive diseases with accurate, up-to-date information. But misunderstandings still exist, and while some folklore is harmless, some can be dangerous if it keeps a person from correctly preventing or treating an illness. Listed below are some common misconceptions (fallacies), about digestive diseases, followed by the facts as professionals understand them today.

[Top]

Ulcers

Spicy food and stress cause stomach ulcers.

False.

The truth is, almost all stomach ulcers are caused either by infection with a bacterium called Helicobacter pylori (H. pylori) or by use of pain medications such as aspirin, ibuprofen, or naproxen, the so-called nonsteroidal anti-inflammatory drugs (NSAIDs). Most H. pylori-related ulcers can be cured with antibiotics. NSAID-induced ulcers can be cured with time, stomach-protective medications, antacids, and avoidance of NSAIDs. Spicy food and stress may aggravate ulcer symptoms in some people, but they do not cause ulcers.

Ulcers can also be caused by cancer.

[Top]

Heartburn

Smoking a cigarette helps relieve heartburn.

False.

Actually, cigarette smoking contributes to heartburn. Heartburn occurs when the lower esophageal sphincter (LES)—a muscle between the esophagus and stomach—relaxes, allowing the acidic contents of the stomach to splash back into the esophagus. Cigarette smoking causes the LES to relax.

[Top]

Celiac Disease

Celiac disease is a rare childhood disease.

False.

Celiac disease affects both children and adults. About 1 in 200 people in the United States have celiac disease. Sometimes celiac disease first causes symptoms during childhood, usually diarrhea, growth failure, and failure to thrive. But the disease can also first cause symptoms in adults of any age. These symptoms may be vague and therefore attributed to other conditions. Symptoms can include bloating, diarrhea, abdominal pain, skin rash, anemia, and thinning of the bones (osteoporosis). Celiac disease may cause such nonspecific symptoms for several years before being correctly diagnosed and treated.

People with celiac disease should not eat any foods containing gluten, a protein in wheat, rye, and barley, whether they have symptoms or not. In celiac disease, gluten destroys part of the lining of the small intestine, which interferes with the absorption of nutrients. Even a small amount of gluten can cause damage, and sometimes no symptoms will be apparent.

[Top]

Bowel Regularity

Bowel regularity means a bowel movement every day.

False.

The frequency of bowel movements among normal, healthy people varies from three a day to three a week, and some perfectly healthy people fall outside both ends of this range.

[Top]

Constipation

Habitual use of enemas to treat constipation is harmless.

False.

Habitual use of enemas is not harmless. Over time, enemas can impair the natural muscle action of the intestines, leaving them unable to function normally. An ongoing need for enemas is not normal; you should see a doctor if you find yourself relying on them or any other medication to have a bowel movement.

[Top]

Irritable Bowel Syndrome

Irritable bowel syndrome is a disease.

True.

Irritable bowel syndrome is a disease, although it is also called a functional disorder. Irritable bowel syndrome involves a problem in how the muscles in the intestines work and pain perception in the bowel. It is characterized by gas, abdominal pain, and diarrhea or constipation, or both. Although the syndrome can cause considerable pain and discomfort, it does not damage the digestive tract as organic diseases do. Also, irritable bowel syndrome does not lead to more serious digestive diseases later, such as cancer.

[Top]

Diverticulosis

Diverticulosis is a serious but uncommon problem.

False.

Actually, the majority of Americans over age 60 have diverticulosis, but only a small percentage have symptoms or complications. Diverticulosis is a condition in which little sacs or out-pouchings called diverticula develop in the wall of the colon. These sacs tend to appear and increase in number with age. Most people have no symptoms and learn that they have diverticula after an x ray or intestinal examination. Less than 10 percent of people with diverticulosis ever develop complications such as infection (diverticulitis), bleeding, or perforation of the colon.

[Top]

Inflammatory Bowel Disease

Inflammatory bowel disease is caused by psychological problems.

False.

Inflammatory bowel disease is the general name for two diseases that cause inflammation in the intestines, Crohn's disease and ulcerative colitis. The cause of the disease is unknown, but researchers speculate that it may be a virus or bacteria interacting with the body's immune system. No evidence has been found to support the theory that inflammatory bowel disease is caused by tension, anxiety, or any other psychological factor or disorder.

[Top]

Cirrhosis

Cirrhosis is caused only by alcoholism.

False.

Alcoholism is just one of many causes of cirrhosis. Cirrhosis is scarring and decreased function of the liver. In the United States, alcohol causes less than one-half of cirrhosis cases. The remaining cases are from diseases that cause liver damage. For example, in children, cirrhosis may result from cystic fibrosis, alpha-1 antitrypsin deficiency, biliary atresia, glycogen storage disease, and other rare diseases. In adults, cirrhosis may be caused by hepatitis B or C, primary biliary cirrhosis, diseases of abnormal storage of metals like iron or copper in the body, severe reactions to prescription drugs, or injury to the ducts that drain bile from the liver. In adults, cirrhosis can also be caused by nonalcoholic steatohepatitis (NASH), which is becoming the most common liver disease in the United States, affecting 2 to 5 percent of Americans.

[Top]

Ostomy Surgery

After ostomy surgery, men have erectile dysfunction and women have impaired sexual function and are unable to become pregnant.

False.

Ostomy surgery does not, in general, interfere with a person's sexual or reproductive capabilities. Ostomy surgery is a procedure in which the diseased part of the small or large intestine is removed and the remaining intestine is attached to an opening in the abdomen. Although some men who have had radical ostomy surgery for cancer lose the ability to achieve and sustain an erection, most men do not, or, if they do, it is temporary. If erectile dysfunction persists, a variety of solutions are available. A urologist, a doctor who specializes in such problems, can help find the best solution. In women, ostomy surgery does not damage sexual or reproductive organs, so it is not a direct cause of sexual problems or sterility. Factors such as pain and the adjustment to a new body image may create temporary sexual problems, but they can usually be resolved with time and, in some cases, counseling. Unless a woman has had a hysterectomy to remove her uterus, she can still bear children.

[Top]

Cerebral palsy

2009-01-17T00:34:00.001-08:00

Cerebral palsy

Definition

"Cerebral palsy" is a general term for a group of disorders that appear during the first few years of life and affect a child's ability to coordinate body movements. Cerebral palsy can cause muscles to be weak and floppy, or rigid and stiff.

In Europe and the United States, cerebral palsy occurs in about two to four out of every 1,000 births. Babies born prematurely or at low birth weights are at higher risk. The disorder is usually caused by brain injuries that occur early in the course of development.

Cerebral palsy isn't curable. However, getting the right therapy for your child can make a big difference.

Symptoms

In general, children with cerebral palsy exhibit a wide variety of signs and symptoms, ranging from mild to severe. They may include:

Lack of muscle coordination when performing voluntary movements (ataxia)
Stiff muscles and exaggerated reflexes (spasticity)
Asymmetrical walking gait, with one foot or leg dragging
Variations in muscle tone, from too stiff to too floppy
Excessive drooling or difficulties swallowing, sucking or speaking
Tremors
Difficulty with precise motions, such as writing or buttoning a shirt

The brain injury causing cerebral palsy doesn't change with time, so the symptoms usually don't worsen with age. Other neurological disorders — such as mental retardation or seizures — also may occur in children with cerebral palsy.

Causes

Most cases of cerebral palsy are believed to be caused by problems that occur before the baby is born, although some cases have been linked to brain injuries or infections during the first few months or years of life. Doctors can't always determine the root cause of the brain damage that results in cerebral palsy. Potential causes include:

Infections
Cerebral palsy has been linked to a variety of infectious diseases occurring either in the mother during pregnancy or in the infant during the first few months of life.

Maternal illnesses that have been linked to cerebral palsy include:

German measles (rubella). Also known as "three-day measles," rubella can be prevented with a vaccine.
Chickenpox (varicella). Associated with the later development of shingles, chickenpox can be prevented with a vaccine.
Cytomegalovirus. Up to 80 percent of the population has been infected with this virus, which causes flu-like symptoms, by the age of 40. Most people have mild symptoms that come and go throughout their lives. If a woman experiences her first bout of cytomegalovirus during pregnancy, it may cause birth defects.
Toxoplasmosis. A parasite found in the soil and in the feces of infected cats, toxoplasmosis can harm the fetuses of women who are infected during pregnancy.
Syphilis. A sexually transmitted disease, syphilis can harm the fetuses of infected women.

Infant illnesses that have been linked to cerebral palsy include:

Meningitis. Meningitis causes inflammation in the membranes that surround the brain and spinal cord. The bacterial form of the disease is the most dangerous.
Viral encephalitis. Encephalitis causes inflammation in the brain itself. Viral encephalitis is the most common variety.

Congenital abnormalities
Some children have cerebral palsy because their brains didn't develop properly while in the womb. In most cases, doctors don't know why this happens. In some instances, however, mutations in the genes responsible for brain development can prevent the brain from developing normally. Exposure to toxins, radiation or infections increases the risk.

Strokes
Although strokes are more commonly associated with older people, they can happen at any age — even before birth. Strokes can occur when clots in the placenta interrupt the flow of blood to the baby. Strokes can also occur if malformed or weak blood vessels leak blood into the brain.

Lack of oxygen
For many years, doctors and researchers believed that cerebral palsy was caused by a lack of oxygen during birth. Now they believe that only a small number of cases are caused by problems during labor and delivery.

Severe jaundice
Jaundice is common in newborns. But severe cases of untreated jaundice can harm the brain permanently and may result in cerebral palsy.

Risk factors

Most children with cerebral palsy don't have any apparent problems during development in the womb and birth. But some factors may increase the risk of cerebral palsy:

Premature birth. A normal pregnancy lasts 40 weeks. Babies who are born less than 37 weeks into the pregnancy are at higher risk of cerebral palsy. The earlier the baby is born, the greater the risk of cerebral palsy.
Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight falls.
Breech births. Babies who are in a feet-first position (breech presentation) at the beginning of labor are more likely to have cerebral palsy.
Multiple babies. The risk of cerebral palsy increases with the number of babies sharing the uterus. If one or more of the other babies die, the chances that the survivors may develop cerebral palsy increase.
Toxic substances. Babies whose mothers were exposed to toxins, such as mercury, during pregnancy are at higher risk of having cerebral palsy.
Mother's health. Women who have thyroid problems, mental retardation or seizures are at higher risk of having a baby with cerebral palsy.

Complications

Besides difficulty with movement and posture, cerebral palsy may result in:

Contractures. This condition occurs when the muscles pull so tightly on the bones that the affected limb curls in. Severe contractures can result in joint deformities or dislocation.
Malnutrition. Swallowing or feeding problems can make it difficult for someone who has cerebral palsy, particularly an infant, to get enough nutrition.

Some children with cerebral palsy will have multiple handicaps and may require long term care. Some of the associated problems may include:

Difficulty with vision, hearing and speech
Dental problems
Mental retardation
Seizures
Abnormal sensation or perception
Urinary incontinence

Preparing for your appointment

While you might first discuss your child's symptoms with your family doctor, he or she will probably refer you to a neurologist for further evaluation.

What you can do
Because appointments can be brief, plan ahead and write a list that includes:

Detailed descriptions of your child's symptoms
Questions you want to ask the doctor

What to expect from your doctor
In addition to a physical exam, your doctor may also check your child's neurological health by testing his or her:

Reflexes
Muscle strength
Muscle tone
Senses of touch and sight
Coordination
Balance

Your child may also be screened for:

Mental retardation
Vision problems
Hearing impairment
Speech and language disorders

Tests and diagnosis

Early signs of cerebral palsy may be present from birth. But if signs and symptoms are mild, it may be difficult to make a definite diagnosis before the age of 4 or 5. In most cases, cerebral palsy is diagnosed by age 1 or 2.

Diagnostic tests may include:

Brain scans
If your baby is born prematurely and is at high risk of cerebral palsy, your doctor may suggest a cranial ultrasound because it is the least intrusive of the imaging techniques used to visualize the brain. Cranial ultrasound, however, provides a less detailed image than does a CT scan or an MRI. An MRI reveals the most details, which help determine a cause and a prognosis.

Cranial ultrasound. This test uses high frequency sound waves to obtain images of the soft tissues inside the skull. Cranial ultrasound is painless and takes between 15 and 30 minutes to complete.
CT scan. This test uses a computer to combine X-ray images taken from many different angles to produce cross-sectional views of your child's brain. Scanning is painless and takes about 30 minutes. If your child can't hold still for the scanning, he or she may be given a light sedative.
MRI. Using radio waves and a powerful magnet, an MRI can produce detailed images of the brain. This test is painless, but it is noisy and can take up to an hour to complete. If your child can't hold still long enough for this test, he or she may be given a sedative.

Electroencephalogram (EEG)
If your child has had seizures, your doctor may recommend an electroencephalogram (EEG) to check for epilepsy. In an EEG test, a series of electrodes must be affixed to your child's scalp. The procedure is painless and records the electrical activity inside your child's brain.

Lab tests
Your child's blood may need to be checked to help rule out other conditions — such as blood-clotting disorders that can cause strokes — that may mimic cerebral palsy signs and symptoms. Lab tests may also screen for genetic or metabolic problems.

Treatments and drugs

The brain abnormality or damage that underlies cerebral palsy doesn't worsen with time, but children with cerebral palsy often require long term care. The type and amount of treatment depend on how many problems your child has and how severe they are.

Medications

Muscle relaxants. Oral medications — such as diazepam, baclofen, dantrolene and tizanidine — are usually the first option to relax stiff, contracted muscles. Side effects may include drowsiness and upset stomach. Baclofen can also be delivered directly to the fluid surrounding the spinal cord via a pump surgically implanted into the abdomen.
Botulinum toxin type A (Botox). Injections of botulinum toxin directly into spastic muscles also can help relieve the muscle spasms and contractures common to cerebral palsy. However, these injections have, in rare instances, caused serious problems with swallowing and breathing, particularly in children with cerebral palsy.

Therapies

Physical therapy. Muscle training and exercises may help your child's strength, flexibility, balance, motor development and mobility. Braces or splints may be recommended for your child. Some of these supports are used to help with function, such as improved walking. Others may stretch stiff muscles to help prevent contractures.
Occupational therapy. Using alternative strategies and adaptive equipment, occupational therapists work to promote your child's independent participation in daily activities and routines in the home, school and community. They may also address difficulties with feeding and swallowing.
Speech therapy. Speech therapists help improve your child's ability to speak clearly or to communicate using sign language. They can also teach your child to use special communication devices — such as a board covered with pictures of everyday items and activities. Sentences can be constructed by pointing to the pictures.

Surgical or other procedures

Orthopedic. Children with severe contractures or deformities may need surgery on tendons, bones or joints to place their arms and legs in their correct positions. This can make it easier to use a walker, braces or crutches.
Severing nerves. In some severe cases, when other treatments haven't helped, surgeons may cut the nerves serving the spastic muscles. This relaxes the muscle and reduces pain, but can also cause numbness.

Coping and support

When a child is diagnosed with a disabling condition, the whole family faces new challenges. Here are a few tips for caring for your child and yourself:

Foster your child's independence. Encourage any effort at independence, no matter how small. Just because you can do something faster and quicker doesn't mean you should.
Be an advocate for your child. You are an important part of your child's health care team. Don't be afraid to speak out on your child's behalf or to ask tough questions of your physicians, therapists and teachers.
Find support. A circle of support can make a big difference in helping you cope with cerebral palsy and its effects. As a parent, you may feel grief and guilt over your child's disability. Your doctor can help you locate support groups, organizations and counseling services in your community. Your child may benefit from family support programs, school programs and counseling.

Prevention

Most cases of cerebral palsy can't be prevented, despite the best efforts of parents and doctors. But, if you're pregnant, you can take these steps to keep healthy and minimize the possibility of pregnancy complications:

Make sure you're immunized. Immunization against diseases such as rubella may prevent an infection that could cause fetal brain damage.
Take care of yourself. The healthier you are heading into a pregnancy, the less likely you'll be to develop an infection that may result in cerebral palsy.
Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy are a good way to reduce health risks to you and your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight and infections.

Chronic fatigue syndrome

2009-01-16T01:17:00.000-08:00

Chronic fatigue syndrome

Definition

Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that doesn't improve with bed rest and may worsen with physical or mental activity.

Chronic fatigue syndrome may occur after an infection, such as a cold or viral illness. The onset can be during or shortly after a time of great stress, or chronic fatigue syndrome come on gradually without a clear starting point or obvious cause.

Women are diagnosed with chronic fatigue syndrome far more often than men are. However, it's unclear whether chronic fatigue syndrome affects women more frequently or if women report it more often than men do.

Treatment for chronic fatigue syndrome focuses on a combination of approaches to relieve signs and symptoms.

Symptoms

Chronic fatigue syndrome is a flu-like condition that can drain your energy and, sometimes, last for years. People previously healthy and full of energy may experience a variety of signs and symptoms.

People with chronic fatigue syndrome exhibit signs and symptoms similar to those of most common viral infections. Unlike flu (influenza) symptoms, which usually subside in a few days or weeks, the signs and symptoms of CFS can last much longer. They may come and go frequently with no identifiable pattern.

Primary signs and symptoms
In addition to persistent fatigue, not caused by other known medical conditions, chronic fatigue syndrome has eight possible primary signs and symptoms. Chronic fatigue syndrome symptoms include:

Loss of memory or concentration
Sore throat
Painful and mildly enlarged lymph nodes in your neck or armpits
Unexplained muscle soreness
Pain that moves from one joint to another without swelling or redness
Headache of a new type, pattern or severity
Sleep disturbance
Extreme exhaustion lasting more than 24 hours after physical or mental exercise

According to the International Chronic Fatigue Syndrome Study Group — a group of scientists, researchers and doctors brought together by the Centers for Disease Control and Prevention (CDC) to determine a standard method for defining and diagnosing chronic fatigue syndrome — a person meets the diagnostic criteria of chronic fatigue syndrome when unexplained persistent fatigue occurs for six months or more along with at least four of the eight primary signs and symptoms.

Additional signs and symptoms
In addition, people with chronic fatigue syndrome have reported other various signs and symptoms that aren't part of the official definition. These include:

Abdominal pain
Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise
Bloating
Chest pain
Chronic cough
Diarrhea
Dizziness, balance problems or fainting
Dry mouth
Earache
Irregular heartbeat
Jaw pain
Morning stiffness
Nausea
Chills and night sweats
Psychological problems, such as depression, irritability, anxiety disorders and panic attacks
Shortness of breath
Tingling sensations
Visual disturbances, such as blurring, sensitivity to light, eye pain and dry eyes
Weight loss or gain

If you have chronic fatigue syndrome, your symptoms may peak and become stable early on, and then come and go over time. Some people go on to recover completely, while others grow progressively worse.

Causes

Of all chronic illnesses, chronic fatigue syndrome is one of the most mysterious. Unlike definite infections, it has no clear cause. Several possible causes have been proposed, including:

Depression
Iron deficiency anemia
Low blood sugar (hypoglycemia)
History of allergies
Virus infection, such as Epstein-Barr virus or human herpesvirus 6
Dysfunction in the immune system
Changes in the levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands
Mild, chronic low blood pressure (hypotension)

The cause of chronic fatigue syndrome may be an inflammation of the pathways of the nervous system as a response to an autoimmune process, but with nothing measurable in the blood as in other autoimmune diseases, such as rheumatoid arthritis and lupus. Chronic fatigue syndrome may also occur when a viral illness is complicated by a dysfunctional immune system. Some people with CFS may have a low blood pressure disorder that triggers the fainting reflex.

In many cases, however, no serious underlying infection or disease is proved to specifically cause chronic fatigue syndrome. Lack of medical knowledge and understanding of CFS has made determining and describing the characteristics of the condition difficult.

Risk factors

Women are diagnosed with chronic fatigue syndrome two to four times as often as men, but sex isn't a proven risk factor for this condition. It may be that women are simply more likely than men are to report their symptoms to their doctor.

The condition is most common in people in their 40s and 50s, but it can affect people of all ages.

Because the cause of the condition is unknown, doctors have yet to determine and confirm definite risk factors for the disease.

When to seek medical advice

Fatigue can be a symptom of many illnesses, such as infections or psychological disorders. In general, see your doctor if you have persistent or excessive fatigue. Severe fatigue that prevents you from fully participating in activities at home, work or school may be a symptom of an underlying medical problem.

Tests and diagnosis

A diagnosis of chronic fatigue syndrome is based on exclusion. This means that before arriving at a diagnosis, a doctor has ruled out any other disease or condition that may be causing your fatigue and related symptoms.

In general, doctors find it difficult to diagnose chronic fatigue syndrome because it has some of the same signs and symptoms as many other diseases. There's no diagnostic or laboratory procedure to confirm the presence of chronic fatigue syndrome.

Doctors exclude certain conditions before considering a diagnosis of chronic fatigue syndrome. These include:

Having an active, identifiable medical condition that often results in fatigue, such as low levels of thyroid hormones (hypothyroidism) or sleep apnea
Using medicines that may cause fatigue
Having a relapse of a previously treated illness that can result in fatigue, such as cancer
Having had a past or current diagnosis of a major depressive disorder or other psychiatric illness, such as schizophrenia or an eating disorder
Abusing alcohol or another substance
Being severely obese, as defined by a body mass index (BMI) of 45 or greater

Over time, be alert to any new cues that might indicate that the problem is caused by something other than chronic fatigue syndrome. When other diseases or conditions are excluded, your doctor may then determine if your illness meets the CFS-specific criteria.

Complications

Possible complications of chronic fatigue syndrome include:

Depression, related both to symptoms and lack of diagnosis
Side effects and adverse reactions related to medication treatments
Side effects and adverse reactions associated with lack of activity (deconditioning)
Social isolation caused by fatigue
Lifestyle restrictions
Missing work

Treatments and drugs

There's no specific chronic fatigue syndrome treatment. In general, doctors aim to relieve signs and symptoms by using a combination of treatments, which may include:

Moderating daily activity. Your doctor may encourage you to slow down and to avoid excessive physical and psychological stress. However, too much rest can make you weaker, worsening your long-term symptoms. Your goal should be to maintain a moderate level of daily activity and gently increase your stamina over time.
Gradual but steady exercise. Often with the help of a physical therapist, you may be advised to begin an exercise program that slowly becomes more challenging. Research has proved that gradually increasing exercise can improve the symptoms of chronic fatigue syndrome. In one study, 70 percent of participants with CFS reported feeling better after completing a supervised program of graduated exercise.
Cognitive behavior therapy. This treatment, often used in combination with graduated exercise, also has been found to improve the symptoms of chronic fatigue syndrome. In cognitive behavior therapy, you work with a mental health professional to identify negative beliefs and behaviors that might be delaying your recovery and replace them with healthy, positive ones.
Treatment of depression. If you're depressed, medications, such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), may help. Antidepressants may also help improve sleep and relieve pain. Tricyclic antidepressants include amitriptyline (Limbitrol, a multi-ingredient drug that contains amitriptyline), desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor). SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft) and bupropion (Wellbutrin).
Treatment of existing pain. Acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), may be helpful to reduce pain and fever.
Treatment of allergy-like symptoms. Antihistamines, such as fexofenadine (Allegra) and cetirizine (Zyrtec), and decongestants that contain pseudoephedrine (Sudafed) may relieve allergy-like symptoms such as runny nose.
Treatment of low blood pressure (hypotension). The drugs fludrocortisone (Florinef), atenolol (Tenormin) and midodrine (ProAmatine, Orvaten) may be useful for certain people with chronic fatigue syndrome.
Treatment for problems of the nervous system. Symptoms such as dizziness and extreme skin tenderness can sometimes be relieved by clonazepam (Klonopin). Your doctor may prescribe medications such as lorazepam (Ativan) and alprazolam (Xanax) to relieve symptoms of anxiety.

Experimental therapies
Research aimed at finding new treatments for chronic fatigue syndrome has included studies of the following medications:

Methylphenidate (Ritalin, Concerta). This psychostimulant appears to boost and balance levels of the brain chemicals called neurotransmitters. It's commonly used to treat attention-deficit/hyperactivity disorder (ADHD). One study found that methylphenidate improved fatigue and concentration in some people with chronic fatigue syndrome.
D-ribose. Also called ribose, this form of sugar is an essential energy source for your cells. Scientists believe that impaired cellular metabolism — some kind of disorder in the way your cells do their work — may play a role in chronic fatigue syndrome. Some research has found that natural D-ribose supplements may significantly improve the symptoms of chronic fatigue syndrome, with particular benefit in study participants' energy level and overall well-being.
Acupuncture. Acupuncture has been studied as a treatment for the symptoms of fibromyalgia, a disease that is considered similar to CFS and is also characterized by fatigue and muscle soreness. In one clinical trial, half the participants received acupuncture, while the other half received a placebo treatment. Those treated with acupuncture experienced a significant improvement in their symptoms — especially fatigue and anxiety — compared with the nonacupuncture group.
Corticosteroids. Some studies have found that oral hydrocortisone may improve symptoms of chronic fatigue syndrome, while other studies have found no benefit.
Immune globulins and interferons. These medications are used to boost your immune system's ability to fight infection. Studies have not found them to be consistently effective in treating chronic fatigue syndrome, and participants have experienced severe side effects.
Antiviral drugs, such as acyclovir. The possible connection between chronic fatigue syndrome and Epstein-Barr virus led researchers to test whether powerful antiviral medications could improve the symptoms of chronic fatigue syndrome. This approach has not been found effective, and the connection between Epstein-Barr virus and chronic fatigue syndrome has since been disproved.
Cholinesterase (ko-lin-ES-tur-ase) inhibitors, such as galantamine. These drugs improve the effectiveness of acetylcholine, a chemical messenger that is believed to be important for memory, thought and judgment. Galantamine is used in the treatment of Alzheimer's disease, but has not been found beneficial for chronic fatigue syndrome.

Prevention

Because the cause of chronic fatigue syndrome remains unknown, there's no known way to prevent the illness from occurring. Be aware of the symptoms and signs of chronic fatigue syndrome and seek the help of your doctor to manage them if they occur.

Lifestyle and home remedies

Learning how to manage fatigue can help you improve your level of functioning and your quality of life despite your symptoms. You may work with a rehabilitation medicine specialist who can teach you how to plan activities to take advantage of times when you usually feel better.

These important self-care steps can help you to maintain good general health:

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. If possible, don't change your routine totally. People who quit work or drop all activity tend to do worse than those who remain active.
Get enough sleep. 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. You may need to start slow and build up gradually. But exercising regularly often improves symptoms. Many people find exercises such as walking, swimming, biking and water aerobics to be helpful. A physical therapist may help you develop a home-exercise program. Stretching, good posture and relaxation exercises also can be 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.
Maintain a healthy lifestyle. Try to eat a balanced diet, drink plenty of fluids, limit your caffeine intake, stop smoking, get adequate rest and exercise regularly. Find a hobby or career that's enjoyable and fulfilling for you.

Coping and support

The experience of chronic fatigue syndrome varies from person to person. For many people, however, the symptoms are more bothersome early in the course of the illness and then gradually decrease. Some people recover completely with time. Emotional support and counseling may help you and your loved ones deal with the uncertainties and restrictions of chronic fatigue syndrome.

You may find it therapeutic to join a support group and meet other people with chronic fatigue syndrome. Support groups aren't for everyone, and you may find that a support group adds to your stress rather than relieves it. Experiment and use your own judgment to determine what's best for you.

Alternative medicine

Some makers of various dietary supplements and herbal remedies claim these substances have potential benefits for people with chronic fatigue syndrome, but the effectiveness of these substances for treating the condition hasn't been proved in controlled studies. Though a product may be of "natural" origin, that doesn't ensure its safety. Dietary supplements and herbal preparations can have potentially harmful side effects and may dangerously interfere or interact with prescription medications.

Some complementary therapies can benefit people with chronic fatigue syndrome by reducing anxiety and promoting a sense of well-being. These include deep-breathing and muscle-relaxation techniques, massage and healing touch, and movement therapies such as stretching, yoga and tai chi.

Talk to your doctor before using any unprescribed remedy or new complementary therapy.

Arthroscopy

2009-01-12T22:19:00.000-08:00

Arthroscopy

Definition

Arthroscopy (ahr-THROS-skuh-pe) is a procedure for diagnosing and treating joint problems. During arthroscopy, a surgeon examines and, in many cases, repairs your injured or diseased joint with the help of an optical instrument called an arthroscope. An arthroscope consists of a light source, a lens system, and bundled glass or plastic fibers (fiber optics) to carry light to the area being examined. These parts are encased in a tube, usually about one-eighth of an inch (4 mm) in diameter. A video camera attached to the arthroscope relays the view from within your joint to a video monitor. Because the arthroscope is so narrow, your surgeon needs only a small incision to place it in your joint.

Why it's done

Doctors use arthroscopy to help diagnose and treat a variety of joint conditions — most commonly those affecting the knee, shoulder, elbow, ankle, hip and wrist — in people of all ages.

In diagnosis, arthroscopy is the definitive examination, typically performed after X-rays and other imaging studies have left some diagnostic questions unanswered. Often, arthroscopy is also used to assess the results of earlier joint surgery, or to supplement some types of standard ("open") orthopedic surgery.

Conditions treated with arthroscopy include:

Bone spurs or loose bone fragments
Damaged or torn cartilage
Inflamed joint linings
Joint infections
Torn ligaments
Scarring or tissue overgrowth within joints

Risks

Arthroscopy is a low-risk procedure. Complications occur in 1 percent to 2 percent of arthroscopies. The risks include:

Bone, cartilage or ligament damage from placing and movement of instruments within the tight space of the joint
Blood vessel or nerve damage in the area around the joint
Tendon or ligament damage
Bleeding within the joint
A blood clot in a leg vein, mainly a risk in procedures lasting over an hour
Infection

How you prepare

Exact preparations depend on which of your joints the surgeon is examining or repairing. In general, you should:

Tell your surgeon about all the medications you're taking, including over-the-counter drugs and dietary supplements. Find out which of your regular medications to discontinue before your procedure and how many days in advance to stop them.
Stop eating and drink only clear liquids at least six hours before the procedure.
Arrange for a ride home after the procedure.
Wear loose, comfortable clothing — baggy gym shorts, for example, if you're having knee arthroscopy — so you can dress easily after the procedure.

What you can expect

CLICK TO ENLARGE

Ice compress

Although the experience varies depending on why you're having the procedure and on which joint is involved, some aspects of arthroscopy are fairly standard.

You'll remove your street clothes and jewelry and put on a hospital gown or shorts.
A nurse will place an intravenous catheter in your hand or arm and inject a mild sedative.

You'll receive general, regional or local anesthesia.

General anesthesia is sometimes the best option for repairing acute injuries, or for procedures in which the surgeon has to reposition the arthroscope repeatedly. You receive general anesthesia by an intravenous injection. If you have general anesthesia, you'll be unconscious throughout the procedure.
Regional anesthesia leaves you awake while blocking sensation in a large part of your body. The most common form of regional anesthesia is delivered through a small tube placed between two of your vertebrae, or spine bones. Another type — sometimes referred to as a nerve block — is injected in the vicinity of a nerve or group of nerves.
Local anesthesia involves injecting numbing agents below the skin to block sensation in a limited area, such as your knee. With local anesthesia, you'll be awake during your arthroscopy, but the most you'll feel is pressure or a sensation of movement within the joint.

During the procedure

You'll be placed in the best position for the procedure you're having. For knee arthroscopy, that's usually on your back on a short table with your knees bent and your feet hanging down. For shoulder arthroscopy, you may be on your side or in the "beach chair" position, with your chest and torso supported at an upright angle. You may be faceup or facedown for an elbow arthroscopy, depending on your surgeon's preference.
The surgeon places your arm or leg in a positioning or traction device to isolate the joint and provide good access to the area from different angles. He or she may use a pressure band (tourniquet) to decrease blood loss and to see the joint better.
A surgical assistant disinfects the area around the joint and applies sterile drapes to prevent infection.
The surgeon makes a small incision in the skin over the surgical site and inserts a hollow tube through the underlying tissue and the membrane covering the joint. The arthroscope is inserted through the tube. To distend the joint for a better view, flexible tubing — attached to the arthroscope or part of a separate irrigation system — carries sterile fluid into the joint to fill it.
Additional small incisions at different points around the joint allow the surgeon to insert surgical tools to grasp, cut, grind and provide suction as needed for joint repair.
When the surgery is complete, your surgeon removes the arthroscope and other instruments and flushes the joint with sterile solution.
The surgeon may also inject local anesthetics into the joint to reduce pain.
The incisions may be closed with sterile adhesive tapes or stitches, as necessary.

After the procedure

Arthroscopic surgery usually takes between 30 minutes and two hours, depending on the procedure performed. After that, you'll be taken to a separate room to recover for a few hours before going home.
Your doctor may give you medication to relieve pain and inflammation.
At home, you'll need to wrap, rest, ice and elevate the joint for several days to reduce swelling and pain.
You may need to temporarily use splints, slings or crutches for comfort and protection.
Your doctor may prescribe physical therapy and rehabilitation to help strengthen your muscles and improve the function of your joint.
In general, you should be able to resume desk work and light activity in a week, and more strenuous activity in two weeks. Remember, however, that your situation may dictate a longer recovery period, along with rehabilitation.

Results

Your surgeon will review the findings of the arthroscopy with you as soon as possible. You may also receive a written report, as may your primary physician.

After arthroscopic surgery to treat a joint injury or disease, healing may take several weeks. Your surgeon will monitor your progress in follow-up visits and address any problems that arise.

Heart Surgery Overview

2008-12-27T01:31:00.000-08:00

Heart Surgery Overview

Thousands of heart surgeries are performed every day in the United States. In fact, in 2005 alone, surgeons performed 575,000 coronary bypass or valve repair and replacement surgeries. And even though there is a shortage of donor organs, in 2006, almost 2,200 people had heart transplants.

Years ago, many doctors thought that heart surgery was a dream. Surgeons during World War II had learned how to operate on the heart, but they could not carry out what they had learned because it was hard to operate on a beating, moving heart. Also, the heart could not be stopped for more than a few minutes without causing brain damage.

Two major advances in medicine made heart surgery possible:

The heart-lung machine, which takes over the work of the heart.
Body cooling techniques, which allow more time for surgery without causing brain damage.

What is a heart-lung machine?

Perfusion technologists operate the heart-lung machine during an open heart surgery procedure.

The heart-lung machine is also called a cardiopulmonary bypass machine. It takes over for the heart by replacing the heart's pumping action and by adding oxygen to the blood. This means that the heart will be still for the operation, which is necessary when the heart has to be opened (open heart surgery). Because the heart-lung machine takes over the work of the heart, surgeons can operate on a heart that is not moving or full of blood.

When you are connected to the heart-lung machine, it does the same job that your heart and lungs would do. The heart-lung machine carries blood from the upper-right chamber of the heart (the right atrium) to a special reservoir called an oxygenator. Inside the oxygenator, oxygen bubbles up through the blood and enters the red blood cells. This causes the blood to turn from dark (oxygen-poor) to bright red (oxygen-rich). Then, a filter removes the air bubbles from the oxygen-rich blood, and the blood travels through a plastic tube to the body's main blood conduit (the aorta). From the aorta, the blood moves throughout the rest of the body.

The heart-lung machine can take over the work of the heart and lungs for hours. Trained technicians called perfusion technologists (blood flow specialists) make sure that the heart-lung machine does its job properly during the surgery. Even so, surgeons still try to limit the time that patients must spend hooked up to the machine.

What are cooling techniques?

Cooling techniques let surgeons stop the heart for long periods without damaging the heart tissue. Cool temperatures avoid damage to the heart tissue by reducing the heart's need for oxygen.

The heart may be cooled in 2 ways:

Blood is cooled as it passes through the heart-lung machine. In turn, this cooled blood lowers body temperature when it reaches all of the body parts.
Cold salt-water (saline) is poured over the heart.

After cooling, the heart slows and stops. Injecting a special potassium solution into the heart can speed up this process and stop the heart completely. The heart is then usually safe from tissue injury for 2 to 4 hours.

View of a coronary artery bypass operation from observation dome overhead.

Who is in the operating room during surgery?

During heart surgery, a highly trained group works as a team. Here is a list of people who will be in the operating room during surgery.

The cardiovascular surgeon, who heads up the surgery team and performs the key parts of the surgery.
The assisting surgeons, who follow the direction of the cardiovascular surgeon.
The cardiovascular anesthesiologist, who gives you the medicines that make you sleep during the surgery (called anesthesia). The anesthesiologist makes sure that you get the right amount of medicines throughout the surgery and monitors the ventilator, which breathes for you during surgery.
The perfusion technologist, who runs the heart-lung machine.
The cardiovascular nurses, who are specially trained to assist in heart surgery.

What kinds of heart and blood vessel surgeries are there?

Many kinds of surgery are now performed on the heart and blood vessels.

Coronary Artery Bypass

This is the most common kind of heart surgery. You may also hear it called coronary artery bypass graft surgery (CABG), coronary artery bypass (CAB), coronary bypass, or bypass surgery.

The surgery involves sewing a section of vein from the leg or arteries from the chest or another part of the body to bypass a part of a diseased coronary artery. This creates a new route for blood to flow, so that the heart muscle will get the oxygen-rich blood it needs to work properly.

During bypass surgery, the breastbone (sternum) is divided, the heart is stopped, and blood is sent through a heart-lung machine. Unlike other kinds of heart surgery, the chambers of the heart are not opened during bypass surgery.

When you hear the words single bypass, double bypass, triple bypass, or quadruple bypass, it refers to the number of arteries that are bypassed. The number of bypasses does not necessarily indicate how severe the heart condition is.

See also on this site: Coronary Artery Bypass Surgery

Valve repair or replacement

Blood is pumped through your heart in only one direction. Heart valves play key roles in this one-way blood flow, opening and closing with each heartbeat. Pressure changes behind and in front of the valves allow them to open their flap-like "doors" (called cusps or leaflets) at just the right time, then close them tightly to prevent a backflow of blood.

Two of the most common kinds of valve problems that require surgery are

Stenosis, which means the leaflets do not open wide enough and only a small amount of blood can flow through the valve. Stenosis occurs when the leaflets thicken, stiffen, or fuse together. Surgery is needed to either open the valve that is there or replace it with a new one.
Regurgitation, which is also called insufficiency or incompetence, means that the valve does not close properly and blood leaks backward instead of moving in the proper forward direction. Surgery is needed to either tighten or replace the valve.

Surgical repair of a valve involves the surgeon rebuilding the valve so that it will work properly. Valve replacement means that the valve is replaced with a biological valve (made of animal or human tissue) or a mechanical valve (made from materials such as plastic, carbon, or metal).

See also on this site:

Arrhythmia Surgery

Any irregularity in your heart's natural rhythm is called an arrhythmia. Arrhythmias are usually treated first with medicines. Other treatments may include

Electrical cardioversion, where the cardiologist or surgeon uses paddles to "shock" the heart back into a normal rhythm.
Catheter ablation, where the cardiologist uses a special tool to destroy (ablate) the cells that are causing the arrhythmia. This is done in the cardiac catheterization laboratory (the cath lab).
Pacing and rhythm-control devices, including pacemakers and implantable cardioverter defibrillators (ICDs).Patients can have these devices implanted while in the operating room or the cath lab.

When these treatments do not work, surgery may be needed. One type of surgery is called Maze surgery. In Maze surgery, surgeons create a "maze" of new electrical pathways to let electrical impulses travel easily through the heart. Maze surgery is used most often to treat a type of arrhythmia called atrial fibrillation. Atrial fibrillation is the most common type of arrhythmia.

See also on this site:

Aneurysm Repair

An aneurysm is a balloon-like bulge in a blood vessel or in the wall of the heart. An aneurysm occurs when the wall of a blood vessel or the heart becomes weakened. Pressure from the blood forces it to bulge outward, forming what you might think of as a blister. An aneurysm can often be repaired before it bursts.

Surgery involves replacing the weakened section of blood vessel or heart with a patch or artificial tube (called a graft).

Aneurysms in the wall of the heart occur most often in the lower-left chamber (called the left ventricle). These aneurysms are called left ventricular aneurysms, and they may develop after a heart attack. (A heart attack can weaken the wall of the left ventricle.) If a left ventricular aneurysm leads to an irregular heartbeat or to heart failure, the surgeon may perform open heart surgery to remove the damaged part of the wall.

See also on this site:

Transmyocardial Laser Revascularization (TMLR)

Angina is the pain you feel when a diseased vessel in your heart (called a coronary artery) can no longer deliver enough blood to a part of the heart to meet its need for oxygen. The heart's lack of oxygen-rich blood is called ischemia. Angina usually occurs when your heart has an extra need for oxygen-rich blood, such as during exercise. Angina is nearly always caused by coronary artery disease (CAD).

Transmyocardial laser revascularization (TMLR) is a procedure that uses lasers to make channels in the heart muscle, in an attempt to allow blood to flow from a heart chamber directly into the heart muscle. If the blood flow is increased, more oxygen can reach the heart. This procedure is only done as a last resort. For example, TMLR may be done in patients who have had many coronary artery bypass operations and cannot have another bypass operation.

See also on this site:

Carotid Endarterectomy

Carotid artery disease is a disease that affects the vessels leading to the head and brain. Like the heart, the brain's cells need a constant supply of oxygen-rich blood. This blood supply is delivered to the brain by the 2 large carotid arteries in the front of your neck and by 2 smaller vertebral arteries at the back of your neck. The right and left vertebral arteries come together at the base of the brain to form what is called the basilar artery. A stroke most often occurs when fatty plaque blocks the carotid arteries and the brain does not get enough oxygen.

Carotid endarterectomy is the most common surgical treatment for carotid artery disease. Surgeons make an incision at the location of the blockage in the neck and a tube is inserted above and below the blockage to reroute blood flow. Surgeons can then remove the fatty plaque.

A carotid endarterectomy can also be done by a technique that does not require blood flow to be rerouted. In this procedure, the surgeon stops the blood flow just long enough to peel the blockage away from the artery.

See also on this site: Carotid Endarterectomy

Heart Transplantation

The first heart transplants were performed in the late 1960s. But it was not until the use of anti-rejection medicines in the 1980s that the procedure became an accepted operation. Today, heart transplantation gives hope to a select group of patients who would otherwise die of heart failure.

The need for a heart transplant can be traced to one of many heart problems, each of which causes damage to the heart muscle. The two most common heart problems are idiopathic cardiomyopathy (disease of the heart muscle without a known cause) and coronary artery disease (the buildup of plaque in the arteries of the heart).

As the heart problem gets worse, the heart grows weaker and is less able to pump oxygen-rich blood to the rest of the body. Because the heart must work harder to pump blood through the body, it tries to make up for this extra work by becoming enlarged (hypertrophied). In time, the heart works so hard to pump blood that it may simply wear out, overcome by disease and unable to meet even the smallest pumping demands. Medicines, mechanical devices to assist the heart, and other therapies can sometimes help and even improve a patient's condition. But when those treatments fail, transplantation becomes the only option.

Sudden cardiac arrest

2008-12-26T02:45:00.000-08:00

Sudden cardiac arrest

Definition

Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness. Sudden cardiac arrest usually results from an electrical disturbance in your heart that disrupts its pumping action and causes blood to stop flowing to the rest of your body.

Sudden cardiac arrest is different from a heart attack, which occurs when blood flow to a portion of the heart is blocked, depriving the heart muscle of necessary oxygen. Like a heart attack, however, sudden cardiac arrest almost always occurs in the context of other underlying heart problems, particularly coronary artery disease.

Sudden cardiac arrest is a medical emergency. If not treated immediately, it is fatal, resulting in sudden cardiac death. With fast, appropriate medical care, survival is possible. Administering cardiopulmonary resuscitation (CPR) — or even just rapid compressions to the chest — can improve the chances of survival until emergency personnel arrive.

Symptoms

Sudden cardiac arrest symptoms are sudden and drastic:

Sudden collapse
No pulse
No breathing
Loss of consciousness

Sometimes, other signs and symptoms precede sudden cardiac arrest. These may include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, palpitations or vomiting. But sudden cardiac arrest often occurs with no warning.

When to see a doctor
If you have frequent episodes of chest pain or discomfort, heart palpitations, irregular or rapid heartbeats, unexplained wheezing or shortness of breath, fainting or near fainting, or you're feeling lightheaded or dizzy, see your doctor promptly. If these symptoms are ongoing, you should call 911 or emergency medical help.

When the heart stops, the absence of oxygenated blood can cause brain damage in only a few minutes. Death will occur within eight to 10 minutes. Time is critical when you're helping an unconscious person who isn't breathing. Take immediate action:

Call 911, or the emergency number in your area, if you encounter someone who has collapsed or is found unresponsive. If the unconscious person is a child and you're alone, administer CPR or chest compressions only for two minutes before calling 911 or emergency medical help or before using a portable defibrillator.
Administer CPR. Quickly check the unconscious person's breathing. If he or she isn't breathing normally, begin CPR. If you don't know CPR, just push hard and fast on the person's chest — about two compressions per second or 100 per minute. Allow the chest to rise completely between compressions. Don't worry about breathing into the person's mouth. Keep doing this until a portable defibrillator is available or emergency personnel arrive.
Use a portable defibrillator, if one is available. If you're not trained to use a portable defibrillator, a 911 or emergency medical help operator may be able to guide you in its use. Deliver one shock if advised by the device, then immediately begin CPR starting with chest compressions, or give chest compressions only, for about two minutes. Using the defibrillator, check the person's heart rhythm. If necessary, the defibrillator will administer a shock. Repeat this cycle until the person recovers consciousness or emergency personnel take over.

Portable automatic external defibrillators (AEDs) are available in an increasing number of places, including airports, casinos and shopping malls. You can also purchase them for your home. AEDs come with built-in instructions for their use. They're programmed to allow a shock only when appropriate.

Causes

CLICK TO ENLARGE

Chambers and valves of the heart

The immediate cause of sudden cardiac arrest is usually an abnormality in your heart rhythm (arrhythmia), the result of a malfunction in your heart's electrical system.

Unlike other muscles in your body, which rely on nerve connections to receive the electrical stimulation they need to function, your heart has its own electrical stimulator — a specialized group of cells called the sinus node, located in the upper right chamber (right atrium) of your heart. The sinus node generates electrical impulses that flow in an orderly manner through your heart to synchronize heart rate and coordinate the pumping of blood from your heart to the rest of your body.

If something goes wrong with the sinus node or the flow of electric impulses through your heart, an arrhythmia can result, causing your heart to beat too fast, too slow or in an irregular fashion. Often, these interruptions in rhythm are momentary and harmless. But some types of arrhythmia can be serious and lead to a sudden stop in heart function (sudden cardiac arrest).

The most common cause of cardiac arrest is an arrhythmia called ventricular fibrillation — when rapid, erratic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood. Without an effective heartbeat, your blood pressure plummets, cutting off blood supply to your vital organs.

Most of the time, cardiac-arrest-inducing arrhythmias don't occur on their own. In a person with a normal, healthy heart, a sustained arrhythmia is unlikely to develop without some outside trigger, such as an electrical shock, the use of illegal drugs, or trauma to the chest at just the wrong time of the heart's cycle (commotio cordis).

Heart conditions that can lead to sudden cardiac arrest
More often, a life-threatening arrhythmia develops in a person with a pre-existing heart condition, such as:

Coronary artery disease. More than 80 percent of cases of sudden cardiac arrest occur in people who have coronary artery disease. In coronary artery disease, your arteries become clogged with cholesterol and other deposits, reducing blood flow to your heart. This can alter the ability of your heart to conduct electrical impulses smoothly.
Heart attack. If a heart attack occurs, often as a result of severe coronary artery disease, it can trigger ventricular fibrillation and sudden cardiac arrest. In addition, a heart attack can leave behind areas of dead scar tissue. Electrical short circuits around the scar tissue can lead to abnormalities in your heart rhythm.
Enlarged heart (cardiomyopathy). This occurs primarily when your heart's muscular walls stretch and enlarge or thicken. In both cases, your heart's muscle is abnormal, a condition that often leads to heart tissue damage and potential arrhythmias.
Valvular heart disease. Leaking or narrowing of your heart valves can lead to stretching or thickening of your heart muscle, or both. When the chambers become enlarged or weakened because of stress caused by a tight or leaking valve, there's an increased risk of developing arrhythmia.
Congenital heart disease. When sudden cardiac arrest occurs in children or adolescents, it's more often due to a heart condition that was present at birth (congenital heart disease). Hypertrophic cardiomyopathy is a genetic disorder and is the most common cause of sudden cardiac arrest in young athletes, triggered perhaps by vigorous exertion, although the process isn't completely understood. Even adults who've had corrective surgery for a congenital heart defect remain at increased risk of sudden cardiac arrest.
Electrophysiological abnormalities. In some people, the problem is in the heart's electrical system itself, instead of a problem with the heart muscle or valves. These are called primary heart rhythm abnormalities. For example, some people have primary ventricular fibrillation, unrelated to another heart condition. Other examples include long QT syndrome, Wolff-Parkinson-White syndrome and Brugada syndrome.

Risk factors

Because sudden cardiac arrest is so often linked with coronary artery disease, the same factors that put you at risk of coronary artery disease may also put you at risk of sudden cardiac arrest. These include:

A family history of coronary artery disease
Smoking
High blood pressure
High blood cholesterol
Obesity
Diabetes
A sedentary lifestyle

Other factors that may increase your risk of sudden cardiac arrest include:

Previous episode of cardiac arrest or a family history of cardiac arrest
Previous heart attack
A personal or family history of other forms of heart disease, such as heart rhythm disorders, congenital heart defects, heart failure and cardiomyopathy
Age; the incidence of sudden cardiac arrest increases with age, especially after age 45 for men and age 55 for women
Being male; men are two to three times more likely to experience sudden cardiac arrest
Using illegal drugs, such as cocaine or amphetamines
Lightning strike or another electrical shock
Immersion in cold water

Complications

When sudden cardiac arrest occurs, your brain is the first part of your body to suffer because, unlike other organs, it doesn't have a reserve of oxygen-rich blood. It's completely dependent on an uninterrupted supply of blood. Reduced blood flow to your brain causes unconsciousness.

If your heart rhythm doesn't rapidly return to its normal rhythm, brain damage occurs and death results. If sudden cardiac arrest lasts more than 10 minutes, the survival rate is less than 5 percent. Survivors of cardiac arrest may show signs of brain damage.

Tests and diagnosis

If you experience an episode of sudden cardiac arrest without warning and survive, your doctor will want to investigate what caused the cardiac arrest. Identifying the underlying problem may help prevent future episodes of cardiac arrest.

Tests your doctor may recommend include:

Electrocardiogram
A test commonly given after cardiac arrest is an electrocardiogram (ECG). During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures the timing and duration of each electrical phase in your heartbeat and can reveal disturbances in heart rhythm. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred.

Blood tests
Blood tests may include:

Cardiac enzyme test. Certain heart enzymes leak into your blood if your heart has been damaged by a heart attack. Because a heart attack can trigger sudden cardiac arrest, it's important to know whether you've had a heart attack. Testing a blood sample for these enzymes may help indicate whether a heart attack has indeed occurred.
Electrolyte test. A sample of your blood may also be tested for levels of electrolytes, such as potassium, calcium and magnesium. Electrolytes are minerals in your blood and body fluids that participate in the creation of electrical impulses. An imbalance in the levels of these substances can increase your risk of arrhythmia and sudden cardiac arrest.
Drug test. Your doctor may check your blood for evidence of drugs that have the potential to induce arrhythmia, including certain prescription and over-the-counter drugs and illegal drugs.
Hormone test. Testing for hyperthyroidism may indicate this condition as the trigger for your cardiac arrest.

Imaging tests
These may include:

Chest X-ray. An X-ray image of your chest allows your doctor to check the size and shape of your heart and its blood vessels. It may also indicate whether you have congestive heart failure.
Nuclear scan. This test, usually done along with a stress test, helps identify blood flow problems to your heart. Trace amounts of radioactive material, such as thallium, are injected into your bloodstream. Special cameras can detect the radioactive material as it flows through your heart and lungs.
Echocardiogram. This test uses sound waves to produce an image of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally or at peak capacity (ejection fraction), or whether there are valvular abnormalities.

Other tests
Other tests that are often done include:

Electrophysiological testing and mapping. This test, if needed, is usually done later, after you've recovered and if an underlying explanation for your cardiac arrest hasn't been identified. With this type of test, your doctor may try to cause an arrhythmia while closely monitoring your heart. The test can help locate where in the heart the arrhythmia originates.

During the test, thin, flexible tubes (catheters) tipped with electrodes are threaded through your blood vessels to a variety of spots within your heart. Once in place, the electrodes can precisely map the spread of electrical impulses through your heart. In addition, your cardiologist can use the electrodes to stimulate your heart to beat at rates that may trigger — or halt — an arrhythmia. This allows your doctor to observe the location of the arrhythmia.
Ejection fraction testing. One of the most important predictors of your risk of sudden cardiac arrest is how well your heart is able to pump blood. Your doctor can determine your heart's pumping capacity by measuring what's called the ejection fraction. This refers to the percentage of blood that's pumped out of a filled ventricle with each heartbeat. A normal ejection fraction is 55 to 70 percent. An ejection fraction of less than 35 percent increases your risk of sudden cardiac arrest.

Your doctor can measure ejection fraction in several ways, such as with an echocardiogram, magnetic resonance imaging (MRI) of your heart, a nuclear medicine scan (multiple gated acquisition, or MUGA) of your heart or a computerized tomography (CT) scan of your heart.
Coronary catheterization (angiogram). This test can show if your coronary arteries are narrowed or blocked. Along with ejection fraction, the number of obstructed blood vessels is another important predictor of sudden cardiac arrest.

During the procedure, a liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's advanced through an artery, usually in your leg, to arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray and videotape, revealing areas of blockage.

Also, while the catheter is in position, your doctor may treat a blockage by performing angioplasty and inserting a stent to hold the artery open.

Treatments and drugs

Sudden cardiac arrest requires immediate action for survival.

CPR
Immediate cardiopulmonary resuscitation (CPR) is critical to treating sudden cardiac arrest. By maintaining a flow of oxygen-rich blood to the body's vital organs, CPR can provide a vital link until more advanced emergency care is available. A quick primer on CPR follows below.

If you don't know CPR but someone collapses unconscious near you, call 911 or emergency medical help. Then, if the person isn't breathing normally, immediately begin pushing hard and fast on the person's chest — two compressions per second, allowing the chest to fully rise between compressions. Do this until an automatic external defibrillator becomes available or emergency personnel arrive.

To perform CPR:

Is the person conscious or unconscious?
If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"
If the person doesn't respond and two people are available, one should call 911 or the local emergency number and one should begin CPR.
If you're alone and have immediate access to a telephone, call 911 or the local emergency number before beginning CPR — unless you think the person has become unresponsive because of suffocation (such as from drowning); in this special case, begin CPR for one minute and then call 911 or emergency medical help. If you're alone and rescuing a child, perform CPR for two minutes before calling 911 or emergency help or using an AED.
If an AED is immediately available, deliver one shock if advised by the device, then begin CPR.
Gently tilt the head back and lift the chin up to open the airway.
Quickly check for normal breathing, taking no more than five or 10 seconds.
Pinch the nostrils shut and give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath.
Start chest compressions by putting the heel of one hand in the center of the person's chest and covering the first hand with the other hand. Keeping your elbows straight, use your upper body weight to push down hard and fast on the person's chest, about two compressions per second. For a child, you may need to use only one hand.
After 30 compressions, give two more rescue breaths, making sure the chest rises after a breath.
If the person has not begun moving after five cycles (about two minutes) and an automatic external defibrillator (AED) is available, apply it and follow the prompts. Administer one shock, then resume CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED, a 911 or emergency medical help operator may be able to guide you in its use.
Continue CPR until the person recovers consciousness and is breathing normally or until emergency medical personnel take over.

Defibrillation
Advanced care for ventricular fibrillation, a type of arrhythmia that can cause sudden cardiac arrest, typically includes delivery of an electrical shock through the chest wall to the heart. The procedure, called defibrillation, momentarily stops the heart and the chaotic rhythm. This often allows the normal heart rhythm to resume.

The shock may be administered by emergency personnel or by a trained citizen if a public-use defibrillator, the device used to administer the shock, is available. If you're not trained to use an AED, a 911 or emergency medical help operator may be able to guide you in its use. Trained staff members at many public places are able to provide and use an AED.

Defibrillators are available in a small, portable form and come with built-in automated instructions to ensure proper use. They're programmed to recognize ventricular fibrillation and send a shock only when it's appropriate. These portable defibrillators are available in an increasing number of public places, including airports, shopping malls, casinos, health clubs, and community and senior citizen centers.

At the emergency room
Once you arrive in the emergency room, the medical staff will work to stabilize your condition and treat possible heart attack, heart failure or electrolyte imbalances. You may be given medications to stabilize your heart rhythm.

The prognosis after sudden cardiac arrest varies. Some people may be in a coma for days, weeks or indefinitely. Others may recover only partial function. After you recover, your doctor will discuss with you or your family what additional tests you may need to determine the cause of the cardiac arrest. Your doctor will also discuss preventive treatment options with you, to reduce your risk of another cardiac arrest.

Therapies may include:

Drugs. Doctors use various anti-arrhythmic drugs for emergency or long-term treatment of arrhythmias or potential arrhythmia complications. A class of medications called beta blockers is commonly used in people at risk of sudden cardiac arrest. Other possible drugs include angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers or a drug called amiodarone (Cordarone).

Anti-arrhythmic drugs may have certain potential side effects. For example, an anti-arrhythmic drug may cause your particular arrhythmia to occur more frequently — or even cause a new arrhythmia to appear that's as bad as or worse than your pre-existing condition. Side effects not related to your heart also may occur.
Implantable cardioverter-defibrillator (ICD). After your condition stabilizes, your doctor is likely to recommend implantation of an ICD. An ICD is a battery-powered unit that's implanted near your left collarbone. One or more electrode-tipped wires from the ICD run through veins to your heart.

The ICD constantly monitors your heart rhythm. If it detects a rhythm that's too slow, it paces your heart as a pacemaker would. If it detects ventricular tachycardia or ventricular fibrillation, it sends out low- or high-energy shocks to reset your heart to a normal rhythm. An ICD may be more effective than is preventive drug treatment at reducing your chance of having a fatal arrhythmia.
Coronary angioplasty. This procedure is for the treatment of severe coronary artery disease. It opens blocked coronary arteries, letting blood flow more freely to your heart, which may reduce your risk of serious arrhythmia. Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg, to a blocked artery in your heart. This catheter is equipped with a special balloon tip that briefly inflates to open up a blocked coronary artery. At the same time, a metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to your heart. Coronary angioplasty may be done at the same time as a coronary catheterization (angiogram), a procedure that doctors do first to locate narrowed arteries to the heart.
Coronary bypass surgery. Another procedure to improve blood flow is coronary bypass surgery. Bypass surgery involves sewing veins or arteries in place at a site beyond a blocked or narrowed coronary artery (bypassing the narrowed section), restoring blood flow to your heart. This may improve the blood supply to your heart and reduce the frequency of ventricular tachycardia, similar to angioplasty.
Radiofrequency catheter ablation. This procedure works best to block a single abnormal electrical pathway, which is the cause of arrhythmias such as Wolff-Parkinson-White syndrome. In this procedure, one or more catheters are threaded through your blood vessels to your inner heart. They're positioned along electrical pathways identified by your doctor as causing your arrhythmia. Electrodes at the catheter tips are heated with radiofrequency energy. This destroys (ablates) a small spot of heart tissue and creates an electrical block along the pathway that's causing your arrhythmia. Usually, this stops your arrhythmia.
Corrective heart surgery. If you have a congenital heart deformity, a faulty valve or diseased heart muscle tissue due to cardiomyopathy, surgery to correct the abnormality may improve your heart rate and blood flow, reducing your risk of fatal arrhythmias.
Heart transplantation. Some people with severe congestive heart failure who've experienced cardiac arrest may be eligible for a heart transplant. But given the limited number of donor hearts, this may be available to few people.

Prevention

There's no sure way to know your risk of sudden cardiac arrest, so primary prevention — methods to stop first-time development of a condition — consists mostly of regular checkups, including screening for heart disease, and living a heart-healthy lifestyle with the following approaches:

Don't smoke.
Eat a nutritious, balanced diet.
Stay physically active.

If you know you have heart disease or conditions that make you more vulnerable to an unhealthy heart, your doctor may recommend that you take appropriate steps to improve your health, such as taking medications for high cholesterol or carefully managing diabetes.

In some people with a known high risk of sudden cardiac arrest — such as those with a heart condition — doctors may recommend anti-arrhythmic drugs or an implantable cardioverter-defibrillator (ICD) as primary prevention.

If you have a high risk of sudden cardiac arrest, you may also wish to consider purchasing an automatic external defibrillator (AED) for home use. Before purchasing one, discuss the decision with your doctor; the devices can be expensive and aren't always covered by health insurance.

If you live with someone who is vulnerable to sudden cardiac arrest, it's important that you be trained in CPR. The American Red Cross offers courses in CPR and defibrillator use to the public. Being trained will help not only your loved one but also those in your community. The more people who know how to respond to a cardiac emergency, the more the survival rate for sudden cardiac arrest can be improved.

Carbon Monoxide (CO)

2008-12-23T02:51:00.001-08:00

An Introduction to Indoor Air Quality

Carbon Monoxide (CO)

Contents

ALERT: Put generators outside.

Definition

Carbon monoxide (CO) is a colorless, practically odorless, and tasteless gas or liquid. It results from incomplete oxidation of carbon in combustion. Burns with a violet flame. Slightly soluble in water; soluble in alcohol and benzene. Specific gravity 0.96716; boiling point -190^oC; solidification point -207^oC; specific volume 13.8 cu. ft./lb. (70^oF). Auto ignition temperature (liquid) 1128^oF. Classed as an inorganic compound.
Source: "The Condensed Chemical Dictionary," 9th ed., revised by Gessner G. Hawley, Van Nostrand Reinhold Co., NY, 1977.

Sources of Carbon Monoxide

Unvented kerosene and gas space heaters; leaking chimneys and furnaces; back-drafting from furnaces, gas water heaters, wood stoves, and fireplaces; gas stoves; generators and other gasoline powered equipment; automobile exhaust from attached garages; and tobacco smoke. Incomplete oxidation during combustion in gas ranges and unvented gas or kerosene heaters may cause high concentrations of CO in indoor air. Worn or poorly adjusted and maintained combustion devices (e.g., boilers, furnaces) can be significant sources, or if the flue is improperly sized, blocked, disconnected, or is leaking. Auto, truck, or bus exhaust from attached garages, nearby roads, or parking areas can also be a source.

Health Effects Associated with Carbon Monoxide

At low concentrations, fatigue in healthy people and chest pain in people with heart disease. At higher concentrations, impaired vision and coordination; headaches; dizziness; confusion; nausea. Can cause flu-like symptoms that clear up after leaving home. Fatal at very high concentrations. Acute effects are due to the formation of carboxyhemoglobin in the blood, which inhibits oxygen intake. At moderate concentrations, angina, impaired vision, and reduced brain function may result. At higher concentrations, CO exposure can be fatal.

Levels in Homes

Average levels in homes without gas stoves vary from 0.5 to 5 parts per million (ppm). Levels near properly adjusted gas stoves are often 5 to 15 ppm and those near poorly adjusted stoves may be 30 ppm or higher.

Steps to Reduce Exposure to Carbon Monoxide

It is most important to be sure combustion equipment is maintained and properly adjusted. Vehicular use should be carefully managed adjacent to buildings and in vocational programs. Additional ventilation can be used as a temporary measure when high levels of CO are expected for short periods of time.

Keep gas appliances properly adjusted.
Consider purchasing a vented space heater when replacing an unvented one.
Use proper fuel in kerosene space heaters.
Install and use an exhaust fan vented to outdoors over gas stoves.
Open flues when fireplaces are in use.
Choose properly sized wood stoves that are certified to meet EPA emission standards. Make certain that doors on all wood stoves fit tightly.
Have a trained professional inspect, clean, and tune-up central heating system (furnaces, flues, and chimneys) annually. Repair any leaks promptly.
Do not idle the car inside garage.

Measurement Methods

Some relatively high-cost infrared radiation adsorption and electrochemical instruments do exist. Moderately priced real-time measuring devices are also available. A passive monitor is currently under development.

Standards or Guidelines

No standards for CO have been agreed upon for indoor air. The U.S. National Ambient Air Quality Standards for outdoor air are 9 ppm (40,000 micrograms per meter cubed) for 8 hours, and 35 ppm for 1 hour.

Genetic Approach Boosts Yeast Infection Treatment

2008-12-22T01:14:00.000-08:00

Genetic Approach Boosts Yeast Infection Treatment

Inhibiting protein could yield new drug targets for mucosal fungus found in most people

HealthDay

By Robert Preidt

Monday, October 27, 2008

MONDAY, Oct. 27 (HealthDay News) -- A new genetic approach to improve treatment of common infections caused by the yeast Candida albicans has been successfully tested by researchers at Georgetown University Medical Center.

The results confirm that inhibition of a protein produced by the Ssk1 gene could offer a new drug target against the yeast. The yeast resides in the mucous membranes of most people and causes problems such as diaper rash, vaginitis, oral infections, and invasive, blood-borne and life-threatening infections, the researchers said.

In laboratory tests, the researchers found that when the Ssk1 gene was deleted from Candida albicans, triazole drugs currently used to treat Candida-related infections were much more effective.

"This is a genetically intelligent approach to target identification and drug design," study lead author Richard Calderone, professor and chairman of the department of microbiology and immunology, and co-director of the doctoral program in the global infectious disease program at the medical center, said in a school news release.

The study was to be presented Oct. 27 at the ICAAC/IDSA annual meeting, in Washington, D.C.

"Candida infections are often treatable; however, in patients that are immunocompromised following cancer chemotherapy, bone marrow transplantation, or surgery, diagnosis is often delayed, postponing therapy," Calderone said. "Also, when drug-resistant yeast pathogens cause the infection, clinical management of the patient becomes a problem."

Candida invasive, blood-borne infections are the fourth most common hospital-acquired infection in the United States, costing the health-care system about $1.8 billion each year, Calderone said.

Calcium

2008-12-17T03:25:00.000-08:00

Calcium

Dietary Sources of Calcium

Calcium is a naturally occurring mineral that is needed by the body to build and maintain strong bones and teeth. Because calcium is not made in the body, it must be absorbed from a person's dietary intake. Calcium is shed from the body in skin, nails, hair, sweat, urine, and feces. When a person does not get enough calcium through their diet, the body must break down bone to obtain the mineral.

Throughout life, bones go through a process known as remodeling, in which small amounts of old bone are removed and new bone is formed in its place. Generally, after age 35, more bone is lost than gained. Bone loss accelerates after menopause.

Women are vulnerable to osteoporosis, or a thinning of the bones, which develops slowly over many years. Researchers believe that decreasing hormone levels, too little calcium in the diet early in life, and lack of exercise play a role in osteoporosis.

Calcium can be obtained from a variety of foods. Milk and dairy products are the biggest sources of calcium. Green leafy vegetables are another source of calcium. Therefore, eating a balanced diet with a variety of foods is very important.

Recommended Calcium and Vitamin D Intake

The National Academy of Sciences' Institute of Medicine has issued daily calcium and vitamin D intake guidelines for various groups of persons.

Calcium

Life Stage Group	Recommended Daily Calcium Intake
Women and men 9 to 18 years	1,300 mg
Women and men 19 to 50 years	1,000 mg
Women and men 51 to 70 years	1,200 mg
Women and men > 70 years	1,200 mg
Pregnant or nursing women 14 to 18 years	1,300 mg
Pregnant or nursing women 19 to 50 years	1,000 mg

Vitamin D**

Life Stage Group	Recommended Daily Vitamin D Intake
Men and women 9 to 50 years with limited sun exposure	1,300 IU
Men and women 51 to 70 years with limited sun exposure	1,000 IU
Men and women > 70 with limited sun exposure	1,300 IU

** People who spend adequate amounts of time in the sun do not need dietary vitamin D intake.

Top of page

Dietary Sources of Calcium

Selecting foods high in calcium is one way to help you achieve your targeted daily calcium intake. Here are 25 major food sources of calcium to assist your meal planning.

Serving Size	Food	Amount of Calcium (mg)
1 cup (8 oz)	Yogurt, plain, low-fat	415
1 cup	Yogurt, fruit, low-fat	314
1 cup	Skim milk	302
1 cup	2% milk	297
1 cup	Whole milk	291
1 oz	Swiss cheese	272
1 oz	Cheddar cheese	204
1 oz	Colby cheese	194
1 oz	American cheese	174
1 cup	Cottage cheese, low-fat	155
1	English muffin, with butter	103
1 cup	Sardines, in oil, drained	351
3 oz	Perch, cooked	117
1 cup	Tofu	260
1-1/2 cups	Chef salad	235
1	Taco	221
1	Plain hamburger, large, with bun	74
1 cup	Almonds	332
1 cup	Collard greens, chopped, cooked	357
1 cup	Kale, chopped, cooked	179
1 cup	Broccoli, cooked	94
1 cup	Kidney beans, canned	69
10 fl oz	Milk shake, vanilla	344
1 cup	Ice cream, vanilla	170
5 oz	Tapioca pudding	119

Source: Agricultural Handbook, U.S. Department of Agriculture.

C. difficile

2008-12-12T04:12:00.000-08:00

C. difficile

Definition

Clostridium difficile, often called C. difficile or "C. diff," is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. Illness from C. difficile most commonly affects older adults in hospitals or in long term care facilities and typically occurs after use of antibiotic medications.

In recent years, C. difficile infections have become more frequent, more severe and more difficult to treat. Each year, tens of thousands of people in the United States get sick from C. difficile, including some otherwise healthy people who aren't hospitalized or taking antibiotics.

Mild illness caused by C. difficile may get better if you stop taking antibiotics. More severe symptoms require treatment with a different antibiotic.

Symptoms

Some people who have C. difficile never become sick, though they can still spread the infection. C. difficile illness usually develops during or shortly after a course of antibiotics. But signs and symptoms may not appear for weeks or even months afterward.

The most common symptoms of mild to moderate C. difficile disease are:

Watery diarrhea three or more times a day for two or more days
Mild abdominal cramping and tenderness

In more severe cases, C. difficile causes the colon to become inflamed (colitis) or to form patches of raw tissue that can bleed or produce pus (pseudomembranous colitis). Signs and symptoms of severe infection include:

Watery diarrhea 10 to 15 times a day
Abdominal cramping and pain, which may be severe
Fever
Blood or pus in the stool
Nausea
Dehydration
Loss of appetite
Weight loss

When to see a doctor
Many people have loose stools during or shortly after antibiotic therapy. See your doctor if your symptoms last more than three days or you have fever, severe pain or cramping, or blood in your stool, or more than three bowel movements a day.

Causes

CLICK TO ENLARGE

Colon

C. difficile bacteria can be found throughout the environment — in soil, air, water, and human and animal feces. A small number of healthy people naturally carry the bacteria in their large intestine. But C. difficile is most common in hospitals and other health care facilities, where a much higher percentage of people carry the bacteria.

C. difficile bacteria are passed in feces and spread to food, surfaces and objects when people who are infected don't wash their hands thoroughly. The bacteria produce hardy spores that can persist in a room for weeks or months. If you touch a surface contaminated with C. difficile, you may then unknowingly ingest the bacteria.

People in good health don't usually get sick from C. difficile. Your intestines contain millions of bacteria, many of which help protect your body from infection. But when you take an antibiotic to treat an infection, the drug can destroy some of the normal, helpful bacteria as well as the bacteria causing the illness. Without enough healthy bacteria, C. difficile can quickly grow out of control. The antibiotics that most often lead to C. difficile infections include fluoroquinolones, cephalosporins, clindamycin and penicillins.

Once established, C. difficile can produce toxins that attack the lining of the intestine. The toxins destroy cells and produce patches (plaques) of inflammatory cells and decaying cellular debris inside the colon.

An aggressive strain of C. difficile has emerged that produces far more deadly toxins than other strains do. The new strain is more resistant to certain medications and has shown up in people who haven't been in the hospital or taken antibiotics. This strain of C. difficile has caused several outbreaks of illness since 2000.

Risk factors

The majority of C. difficile cases occur in health care settings, where germs spread easily, antibiotic use is common and people are especially vulnerable to infection. In hospitals and nursing homes, C. difficile spreads mainly on the hands of caregivers, but also on cart handles, bedrails, bedside tables, toilets, sinks, stethoscopes, thermometers — even telephones and remote controls.

Although people — including children — with no known risk factors have gotten sick from C. difficile, your risk is greatest if you:

Are taking or have recently taken antibiotics. The risk goes up if you take broad-spectrum drugs that target a wide range of bacteria, use multiple antibiotics or take antibiotics for a prolonged period.
Are 65 years of age or older. The risk of becoming infected with C. difficile is 10 times greater for people age 65 and up compared with younger people.
Are or have recently been hospitalized, especially for an extended period.
Live in a nursing home or long term care facility.
Have a serious underlying illness or a weakened immune system as a result of a medical condition or treatment (such as chemotherapy).
Have had abdominal surgery or a gastrointestinal procedure.
Have a colon disease such as inflammatory bowel disease or colorectal cancer.
Have had a previous C. difficile infection.

Complications

Complications of C. difficile infections include:

Dehydration. Severe diarrhea can lead to a significant loss of fluids and electrolytes. This makes it difficult for your body to function normally and can cause blood pressure to drop to dangerously low levels.
Kidney failure. In some cases, dehydration can occur so quickly that kidney function deteriorates (kidney failure).
A hole in your large intestine (bowel perforation). This results from extensive damage to the lining of your large intestine. A perforated bowel can spill bacteria from the intestine into your abdominal cavity, leading to a life-threatening infection (peritonitis).
Toxic megacolon. In this condition, the colon becomes grossly distended when it's unable to expel gas and stool. Left untreated, your colon can rupture, causing bacteria from the colon to enter your abdominal cavity. A ruptured colon requires emergency surgery and may be fatal.
Death. Even mild to moderate C. difficile infections can quickly progress to a fatal disease if not treated promptly.

Tests and diagnosis

Doctors often suspect C. difficile in anyone with diarrhea who has taken antibiotics during the past two months or when diarrhea develops a few days after hospitalization. In such cases, you're likely to have one or more of the following tests:

Stool tests. Toxins produced by C. difficile bacteria can usually be detected in a sample of your stool. There are several main types of lab tests (enzyme immunoassay, polymerase chain reaction, and tissue culture assay). Most labs use the enzyme immunoassay (EIA) test, which is faster but can produce a false-positive result. Some hospitals use both the EIA test and tissue culture assay to ensure accurate results.
Colon examination. In some cases, to help confirm a diagnosis of C. difficile infection, your doctor may examine the inside of your colon. This test (flexible sigmoidoscopy) involves inserting a flexible tube with a small camera on one end into your lower colon to look for areas of inflammation and pseudomembranes.
Imaging tests. If there's concern about possible complications of C. difficile, your doctor may order a computerized tomography (CT) scan, which provides detailed images of your colon. The scan can show a thickening of the wall of your colon, which is common in pseudomembranous colitis.

Treatments and drugs

The first step in treating C. difficile is to stop taking the antibiotic that triggered the infection. For mild illness, this may be enough to relieve symptoms. But many people require further treatment.

Antibiotics
In an ironic twist, the standard treatment for C. difficile is another antibiotic. Doctors usually prescribe metronidazole (Flagyl) for mild to moderate illness. Vancomycin (Vancocin) may be prescribed for more severe symptoms. These antibiotics keep C. difficile from growing, which allows normal bacteria to flourish again in the intestine.

Side effects of metronidazole and vancomycin include nausea and a bitter taste in your mouth. It's important not to drink alcohol when taking metronidazole.

Probiotics
Probiotics are organisms, such as bacteria and yeast, which help restore a healthy balance to the intestinal tract. A natural yeast called Saccharomyces boulardii, in conjunction with antibiotics, has proved effective in helping prevent recurrent C. difficile infections.

Surgery
For people with severe pain, organ failure or inflammation of the lining of the abdominal wall, surgery to remove the diseased portion of the colon may be the only option.

Recurrent disease
About one-fourth of people with C. difficile get sick again, either because the initial infection never went away or because they're reinfected with a different strain of the bacteria. Treatment for recurrent disease may include:

Antibiotics, which may involve one or more courses of a medication, a longer course of treatment or an antibiotic given once every two days
Probiotics, such as S. boulardii, given along with the antibiotic medication
"Stool transplant" to restore healthy intestinal bacteria by placing donor stool (usually from a relative) in your colon. Although this is rarely done in practice, research has shown stool transplant to be helpful.

Lifestyle and home remedies

Supportive treatment for diarrhea includes:

Plenty of fluids. Choose fluids containing water, salt and sugar, such as diluted fruit juice, soft drinks and broths.
Good nutrition. If you have watery diarrhea, eat starchy foods, such as potatoes, noodles, rice, wheat and oatmeal. Other good choices are saltine crackers, bananas, soup and boiled vegetables. If you aren't hungry, you may follow a liquid diet at first. After your diarrhea clears up, you may have temporary difficulty digesting milk and milk-based products.

Prevention

To help prevent the spread of C. difficile, hospitals and other health care facilities follow strict infection control guidelines. If you have a friend or family member in a hospital or nursing home, don't be afraid to remind caregivers to follow the recommended precautions.

Preventive measures include:

Hand washing. Health care workers should wash their hands thoroughly with soap and warm water before and after treating each patient. Alcohol-based hand sanitizers do not effectively destroy C. difficile spores. Visitors also should be diligent about washing hands with soap and warm water before and after leaving the room or using the bathroom.
Contact precautions. People who are hospitalized with C. difficile have a private room or share a room with someone who has the same illness. Hospital staff and visitors wear disposable gloves and gowns while in the room.
Thorough cleaning. In any setting, all surfaces should be carefully disinfected with a product that contains chlorine bleach. C. difficile spores can survive routine cleaning products that don't contain bleach.
Avoid unnecessary use of antibiotics. Antibiotics are often prescribed for viral illnesses that aren't helped by these drugs. Take a wait-and-see attitude with simple ailments. If you do need an antibiotic, ask your doctor to prescribe one that has a narrow range and that you take for the shortest time possible.
Consider taking probiotics or eating yogurt before, during and after antibiotic treatment. This helps replace the beneficial bacteria in your digestive tract that antibiotics destroy. Probiotic supplements are available at natural foods stores and many pharmacies. Yogurt also contains probiotics.

Cesarean Birth

2008-12-04T02:47:00.001-08:00

Medical Library

Done with printing

Cesarean Birth

Sometimes it isn't possible for babies to be born through the mother's vagina. In such cases, a cesarean delivery may be performed. Cesarean birth is the birth of a baby through surgical incisions (cuts) made in the abdomen and uterus.

Reasons for a Cesarean Birth
There are many reasons why a cesarean birth may be used to deliver your baby. It may be the best approach for both you and your baby. A cesarean delivery may be planned in advance when certain conditions are known. In some cases, if problems arise, the decision is made during labor.

Multiple Pregnancy
Women having two or more babies may need to have a cesarean delivery. Many women having twins are able to have a vaginal delivery. However, if the babies are being born too early or are not in good positions in the uterus, a cesarean birth may be needed.

Failure of Labor to Progress
About one-third of cesarean births are done because labor does not progress normally. In these cases, contractions may not open the cervix enough for the baby to move through the vagina.

Concern for the Baby
The baby could be having trouble during labor and may need to be delivered by cesarean birth. It may be because the umbilical cord is pinched or compressed or not enough blood is flowing to the baby from the placenta.

Problems With the Placenta
Placenta previa is a condition in which the placenta is below the baby and covers part or all of the cervix. This will block the baby's exit from the uterus. Another problem that may arise is placental abruption. This is when the placenta separates before the baby is born and cuts off the flow of oxygen to the baby.

Previous Cesarean Birth
Having had a cesarean birth before plays a part in whether you will need to have one again. Many women who have had a cesarean birth before may be able to give birth vaginally. However, a vaginal delivery after a previous cesarean delivery is not a good option for women when there is a significant risk of rupture of the uterus.

The Procedure
In most hospitals, your birth partner may stay with you in the operating room for the cesarean birth. However, this may depend on whether you are awake for the surgery and the urgency of the surgery.

Preparation
Before you have a cesarean delivery, a nurse will prepare you for the operation.

Anesthesia
Anesthesia will be given so that you do not feel pain during surgery. You will be given either general anesthesia, an epidural block, or a spinal block. If general anesthesia is used, you will not be awake during the delivery.

Delivery
The doctor will make an incision through your skin and the wall of the abdomen. The skin incision may be transverse (horizontal) or vertical, just above the pubic hairline. The muscles in your abdomen are moved and, in most cases, do not need to be cut. Another incision will be made in the wall of the uterus. The incision in the wall of the uterus also will be either transverse or vertical.

The baby will be delivered through the incisions, the umbilical cord will be cut, and then the placenta will be removed. The uterus will be closed with stitches that will dissolve in the body. Stitches or staples are used to close your skin.

Complications
Like any major surgery, cesarean birth involves risks. These problems occur in a small number of women and usually are easily treated.

After Delivery
If you are awake for the surgery, you can probably hold your baby right away. You will be taken to a recovery room or directly to your room. Your blood pressure, pulse rate, breathing rate and abdomen will be checked regularly.

If you are planning on breastfeeding, be sure to let your doctor know. Having a cesarean delivery does not mean you won't be able to breastfeed your baby.

A hospital stay after a cesarean birth is usually two to four days. The length of your stay depends on the reason for the cesarean birth and on how long it takes for your body to recover.

After You Go Home
It will take a few weeks for your abdomen to heal. While you recover, you may have:

Mild cramping, especially if you are breastfeeding

Bleeding or discharge for about four to six weeks

Bleeding with clots and cramps

Pain in the incision

To prevent infection, for a few weeks after the cesarean birth you should not place anything in your vagina or have sex.

Finally...
There are many reasons why a cesarean birth may be needed to deliver your baby. Many maternity centers have classes for couples who may need cesarean birth. If you have questions or concerns about cesarean birth, talk to your doctor.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

BELCHING, BLOATING AND FLATULENCE

2008-12-03T02:15:00.000-08:00

Larry Szarka, M.D., Mayo Graduate School of Medicine, Rochester, Minnesota
Michael Levitt, M.D., Veteran Affairs Medical Center, Minneapolis, Minnesota

1. What are the Gas Related Symptoms?

Belching, or burping, refers to the noisy release of air or gas from the stomach through the mouth. Unpleasant abdominal fullness or distention is called bloating. Flatulence is the passage of excessive amounts of intestinal gas, or flatus, through the anus.

2. How Common are Gas Symptoms?

As much as 7% of the general population complain of excessive or bothersome belching, and 11% report frequent bloating. Normal people pass gas (flatus), on average, ten times each day. Passage of gas up to twenty times daily is still considered normal.

3. What are the Causes of Gas Symptoms?

There are several important factors that influence gas related symptoms. These include the amount of air that is swallowed; the efficiency with which the gastrointestinal tract moves and expels the air or gas; and the amount of gas that is produced by the bacteria living in the colon that act on incompletely digested food. There are also individual differences in sensitivity or tolerance to normal amounts of retained gas or the passage of a normal amount of flatus.

4. Can a Person Swallow Too Much Air?

It is clear that some individuals swallow too much air into the stomach. Eating quickly, gulping food or beverages, and other habits such as drinking through a straw, chewing gum, sucking on hard candy or wearing loose fitting dentures may contribute to excessive air swallowing. People also swallow more frequently, and swallow more air, when they are nervous. Air can also be swallowed and released voluntarily as many people are able to belch at will. In some people, excessive belching has become a learned behavior, or habit, that initially may have been associated with some relief of indigestion symptoms, but now continues almost unconsciously.

The air that is swallowed and not removed by belching will pass through the digestive tract and eventually pass as flatus from the rectum. In normal people, about 50% of the gas passed from the rectum comes from swallowed air, and this amount can increase significantly in those individuals who swallow air excessively. Surprisingly, most people who experience excessive bloating and flatulence do not swallow or produce excessive gas. In these individuals, it seems that the movement of swallowed air, from the stomach toward the rectum, is much slower than normal. Additionally, the gas may sometimes move the wrong way, returning to the stomach. So, in spite of the fact that the amount of gas may be normal, people can experience bloating and "gas" because the gas is not moved efficiently, and it may accumulate, causing discomfort from the increased stretching of the bowel walls.

5. How Do Some Foods Lead to Excess Gas?

Some people have difficulty digesting certain foods completely. This can lead to partially digested food passing from the small intestines to the colon. There are a large number of bacteria in the colon that will readily "digest" the food further and produce gases in the process. Foods that contain certain sugars that are very difficult for most people to digest include the well-known gas-forming foods such as baked beans, lima beans and lentils. Most people also have difficulty properly digesting commonly added sweeteners such as fructose and sorbitol. Some people (particularly adults of Asian, African and Southern European descent) have difficulty digesting lactose (milk sugar) because they do not make enough of the enzyme, lactase, which is needed to breakdown lactose. If there is a large amount of lactose in their diet, then the incompletely digested lactose will pass to the colon where bacteria break it down and produce gas.

It is also thought that there are differences between individuals in their sensitivity to intestinal stretching from gas, and their tolerance for gas related symptoms. The sensitivity of the gastrointestinal tract and the severity of symptoms tend to increase as the amount of stress increases.

6. Can Certain Medications Cause Excess Gas?

There are some prescription medications that purposefully inhibit digestive enzymes (e.g. acarbose) and others that contain indigestible sugars (lactulose and sorbitol) to accomplish their intended effect. These medications will often cause gas-related symptoms.

7. Can Excess Gas Mean There is a Serious Problem?

Rarely, patients can have a serious underlying disease of the digestive tract, such as celiac disease (gluten intolerance), dumping syndrome or pancreatic insufficiency that is the cause of their gas symptoms. These conditions may lead to improper digestion of food and result in excessive diarrhea, flatulence and finally, malnutrition and weight loss.

8. When Should You See a Doctor about Belching, Bloating or Flatulence?

By themselves, gas-symptoms are not worrisome or indicative of any underlying serious condition. A visit to the doctor may be helpful if the symptoms are very bothersome and there are other associated symptoms that may benefit from further testing and or treatment. Symptoms that should be further evaluated by a doctor include abdominal pain, vomiting, diarrhea, constipation, weight loss, bleeding from the gastrointestinal tract and sometimes heartburn.

Currently, there are few clinical tests (other than the history obtained from the patient and a physical examination) that are used to further assess gas symptoms. In some cases, endoscopy (the insertion of a small lighted flexible tube through the mouth into the esophagus and stomach) may be helpful if ulcer disease or reflux disease is suspected, or sigmoidoscopy or colonoscopy (insertion of a similar tube into the rectum and colon) if there are associated changes in the bowel patterns. An x-ray of the abdomen may be performed if blockage of the intestines needs to be excluded. Sometimes lactose intolerance should be assessed with a trial of a lactose free diet for two weeks, or with a special blood or breath test. There are also simple blood tests available to screen for celiac disease (gluten sensitivity) if there are other features to suggest this disorder.

9. What Treatments are Available for the Gas-Related Symptoms?

Sometimes excessive belching is associated with gastroesophageal reflux disease (GERD), and treatment of this condition may alleviate bothersome burping. Anti-gas medications, such as simethicone, are generally useless for excessive belching. Lifestyle modification such as avoidance of rapid eating, chewing gum, carbonated beverages and stopping smoking are often recommended but the response is variable. When simple reassurance and lifestyle modifications are not satisfactory, then psychological treatments such as relaxation therapy or behavioral therapy are currently the most useful approaches.

Bloating and flatulence are sometimes related to constipation, and treating the underlying condition may be helpful. After other conditions, such as lactose intolerance, have been excluded, a low gas-forming diet should be recommended. The diet excludes poorly digested foods such as the Brassica vegetables (brussels sprouts, turnip, grape, mustard and cabbage, as well as beans and lentils. Foods (including any drink, candy, gum or breath freshener) that contain sorbitol and added fructose should also be avoided. Fiber supplements and a high fiber diet can aggravate bloating symptoms, and should be discontinued if there is no benefit. A diet containing rice flour is fully absorbed in the small intestines and so produces the least amount of gas. There are several over-the-counter medications to treat gas-related symptoms including simethicone, activated charcoal and beano. Unfortunately, none of these products are very effective.

Brain and Spinal Tumors

2008-11-22T01:12:00.001-08:00

Synonym(s): Spinal Cord Tumors
Condensed from Brain and Spinal Tumors: Hope Through Research

Table of Contents (click to jump to sections)
What are Brain and Spinal Tumors?
Is there any treatment?
What is the prognosis?
What research is being done?

Organizations
Related NINDS Publications and Information
Additional resources from MEDLINEplus

What are Brain and Spinal Tumors?
Brain and spinal cord tumors are abnormal growths of tissue found inside the skull or the bony spinal column, which are the primary components of the central nervous system (CNS). Benign tumors are noncancerous, and malignant tumors are cancerous. The CNS is housed within rigid, bony quarters (i.e., the skull and spinal column), so any abnormal growth, whether benign or malignant, can place pressure on sensitive tissues and impair function. Tumors that originate in the brain or spinal cord are called primary tumors. Most primary tumors are caused by out-of-control growth among cells that surround and support neurons. In a small number of individuals, primary tumors may result from specific genetic disease (e.g., neurofibromatosis, tuberous sclerosis) or from exposure to radiation or cancer-causing chemicals. The cause of most primary tumors remains a mystery. They are not contagious and, at this time, not preventable. Symptoms of brain tumors include headaches, seizures, nausea and vomiting, vision or hearing problems, behavioral and cognitive problems, motor problems, and balance problems. Spinal cord tumor symptoms include pain, sensory changes, and motor problems. The first test to diagnose brain and spinal column tumors is a neurological examination. Special imaging techniques (computed tomography, and magnetic resonance imaging, positron emission tomography) are also employed. Laboratory tests include the EEG and the spinal tap. A biopsy, a surgical procedure in which a sample of tissue is taken from a suspected tumor, helps doctors diagnose the type of tumor.

Is there any treatment?

The three most commonly used treatments are surgery, radiation, and chemotherapy. Doctors also may prescribe steroids to reduce the swelling inside the CNS.

What is the prognosis?

Symptoms of brain and spinal cord tumors generally develop slowly and worsen over time unless they are treated. The tumor may be classified as benign or malignant and given a numbered score that reflects how malignant it is. This score can help doctors determine how to treat the tumor and predict the likely outcome, or prognosis, for the patient.

What research is being done?

Researchers are studying brachytherapy (small radioactive pellets implanted directly into the tumor) and advanced drugs and techniques for chemotherapy and radiation therapy. In gene therapy for brain and spinal cord tumors, scientists insert a gene to make the tumor cells sensitive to certain drugs, to program the cells to self-destruct, or to instruct the cells to manufacture substances to slow their growth. Scientists are also investigating why some genes become cancer-causing. Since tumors are more sensitive to heat than normal tissue, research scientists are testing hyperthermia as a treatment by placing special heat-producing antennae into the tumor region after surgery. In immunotherapy, scientists are looking for ways to duplicate or enhance the body's immune response to fight against brain and spinal cord cancer.

Select this link to view a list of studies currently seeking patients.

Organizations

National Cancer Institute (NCI) National Institutes of Health, DHHS 6116 Executive Boulevard, Ste. 3036A, MSC 8322 Bethesda, MD 20892-8322 cancergovstaff@mail.nih.gov http://cancer.gov Tel: 800-4-CANCER (422-6237) 800-332-8615 (TTY)	American Brain Tumor Association (ABTA) 2720 River Road Suite 146 Des Plaines, IL 60018-4117 info@abta.org http://www.abta.org Tel: 847-827-9910 800-886-2282 Fax: 847-827-9918
Brain Tumor Society 124 Watertown Street Suite 3H Watertown, MA 02472-2500 info@tbts.org http://www.tbts.org Tel: 617-924-9997 800-770-TBTS (8287) Fax: 617-924-9998	Childhood Brain Tumor Foundation 20312 Watkins Meadow Drive Germantown, MD 20876 cbtf@childhoodbraintumor.org http://www.childhoodbraintumor.org Tel: 877-217-4166 301-515-2900
Children's Brain Tumor Foundation 274 Madison Avenue Suite 1004 New York, NY 10016 info@cbtf.org http://www.cbtf.org Tel: 212-448-9494 866-CBT-HOPE (228-4673) Fax: 212-448-1022	Katie's Kids for the Cure/ National Fund for Pediatric Brain Tumor Research 3741 Walnut Street Box 612 Philadelphia, PA 19104 info@katieskids.org http://www.katieskids.org Tel: 877-KTS-KIDS (587-5437) 610-831-9026 Fax: 215-689-1454
National Brain Tumor Foundation (NBTF) 22 Battery Street Suite 612 San Francisco, CA 94111-5520 nbtf@braintumor.org http://www.braintumor.org Tel: 415-834-9970 800-934-CURE (2873) Fax: 415-834-9980	Musella Foundation for Brain Tumor Research and Information 1100 Peninsula Blvd. Hewlett, NY 11557 musella@virtualtrials.com http://www.virtualtrials.com Tel: 516-295-4740 888-295-4740 Fax: 516-295-2870
American Cancer Society National Home Office 250 Williams Street, NW Atlanta, GA 30303-1002 http://www.cancer.org Tel: 800-ACS-2345 (227-2345)	International RadioSurgery Association 3002 N. Second Street Harrisburg, PA 17110 office1@irsa.org http://www.irsa.org Tel: 717-260-9808 Fax: 717-260-9809
Cushing's Support and Research Foundation 65 East India Row Suite 22B Boston, MA 02110-3389 cushinfo@csrf.net http://csrf.net Tel: 617-723-3674 Fax: same as phone	Pediatric Brain Tumor Foundation 302 Ridgefield Court Asheville, NC 28806 familysupport@pbtfus.org http://www.pbtfus.org Tel: 828-665-6891 800-253-6530 Fax: 828-665-6894
Pituitary Network Association P.O. Box 1958 Thousand Oaks, CA 91358 rnr@pituitary.org http://www.pituitary.org Tel: 805-499-9973 Fax: 805-480-0633	Preuss Foundation, Inc. [For Brain Tumor Research] 2223 Avenida de la Playa Suite 220 La Jolla, CA 92037 fari@preuss.org Tel: 858-454-0200 Fax: 858-454-4449

Navigating the Health Care System

2008-11-15T02:53:00.000-08:00

Asking Questions About Medical Tests

By Carolyn M. Clancy, M.D.

February 5, 2008

A registered nurse in her mid-40s, Nancy Keelan was concerned that her heavy, irregular bleeding could be something more serious than the start of menopause. But her doctor did not agree and told her on several occasions not to worry.

Three years later, at age 46, Keelan discovered she had advanced endometrial and ovarian cancer.

Today, she speaks to women's groups and advises them not to wait to see their doctors if they develop new, unusual symptoms, according to a recent CNN news report. Keelan also urges women who are worried about new symptoms to ask their doctors if they should be tested to diagnose or rule out a disease or illness.

If a nurse like Keelan—who is familiar with medical tests and terms—didn't insist that her doctor perform a test when she experienced symptoms, I wouldn't be surprised if you were also reluctant to ask for a test. That's why her story and her advice are so important. Asking questions about medical tests—which ones you need, which ones you don't, and what the results tell you—can help you stay healthy and alert your doctor to the signs of a medical problem.

A wide array of medical tests are available today that can detect disease or illness at an early stage, when many conditions can be treated effectively. Your physician shouldn't prescribe tests that you don't need, but you should get the tests that are right for your age, gender, and medical history.

Maybe you don't know why you need a particular test or don't understand how it will help you. Here are some questions about medical tests that my agency, the Agency for Healthcare Research and Quality (AHRQ), developed to help you talk to your doctor.

Ask your doctor:

How is the test done?
What kind of information will the test provide?
Is this test the only way to find out that information?
What are the risks and benefits of having this test?
How accurate is the test?
What do I need to do to prepare for the test?
Will the test be uncomfortable?
How long will it take to get the results, and how will I get them?
What's the next step after the test?

Your doctor should be able to tell you when the results of your medical test will be ready. Do not assume that everything is fine if you don't hear from your doctor. Tests results can get lost, or people can think someone else gave you the results. No news is not necessarily good news.

In fact, a study conducted at Harvard Medical School found that up to 33 percent of doctors did not always notify patients about abnormal test results. If you don't hear from your doctor, call to get your results.

It is also possible that your test results are incorrect. If you or your doctor think the test results may not be right, retake the test. A second test can confirm or rule out a diagnosis.

It's also a good idea to get information on the lab your doctor uses to analyze test results. For example, you may want to know if your doctor uses a lab because he or she has a business arrangement with them or if a health insurance company requires your doctor to use a certain lab.

You can find out if a lab is accredited by or has a seal of approval from groups such as the College of American Pathologists or the Joint Commission. Both groups require labs to meet certain standards, which are linked to better-quality services.

If you need a mammogram, which is a test to detect breast cancer, make sure the test is performed at a facility that is approved by the Food and Drug Administration. You can ask this when you make your appointment, or you can call 800-4-CANCER to find out the names and locations of approved facilities in your area.

By asking your doctor questions about medical tests and your test results, you will have the information that you need to make smart decisions about your health care.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

What is a Urinary (YOOR-uh-nair-ee) Tract Infection (UTI)?

2008-11-05T01:14:00.000-08:00

What is a Urinary (YOOR-uh-nair-ee) Tract Infection (UTI)?

A UTI is an infection anywhere in the urinary tract. The urinary tract makes and stores urine and removes it from the body. Parts of the urinary tract include:

Kidneys—collect waste from blood to make urine
Ureters (YOOR-uh-turz)—carry the urine from the kidneys to the bladder
Bladder—stores urine until it is full
Urethra (yoo-REE-thruh)—a short tube that carries urine from the bladder out of your body when you pass urine

[Return to Top]

What causes Urinary Tract Infections (UTIs)?

Bacteria (bak-TIHR-ee-uh), a type of germ that gets into your urinary tract, cause a UTI. This can happen in many ways:

Wiping from back to front after a bowel movement (BM). Germs can get into your urethra, which has its opening in front of the vagina (vuh-JEYE-nuh).
Having sexual intercourse. Germs in the vagina can be pushed into the urethra.
Waiting too long to pass urine. When urine stays in the bladder for a long time, more germs are made, and the worse a UTI can become.
Using a diaphragm (DEYE-uh-fram) for birth control, or spermicides (creams that kill sperm) with a diaphragm or on a condom. To read more about diaphragms, go to http://www.plannedparenthood.org/health-topics/birth-control/diaphragm-cervical-cap-shield-4244.htm.
Anything that makes it hard to completely empty your bladder, like a kidney stone.
Having diabetes, which makes it harder for your body to fight other health problems.
Loss of estrogen (ESS-truh-juhn) (a hormone) and changes in the vagina after menopause. Menopause is when you stop getting your period.
Having had a catheter (KATH-uh-tur) in place. A catheter is a thin tube put through the urethra into the bladder. It’s used to drain urine during a medical test and for people who cannot pass urine on their own.

[Return to Top]

What are the signs of a Urinary Tract Infection (UTI)?

If you have an infection, you may have some or all of these signs:

Pain or stinging when you pass urine.
An urge to pass urine a lot, but not much comes out when you go.
Pressure in your lower belly.
Urine that smells bad or looks milky, cloudy, or reddish in color. If you see blood in your urine, tell a doctor right away.
Feeling tired or shaky or having a fever.

[Return to Top]

How does a doctor find out if I have a Urinary Tract Infection (UTI)?

To find out if you have a UTI, your doctor will need to test a clean sample of your urine. The doctor or nurse will give you a clean plastic cup and a special wipe. Wash your hands before opening the cup. When you open the cup, don’t touch the inside of the lid or inside of the cup. Put the cup in easy reach. Separate the labia, the outer lips of the vagina, with one hand. With your other hand, clean the genital area with the wipe. Wipe from front to back. Do not touch or wipe the anus. While still holding the labia open, pass a little bit of urine into the toilet. Then, catch the rest in the cup. This is called a “clean-catch” sample. Let the rest of the urine fall into the toilet.

If you are prone to UTIs, your doctor may want to take pictures of your urinary tract with an x-ray or ultrasound. These pictures can show swelling, stones, or blockage. Your doctor also may want to look inside your bladder using a cystoscope (SISS-tuh-skohp). It is a small tube that's put into the urethra to see inside of the urethra and bladder.

[Return to Top]

How is a Urinary Tract Infection (UTI) treated?

UTIs are treated with antibiotics (an-tuh-beye-OT-iks), medicines that kill the bacteria that cause the infection. Your doctor will tell you how long you need to take the medicine. Make sure you take all of your medicine, even if you feel better! Many women feel better in one or two days.

If you don't take medicine for a UTI, the UTI can hurt other parts of your body. Also, if you're pregnant and have signs of a UTI, see your doctor right away. A UTI could cause problems in your pregnancy, such as having your baby too early or getting high blood pressure. Also, UTIs in pregnant women are more likely to travel to the kidneys.

[Return to Top]

Will a UTI hurt my kidneys?

If treated right away, a UTI is not likely to damage your kidneys or urinary tract. But UTIs that are not treated can cause serious problems in your kidneys and the rest of your body.

[Return to Top]

How can I keep from getting Urinary Tract Infections (UTI)?

These are steps you can take to try to prevent a UTI. But you may follow these steps and still get a UTI. If you have symptoms of a UTI, call your doctor.

Urinate when you need to. Don't hold it. Pass urine before and after sex. After you pass urine or have a bowel movement (BM), wipe from front to back.
Drink water every day and after sex. Try for 6 to 8 glasses a day.
Clean the outer lips of your vagina and anus each day. The anus is the place where a bowel movement leaves your body, located between the buttocks.
Don't use douches or feminine hygiene sprays.
If you get a lot of UTIs and use spermicides, or creams that kill sperm, talk to your doctor about using other forms of birth control.
Wear underpants with a cotton crotch. Don’t wear tight-fitting pants, which can trap in moisture.
Take showers instead of tub baths.

[Return to Top]

I get UTIs a lot. Can my doctor do something to help?

About one in five women who get UTIs will get another one. Some women get three or more UTIs a year. If you are prone to UTIs, ask your doctor about your treatment options. Your doctor may ask you to take a small dose of medicine every day to prevent infection. Or, your doctor might give you a supply of antibiotics to take after sex or at the first sign of infection. “Dipsticks” can help test for UTIs at home. They are useful for some women with repeat UTIs. Ask your doctor if you should use dipsticks at home to test for UTI. Your doctor may also want to do special tests to see what is causing repeat infections. Ask about them.

[Return to Top]

For more Information

For more information on urinary tract infections, please call womenshealth.gov at 1-800-994-9662 or contact the following organizations:

National Kidney and Urologic Diseases Information Clearinghouse, NIH
Phone number: (800) 891-5390
Internet address: http://kidney.niddk.nih.gov

American College of Obstetricians and Gynecologists Resource Center
Phone number: (202) 638-5577
Internet address: http://www.acog.org

American Urogynecologic Society
Internet address: http://www.augs.org

American Urological Association
Phone number: (866) 746-4282
Internet address: http://www.urologyhealth.org

All material contained in the FAQs is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services; citation of the sources is appreciated.

This FAQ was reviewed by:

Magda Barini-García, MD, MPH
Senior Medical Advisor
Center for Quality
Health Resources and Services Administration
Rockville, MD

Kristene Whitmore, MD
Director, Pelvic and Sexual Health Institute
Graduate Hospital
Philadelphia, PA

Bladder cancer

2008-11-03T04:16:00.001-08:00

Bladder cancer

Definition

Bladder cancer is a type of cancer that occurs in your bladder — a balloon-shaped organ in your pelvic area that stores urine. Bladder cancer begins most often in the cells that line the inside of the bladder. Bladder cancer typically affects older adults, though it can occur at any age.

The great majority of bladder cancers are diagnosed at an early stage — when bladder cancer is highly treatable. However, even early-stage bladder cancer is likely to recur. For this reason, bladder cancer survivors often undergo follow-up screening tests for years after treatment.

Symptoms

CLICK TO ENLARGE

Urinary tract

Bladder cancer signs and symptoms may include:

Blood in urine (hematuria) — blood may appear cola colored or bright red in your urine, or may appear in a microscopic examination of your urine
Frequent urination
Painful urination
Urinary tract infection
Abdominal pain
Back pain

Causes

Your bladder is a muscular, balloon-shaped organ located in your pelvis. It stores urine that your kidneys produce during the process of filtering your blood. Like a balloon, the bladder gets larger or smaller depending on the amount of urine it's holding. Urine passes from your kidneys into your bladder through thin tubes called ureters and is eliminated from your body through another narrow tube, the urethra.

How cancer develops
Cancer occurs when healthy cells go awry. Rather than grow and divide in an orderly way, these cells develop mutations that cause them to grow out of control and not die. These abnormal cells form a tumor.

Types of bladder cancer
Different types of cells in your bladder can become cancerous. The type of cell involved in your cancer determines the type of treatments that may work best for you. Types of bladder cancer include:

Transitional cell carcinoma. Transitional cell carcinoma occurs in the cells that line the inside of your bladder. Transitional cells expand when your bladder is full and contract when your bladder is empty. These same cells line the inside of your ureters and your urethra, and tumors can form in those places as well. Transitional cell carcinoma is the most common type of bladder cancer in the United States.
Squamous cell carcinoma. Squamous cells appear in your bladder in response to infection and irritation. Over time they can become cancerous. Squamous cell bladder cancer is rare in the United States. It's a more common type of bladder cancer in areas of the world where a certain parasitic infection (schistosomiasis) is a more prevalent cause of bladder infections.
Adenocarcinoma. Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is rare in the United States.

Some bladder cancers include more than one type of cell.

Risk factors

A number of factors may increase your risk of bladder cancer, including:

Smoking. Smoking may increase your risk of bladder cancer by causing harmful chemicals to accumulate in your urine. When you smoke, your body processes the chemicals in the smoke and excretes some of them in your urine. These harmful chemicals may damage the lining of your bladder, which can increase your risk of cancer.
Chemical exposure. Your kidneys play a key role in filtering harmful chemicals from your bloodstream and moving them into your bladder. Because of this, it's thought that being around certain chemicals may increase your risk of bladder cancer. Chemicals linked to bladder cancer risk include arsenic and chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products. Smokers who are exposed to toxic chemicals may have an even higher risk of bladder cancer.
Chemotherapy and radiation therapy. Treatment with the anti-cancer drugs cyclophosphamide (Cytoxan) and ifosfamide (Ifex) increases your risk of bladder cancer. Studies of women treated with radiation therapy for cervical cancer have shown an elevated risk of subsequently developing bladder cancer. But the same doesn't appear to be true for men who receive primary radiation therapy for prostate cancer.
Chronic bladder inflammation. Chronic or repeated urinary infections or inflammations (cystitis), such as may happen with long-term use of a urinary catheter, may increase your risk of a squamous cell bladder cancer. In some areas of the world, squamous cell carcinoma is linked to chronic inflammation caused by infection with a parasite.
Personal or family history of cancer. If you've had bladder cancer, you're more likely to get it again. Cancer can recur in your ureters or urethra as well as in the bladder itself. If one or more of your immediate relatives have a history of bladder cancer, you may have an increased risk of the disease, although it's rare for bladder cancer to run in families. A family history of hereditary nonpolyposis colorectal cancer (HNPCC), sometimes called Lynch syndrome, can increase your risk of cancer in your urinary system, as well as in your colon, uterus, ovaries and other organs.
Bladder birth defect. Rare birth defects of the bladder can increase your risk of adenocarcinoma of the bladder.
Age. Older adults are more likely to be diagnosed with bladder cancer. Bladder cancer diagnosis typically occurs in people 65 and older. People younger than 40 rarely get bladder cancer.
Race. Whites have a greater risk of bladder cancer than do people of other races.
Sex. Men are more likely to develop bladder cancer than women are.

When to seek medical advice

Make an appointment with your doctor if you develop any signs or symptoms that bother you.

See your doctor right away if you develop bloody or painful urination.

Tests and diagnosis

Tests and procedures used to diagnose bladder cancer may include:

Using a scope to see inside your bladder. During cystoscopy, your doctor inserts a narrow tube (cystoscope) through your urethra. The cystoscope has a lens and fiber-optic lighting system, allowing your doctor to see the inside of your urethra and bladder. You usually receive a local anesthetic or light sedation during cystoscopy to make you more comfortable.
Removing suspicious cells for testing. During a procedure similar to cystoscopy, your doctor may pass a special tool through your urethra and into your bladder in order to collect a small cell sample (biopsy) for testing. This procedure is sometimes called transurethral resection of bladder tumor (TURBT). TURBT can also be used to treat bladder cancer. TURBT is usually performed under general anesthesia.
Testing your urine for cancer cells. A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.
Imaging tests. Imaging tests allow your doctor to examine the structures of your urinary tract. You may receive a dye, which can be swallowed or injected into a vein, depending on the type of test you're undergoing. An intravenous pyelogram is a type of X-ray imaging test that uses a dye to highlight your kidneys, ureters and bladder. A computerized tomography (CT) scan is a type of X-ray test that allows your doctor to better see your urinary tract and the surrounding tissues.

Bladder cancer stages
Once it's confirmed that you have bladder cancer, your doctor may order additional tests to determine the extent, or stage, of the cancer. Staging tests may include:

CT scan
Magnetic resonance imaging (MRI)
Bone scan
Chest X-ray

The stages of bladder cancer are:

Stage I. Cancer at this stage occurs in the bladder's inner lining, but hasn't invaded the muscular bladder wall.
Stage II. At this stage, cancer has invaded the bladder wall.
Stage III. The cancer cells have spread through the bladder wall to surrounding tissue. They may also have spread to the prostate in men or the uterus or vagina in women.
Stage IV. By this stage, cancer cells may have spread to the lymph nodes and other organs, such as your lungs, bones or liver.

Complications

Bladder cancer often recurs. Because of this, bladder cancer survivors often undergo follow-up testing for years after successful treatment. What tests you'll undergo and how often will depend on your type of bladder cancer and your treatment, among other factors.

What types of tests are used to screen for bladder cancer recurrence?
Tests and procedures commonly used to screen for recurrent bladder cancer include:

Looking for abnormal growths in your bladder. Cystoscopy is a common screening test for bladder cancer recurrence.
Looking for cancer cells in your urine. Your doctor may recommend urine cytology testing every few months for the first few years after cancer treatment.
Taking random samples of bladder tissue. If you have a high risk of bladder cancer recurrence, your doctor may recommend that samples of your bladder tissue be analyzed periodically. This may help doctors diagnose a bladder cancer recurrence before it can be seen with cystoscopy.

How often should you undergo screening for bladder cancer recurrence?
Ask your doctor to create a follow-up plan for you. In general, doctors recommend cystoscopy screening every three months for the first two years after bladder cancer treatment. For the next two years, you may undergo cystoscopy every six months. Then you may undergo cystoscopy every year. Your doctor may recommend other tests at various intervals as well.

People with aggressive cancers may undergo more frequent screening. Those with less aggressive cancers may undergo screening tests less often.

How can you prevent a bladder cancer recurrence?
Doctors don't yet know a reliable way to prevent bladder cancer recurrence. Talk to your doctor about ways to reduce your risk, such as:

Stopping smoking. Ask your doctor about strategies to help you quit smoking. Support programs and medications can help.
Increasing your intake of antioxidant vitamins. Some studies suggest that large amounts of certain vitamins may reduce the risk of recurrent bladder cancer in some people. But not enough study has been done to recommend taking big doses of antioxidants in pill form. In fact, large doses of vitamin supplements could be harmful. A safe way to increase your antioxidant intake is to increase fruits and vegetables in your diet. Talk to your doctor about other ways to get more vitamins.
Joining a clinical trial. Consider joining a clinical trial that's studying a new way of preventing bladder cancer recurrence. These studies can't guarantee that you won't have a bladder cancer recurrence. But joining a clinical trial may help doctors discover ways to reduce the risk of bladder cancer recurrence for people in the future.

Treatments and drugs

Your treatment options for bladder cancer depend on a number of factors, including the type and stage of the cancer, your overall health and your treatment preferences. Discuss your options with your doctor to determine what treatments are best for you.

Surgical procedures

Most people with bladder cancer undergo surgery to remove the cancerous cells. The types of surgical procedures available to you may be based on factors such as the stage of your bladder cancer, your overall health and your preferences.

Surgery for early-stage bladder cancer
If your cancer is very small and hasn't invaded the wall of your bladder, your doctor may recommend:

Surgery to remove the tumor. Transurethral resection of bladder tumor (TURBT) is often used to remove bladder cancers that are confined to the inner layers of the bladder. During TURBT, your doctor passes a small wire loop through your urethra and into your bladder. The loop is used to burn away cancer cells with an electric current (fulguration). In some cases, a high-energy laser may be used instead of electric current.

TURBT may cause painful or bloody urination for a few days following the procedure.
Surgery to remove the tumor and a small portion of the bladder. During segmental cystectomy, sometimes called partial cystectomy, the surgeon removes only the portion of the bladder that contains cancer cells. Segmental cystectomy may be an option if your cancer is limited to one area of the bladder that can easily be removed without harming bladder function. To remove the tumor, the surgeon makes an incision in your abdomen. General anesthesia is used, and you usually stay in the hospital for a week to 10 days.

Surgery carries a risk of bleeding and infection. You may experience more frequent urination after segmental cystectomy, since the operation reduces the size of your bladder. Over time this may improve, though in some people it's permanent.

Surgery for invasive bladder cancer
If your cancer has invaded the deeper layers of the bladder wall, you may consider:

Surgery to remove the entire bladder. A radical cystectomy is an operation to remove the entire bladder, as well as surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy involves removal of the uterus, ovaries and part of the vagina.

Cystectomy carries a risk of infection, bleeding, blood clots and bowel obstruction. In men, removal of the prostate and seminal vesicles will cause infertility. But in most cases your surgeon will take care to spare the nerves necessary for an erection. In women, removal of the ovaries causes infertility and premature menopause in women who haven't experienced menopause prior to this surgery.
Surgery to create a new way for urine to leave your body. Immediately after your radical cystectomy, your surgeon works to create a new way for your body to expel urine. Several options exist. Which option is best for you depends on your cancer, your health and your preferences. Your surgeon may create a tube (urinary conduit) using a piece of your intestine. The tube runs from your kidneys to the outside of your body, where your urine drains into a pouch (urostomy bag) you wear on your abdomen.

In another procedure, your surgeon may use a section of intestine to create a small reservoir for urine inside your body (cutaneous continent urinary diversion). You can drain urine from the reservoir through a hole in your abdomen using a catheter a few times each day.

In select cases, your surgeon may create a bladder-like reservoir out of a piece of your intestine (neobladder). This reservoir sits inside your body and is attached to your urethra, which allows you to urinate normally. You may need to use a catheter to drain all the urine from your new bladder.

Biological therapy (immunotherapy)

Biological therapy, sometimes called immunotherapy, works by signaling your body's immune system to help fight cancer cells. Biological therapy for bladder cancer is typically administered through your urethra and directly into the bladder (intravesical therapy).

Biological therapy drugs commonly used to treat bladder cancer include:

An immune-stimulating bacterium. Bacille Calmette-Guerin (BCG) is a bacterium used in tuberculosis vaccines. BCG can cause bladder irritation and blood in your urine. Some people feel as if they have the flu after treatment with BCG.
A synthetic version of immune system cell. An interferon is a type of cell your body uses to fight infections. A synthetic version of interferon, called interferon alfa, may be used to treat bladder cancer. Interferon alfa is sometimes used in combination with BCG. Interferon alfa can cause flu-like symptoms.

Biological therapy can be administered after TURBT to reduce the risk that cancer will recur. Biological therapy can also be given before surgery to shrink a tumor to a more manageable size.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment for bladder cancer usually involves two or more chemotherapy drugs used in combination. Drugs can be given through a vein in your arm (intravenously), or they can be administered directly to your bladder by passing through your urethra (intravesical therapy).

Chemotherapy may be used to kill cancer cells that might remain after an operation. It may also be used before surgery. In this case, chemotherapy may shrink a tumor enough to allow the surgeon to perform a less invasive surgery. Chemotherapy is sometimes combined with radiation therapy.

Radiation therapy

Radiation therapy uses high-energy beams aimed at your cancer to destroy the cancer cells. Radiation therapy can come from a machine outside your body (external beam radiation) or it can come from a device placed inside your bladder (brachytherapy).

Radiation therapy may be used before surgery to shrink a tumor so that it can more easily be removed with surgery. Radiation therapy can also be used after surgery to kill cancer cells that might remain. Radiation therapy is sometimes combined with chemotherapy.

Prevention

Although there's no guaranteed way to prevent bladder cancer, you can take steps to help reduce your risk. For instance:

Don't smoke. Not smoking means that cancer-causing chemicals in smoke can't collect in your bladder. If you don't smoke, don't start. If you smoke, talk to your doctor about a plan to help you quit. Support groups, medications and other methods may help you quit.
Take caution with chemicals. If you work with chemicals, follow all safety instructions to avoid exposure.
Have your well tested for arsenic. If you have your own well, consider having it tested for high levels of arsenic in the water.
Drink plenty of fluids. Drinking liquids, especially water, dilutes toxic substances that may be concentrated in your urine and flushes them out of your bladder more quickly.
Eat your fruits and vegetables. Choose a diet rich in a variety of colorful fruits and vegetables. The antioxidants in fruits and vegetables may help reduce your risk of cancer.

Coping and support

Living with the concern that your bladder cancer may recur can leave you feeling as if you have little control over your future. But while there's no way to ensure you won't have a recurrence of bladder cancer, you can take steps to manage the stress.

Over time you'll find what works for you, but until then, you might:

Have a personalized schedule of follow-up tests, and go to each appointment. When you finish bladder cancer treatment, ask your doctor to create a personalized schedule of follow-up tests. Before each follow-up cystoscopy exam, expect to have some anxiety. You may fear that cancer has come back or worry about the uncomfortable exam. But don't let this stop you from going to your appointment. Instead, plan ways to cope with your concerns in the weeks and days leading to your appointment. Write your thoughts in a journal, talk with a friend or use relaxation techniques, such as meditation.
Take care of yourself so that you're ready to fight cancer if it comes back. Take care of yourself by adjusting your diet to include plenty of fruits, vegetables and whole grains. Exercise for at least 30 minutes most days of the week. Get enough sleep so you wake feeling rested.
Talk with other bladder cancer survivors. Connect with bladder cancer survivors who are experiencing the same fears you're feeling. Contact the American Cancer Society at 800-ACS-2345, or 800-227-2345, to ask about support groups in your community. Or contact CancerCare at 800-813-HOPE, or 800-813-4673, for information on telephone-based support groups. Or go online — message boards, such as the American Cancer Society's Cancer Survivors Network and the Bladder Cancer WebCafe, are another option.

Alternative medicine

No complementary or alternative bladder cancer treatments have been found to cure bladder cancer. But doctors are studying ways to prevent bladder cancer, including some complementary and alternative approaches. If you're worried about your risk of bladder cancer or that your cancer could recur, you may be interested in trying complementary and alternative treatments. Talk to your doctor about your options.

Vitamins
Fruits and vegetables are the safest way to get your vitamins. Some research suggests larger doses of certain vitamins, such as vitamin E, in pill form may help reduce the risk of bladder cancer. Studies of vitamin E showed a reduced risk of bladder cancer in people who took supplements for 10 years.

More study is needed to understand what dose is safest and most effective. Until then, talk to your doctor about the best way to get the vitamins you need. And if you're interested in vitamin supplements, ask your doctor about what doses may be reasonable.

Green tea
Drinking green tea has been linked to many health benefits. But whether it can reduce the risk of bladder cancer isn't clear. Animal studies have shown promise, but studies in humans have been mixed. For example, one study showed that people who drink the most green tea have a reduced risk of bladder cancer, while another study found that drinking green tea over many years increased the risk of bladder cancer. More study is needed to understand whether green tea is helpful or harmful when it comes to preventing bladder cancer.

What Is Bile Duct Cancer?

2008-10-23T03:48:00.000-07:00

Detailed Guide: Bile Duct Cancer
What Is Bile Duct Cancer?

The major function of the bile duct is to transport bile to the small intestine where it aids in digesting food. The bile duct is a thin tube, about 4 to 5 inches long, that reaches from the liver to the small intestine. In the liver, it begins as many small channels that gather bile from the liver cells. These all join into one tube or duct (this part of the bile duct is called the hepatic duct). About one third of the way along the length of the bile duct, the gallbladder attaches by a small duct called the cystic duct. The combined duct is called the common bile duct. The end of this part of the bile duct empties into the earliest part of the small intestine, next to where the pancreatic duct also enters the small intestine.

Cancers can develop in any part of the bile duct and, based on their location, are divided into 3 groups. About half of the cancers develop in the smaller bile duct branches inside the liver and are called intrahepatic (inside the liver) bile duct cancers. These can be confused with cancers that start in the liver cells and are called hepatic carcinomas. It is possible to tell these 2 types of tumors apart by looking at them under a microscope.

The next most common type of bile duct cancers is found in the common bile duct nearest the intestine. Doctors call these distal bile duct cancers.

The least common type is bile duct cancer that develops at the part of the hepatic duct where the bile ducts have joined and are just leaving the liver. Cancers that develop here are called perihilar cancers, or sometimes Klatskin tumors (named after the doctor who described them). Cancers beginning in these 3 different areas may cause different symptoms.

More than 95% of bile duct cancers are of the adenocarcinoma type. Adenocarcinomas are cancers of glandular cells that can develop in several organs of the body. Bile duct adenocarcinomas develop from the mucus glands that line the inside of the duct. Cholangiocarcinoma is another name for a bile duct adenocarcinoma. Today, most doctors use this term for all bile duct adenocarcinomas. In the past, doctors used this term only in describing intrahepatic or perihilar tumors, but not distal bile duct cancers.

Not all bile duct tumors are cancerous. Bile duct hamartomas and bile duct adenomas are benign (non-cancerous) tumors and, therefore, are not discussed further in this document. Hepatocellular carcinomas, which develop from liver cells, are more common than cholangiocarcinomas of bile duct cells. Hepatocellular carcinoma is discussed in more detail in the American Cancer Society document, Liver Cancer.

Adenocarcinomas that form in other organs, such as the pancreas, colon, rectum, stomach, lung, breast, or prostate, may spread through the bloodstream to the liver. These are called secondary liver cancers or liver metastases. Their prognosis and treatment are not the same as cholangiocarcinomas, and depend on where the cancer started.
Last Revised: 04/17/2006

Behcet's Disease

2008-10-18T01:52:00.001-07:00

Behcet's Disease

First Description

Hippocrates may have been the first physician to describe this disease, several centuries B.C. In the 1930's, a Turkish dermatologist, Hulusi Behcet, noted the triad of aphthous oral ulcers, genital lesions, and recurrent eye inflammation, and became the first physician to describe the disease in modern times. Another name for Behcet’s Disease is Behcet’s syndrome.

Who gets Behcet's Disease (the “typical” patient)?

Behcet’s disease is most common along the “Old Silk Route”, which spans the region from Japan and China in the Far East to the Mediterranean Sea, including countries such as Turkey and Iran. Although the disease is rare in the United States, sporadic cases do occur in patients who would not appear to be at risk because of their ethnic backgrounds (e.g., in Caucasians or African–Americans). The disease is not rare in regions along the Old Silk Route, but the disease’s epidemiology is not well understood. In Japan, Behcet’s disease ranks as a leading cause of blindness. Below is a magnetic resonance image (MRI) study of a Behcet's patient demonstrating central nervous system involvement (white matter changes in the pons).

Classic symptoms and signs of Behcet's Disease

Behcet’s disease is virtually unparalleled among the vasculitides in its ability to involve blood vessels of nearly all sizes and types, ranging from small arteries to large ones, and involving veins as well as arteries. Because of the diversity of blood vessels it affects, manifestations of Behcet’s may occur at many sites throughout the body. However, the disease has a predilection for certain organs and tissues; these are described below.

Eye

Behcet’s may cause either anterior uveitis (inflammation in the front of the eye) or posterior uveitis (inflammation in the back of the eye), and sometimes causes both at the same time.
Anterior uveitis results in pain, blurry vision, light sensitivity, tearing, or redness of the eye.
Posterior uveitis may be more dangerous and vision–threatening because it often causes fewer symptoms while damaging a crucial part of the eye — the retina.

(top of section)

Mouth

Painful sores in the mouth called “aphthous ulcers”(pictured below). These are very similar in appearance to ulcers that frequently occur in the general population, usually as a result of minor trauma. In Behcet’s, however, the lesions are more numerous, more frequent, and often larger and more painful. Aphthous ulcers can be found on the lips, tongue, and inside of the cheek. Aphthous ulcers may occur singly or in clusters, but occur in virtually all patients with Behcet’s.

Skin

Pustular skin lesions that resemble acne, but can occur nearly anywhere on the body. This rash is sometimes called “folliculitis”.
Skin lesions called erythema nodosum: red, tender nodules that usually occur on the legs and ankles but also appear sometimes on the face, neck, or arms. Unlike erythema nodosum associated with other diseases (which heal without scars), the lesions of Behcet’s disease frequently ulcerate.

Lungs

Aneurysms (outpouchings of blood vessel walls, caused by inflammation) of arteries in the lung, rupture of which may lead to massive lung hemorrhage.

Joints

Arthritis or “arthralgias” (pain in the joints not accompanied by joint swelling).

Brain

Central nervous system involvement is one of the most dangerous manifestations of Behcet’s. The disease tends to involve the “white matter” portion of the brain and brainstem, and may lead to headaches, confusion, strokes, personality changes, and (rarely) dementia. Behcet’s may also involve the protective layers around the brain (the meninges), leading to meningitis. Because the meningitis of Behcet's disease is not associated with any known infection, it is often referred to as “aseptic” meningitis.

Genitals

Male — painful genital lesions that form on the scrotum, similar to oral lesions, but deeper.
Female — painful genital ulcers that develop on the vulva.

Gastrointestinal

Ulcerations may occur anywhere in the gastrointestinal tract from the mouth to the anus. The terminal ileum and cecum are common sites. Involvement of the GI tract by Behcet’s may be difficult to distinguish from inflammatory bowel disease (such as Crohn’s disease).

What causes Behcet's Disease?

Behcet’s is one of the few forms of vasculitis in which there is a known genetic predisposition. The presence of the gene HLA–B51 is a risk factor for this disease. However, it must be emphasized that presence of the gene in and of itself is not enough to cause Behcet’s: many people possess the gene, but relatively few develop Behcet’s. Despite the predisposition to Behcet’s conferred by HLA–B51, familial cases are not the rule, constituting only about 5% of cases. Thus, it is believed that other factors (perhaps more than one) play a role. Possibilities include infections and other environmental exposures. Pictured below is a typical aphthous ulcer in a patient with Behcet's disease.

How is Behcet's Disease Diagnosed?

There is no specific “Behcet’s test”. Consequently, the diagnosis is based on the occurrence of symptoms and signs that are compatible with the disease, the presence of certain features that are particularly characteristic (e.g., oral or genital ulcerations), elimination of other possible causes of the patient’s presentation, and — whenever possible — proof of vasculitis by biopsy of an involved organ.

An international group of physicians has established a set of guidelines to aid in the classification of Behcet’s patients for the purpose of conducting research in the disease. The criteria put forth by the group include recurrent oral ulceration (at least three occasions in a year). In addition, a patient must also meet two of the following four criteria for Behcet’s disease: recurrent genital ulcerations, eye lesions (uveitis or retinal vasculitis), skin lesions (erythema nodosum, lesions, acne), and or positive "pathergy test".

The pathergy test is a simple test in which the forearm is pricked with a small, sterile needle. Occurrence of a small red bump or pustule at the site of needle insertion constitutes a positive test. Although a positive pathergy test is helpful in the diagnosis of Behcet’s, only a minority of Behcet’s patients demonstrate the pathergy phenomenon (i.e., have positive tests). Patients from the Mediterranean region are more likely to demonstrate pathergy. In addition, other conditions can occasionally result in positive pathergy tests, so the test is not 100% specific.

Pictured below is an example of the pathergy test; 1) taken at the time when the patient was “stuck” with the sterile needle; 2) shows the area immediately after the stick; 3) & 4) show the area one day and two days after the needle stick, respectively.

Treatment and Course of Behcet's Disease

For disease that is confined to mucocutaneous regions (mouth, genitals, and skin), topical steroids and non–immunosuppressive medications such as colchicine may be effective. Moderate doses of systemic corticosteroids are also frequently required for disease exacerbations, and some patients require chronic, low doses of prednisone to keep the disease under control.

In the event of serious end–organ involvement such as eye or central nervous system disease, both high doses of prednisone and some other form of immunosuppressive treatment are usually necessary. Immunosuppressive agents used in the treatment of Behcet’s include azathioprine, cyclosporine, cyclophosphamide, and chlorambucil. With organ- or life-threatening disease, the combination of prednisone and either cyclophosphamide or chlorambucil (both of which are from the same class of drug — “alkylating agents”) is the preferred therapy.

What's new in Behcet's Disease?

Thalidomide, a drug long banned in the United States because of its teratogenic potential (its ability to cause birth defects in the offspring of women who take the drug when pregnant), has been demonstrated to be effective in the treatment of mucocutaneous Behcet’s disease. Its effectiveness in more severe Behcet’s disease, however, is not known. In addition, thalidomide use is associated with the development of peripheral neuropathy (frequently irreversible) in a high percentage of patients who take the drug for prolonged periods. For more information about Thalidomide, please visit the United States Food and Drug Administration / Center for Drug Evaluation and Research’s Website on Consumer Drug Information.

Interferon–alpha, a drug used in the treatment of hepatitis C, has also demonstrated some promise in Behcet’s.

In medical terms, by David Hellmann, M.D.

A discussion of Behcet's Disease written in medical terms by David Hellmann, M.D. (F.A.C.P.) for the Rheumatology Section of the Medical Knowledge Self–Assessment Program published and copyrighted by the American College of Physicians (Edition 11, 1998). The American College of Physicians has given us permission to make this information available to patients contacting our Website:

Named after the Turkish dermatologist who described it, Behçet's syndrome is an idiopathic disorder classified as a vasculitis, consisting of recurrent oral and genital ulcers plus other features, which may include uveitis, erythema nodosum, folliculitis, meningitis or central nervous system vasculitis, arthritis, and a bowel disease that resembles inflammatory bowel disease. Pathergy - the phenomenon of sterile pustule formation at venipuncture sites - is common in Turks but rare in Americans. Corticosteroids, azathioprine, and chlorambucil have helped treat systemic symptoms. Cyclosporine can be an effective treatment of uveitis.

All information contained within the Johns Hopkins Vasculitis Center website is intended for educational purposes only. Visitors are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.

Skin Cancer

2008-10-11T02:27:00.000-07:00

Skin Cancer

Copyrighted Material: Not for Reproduction or Distribution

Skin cancer is the most prevalent of all types of cancers. It is estimated that more than one million Americans develop skin cancer every year.

Fair-skinned people who sunburn easily are at a particularly high risk for developing skin cancer. Other less important factors include repeated medical and industrial x-ray exposure, scarring from diseases or burns, occupational exposure to compounds such as coal tar and arsenic, and family history.

Actinic Keratoses (AK)

Actinic keratoses or solar keratoses are considered the earliest stage in the development of skin cancer. They are small, scaly spots most commonly found on the face, ears, neck, lower arms, and back of the hands in fair-skinned individuals who have had significant sun exposure. Actinic keratoses can be treated by cryotherapy (freezing), topical chemotherapy (applying a cream or lotion), chemical peeling, dermabrasion, laser surgery, curettage, photodynamic therapy (a chemical is applied to the skin prior to exposure to a light source), or other dermatologic surgical procedures. Some actinic keratoses may progress to advanced stages which require more extensive treatment. Proper use of sunscreens can help prevent actinic keratoses even after extensive sun damage has already occurred.

Basal Cell Carcinoma (BCC)

Basal cell carcinoma is the most common type of skin cancer and appears frequently on the head, neck, and hands as a small, fleshy bump, nodule, or red patch. Other parts of the body may be affected as well. Basal cell carcinomas are frequently found in fair-skinned people and rarely occur in dark skin. They usually do not grow quickly. It can take many months or years for one to grow to a diameter of one-half inch. Untreated, the cancer often will begin to bleed, crust over, heal, and repeat the cycle, and can extend below the skin to the bone and nerves, causing considerable local damage.

Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma is the second most common skin cancer; it is primarily found in fair-skinned people and rarely in dark-skinned individuals. Typically located on the rim of the ear, the face, lips, and mouth, this cancer may appear as a bump, or as a red, scaly patch. SCC can develop into large masses and become invasive. Unlike basal cell carcinoma, this form of cancer can metastasize (spread to other parts of the body); therefore, it is important to get early treatment.

When found early and treated properly, the cure rate for both basal cell and squamous cell carcinomas is over 95 percent.

Malignant Melanoma

Malignant Melanoma is the most deadly of all skin cancers. Every year, an estimated 8,000 Americans will die from melanoma; it is projected that greater than 108,000 Americans will develop melanoma annually. The death rate is declining because melanoma is usually curable when detected in its early stages and patients are seeking help sooner.

Melanoma begins in melanocytes, the skin cells that produce the dark protective pigment called melanin which makes the skin tan. Since melanoma cells usually continue to produce melanin, the cancer appears in mixed shades of tan, brown, and black; although, it can also be red or white. Melanoma can metastasize (spread), making treatment essential.

Melanoma may appear suddenly or begin in or near a mole, or another dark spot in the skin. It is important to know the location and appearance of the moles on the body to detect changes early. Any changing mole must be examined by a dermatologist. Early melanoma can be removed while still in the curable stage.

Excessive sun exposure, especially sunburn, is the most important preventable cause of melanoma. Light-skinned individuals are at particular risk. Heredity also plays a part. A person has an increased chance of developing melanoma if a relative or close family member has had melanoma. Atypical moles, which may run in families, and a large number of moles, can serve as markers for people at increased risk for developing melanoma.

Dark skin is not a guarantee against melanoma. People with skin of color can develop melanoma, especially on the palms, soles, under the nails, in the mouth, or on the genitalia.

The ABCDs of Melanoma

Consult a dermatologist immediately if any of your moles or pigmented spots exhibit:

	Asymmetry - One half does not match the other half in size, shape, color, or thickness.
	Border irregularity - The edges are ragged, scalloped, or poorly defined.
	Color - The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance.
	Diameter - While melanomas are usually greater than 6mm in diameter (the size of a pencil eraser) when diagnosed, they can be smaller. If you notice a mole different from others, or which changes, itches, or bleeds (even if it is small), you should see a dermatologist.

Warning signs of melanoma include:

Changes in the surface of a mole.
Scaliness, oozing, bleeding, or the appearance of a new bump.
Spread of pigment from the border of a mole into surrounding skin.
Change in sensation including itchiness, tenderness, or pain.

Treatment of Skin Cancer

If a skin biopsy reveals cancer, the dermatologist has an array of medical and surgical procedures as treatment, depending upon the type of cancer, its location, and the needs of the individual.

Dermatologic surgical treatments include: surgical excision; electrodessication and curettage (ED&C), which involves alternately scraping or burning the tumor in combination with low levels of electricity; cryosurgery (freezing using liquid nitrogen); and laser surgery. Mohs micrographic surgery is a special procedure used to remove the whole tumor while sparing as much normal skin as possible.

Other dermatologic treatments include radiation therapy and photodynamic therapy (a chemical is applied to the skin prior to exposure to a light source). Topical chemotherapy products may also be used.

Early Detection is the Surest Way to a Cure

Develop a regular routine to inspect your body for any skin changes. If a growth, mole, sore, or skin discoloration appears suddenly, or begins to change, see a dermatologist. It is wise to have an annual skin examination by a dermatologist, especially for adults with significant past sun exposure or a family history of skin cancer.

HOW TO PROTECT YOURSELF FROM ULTRAVIOLET LIGHT

Sun exposure is the most preventable risk factor for all skin cancers, including melanoma.^[1],[2] You can have fun in the sun and decrease your risk of skin cancer. Here's how to Be Sun Smart^SM:

Generously apply a water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 15 that provides broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays to all exposed skin. Re-apply every two hours, even on cloudy days, and after swimming or sweating. Look for the AAD SEAL OF RECOGNITION^TM on products that meet these criteria.

Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.

Seek shade when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade.

Protect children from sun exposure by playing in the shade, using protective clothing and applying sunscreen.
Use extra caution near water, snow and sand as they reflect the damaging rays of the sun, which can increase your chance of sunburn.

Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.^[3]

Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.

Check your birthday suit on your birthday. If you notice anything changing, growing or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.

[1] American Cancer Society. 2008 Cancer Facts and Figures. http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf
[2} Robinson, JK. Sun Exposure, Sun Protection and Vitamin D. JAMA 2005; 294: 1541-43.
[3] Hemminki K, Dong C. Subsequent cancers after in situ and invasive squamous cell carcinoma of the skin. Arch Dermatol 2000;136:647-51.

PERIODIC SELF-EXAMINATION - Early detection and removal offer the best chance for a cure. Periodic self-examinations aid in recognition of any new or developing lesion. Get familiar with your skin and your own pattern of moles, freckles, and “beauty marks.” Make sure to look at the entire body every month or two. Watch for changes in the number, size, shape, and color of pigmented areas. Consult a dermatologist promptly if any changes are noticed. Individuals at high risk should be examined by a dermatologist on a regular basis. It is beneficial to get assistance from a partner in performing skin self exams.

1. Examine body front and back in mirror, then right and left sides, arms raised.
2. Bend elbows, look carefully at forearms, back of upper arms, and palms.
3. Next, look at backs of legs and feet, spaces between toes, and soles.
4. Examine back of neck and scalp with a hand mirror. Part hair to lift.
5. Finally, check back and buttocks with a hand mirror.

To learn more about skin cancer, call toll free (888) 462-DERM (3376) to find a dermatologist in your area.

Patient information: Weight loss surgery

2008-10-08T03:28:00.000-07:00

Patient information: Weight loss surgery

Author Edward C Mun, MD, FACS	Section Editor F Xavier Pi-Sunyer, MD, MPH	Deputy Editor Leah K Moynihan, RNC, MSN Peter A L Bonis, MD

Last literature review version 16.2: May 2008 | This topic last updated: December 7, 2006 (More)

INTRODUCTION — Obesity is a major international problem and Americans are among the heaviest people in the world. A person is categorized as underweight, healthy weight, overweight, or obese based on his or her body mass index (BMI). Body mass index is a standardized measure of body fat that can be calculated based on an adult's height and weight; a BMI of 25 to 29.9 is considered overweight, while a BMI of ≥30 is considered obese (show table 1).

Bariatric surgery (from the Greek words "baros" meaning "weight", and "iatrikos" meaning "medicine") is the collective term for a group of surgical procedures that may be used to promote weight loss in certain cases.

SHOULD I HAVE SURGERY TO LOSE WEIGHT? — Surgical procedures are recommended ONLY for people with severe obesity who have not responded to diet, exercise, or medication; for those with less severe obesity, the risks of the surgical procedure may outweigh any potential benefits. Candidates should be sure they understand the implications of bariatric surgery and are willing to commit to the lifestyle changes necessary for reaching and maintaining a healthy weight following the procedure.

The National Institutes of Health recommend that surgery be considered for people at the following weight levels:

Patients with a body mass index >40 kg/m2

Patients with a body mass index between 35 and 40 kg/m2 who also have serious medical problems (including diabetes, disabling joint conditions such as arthritis, or obstructive sleep apnea) that would improve with weight loss.

This discussion will focus on surgical management of obesity. Nonsurgical treatment options are reviewed separately. (See "Patient information: Weight loss treatments").

PREPARING FOR SURGERY — Most patients in the United States who undergo a weight loss surgery must meet with several healthcare providers before surgery is scheduled. This often includes a nutritionist and mental health specialist. Some patients need to work with these providers for several weeks or months before proceeding with surgery.

The nutritionist ensures that the patient understands and can follow the strict dietary guidelines necessary after surgery. Some patients will be required to lose a small amount of weight before surgery.

The mental health specialist helps the patient to identify factors involved in stress, coping, and lifestyle.

Other healthcare providers may also be involved in the presurgical evaluation, including a cardiologist, internal medicine specialist, or sleep medicine specialist. A cardiologist helps to ensure that the patient's heart is healthy enough for surgery. An internal medicine provider may be needed to assess the patient's overall health. A sleep medicine specialist can determine if the patient has a common obesity-related condition, sleep apnea. Sleep apnea can cause difficulty breathing while sleeping and may pose a risk around the time of surgery.

TYPES OF SURGERY — Weight-loss surgery can be divided into the following categories: restrictive, malabsorptive, and mixed or combination. A comparison of these procedures is available in table 2 (show table 2). All of these procedures are performed under general anesthesia (the patient is given medication to induce sleep).

Restrictive — Restrictive procedures reduce the size of the stomach, limiting the amount of food that can be consumed at once. There are several types of restrictive surgeries.

Gastroplasty — Vertical banded gastroplasty (VBG), commonly known as "stomach stapling", involves the use of surgical staples to partition off a small pouch in the upper part of the stomach (show figure 1). The outlet from this pouch to the rest of the stomach is wrapped with a band that delays the emptying of food from the pouch. This results in a feeling of fullness after eating only a small amount of food; the decrease in overall calorie consumption leads to weight loss.

Patients who undergo VBG can expect to lose more than 50 percent of their excess weight after two years; for example, a person who wants to lose 120 pounds is likely to lose at least 60 pounds within two years after undergoing VBG. However, VBG has mostly been replaced by other procedures because less weight is typically lost and kept off with VBG, and there is a higher risk of complications (such as disruption or erosion of the staples and/or band) that require a surgical revision (see "Complications" below).

Lap banding — Laparoscopic gastric banding (LAGB), or lap banding, is a restrictive procedure that compartmentalizes the upper stomach by placing a silicone band around the entrance to the stomach (show figure 2). This procedure is done laparoscopically, which means that the surgeon makes small incisions and inserts an instrument with a tiny camera to perform surgery without cutting open the abdomen. The band is connected to a narrow tube that extends to an access port just beneath the skin; a healthcare provider can narrow or widen the entrance to the stomach by injection or removal of saline through the port. As with gastroplasty, the passage of food from the upper pouch to the rest of the stomach is delayed, and the patient feels full after eating less.

Lap banding is a popular choice of weight-loss surgery because it is relatively simple to perform, can be adjusted or removed, and has a low complication rate; it has largely replaced gastroplasty (VBG).

The procedure's effectiveness is variable according to different reports, with excess weight loss ranging from 45 to 75 percent after two years. Using the above example, a person who is 120 pounds overweight could expect to lose approximately 54 to 90 pounds in the two years following lap banding.

Sleeve gastrectomy — Sleeve gastrectomy is sometimes performed on patients with a BMI of greater than 50. This procedure involves the removal of the majority of the stomach to create a smaller, tubular (sleeve-shaped) stomach that can hold less food and is resistant to stretching.

Although sometimes done without plans for more surgery, sleeve gastrectomy is most often performed with the intention of doing another procedure, such as a gastric bypass or biliopancreatic diversion at a later date. It is often difficult to operate on extremely obese patients, and performing a sleeve gastrectomy allows the patient to lose some excess weight before undergoing a second, more intensive procedure (see "Gastric bypass" below and see "Biliopancreatic diversion with or without duodenal switch" below).

Expected excess weight loss is approximately 33 percent after two years. Using the above example, a person who is 120 pounds overweight could expect to lose 40 pounds in the two years following surgery.

Malabsorptive — In the normal digestive process, food is swallowed and then enters the stomach, where it is mechanically ground by the body. It is then pushed into the small intestine and is mixed with digestive juices and bile. Throughout the long loops of small intestine, the intestinal walls absorb nutrients from the food (including vitamins, carbohydrates, proteins, and fats). The remaining contents are then passed into the large intestine, where water is absorbed, and then out of the body in the form of feces.

The goal of malabsorptive surgical procedures is to decrease the effective length of small intestine through which food must pass, thereby reducing the absorption of nutrients and calories and inducing weight loss. Biliopancreatic diversion, with or without duodenal switch, is the primary malabsorptive procedure performed today.

Biliopancreatic diversion with or without duodenal switch — In biliopancreatic diversion (BPD), part of the stomach is removed, and the remaining section is surgically connected to the lower part of the small intestine. Weight loss occurs primarily because the stomach contents bypass the majority of the small intestine, passing into the large intestine before most of the nutrients and calories can be absorbed.

Mixed — Mixed or combination procedures have both a restrictive and malabsorptive component, meaning that they limit food intake while also decreasing absorption of nutrients within the body. Gastric bypass is the most common mixed surgical procedure used to treat weight loss in the United States.

Gastric bypass — Roux-en-Y gastric bypass (RYGB) is primarily a restrictive procedure, but also has a malabsorptive element, making it more successful than a solely restrictive surgery (see "Restrictive" above).

The surgeon creates a small stomach pouch by dividing the stomach, and attaches it to the small intestine (show figure 3). The pouch is only able to hold about an ounce of food (the approximate equivalent of one slice of bread or 1/2 cup of cooked rice or pasta), causing a feeling of fullness after consuming a very small amount; over time, the pouch stretches to hold about one cup. Additionally, the body absorbs fewer calories since food bypasses the majority of the stomach as well as the upper small intestine (duodenum). This kind of new intestinal arrangement (Roux-en-Y) seem to cause decreased appetite and improved metabolism by changing the release of various hormones.

RYGB can be performed as open surgery (through a large incision in the abdomen) or laparoscopically. The laparoscopic procedure, if technically possible, is preferred because patients typically require less time to recover and have fewer complications.

RYGB has a high success rate, and patients lose an average of 62 to 68 percent of their excess body weight in the first year. Weight loss typically plateaus after one to two years, with an overall excess weight loss between 50 and 75 percent. For a person who is 120 pounds overweight, an average of 60 to 90 pounds of weight loss would be expected.

COMPLICATIONS — A variety of complications can occur with surgical weight loss procedures. The specific risks depend upon the procedure used and any preexisting medical conditions. In addition, complications are less likely when surgery is performed in centers with vast experience in bariatric surgery. Common potential complications of bariatric surgery include pulmonary embolus, bleeding, infection, narrowing of outlets, and hernias at the incisions.

Restrictive procedures

Vertical banded gastroplasty (VBG) — Specific complications following VBG include disruption of the staple line, which allows the patient to eat more before feeling full, and narrowing of the pouch outlet, which can lead to food intolerance and gastroesophageal reflux. (See "Patient information: Gastroesophageal reflux disease in adults").

The prosthetic band may also wear down, causing abdominal pain and/or vomiting. Patients may experience weight regain due to an increase in pouch size (after staple disruption), or by eating soft or sweet foods that are easier to digest but high in calories. (See "Gastroplasty" above).

Lap banding — Patients who undergo lap banding (LAGB) may also experience complications. These include developing a block in the passage leading from the upper pouch to the rest of the stomach and erosion of the band, both of which can cause pain, nausea, and vomiting.

In some cases, the band can slip out of place or cause the stomach wall to prolapse or fall inward; symptoms include food intolerance, abdominal pain, and acid reflux, and surgery is required to correct the problem.

If the band is too tight or the patient consumes an excessive amount of food over a long period of time, the esophagus may dilate or expand; this can usually be fixed by loosening the band.

A small number of patients may also experience infection of the access port; the infected port can be surgically removed and a new one implanted. (See "Lap banding" above See "Lap banding" above).

Malabsorptive procedures — Some of the potentially serious complications that arise from biliopancreatic diversion (BPD) are related to the decrease in absorption of nutrients (in addition to calories). Patients may experience deficiencies in protein, iron, and/or vitamin B12; metabolic bone disease may also occur. (See "Biliopancreatic diversion with or without duodenal switch" above).

Mixed procedures — Complications of gastric bypass can vary based upon the surgical approach (open versus laparoscopic); some are seen during the early postoperative period, while others may arise weeks to months following the surgery.

Some of the early complications include peritonitis (infection of the abdominal lining) from leaks at the site of staples or sutures, gastrointestinal bleeding, narrowing of the passage between the stomach and intestine, or ulcers. Patients may also experience vitamin deficiencies due to the malabsorptive component of the procedure (see "Gastric bypass" above).

Gallstone formation may occur as patients experience rapid weight loss following gastric bypass. This risk can be decreased by taking a medication called ursodeoxycholic acid for several months following surgery. If gallstones are seen on ultrasound before surgery, and if they cause pain, the gallbladder may be removed at the time of the surgery. (See "Patient information: Gallstones").

Surgical revision — Although rare, some patients may need to undergo repeat surgery if complications develop that cannot be controlled using nonsurgical methods.

Mortality — One analysis of multiple studies estimated the overall mortality (death rate) of patients undergoing bariatric surgery to be less than 1 percent [1] . However, other studies have suggested that the mortality may be higher, particularly in older and/or male patients.

EFFECTIVENESS OF BARIATRIC SURGERY — The goal of any weight-loss surgery is to reduce the risk of illness or death associated with obesity, and to improve body system and organ function. Research has shown that bariatric surgery is effective in achieving these objectives, and also has additional benefits such as reducing the amount of money spent on medication, cutting down on sick days, and improving quality of life.

One study of bariatric surgery outcomes showed that overall, patients lost an average of 61 percent of their excess weight; total weight loss varied depending on the specific procedure performed [2] . Other conditions caused or worsened by obesity also improved to the point of needing less or no treatment; these included diabetes (86 percent of patients), hyperlipidemia or high blood cholesterol (70 percent), high blood pressure (79 percent), and obstructive sleep apnea (84 percent).

In addition to achieving weight loss, patients who undergo bariatric surgery are significantly less likely to develop heart disease, cancer, and endocrine, infectious and psychiatric disorders, although they are more likely to develop digestive diseases.

AFTER SURGERY

In the hospital — Post-operative pain is controlled with medication. Many bariatric surgery patients are given "patient-controlled analgesia" while still in the hospital; this delivers pain medication through an intravenous line (IV) in the hand or arm. Patients are able to control, within preset limits, when a dose is given.

Patients will typically remain in the hospital for a day or two after surgery, during which time pain, mobility, and food intake will be monitored. Following surgery, patients will work with a healthcare provider and dietitian to establish guidelines for eating and activity after discharge from the hospital.

At home — A strict diet of liquids and soft foods (such as yogurt, scrambled eggs, and cottage cheese) must be followed for about six weeks following surgery; a dietitian can recommend soft or pureed foods that will provide adequate nutrition. It is important to follow eating guidelines during the weeks, months, and years following surgery in order to maintain a healthy weight and ensure that an adequate number and type of nutrients are eaten.

Instructions generally include slowly increasing calorie intake over time, eating small meals, chewing slowly and thoroughly, separating food and fluid intake by at least 30 minutes, and avoiding foods high in fat or sugar. Patients may also be prescribed vitamin supplements.

Most patients will be encouraged to get out of bed and start walking the day after surgery to prevent blood clots from forming in the body; however, strenuous activity is not recommended until the incisions have healed. Driving should be avoided if the patient is taking any pain medication stronger than acetaminophen (Tylenol). Patients are encouraged to begin a regular fitness program as soon as possible after healing; a healthcare provider can help recommend appropriate and beneficial forms of exercise.

Results of surgery — It usually takes between one and two years for maximum weight loss to occur. After reaching a plateau at a healthy weight, some patients have plastic surgery (called "body contouring") to remove excess skin from the body, particularly in the abdominal area.

Although bariatric surgery can produce dramatic results, it is crucial that the patient make a commitment to maintaining a healthy lifestyle, including follow-up contact with a healthcare provider to monitor progress. It can be difficult to make lifestyle adjustments after weight-loss surgery, and patients should be aware that they will have to work to develop and stick to new habits.

Recovery and the subsequent weight management can be stressful and emotional, and it is important to have the support of family and friends. Professional counseling with a social worker or therapist should be considered if patients experience anxiety or depression.

SUMMARY

Weight loss surgery is only recommended for severely obese people. Surgery may be recommended for moderately obese people who have another illness such as diabetes, severe arthritis (or other joint problems), or sleep apnea (see "Introduction" above).

There are three types of weight-loss surgery. The best type of surgery depends upon how much weight needs to be lost. The most common surgeries are lap banding and gastric bypass (See "Types of surgery" above).

One surgery, called lap banding, can be adjusted or removed. This procedure places a band around the top of the stomach (show figure 2). This causes the person to feel full after eating a small amount of food (See "Lap banding" above See "Lap banding" above).

In gastric bypass, the doctor creates a small pouch in the stomach. The pouch is connected to the small intestine. These changes cause the person to feel full after eating a small amount of food. It also causes the body to absorb fewer calories from food. (See "Gastric bypass" above).

Weight loss surgery can have complications, such as pain, infection, need for a second surgery, or nutrition problems). The specific complication depends upon which surgery is done and if the person has other medical problems. There is a smaller risk of complications when weight loss surgery is done in centers with a great deal of experience. Less than 1 in 100 people die because of weight loss surgery. (See "Complications" above).

After surgery, people lose about 60 percent of their extra weight (just over 73 pounds for a person who needs to lose 120 pounds); the amount of weight lost depends upon which surgery is done. Other health problems (eg, diabetes or arthritis) often improve after weight loss surgery. (See "Effectiveness of bariatric surgery" above).

After surgery, it is important to eat the right foods and exercise to stay healthy. Help with diet and exercise planning is available (see "After surgery" above).

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two patients are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Dizziness

2008-10-06T05:39:00.001-07:00

Dizziness

Definition

Dizziness is a term used to describe everything from feeling faint or lightheaded to feeling weak or unsteady. Dizziness that creates the sense that you or your surroundings are spinning or moving is called vertigo.

As a child, spinning until you were dizzy may have been great fun. But otherwise, finding the room spinning isn't pleasant at all.

Dizziness is one of the most common reasons adults visit their doctors — right up there with back pain and headaches. Although it may be disabling and incapacitating, dizziness rarely signals a serious, life-threatening condition. Treatment of dizziness depends on the cause and your symptoms, but is usually effective.

Symptoms

Characteristics of dizziness may include:

A sense that you or your surroundings are spinning or moving (vertigo)
A loss of balance
Nausea
Unsteadiness
Wooziness
Lightheadedness
Faintness
Weakness
Fatigue
Difficulty concentrating
Blurred vision during quick head movements

When to see a doctor
See your doctor if you experience any unexplained, recurrent or severe dizziness.

Call 911 or go to the emergency room if you experience dizziness or vertigo along with any of the following:

Head injury
A new, different or severe headache
A fever higher than 101 F (38.3 C)
A very stiff neck
Blurred vision
Hearing loss
Speech impairment
Leg or arm weakness
Loss of consciousness
Falling or difficulty walking
Numbness or tingling
Chest pain or rapid or slow heart rate

Causes

CLICK TO ENLARGE

Inner ear and balance

Under normal circumstances, your sense of balance is controlled by a number of signals that your brain receives from several locations:

Eyes. No matter what your position, visual signals help you determine where your body is in space and how it's moving.
Sensory nerves. These are in your skin, muscles and joints. Sensory nerves send messages to your brain about body movements and positions.
Inner ear. The organ of balance in your inner ear is the vestibular labyrinth. It includes loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head. Near the semicircular canals are the utricle and saccule, which contain tiny particles called otoconia (o-toe-KOE-nee-uh). These particles are attached to sensors that help detect gravity and back-and-forth motion.

Good balance depends on at least two of these three sensory systems working well. For instance, closing your eyes while washing your hair in the shower doesn't mean you'll lose your balance. Signals from your inner ear and sensory nerves help keep you upright.

However, if your central nervous system can't process signals from all of these locations, if the messages are contradictory or if the sensory systems aren't functioning properly, you may experience loss of balance.

Dizziness may have a number of potential causes, depending on the type of dizziness. The causes of dizziness may include:

Vertigo
Vertigo — the false sense of motion or spinning — is a common type of dizziness. Sitting up or moving around may make it worse. Sometimes vertigo is severe enough to cause nausea and vomiting.

Vertigo usually results from a problem with the nerves and the structures of the balance mechanism in your inner ear (vestibular system), which sense movement and changes in your head position. Abnormal rhythmic eye movements (nystagmus) almost always accompany vertigo. Causes of vertigo may include:

Benign paroxysmal positional vertigo (BPPV). BPPV causes intense, brief episodes of vertigo immediately following a change in the position of your head, often when you turn over in bed or sit up in the morning. It occurs when normal calcium carbonate crystals (otoconia) break loose and fall into the wrong part of the canals in your inner ear. When these particles shift, they stimulate sensors in your ear, producing an episode of vertigo. Doctors don't know what causes BPPV, but it may be a natural result of aging. Trauma to your head also may lead to BPPV.
Inflammation in the inner ear. Signs and symptoms of inflammation of your inner ear (acute vestibular neuronitis or labyrinthitis) include sudden, intense vertigo that may persist for several days, along with nausea, vomiting and imbalance. It can be incapacitating, requiring bed rest. Fortunately, vestibular neuronitis generally subsides and clears up on its own. Recovery time may be shorter with vestibular rehabilitation exercises and — if started within two days of symptom onset — a course of oral prednisone. Although the cause of this condition is unknown, it may be a viral infection.
Meniere's disease. This disease involves the excessive buildup of fluid in your inner ear. It may affect adults at any age and is characterized by sudden episodes of vertigo lasting 30 minutes to an hour or longer. Other signs and symptoms include the feeling of fullness in your ear, buzzing or ringing in your ear (tinnitus), and fluctuating hearing loss. The cause of Meniere's disease is unknown.
Migraine-related vertigo. Migraine is more than a headache disorder. Just as some people experience a visual "aura" with their migraines, others can get vertigo episodes and have other types of dizziness between migraines. Attacks of migraine-related vertigo can last from a few minutes to several days. If you are affected by migraine-related vertigo, you may be motion-sensitive as well, with a history of carsickness.

Dizziness and vertigo caused by a vestibular migraine may be provoked by common migraine triggers, such as certain foods, altered sleep, stress, or hormonal changes related to your menstrual cycle. A vestibular migraine may cause feelings of imbalance or unsteadiness, hearing loss, "muffled" hearing, or ringing in your ears (tinnitus), sometimes mimicking Meniere's disease or other inner ear disorders. For most people with migraine-related vertigo, the attacks of vertigo don't necessarily happen at the same time as the headache.
Acoustic neuroma. An acoustic neuroma (vestibular schwannoma) is a noncancerous (benign) growth on the vestibular nerve, which connects the inner ear to your brain. Signs and symptoms of an acoustic neuroma may include dizziness, loss of balance, hearing loss and tinnitus.
Rapid changes in motion. Riding on roller coasters or in boats, cars or even airplanes may make you dizzy.
Other causes. Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke, brain hemorrhage or multiple sclerosis.

Feeling of faintness (presyncope)
"Presyncope" is the medical term for feeling faint and lightheaded without losing consciousness. Sometimes nausea, pale skin and a sense of dizziness accompany a feeling of faintness. Causes of presyncope include:

Drop in blood pressure (orthostatic hypotension). A dramatic drop in your systolic blood pressure — the higher number in your blood pressure reading — may result in lightheadedness or a feeling of faintness. It can occur after sitting up or standing too quickly.
Inadequate output of blood from the heart. Conditions such as partially blocked arteries (atherosclerosis), disease of the heart muscle (cardiomyopathy), abnormal heart rhythm (arrhythmia) or a decrease in blood volume may cause inadequate blood flow from your heart.

Loss of balance (disequilibrium)
Disequilibrium is the loss of balance or the feeling of unsteadiness when you walk. Causes may include:

Inner ear (vestibular) problems. Abnormalities with your inner ear can cause you to feel like you are floating, have a heavy head or are unsteady in the dark.
Sensory disorders. Failing vision and nerve damage in your legs (peripheral neuropathy) are common in older adults and may result in difficulty maintaining your balance.
Joint and muscle problems. Muscle weakness and osteoarthritis — the type of arthritis that involves wear and tear of your joints — can contribute to loss of balance when it involves your weight-bearing joints.
Medications. Loss of balance can be a side effect of certain medications, such as anti-seizure drugs, sedatives and tranquilizers.

Lightheadedness and other kinds of 'dizziness'
Feeling lightheaded is the feeling of being "spaced out" or having the sensation of spinning inside your head. It can also give you the sensation that if your lightheadedness worsens, you might lose consciousness. Causes may include:

Inner ear disorders. These abnormalities of your inner ear can lead to illusions of motion and make you feel like you're floating.
Anxiety disorders. Certain anxiety disorders, such as panic attacks and a fear of leaving home or being in large, open spaces (agoraphobia), may cause dizziness. Sometimes one cause — such as a vestibular disorder — may produce symptoms, but then anxiety causes your dizziness to persist even after your inner ear problem has resolved.
Hyperventilation. Abnormally rapid breathing that often accompanies anxiety disorders may make you feel lightheaded.

Complications

Dizziness can increase your risk of falling and injuring yourself. Experiencing dizziness while driving a car or operating heavy machinery can increase the likelihood of an accident. You may also experience long-term consequences if an existing health condition that may be causing your dizziness goes untreated.

Preparing for your appointment

Your family doctor or general practitioner will probably be able to diagnose and treat the cause of your dizziness. However, in some cases you may be referred to a specialist such as an ear, nose and throat (ENT) specialist or a neurologist.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. If you're scheduled for vestibular testing, your doctor will provide instructions regarding any medications to withhold the night before and what to eat on the day of testing.
Be prepared to describe your dizziness in specific terms. When you have an episode of dizziness, do you feel like the room is spinning, or like you are spinning in the room? Do you feel like you might pass out? Your description of these symptoms is crucial to helping your doctor make a diagnosis.
Write down any other health conditions or symptoms you have, including any that may seem unrelated to your dizziness. For example, if you have felt depressed or anxious recently, this is important information for your doctor.
Write down key personal information, including any major stresses or recent life changes.
Bring a list of all prescription and over-the-counter medications, as well as any vitamins or supplements, that you're taking.
Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For dizziness, some basic questions to ask your doctor include:

What is likely causing my symptoms?
Other than the most likely cause, what are other possible causes for my symptoms?
What kinds of tests do I need?
Is this problem likely temporary or chronic?
Is it possible my symptoms will go away without treatment?
What treatment options might help?
I have these other health conditions. How can I best manage them together?
Are there any restrictions that I need to follow? For example, is it safe for me to drive?
Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
Is there a generic alternative to the medicine you're prescribing me?
Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor will likely ask you a number of questions about your dizziness. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

Is your dizziness continuous, or does it occur in spells or episodes?
When do your dizzy spells seem to happen, and what triggers them?
Does your dizziness cause the room to spin or produce a sensation of motion?
When you feel dizzy, do you also feel faint or lightheaded?
Does your dizziness cause you to lose your balance?
Are your symptoms accompanied by a ringing or fullness in your ears (tinnitus) or trouble hearing?
Does your vision blur?
Is your dizziness made worse by moving your head?

Your doctor will want to know what medications you're taking. He or she will also ask you when you experience dizziness, how long it lasts and how often it occurs. Your doctor can narrow down possible causes of dizziness after determining the type of dizziness you're experiencing, reviewing your medical history and current medications, conducting a physical examination, and ordering further testing based on your signs and symptoms.

What you can do in the meantime
If you tend to feel lightheaded when you stand up, take your time making changes in posture. Drink plenty of fluids to avoid dehydration, which can cause or worsen lightheadedness.

In addition, if you have had episodes of dizziness while driving, arrange for alternate transportation while you're waiting to see your doctor. Ask friends, family or colleagues to help you get to and from work and other activities, or look into public transportation.

If your dizziness causes you to feel like you might fall, take steps to reduce your risk. Keep your home well lit and free of hazards that might cause you to trip. Avoid area rugs and exposed electrical cords. Place furniture where you're unlikely to bump into it, and use nonslip mats in the bathtub and on shower floors.

Tests and diagnosis

Doctors can usually determine the cause of dizziness. To pinpoint what's causing your symptoms, you may be asked to perform positioning tests in the office so that your doctor can observe you and ask how you feel when you tip your head back or lie on a particular side.

You may need additional tests in a vestibular and balance laboratory, including:

Posturography testing. This test tells your doctor which parts of the balance system you rely on the most and which parts may be giving you problems. You stand in your bare feet on a special platform and work to keep your balance under various conditions.
Rotary-chair testing. During this test, you sit in a computer-controlled chair that moves very slowly in a full circle. At faster speeds, it moves back and forth in a very small arc.
Eye movement testing. Your eye movements in response to certain stimuli also can provide helpful information in making a diagnosis. For example, your doctor may watch the path of your eyes when you track a moving object. You may also be given what's called a caloric test, in which the movement of your eyes is observed when cold and warm water are delivered to your ear canal at different times.

In some cases, you may need magnetic resonance imaging (MRI). This technique uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these detailed, clear images to identify and diagnose a wide range of conditions. MRI may be performed to rule out acoustic neuroma - a noncancerous brain tumor of the vestibular nerve, which carries sound from the inner ear to the brain - or other abnormalities in the brain that may be the cause of vertigo.

Even if no cause is found or if your dizziness persists, prescription drugs and other treatments may make your symptoms more manageable.

Treatments and drugs

Doctors base treatment of dizziness on the cause and your symptoms.

BPPV. Treatment of BPPV is with canalith repositioning, a simple procedure that involves your doctor or physical therapist maneuvering the position of your head. The goal is to move the loose particles in your ear to a place within your ear where they won't cause dizziness and will be reabsorbed into your body's fluids. The success rate of this procedure may be as high as 90 percent. You may need to have the procedure repeated.
Inner ear conditions. Balance retraining exercises (vestibular rehabilitation) are used to treat acute vestibular neuronitis or labyrinthitis. These are exercises you learn from a physical therapist or occupational therapist and then do at home. This rehabilitation involves movements of your head and body to correct loss of balance. To provide immediate relief of nausea and dizziness, your doctor may prescribe medications such as meclizine (Antivert), dimenhydrinate (Dramamine) and diazepam (Valium). A short course of corticosteroids may improve your vestibular function.
Meniere's disease. Treatment of Meniere's disease involves reducing your body's retention of fluids through diuretic use and often dietary changes, such as a low-salt diet. Occasionally, surgery is an option.
Vestibular migraine. To combat vertigo associated with a vestibular migraine, your doctor will likely try to help you determine and avoid the triggers for your attacks. He or she may suggest that you avoid certain foods, reduce stress in your life, develop a regular sleep pattern and practice aerobic exercise. You may also be taught specific exercises to help make your balance system less sensitive to motion (vestibular rehabilitation). Certain medicines may help prevent attacks of migrainous vertigo or make them less uncomfortable by providing relief for nausea and vomiting.
Anxiety disorders. Your doctor may suggest medications and psychotherapy, either alone or in combination, to help you deal with your anxiety and manage your dizziness.
Other contributing health conditions. Your doctor will recommend treatment of an existing disease or disorder that may be causing or contributing to your dizziness, such as ear infection, stroke, heart problems or multiple sclerosis.

Lifestyle and home remedies

If you experience dizziness, consider these tips:

Be aware of the possibility of losing your balance, which can lead to falling and serious injury.
Fall-proof your home by removing tripping hazards such as area rugs and exposed electrical cords. Use nonslip mats on your bath and shower floors.
Sit or lie down immediately when you feel dizzy.
Avoid driving a car or operating heavy machinery if you experience frequent dizziness.
Use good lighting if you get out of bed at night.
Walk with a cane for stability.
Avoid using caffeine, alcohol and tobacco. Excessive use of these substances can restrict your blood vessels and worsen your signs and symptoms.
Work closely with your doctor to manage your symptoms effectively.

Colposcopy

2008-10-04T02:06:00.000-07:00

Colposcopy

What is a colposcopy?

A colposcopy is a way your doctor can examine your vagina, vulva (vagina opening) and cervix closely. A colposcope is an instrument that shines a light on the cervix and magnifies the view for your doctor. At the beginning of the exam, you lie back and place your feet in the stirrups as you would for a Pap smear. Your doctor inserts a speculum into your vagina and opens it slightly so he or she can see your cervix. Then your doctor applies a vinegar solution to the cervix and vagina with a cotton ball or swab. The vinegar makes abnormal tissue turn white so your doctor can identify areas that may need further evaluation.

If your doctor sees areas of abnormal tissue during the colposcopy, he or she may also perform a biopsy. This involves removing small samples of tissue from any abnormal areas in or around the cervix. A specialist doctor called a pathologist will examine these samples.

It usually only takes 20 to 30 minutes for your doctor to complete a colposcopy and biopsy.

Return to top

Why is a colposcopy performed?

A colposcopy is usually performed to help your doctor find the reason for an abnormal Pap smear.

Return to top

Why is colposcopy important?

Colposcopy is important because it can detect cancer of the cervix at an early stage. Be sure to talk with your doctor after the test so that any problems are taken care of right away.

Return to top

Is the procedure painful?

If your doctor takes a biopsy sample, you may feel mild cramps and pinching when he or she removes the abnormal tissue. Relaxing your muscles as much as possible and taking slow, deep breaths during the procedure may help. You may feel less discomfort if you take an over-the-counter pain reliever before the procedure. Ask your doctor whether you should take medicine, what kind to take, how much to take and when to take it. (When you ask, be sure to let your doctor know if you're pregnant or if you're allergic to aspirin or ibuprofen.)

Return to top

How should I prepare to have a colposcopy?

You may be more comfortable if you empty your bladder and bowels before the procedure. Don't douche, use vaginal medications, tampons or have sexual intercourse during the 24 hours before your appointment.

Return to top

Does this procedure affect my ability to have children?

No. If your doctor takes a biopsy sample, the amount of tissue taken from your cervix is very small and removing it will not affect any future pregnancies. However, it is important to let your doctor know if you are pregnant now or even if you might be pregnant. This information will change the way your doctor approaches the procedure.

Return to top

Will I have bleeding after a colposcopy?

You may have a dark-colored vaginal discharge after the colposcopy. If your doctor takes a biopsy sample, he or she will put a thick, brownish-yellow paste on that area to stop any bleeding. When this paste mixes with blood, it forms a thick black discharge. It's normal to have this discharge for a couple of days after the procedure. It's also normal to have a little spotting for at least two days after a colposcopy.

Return to top

Can I use tampons after the procedure?

No. Don't use tampons or put anything in your vagina for at least 1 week after the procedure, or until your doctor tells you it's safe. Don't have sexual intercourse for at least 1 week.

Return to top

When should I call my doctor?

Call your doctor right away if you have any of the following problems after your colposcopy:

Heavy vaginal bleeding (using more than one sanitary pad per hour).
Lower abdominal pain.
Fever, chills or a bad-smelling vaginal odor.

Return to top

When will I get the results of my colposcopy?

It usually takes 1 to 2 weeks for your doctor to get a report from the pathologist who looks at your biopsy samples. Your doctor's office will contact you when these results are available. You will need to make a follow-up appointment with your doctor to talk about the results and any additional treatment you may need. Try to schedule an appointment no later than 1 month after your colposcopy.

Germs: Understand and protect against bacteria, viruses and infection

2008-10-03T01:57:00.000-07:00

Germs: Understand and protect against bacteria, viruses and infection

Germs were behind every fever, runny nose, ache, pain and other sign and symptom of every cold and flu you've ever had. When you're in the midst of such symptoms, you might not stop to think about the germs (microbes) that are causing them. Not all germs will harm you, but knowing more about germs — including bacteria, viruses and parasites — can increase your chances of avoiding infection.

Germs: A multitude of microscopic invaders

Bacteria, viruses and other infectious organisms — germs — live everywhere. You can find them in the air, on food, plants and animals, in the soil, in the water, and on just about every other surface — including your own body. These microbes range in size from microscopic single-celled organisms to parasitic worms that can grow to several feet in length.

Most of these organisms won't harm you. Your immune system protects you against a multitude of infectious agents. However, some bacteria and viruses are formidable adversaries because they're constantly mutating to breach your immune system's defenses.

E. coli O157:H7 is a bacterium responsible for food-borne infections often linked to eating undercooked ground beef or improperly washed vegetables.

Bacteria
Bacteria are one-celled organisms visible only with a microscope. They're so small that if you lined up a thousand of them end to end, they could fit across the end of a pencil eraser. They're shaped like short rods, spheres or spirals. Bacteria are self-sufficient — they don't need a host to reproduce and they multiply by subdivision.

Among the earliest forms of life on earth, bacteria have evolved to thrive in a variety of environments. Some can withstand searing heat or frigid cold, and others can survive radiation levels that would be lethal to humans. Many bacteria, however, prefer the mild environment of a healthy body.

Not all bacteria are harmful. In fact, less than 1 percent cause disease, and some bacteria that live in your body are actually good for you. For instance, Lactobacillus acidophilus — a harmless bacterium that resides in your intestines — helps you digest food, destroys some disease-causing organisms and provides nutrients to your body.

But when infectious bacteria enter your body, they can cause illness. They rapidly reproduce, and many produce toxins — powerful chemicals that damage specific cells in the tissue they've invaded. That's what makes you ill. The organism that causes gonorrhea (gonococcus) is an example of a bacterial invader. Others include some strains of the bacterium Escherichia coli — better known as E. coli — which cause severe gastrointestinal illness and are most often contracted via contaminated food. If you've ever had strep throat, bacteria caused it.

The influenza virus takes over healthy cells, spreads through your body and causes illness. Signs and symptoms include fever, chills, muscle aches and fatigue.

Viruses
In its simplest form, a virus is a capsule that contains genetic material — DNA or RNA. Viruses are even tinier than bacteria. To put their size into perspective, consider that, according to the American Society for Microbiology, if you were to enlarge an average virus to the size of a baseball, the average bacterium would be about the size of the pitcher's mound. And just one of your body's millions of cells would be the size of the entire ballpark.

The main mission of a virus is to reproduce. However, unlike bacteria, viruses aren't self-sufficient — they need a suitable host to reproduce. When a virus invades your body, it enters some of your cells and takes over, instructing these host cells to make what it needs for reproduction. Host cells are eventually destroyed during this process. Polio, AIDS and the common cold are all viral illnesses.

Infection with candida fungus can lead to problems such as diaper rash, vaginal yeast infections and oral thrush.

Fungi
Molds, yeasts and mushrooms are types of fungi. For the most part, these single-celled organisms are slightly larger than bacteria, although some mushrooms are multicelled and plainly visible to the eye. Mushrooms can't infect you, but certain yeasts and molds can.

Fungi live in the air, water, soil and on plants. They can live in your body, usually without causing illness. Some fungi have beneficial uses. For example, penicillin — an antibiotic that kills harmful bacteria in your body — is derived from fungi. Fungi are also essential in making certain foods, such as bread, cheese and yogurt.

Other fungi aren't as beneficial and can cause illness. One example is candida — a yeast that can cause infection. Candida can cause thrush — an infection of the mouth and throat — in infants and in people taking antibiotics or who have an impaired immune system. It's also responsible for most types of infection-related diaper rash.

Cryptosporidium is a protozoan that can survive outside the body for long periods of time.

Protozoa
Protozoa are single-celled organisms that behave like tiny animals — hunting and gathering other microbes for food. Protozoa can live within your body as a parasite. Many protozoa call your intestinal tract home and are harmless. Others cause disease, such as the 1993 Cryptosporidium parvum invasion of the Milwaukee water supply, sickening more than 400,000 people. Often, these organisms spend part of their life cycle outside of humans or other hosts, living in food, soil, water or insects.

Most protozoa are microscopic, but there are some exceptions. One type of ocean-dwelling protozoa (foraminifer) can grow to more than 2 inches in diameter.

Some protozoa invade your body through the food you eat or the water you drink. Others can be transmitted through sexual contact. Still others are vector-borne, meaning they rely on another organism to transmit them from person to person. Malaria is an example of a disease caused by a vector-borne protozoan parasite. Mosquitoes are the vector transmitting the deadly parasite plasmodium, which causes the disease.

Infection by one type of roundworm, known as a hookworm, can cause problems in your small intestine or lungs. The average hookworm is about half an inch long.

Helminths
Helminths are among the larger parasites. The word "helminth" comes from the Greek for "worm." If this parasite — or its eggs — enters your body, it takes up residence in your intestinal tract, lungs, liver, skin or brain, where it lives off the nutrients in your body. The most common helminths are tapeworms and roundworms.

The largest of the roundworms can be more than 12 inches long. And the largest of the tapeworms can grow to be 25 feet or longer. Tapeworms are made up of hundreds of segments, each of which is capable of breaking off and developing into a new tapeworm.

Understanding infection vs. disease

There's a distinct difference between infection and disease. Infection, often the first step, occurs when bacteria, viruses or other microbes enter your body and begin to multiply. Disease occurs when the cells in your body are damaged — as a result of the infection — and signs and symptoms of an illness appear.

In response to infection, your immune system springs into action. An army of white blood cells, antibodies and other mechanisms goes to work to rid your body of whatever is causing the infection. For instance, in fighting off the common cold, your body might react with fever, coughing and sneezing.

Warding off germs and infection

What's the best way to stay disease-free? Prevent infections from happening in the first place. You can prevent infection through simple tactics such as regular hand washing, vaccinations and appropriate medications.

Hand washing. Often overlooked, hand washing is one of the easiest and most effective ways to protect yourself from germs and most infections. Wash your hands thoroughly before preparing or eating food, after coughing or sneezing, after changing a diaper and after using the toilet. When soap and water aren't readily available, alcohol-based hand-sanitizing gels can offer protection.
Vaccines. Vaccination is your best line of defense for certain diseases. As researchers understand more about what causes disease, the list of vaccine-preventable diseases continues to grow. Many vaccines are given in childhood, but adults still need to be routinely vaccinated to prevent some illnesses, such as tetanus and influenza.
Medicines. Some medicines can help you from becoming susceptible to germs. For example, taking an anti-parasitic medication might protect you from contracting malaria if you travel to or live in an area where your risk is high. Or when you are at high risk of exposure to certain organisms — such as those that cause bacterial meningitis — your doctor may prescribe antibiotics to lower your risk of infection. Using over-the-counter antibiotic creams can decrease the chance of infection of minor cuts and scrapes. But long-term, indiscriminate use of antibiotics isn't recommended in most cases. It won't prevent bacterial infections and instead may result in a more resistant, harder-to-treat strain of bacteria when infections do occur.

When to seek medical advice

Although some infectious diseases, such as the common cold, might not require a visit to the doctor, others might.

Seek medical care if you suspect that you have an infection and you have experienced any of the following:

An animal or human bite
Difficulty breathing
A cough lasting longer than a week
A fever of 100.4 F (38.0 C) or more
Periods of rapid heartbeat
A rash, especially if it's accompanied by a fever
Swelling
Blurred vision or other difficulty seeing
Persistent vomiting
An unusual or severe headache

Your doctor can perform diagnostic tests to find out if you're infected, the seriousness of the infection, and how best to treat that infection.

Postpartum depression

2008-10-01T03:04:00.000-07:00

Postpartum depression

Definition

The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to fear and anxiety. But it can also result in something you might not expect — depression.

Many new moms experience the baby blues after childbirth. An estimated 10 percent of new moms experience a more severe form of emotional distress known as postpartum depression. Rarely, an extreme form of postpartum depression known as postpartum psychosis develops after childbirth.

Postpartum depression isn't a character flaw or a weakness. Sometimes postpartum depression is simply part of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms — and enjoy your baby.

Symptoms

Signs and symptoms of depression after childbirth vary depending on the type of depression.

Baby blues
Signs and symptoms of the baby blues — which last only a few days or weeks — may include:

Mood swings
Anxiety
Sadness
Irritability
Crying
Decreased concentration
Trouble sleeping

Postpartum depression
Postpartum depression may appear to be the baby blues at first — but the signs and symptoms are more intense and longer lasting, eventually interfering with your ability to care for your baby and handle other daily tasks. Signs and symptoms of postpartum depression may include:

Loss of appetite
Insomnia
Intense irritability and anger
Overwhelming fatigue
Loss of interest in sex
Lack of joy in life
Feelings of shame, guilt or inadequacy
Severe mood swings
Difficulty bonding with the baby
Withdrawal from family and friends
Thoughts of harming yourself or the baby

Postpartum psychosis
With postpartum psychosis — a rare condition that typically develops within the first two weeks after delivery — the signs and symptoms are even more severe. Signs and symptoms of postpartum psychosis may include:

Confusion and disorientation
Hallucinations and delusions
Paranoia
Attempts to harm yourself or the baby

Causes

There's no single cause for postpartum depression. Physical, emotional and lifestyle factors may all play a role.

Physical changes. After childbirth, a dramatic drop in estrogen and progesterone may contribute to postpartum depression. The hormones produced by your thyroid gland also may drop sharply — which can leave you feeling tired, sluggish and depressed. Changes in your blood volume, blood pressure, immune system and metabolism can lead to fatigue and mood swings.
Emotional factors. When you're sleep deprived and overwhelmed, you may have trouble handling even minor problems. You may be anxious about your ability to care for a newborn. You may feel less attractive or struggle with your sense of identity. You may feel that you've lost control over your life. Any of these factors can contribute to postpartum depression.
Lifestyle influences. Many lifestyle factors can lead to postpartum depression, including a demanding baby or older siblings, difficulty breast-feeding, exhaustion, financial problems, and lack of support from your partner or other loved ones.

Risk factors

Postpartum depression can develop after the birth of any child, not just the first. The risk increases if:

You have a history of depression, either during pregnancy or at other times
You had postpartum depression after a previous pregnancy
You've experienced stressful events during the past year, including illness, job loss or pregnancy complications
You're experiencing marital conflict
You have a weak support system
The pregnancy is unplanned or unwanted

The risk of postpartum psychosis is higher for women who have bipolar disorder.

When to seek medical advice

If you're feeling depressed after your baby's birth, you may be reluctant or embarrassed to admit it. But it's important to tell your doctor. If the signs and symptoms of depression don't fade after a few weeks or if they're so severe that they interfere with your ability to complete everyday tasks, call your doctor. Early intervention can speed your recovery.

If you suspect that you're developing postpartum psychosis, seek medical attention immediately. Don't wait and hope for improvement. Postpartum psychosis may lead to life-threatening thoughts or behaviors.

Tests and diagnosis

To distinguish between a short-term case of the baby blues and a more severe form of depression, your doctor may ask you to complete a depression-screening questionnaire. Blood tests can help your doctor determine whether an underactive thyroid is contributing to your signs and symptoms.

Complications

Left untreated, postpartum depression can interfere with mother-child bonding and cause family distress. Children of mothers who have untreated postpartum depression are more likely to have behavioral problems, such as sleeping and eating difficulties, temper tantrums and hyperactivity. Delays in language development are common as well.

Untreated postpartum depression can last up to a year or longer. Sometimes untreated postpartum depression becomes a chronic depressive disorder. Even when treated, postpartum depression increases a woman's risk of future episodes of major depression.

Treatments and drugs

Treatment and recovery time vary, depending on the severity of your depression and your individual needs.

Baby blues
The baby blues usually fade on their own within a few days to weeks. In the meantime, get as much rest as you can. Accept help from family and friends. Connect with other new moms. Avoid alcohol, which can make mood swings worse. If you have an underactive thyroid, your doctor may prescribe thyroid medication.

Postpartum depression
Postpartum depression is often treated with counseling and medication.

Counseling. It may help to talk through your concerns with a psychiatrist, psychologist or other mental health professional. Through counseling, you can find better ways to cope with your feelings, solve problems and set realistic goals. Sometimes, family or marital therapy also is helpful.
Antidepressants. Antidepressants are a proven treatment for postpartum depression. If you're breast-feeding, it's important to know that any medication you take will enter your breast milk. However, various antidepressants can be used during breast-feeding with little risk of side effects for your baby. Work with your doctor to weigh the potential risks and benefits of specific antidepressants.
Hormone therapy. Estrogen replacement may help counteract the rapid drop in estrogen that accompanies childbirth, which may ease the signs and symptoms of postpartum depression in some women. Research on the effectiveness of hormone therapy for postpartum depression is limited, however. As with antidepressants, weigh the potential risks and benefits of hormone therapy with your doctor.

With appropriate treatment, postpartum depression usually goes away within a few months. In some cases, postpartum depression lasts up to a year. It's important to continue treatment after you begin to feel better, however. Stopping treatment too early may only lead to a relapse.

Postpartum psychosis
Postpartum psychosis requires immediate treatment, often in the hospital.

When your safety is assured, a combination of medications — such as antidepressants, antipsychotic medications and mood stabilizers — may be used to control your signs and symptoms. Sometimes electroconvulsive therapy (ECT) is recommended as well. During ECT, a small amount of electrical current is applied to your brain to produce brain waves similar to those that occur during a seizure. The chemical changes triggered by the electrical currents can reduce the symptoms of depression, especially when other treatments have failed or when you need immediate results.

Treatment for postpartum psychosis can challenge a mother's ability to breast-feed. Separation from the baby makes breast-feeding difficult, and some medications used to treat postpartum psychosis aren't recommended for women who are breast-feeding. If you're experiencing postpartum psychosis, a team of health care providers will help you work through these challenges.

Prevention

If you have a history of depression — especially postpartum depression — mention it to your doctor as soon as you find out you're pregnant. Your doctor will monitor you closely for signs and symptoms of depression. Sometimes mild depression can be managed with support groups, counseling or other therapies. In other cases, antidepressants are recommended — even during pregnancy.

After your baby is born, your doctor may recommend an early postpartum checkup to screen for signs and symptoms of postpartum depression. The earlier postpartum depression is detected, the earlier treatment can begin. If you have a history of postpartum depression, your doctor may recommend antidepressant treatment immediately after delivery.

Lifestyle and home remedies

Postpartum depression isn't generally a condition that you can treat on your own — but you can do some things for yourself that build on your treatment plan. In fact, taking good care of yourself can help speed your recovery.

Make healthy lifestyle choices. Rest as much as you can. Include physical activity, such as a walk with your baby, in your daily routine. Eat healthy foods — plenty of fruits, vegetables and whole grains. Avoid alcohol.
Set realistic expectations. Don't pressure yourself to do everything. Scale back your expectations for the perfect household. Do what you can and leave the rest. Ask for help when you need it.
Make time for yourself. If you feel like the world is coming down around you, take some time for yourself. Get dressed, leave the house, and visit a friend or run an errand. Or schedule some time alone with your partner.
Avoid isolation. Talk with your partner, family and friends about how you're feeling. Ask other mothers about their experiences. Ask your doctor about local support groups for new moms or women who have postpartum depression.

Remember, the best way to take care of your baby is to take care of yourself.

Alternative medicine

Little research has been done on complementary and alternative therapies for postpartum depression. Although some data is available, it's not definitive.

If you'd like to try a complementary or alternative therapy for postpartum depression, share your wishes with your doctor. He or she can help you weigh the benefits and risks of specific therapies, such as:

Acupuncture. Acupuncture helps promote deep relaxation, and sometimes even sleep. This may help relieve the fatigue that accompanies postpartum depression.
Omega-3 fatty acids. Omega-3 fatty acids are known to support infant brain development during pregnancy. Some research suggests that omega-3 fatty acids — whether eaten in fish and other seafood or taken as a nutritional supplement — may help relieve postpartum depression as well.
Massage therapy. Some studies suggest that massage therapy may be helpful for postpartum depression.
Creative arts. Art, music and drama therapy have been suggested as possible ways to relieve postpartum depression, perhaps by providing a supportive, relaxed environment, offering new ways of expression or encouraging positive behavior changes.

Some studies suggest that the herb St. John's wort may be helpful for mild to moderate depression, although there's been no research published on St. John's wort and postpartum depression specifically. It's best to avoid St. John's wort if you're breast-feeding. St. John's wort may cause colic, drowsiness or lethargy in a nursing baby.

In Case of Emergency

DIABETIC CURE

Cushing's Syndrome

Computed Tomography (CT): Questions and Answers

Infant Health

Common cold

Common cold

Definition

Symptoms

Causes

Risk factors

Complications

Preparing for your appointment

Treatments and drugs

Lifestyle and home remedies

Alternative medicine

Prevention

Carbon Monoxide (CO)

Carbon Monoxide (CO)

ALERT: Put generators outside.

What is Child Pornography?

Chewing tobacco: Not a risk-free alternative to cigarettes

Chewing tobacco: Not a risk-free alternative to cigarettes

Chewing tobacco: Just one form of smokeless tobacco

Health risks of chewing tobacco and other forms of smokeless tobacco

CLICK TO ENLARGE

Smokeless doesn't mean harmless

It's never too late to quit

Facts and Fallacies About Digestive Diseases

Facts and Fallacies About Digestive Diseases

Ulcers

Spicy food and stress cause stomach ulcers.False.

Heartburn

Smoking a cigarette helps relieve heartburn.False.

Celiac Disease

Celiac disease is a rare childhood disease.False.

Bowel Regularity

Bowel regularity means a bowel movement every day.False.

Constipation

Habitual use of enemas to treat constipation is harmless.False.

Irritable Bowel Syndrome

Irritable bowel syndrome is a disease.True.

Diverticulosis

Diverticulosis is a serious but uncommon problem.False.

Inflammatory Bowel Disease

Inflammatory bowel disease is caused by psychological problems.False.

Cirrhosis

Cirrhosis is caused only by alcoholism.False.

Ostomy Surgery

After ostomy surgery, men have erectile dysfunction and women have impaired sexual function and are unable to become pregnant.False.

Cerebral palsy

Cerebral palsy

Definition

Symptoms

Causes

Risk factors

Complications

Preparing for your appointment

Tests and diagnosis

Treatments and drugs

Coping and support

Prevention

Chronic fatigue syndrome

Chronic fatigue syndrome

Definition

Symptoms

Causes

Risk factors

When to seek medical advice

Tests and diagnosis

Complications

Treatments and drugs

Prevention

Lifestyle and home remedies

Coping and support

Alternative medicine

Arthroscopy

Arthroscopy

Definition

Why it's done

Spicy food and stress cause stomach ulcers.

False.

Smoking a cigarette helps relieve heartburn.

False.

Celiac disease is a rare childhood disease.

False.

Bowel regularity means a bowel movement every day.

False.

Habitual use of enemas to treat constipation is harmless.

False.

Irritable bowel syndrome is a disease.

True.

Diverticulosis is a serious but uncommon problem.

False.

Inflammatory bowel disease is caused by psychological problems.

False.

Cirrhosis is caused only by alcoholism.

False.

After ostomy surgery, men have erectile dysfunction and women have impaired sexual function and are unable to become pregnant.

False.