Nurses

mY bLoG

2009-02-11T23:25:00.000-08:00

Rheumatoid Arthritis

2009-01-11T05:46:00.000-08:00

Rheumatoid Arthritis
Definition
Rheumatoid arthritis (RA) is an autoimmune disease that causes pain, swelling, stiffness, and loss of function in the joints. RA usually affects the same joint on both sides of the body. It occurs most frequently in the:
• Fingers
• Wrists
• Elbows
• Shoulders
• Jaw
• Hips
• Knees
• Toes
Rheumatoid Arthritis

Causes
Rheumatoid arthritis is likely to be caused by a combination of genetic and environmental factors that trigger an abnormal immune response. Possible causes include:
• Genetic Factors–certain genes that play a role in the immune system are associated with the development of RA
• Defects in the immune system, which cause ongoing inflammation
• Environmental Factors–certain infectious agents, such as some viruses or bacteria, may increase susceptibility to RA
• Other Factors–some evidence suggests that hormonal factors may promote the development of RA in combination with genetic factors and environmental exposure
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
• Family members with rheumatoid arthritis
• Sex: Female
• Ethnic background: Pima Indians
• Heavy or long-term smoking
Symptoms
When RA first begins, symptoms may include:
• Joint pain and stiffness that is:
o Symmetrical
o Most prominent in the morning
o Lasts for at least half an hour
• Red, warm, or swollen joints
• Joint deformity
• Mild fever, tiredness
• Loss of appetite
• Small lumps or nodules under the skin
As RA progresses, it may cause complications with the:
• Heart
• Lungs
• Eyes
• Skin
• Liver
• Kidneys
• Blood
• Nervous system
• Blood vessels
• It is also associated with the development of early cardiovascular disease and death
Diagnosis
There is no single test for RA. The doctor will ask about your symptoms and medical history. Physical exam will include an examination of your joints, skin, reflexes, and muscle strength.
Tests may include:
• Measuring rheumatoid factor (RF) level in the blood
• Measuring erythrocyte sedimentation rate (ESR) of the blood to measure inflammation in the body
• Measuring C-reactive protein (CRP)–an indicator of active inflammation in the blood
• White blood cell count
• X-rays of affected joints (especially dual energy x-ray absorptiometry)
Treatment
There is no treatment to cure RA. The goals of treatment are to:
• Relieve pain
• Reduce inflammation
• Slow down joint damage
• Improve functional ability
Treatments include:
Medications
• Disease-modifying Antirheumatic Drugs (DMARDS)–to slow the course of the disease. These medications are used early in the course of the disease to prevent long-term damage:
o Methotrexate (Rheumatrex)
o Hydroxychloroquine (Plaquenil)
o Sulfasalazine (Azulfidine)
o Leflunomide (Arava), cyclosporine (Neoral)
o Penicillamine (Cuprimine)
o Gold (Ridaura)–gold can also be given as an injection
o Minocycline (Minocin)
• Immunosuppressive drugs (only used when other DMARDS are ineffective):
o Azathioprine (Imuran)
o Cyclophosphamide (Cytoxan)–rarely used
o Chlorambucil (Leukeran)–rarely used
• Biologic response modifiers–drugs that interfere with the autoimmune response associated with RA.
o Etanercept (Enbrel)
o Infliximab (Remicade)
o Adalimumab (Humira)
o Abatacept (Orencia)
o Rituximab (Rituxan)
• Adjunctive medications include:
o Acetaminophen (Tylenol)
o Non-steriodal anti inflammatory medications including ibuprofen and naproxen
A study showed a small but significant increased risk of cardiovascular events (such as heart attack) in patients taking the prescription medication. Vioxx(R) is a so-called "selective" nonsteroidal anti-inflammatory drug (NSAID) specially designed to lower the risk of stomach irritation. It is commonly used in the treatment of acute and chronic pain associated with arthritis, menstruation, and other conditions. Since Merck's withdrawal of Vioxx(R), evidence has come to light regarding similar dangers posed by the other popular selective NSAID, Celebrex(R) (cefecoxib), which is produced by Pfizer. Most physicians now question the wisdom of prescribing any medications from the COX-2 class, particularly in patients with known cardiovascular disease.
Steroids
Low-dose corticosteroids (prednisone 10mg or the equivalent) are often used initially, and may be tapered when other drugs gain efficacy. Long-term steroid use should be avoided. Corticosteroid injections to individual inflamed joints may also be used.
Rest and Exercise
Rest helps reduce active joint inflammation and pain, and fight fatigue. Exercise is important for maintaining muscle strength and flexibility, as well as preserving joint mobility.
Joint Care
Splints applied to painful joints may reduce pain and swelling. Devices that assist in activities of daily living can also reduce stress on joints, such as:
• Zipper extenders
• Long-handled shoehorns
• Specially designed kitchen tools
Stress Reduction
Stress reduction can ease the difficulties of living with a chronic, painful disease. Exercise programs, support groups, and open communication with healthcare providers can all help reduce stress.
Surgery
Joint replacement and tendon reconstruction help alleviate severe joint damage.
Lifestyle Measures
The following measures may relieve stiffness and weakness and reduce inflammation:
• Maintain a balance between rest and exercise
• Attempt mild strength training
• Aerobic exercise (walking, swimming, dancing)
• Avoid heavy impact exercise
• Stop smoking
• Control weight
• Physical therapy
Prevention
There are no guidelines for preventing rheumatoid arthritis.

Rheumatic Fever

2009-01-11T05:44:00.000-08:00

Rheumatic Fever

Definition
Rheumatic fever is an inflammatory condition involving the connective tissues in the body. It's most severe complication is rheumatic heart disease. This condition may permanently damage the heart valves, and affect the flow of blood to and from the heart. Symptoms of valve damage often don't appear for 10-30 years after the initial episode of rheumatic fever.
Causes
Rheumatic fever is a complication of group A streptococcus pharyngitis (strep throat). The vast majority of people with strep throat do not develop rheumatic fever. However, in some people infected with group A strep, the body's immune system not only fights the bacteria, but also attacks its own tissues, especially heart tissue.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
• Age: 5-15 years old
• Previous case of rheumatic fever
• Malnutrition
• Overcrowded living conditions
Symptoms
Symptoms usually appear 2-4 weeks after a strep infection. They may include:
• Pain and swelling in large joints
• Fever
• Weakness
• Muscle aches
• Shortness of breath
• Chest pain
• Nausea and vomiting
• Hacking cough
• Circular rash
• Lumps under the skin
• Abnormal, sudden movements of arms and legs
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. This will include a careful exam of your heart. The doctor may take a throat culture and perform a blood test for streptococcal antibodies.
Other tests may include:
Other Blood Tests–such as erythrocyte sedimentation rate to measure inflammation in the body, and blood cultures to determine if bacteria is present in the blood
Electrocardiogram–a test that records the heart's activity by measuring electrical currents through the heart muscle
Echocardiogram–a sonogram which visualizes the heart valves, and measures the contractile function of the heart muscle
Chest X-ray–a test that uses radiation to take a picture of structures inside the body, in this case the heart
Treatment
The goals of treatment are to:
• Kill the strep bacteria
• Treat the inflammation caused by the rheumatic fever
• Prevent future cases of rheumatic fever
Treatment may include:
Antibiotics
Penicillin or other antibiotics including erythromycin and azithromycin may be given to treat the strep infection. People who have had rheumatic fever are at high risk of getting it again. To prevent another bout of rheumatic fever, you may need to take antibiotics regularly for several years after the initial infection. These may be given by mouth or by monthly injections.
Anti-inflammatory Drugs
Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) may help with joint pain and swelling. Corticosteroids may be used if NSAIDs are not effective.
Rest
If inflammation is severe, the doctor may prescribe bed rest or severe restriction of physical activity for a period of time.
Prevention
Promptly treating strep throat with antibiotics can prevent rheumatic fever. If you or your child has a sore throat and a fever that lasts more than 24 hours, contact your doctor.

Rhabdomyolysis

2009-01-11T05:43:00.000-08:00

Rhabdomyolysis
Definition
Rhabdomyolysis occurs when skeletal muscles are damaged and release myoglobin into the bloodstream. Myoglobin is an iron-containing pigment that can cause severe damage to the kidneys.
Causes
Rhabdomyolysis results from any condition that causes significant muscle damage. These include:
• Certain muscle diseases
• Severe muscle injuries (eg, crush injury)
• Overuse of alcohol or illicit drugs
• Use of some prescription drugs
• Severe seizures or convulsions
• Rarely may be caused by extensive surgical procedures using large muscle dividing incisions
Risk Factors
A risk factor is something that increases your chances of getting a disease or condition. Factors that may increase the risk of muscle damage include:
• Extreme exertion, such as running a marathon
• Heatstroke
• Alcohol or drug abuse
• Uncontrolled seizure disorder
Symptoms
The most common symptoms include:
• Dark colored (brown or red) urine
• Muscle pain
• Muscle weakness
Other symptoms include:
• Muscle swelling
• Back pain
• Nausea
• Vomiting
In severe cases, rhabdomyolysis may result in:
• Kidney damage or failure due to blocked arterial blood flow
• Multi-organ failure
• Abnormal heartbeat (arrhythmia)
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
• Urine tests
• Blood tests
• Muscle testing (electromyography)
Treatment
Treatment may include:
Hydration
Giving large amounts of fluid is the main treatment. Fluids are usually given directly into a vein by an IV. Hydration helps to quickly flush myoglobin out of the kidneys, in order to restore their function.
Medication
Medication may include:
• Diuretics, to help flush out the kidneys
• Bicarbonate, to minimize myoglobin's toxic effects
Dialysis
Dialysis is a procedure that uses an artificial kidney machine to filter blood. The clean blood is then returned to your body.
Prevention
Steps for prevention include:
• Drink plenty of fluids when:
o Exercising
o Sitting or working in hot, humid weather
• Avoid overuse of alcohol
• Avoid illicit drugs

Rh Incompatibility

2009-01-11T05:42:00.000-08:00

Rh Incompatibility and Isoimmunization
(D Incompatibility)
Definition
One of the first tests performed at the beginning of a pregnancy is blood-type. This basic test determines your blood type and Rh factor. People with different blood types have proteins specific to that blood type on the surfaces of their red blood cells.
There are four blood types (A, B, AB, and O). Each of the four blood types is additionally classified according to the presence of another protein on the surface of red blood cells that indicates your Rh factor. If you carry this protein, you are Rh positive. If you don't carry the protein, you are Rh negative.
Most people—about 85%—are Rh positive. But if a woman who is Rh negative and a man who is Rh positive conceive a baby, there is the potential for incompatibility. The baby growing inside the Rh-negative mother may have Rh-positive blood, inherited from the father. Statistically, at least 50% of the children born to an Rh-negative mother and Rh-positive father will be Rh positive.
Causes
Rh incompatibility occurs when a woman is Rh negative, but her fetus has inherited Rh-positive blood from the father. It rarely occurs in a woman's first pregnancy. She only becomes sensitized to the fetus's Rh-positive blood once she comes in contact with it. This is usually not until very late in pregnancy or during childbirth. This can also occur during a miscarriage or if the fetus is aborted. In rare cases, it can happen during an amniocentesis or other invasive procedures related to pregnancy.
A woman can also become sensitized to Rh-positive blood if she receives an incompatible blood transfusion. In most cases of Rh incompatibility, there are not disease manifestations. If maternal antibodies develop against Rh-positive proteins, then these antibodies could affect a current or future fetus during pregnancy. This is called Rh isoimmunization.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
• Being a pregnant woman with Rh-negative blood who had a prior pregnancy with a fetus that was Rh positive
• Being a pregnant woman who had a prior blood transfusion or amniocentesis
• Being a pregnant woman with Rh-negative blood who did not receive Rh immunization during a prior pregnancy
Symptoms
Symptoms and complications only affect the fetus and/or newborn. They occur when standard preventive measures are not taken and can vary from mild to very serious. The mother's health is not affected.
Symptoms of the newborn baby include:
• Anemia
• Swelling of the body, which may be associated with:
o Heart failure
o Respiratory problems
This condition is also referred to a hydrops fetalis.
• Kernicterus (a neurological syndrome), which can occurs in stages:
o Early:
 High bilirubin level (greater than 18 mg/cc)
 Extreme jaundice
 Absent moro (startle) reflex
 Poor suck
 Lethargy
o Intermediate:
 High-pitched cry
 Arched back with neck hyperextended backwards (opisthotonos)
 Bulging fontanel (soft spot)
 Seizures
o Late:
 High-pitched hearing loss
 Mental retardation
 Muscle rigidity
 Speech difficulties
 Seizures
 Movement disorder
Diagnosis
There aren't any physical symptoms that would allow you to detect on your own if you are Rh incompatible with any given pregnancy. If you are pregnant, it is standard procedure for your healthcare provider to order a blood test that will determine whether you are Rh positive or Rh negative. If the blood test indicates that you have developed Rh antibodies, your blood will be monitored regularly to assess the level of antibodies it contains. If the levels are high, an amniocentesis would be recommended to determine the degree of impact on the fetus.
Treatment
Since Rh incompatibility is almost completely preventable with the use of immunization (immune globulin injection of RhoGAM), prevention remains the best treatment.
Immune Globulin Injection
You will be given an injection of Rh0 immune globulin at week 28 of the pregnancy. This desensitizes your blood to Rh-positive blood. You will also have another injection of immune globulin within 72 hours after delivery (or miscarriage or abortion). This further desensitizes your blood for future pregnancies.
Treatment to Newborn
Treatment of a pregnancy or newborn depends on the severity of the condition.
• Mild:
o Aggressive hydration
o Phototherapy using 'bilirubin' lights
• Hydrops fetalis:
o Amniocentesis to determine severity
o Intrauterine fetal transfusion
o Early induction of labor
o A direct transfusion of packed red blood cells (compatible with the infant's blood) and also exchange transfusion of the newborn to rid the blood of the maternal antibodies that are destroying the red blood cells
o Control of congestive failure and fluid retention
• Kernicterus:
o Exchange transfusion (may require multiple exchanges)
o Phototherapy
Outcome
Full recovery is expected for mild Rh incompatibility. Both hydrops fetalis and kernicterus represent extreme conditions caused by hemolysis. Both have guarded outcomes. Hydrops fetalis has a high risk of mortality. Long-term problems can result from severe cases. These can include:
• Cognitive delays
• Movement disorders
• Hearing loss
• Seizures
Prevention
Rh incompatibility is almost completely preventable. Rh-negative mothers should be followed closely by their obstetricians during pregnancy. If the father of the infant is Rh-positive, the mother is given a mid-term injection of RhoGAM and a second injection within a few days of delivery. These injections prevent the development of antibodies against Rh-positive blood. This effectively prevents the condition. Routine prenatal care should help identify, manage, and treat any complications of Rh incompatibility.

Reye's Syndrome

2009-01-11T05:41:00.000-08:00

Reye's Syndrome

Definition
Reye's syndrome is a serious disorder that causes increased pressure in the brain and build-up of fat in the liver and other organs. It affects all organs of the body, but is most harmful to the brain and liver. Reye's syndrome occurs primarily in children, most often during recovery from a viral infection.
Causes
The cause of Reye's syndrome is unknown. However, studies have found a link with the use of aspirin and other salicylates during a viral illness.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Your risk of Reye's syndrome increases with:
• Age: 2-16 years old
• Recent viral illness, including:
o Upper respiratory infection
o Influenza (the Flu)
o Chickenpox
• Use of aspirin or other salicylates
Symptoms
Symptoms usually occur after a viral illness, and are divided into five stages:
Stage 1:
• Frequent or persistent vomiting
• Drowsiness and fatigue
Stage 2:
• Personality changes, such as irritability and aggression
• Confusion
• Disordered speech
• Hallucinations
Stages 3-5:
• Coma
• Seizures
• Inability to breathe without help
Brain swelling and other problems in Reye's syndrome progress very quickly. They may result in permanent neurologic damage or death. Call a doctor immediately if you think your child has Reye's syndrome.
Diagnosis
The doctor will ask about symptoms and medical history, and perform a physical exam. Tests may include:
Liver Function Tests - These include:
• SGOT (AST)
• SGPT (ALT)
• LDH
• Ammonia
• Prothrombin time
Spinal Tap (Lumbar Puncture) – insertion of a needle between the lumbar vertebrae in the back to remove spinal fluid for testing
Liver Biopsy – removal of a sample of liver tissue for testing
Note that certain inherited metabolic disorders can present with signs and symptoms that mimic Reye’s syndrome. Some have specific treatments, and all may recur—sometimes fatally—unless diagnosed appropriately. Tests for these disorders (such as ornithine transcarbamylase syndrome) should be done in all children with Reye’s syndrome.
Treatment
Early diagnosis and treatment are essential for a successful recovery.
Treatment may include:
Medication
Medications include:
• Corticosteroids
• Diuretics
• Glucose
• Insulin
• Barbiturates
• Specific treatments to reduce blood ammonia levels
o Sodium phenylacetate and sodium benzoate
o Dialysis
• Odansetran (Zofran) for severe vomiting
Arterial Catheter
If symptoms affect the brain, an arterial catheter may be inserted to monitor the pressure, carbon dioxide, and oxygen content of blood.
Pressure Monitoring
In stage 3-5 Reye’s syndrome, a “bolt” or other device may be used to monitor pressure within the brain.
Ventilator
In advanced stages, a ventilator may be used to assist with breathing.
Surgery
A drainage procedure or decompression craniotomy may occasionally be needed to reduce pressure in the brain.
Prevention
To prevent Reye's syndrome:
• Aspirin is not recommended for children and teens with a current or recent viral infection. Check with your doctor before giving aspirin to a child or teen. Widespread decline in the use of aspirin for children is one reason why the incidence of Reye’s syndrome has decreased dramatically in recent years.
• Avoid giving children and teens medications that contain salicylates. Examples include Alka-Seltzer, Anacin, Bufferin, and Pepto-Bismol.

Retinoblastoma

2009-01-11T05:40:00.001-08:00

Retinoblastoma

Definition
Retinoblastoma is a rare type of cancer found in the eye. In retinoblastoma, one or more tumors form in the retina. The retina is a layer of light-sensitive tissue that lines the back of the eye. It converts visual images into nerve impulses in the brain that allow us to see. If not treated, the tumors will continue growing. The cancer may grow along the optic nerve and reach the brain. Or it may travel to other parts of the body.
Cancer occurs when cells in the body (in this case retina cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. Tumors can invade nearby tissues and spread to other parts of the body.
Normal Anatomy of the Eye

Causes
During early stages of fetal development, fast-growing, immature cells called retinoblasts form. Later, these cells become retinal cells. In retinoblastoma, some of these cells quickly grow out of control. Some cases of the tumor are inherited. Others are not. Retinoblastoma usually forms only in one eye. But both eyes may have tumors.
Risk Factors
A risk factor is something that increases your chances of getting a disease or condition. Risk factors for retinoblastoma include:
• Age: Less than 5 years old (typically)
• Family members with retinoblastoma
Symptoms
Symptoms are usually noticed by the parent or caregiver and may include, but are not limited to:
• Eyes do not look normal, often described as a glazed look or a “cat’s eye.”
• When a light is directed at the eye, the pupil looks white rather than red. This is often noticed on a photograph.
• Eyes may appear to be crossed or looking in different directions.
• Less common symptoms may include:
o Eye may grow in size
o Eye pain
o Redness in the white part of the eye
o Tearing
o Pupil may not respond to light
o Iris (colored part of the eye) changes color
Diagnosis
The doctor will ask about symptoms and family medical history, and perform a physical exam. Many retinoblastomas are found during routine physical exams. If a tumor is suspected, the child will usually be referred to a specialist for a more complete eye exam. In children with a family history of the disease, eye exams often begin within a day or two of birth. Additional eye exams are scheduled at regular intervals thereafter.
Once retinoblastoma is found, staging tests are performed to find out if the cancer has spread, and, if so, to what extent. Treatment depends on the stage of the cancer. The cancer may be localized to the eyes. Or it may have spread to tissues around the eye or to other parts of the body.
Tests may include, but are not limited to:
• Eye Exam–the pupil is dilated with eye drops. Then the inside of the eye is examined with a lighted instrument that allows the examiner to view structures inside the eye.
• Ultrasound–a test that uses sound waves to examine the inner part of the eye.
• MRI Scan–a test that uses magnetic waves to make pictures of the inside of the body. It can be used to check for spread of the cancer to the brain or other tissue.
• CT Scan–a type of x-ray that uses a computer to make pictures of the eye. CT scans of other areas of the body may be done to check if the cancer has spread.
General anesthesia may be given to keep the child still during close examination and testing.
Treatment
Your child will likely be referred to a specialist for treatment. Without treatment, the cancer cells will continue to grow.
Treatment aims to cure the cancer and preserve sight. Options vary, depending on whether the disease is limited to the eye or has spread, and how large and where in the eye the tumor is located. Therapies may be used alone or in combination.
Treatments include:
Surgery–surgical removal of the entire eye and as much of the optic nerve as possible. The optic nerve is the nerve leading from the eye to the brain that is responsible for vision. Surgery may be used for a large tumor in one eye.
Radiation Therapy–the use of radiation to kill cancer cells and shrink tumors. Radiation may be:
External Radiation Therapy–radiation directed at the tumor from a source outside the body
Internal Radiation Therapy–radioactive materials placed into the body near the cancer cells
Cryotherapy –the use of cold to freeze and destroy cancer cells. It is used on small tumors.
Thermotherapy–the use of heat to kill cancer cells.
Photocoagulation–the use of lasers to destroy a small tumor.
Chemotherapy–the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including pill, injection, and through a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.
Prevention
Genetic counseling and close monitoring and screening for people at risk for retinoblastoma can help prevent the disease or detect it early if it occurs.
Early diagnosis and treatment improve the chance of successful treatment. Prevention and early detection techniques include:
• Screening–children born into families with a history of retinoblastoma should have regular eye exams to screen for development of the tumor. All children should have regular eye screening by their doctor.
• Genetic Counseling–may help determine a person’s risk of developing retinoblastoma. If you have retinoblastoma or have a family history of the disorder, you can talk to a genetic counselor when deciding to have children.
• Monitoring for Recurrence–people who have been treated for retinoblastoma require regular medical exams to assess the success of treatment and check for recurrence or bilateral disease.
• Monitoring for Other Cancers–children with retinoblastoma are at increased risk for an associated brain tumor and other cancers in the body.

Acute Respiratory Distress Syndrome (ARDS)

2009-01-11T05:37:00.000-08:00

Respiratory Distress Syndrome in Newborns
(Hyaline Membrane Disease)
Definition
Respiratory distress syndrome (RDS) occurs mainly in infants who are born prematurely. It causes newborns to have difficulty breathing. If it is not properly treated, RDS can result in complications, such as an infection of the bloodstream and bleeding into the brain. In severe cases, RDS can lead to convulsions and death.
Causes
RDS occurs in premature infants because their lungs have not developed enough. Immature lungs lack surfactant. Surfactant is a foamy fluid that is crucial for the air sacs in the lungs to expand and take in air. When there is not enough surfactant, the lungs cannot expand and the baby has a hard time breathing.
The chance of developing RDS decreases as the fetus grows. Babies born after 36 weeks rarely develop this condition.
Respiratory System of an Infant

Risk Factors
A risk factor is something that increases your chances of getting a disease or condition.
• Birth before 37 weeks; this condition is more common and more severe with greater prematurity
• Mother with insulin dependent diabetes
Symptoms
The following symptoms usually start immediately or within a few hours after birth:
• Difficulty breathing
• Rapid, shallow breathing
• Delayed or weak cry
• Grunting noise with every breath
• Flaring of the nostrils
• Frothing at the lips
• Blue color around the lips and nail beds
• Swelling of the extremities
• Decreased urine output
Diagnosis
The doctor will ask about the mother's medical history and pregnancy. The baby will also be evaluated, as outlined here:
Before Birth
Amniotic fluid may be tested for indicators of fetal lung maturity such as:
• Surfactant
• Lecithin:sphingmyelin ratio
• Phosphatidyl glycerol
After Birth
Physical Exam–includes checking the baby's breathing and looking for bluish color around the lips and nail beds
Testing for Blood Gases–to check the levels of oxygen and carbon dioxide in the blood
Chest X-ray–a test that uses radiation to take a picture of structures inside the body, in this case the chest
Treatment
Treatment for a baby with RDS usually includes oxygen and may also include:
Mechanical Respirator
A mechanical respirator (breathing machine) is used to keep the air sacs from collapsing and to improve the exchange of oxygen and other gases in the lungs. This treatment helps the baby breathe better and is almost always required in severe RDS.
Surfactant Treatment
Surfactant can be given to help the air sacs in the lungs expand and take in more oxygen. There are two options, both of which are delivered directly into the baby's windpipe. One type of surfactant comes from cows and the other is synthetic. As the surfactant takes effect, use of the respirator can gradually be reduced.
Partial Liquid Ventilation
Babies with severe RDS may need to have a special liquid put into their lungs that contains extra oxygen.
Nutrition Support
Newborns with RDS may be given food and water by the following means:
• Tube feeding–a tube is inserted through the baby's mouth and into the stomach
• Parenteral feeding–nutrients are delivered directly into a vein
Prevention
Steps to help prevent RDS can be taken at a few different times.
To reduce your chance of having a premature baby:
• Get good prenatal care beginning as early as possible in pregnancy.
• Eat a healthful diet and take vitamins suggested by your doctor.
• Do not smoke or use alcohol or drugs.
• Only take medicines that your doctor has approved.
If you are at high risk of giving birth to a premature baby:
• You may be given steroids just before delivery to help your baby's lungs develop
• Your doctor may do an amniocentesis to check the maturity of your baby's lungs and to help determine the best time for delivery
After delivery, if a premature baby has a very high chance of developing RDS, surfactant may be given right after birth to help the baby breathe better.

Raynaud's Disease

2009-01-11T05:35:00.000-08:00

Raynaud's Disease and Phenomenon
Pronounced: ray-NODES
Definition
Raynaud's disease and phenomenon are circulatory disorders. During an attack, blood vessels narrow. This causes blood flow to the fingers and sometimes ears, nose, and lips to be severely reduced. Cold temperatures or emotional stress, such as excitement or nervousness, are the usual causes of attacks. Although blood vessels naturally become narrower under these circumstances, Raynaud's is an abnormally exaggerated response.
Constriction of Blood Vessels

There are two types:
Primary Raynaud's (Raynaud's Disease)
This is the most common form. Primary Raynaud's occurs by itself, in the absence of other medical conditions.
Secondary Raynaud's (Raynaud's Phenomenon)
This is the more severe form. People with secondary Raynaud's also have some other underlying medical condition that is thought to also cause Raynaud's. Some common conditions associated with Raynaud's include:
• Scleroderma
• Lupus
• Rheumatoid arthritis
• Sjogren's syndrome
• Carpal tunnel syndrome
Causes
The cause of primary Raynaud's is not known, but it is probably related to an abnormality of the sympathetic nervous system. Secondary Raynauld's is believed to be caused by the associated disease.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for Raynaud's syndrome include:
• Sex: Female
• Age: 15-40 years old
• Jobs or leisure activities: Activities that subject the hands to repeated stress may increase the chance of developing Raynaud's. For example:
o Typing
o Playing piano
o Regular operation of vibrating tools, as in construction
o Exposure to certain chemicals
• A connective tissue disease
• Diseases of the arteries, including atherosclerosis
• Injuries to the hands or feet, such as wrist fractures or frostbite
• Smoking
• Certain medications, such as:
o Beta-blockers
o Cancer chemotherapy
o Cold remedies
o Migraine medications containing ergotamine
o Estrogen-containing medications
Symptoms
An attack of Raynaud's may last a few minutes to a few hours. During an attack, symptoms may include:
• Skin discoloration–during an attack, skin color may change to white, blue, and red.
o White occurs when the arteries narrow or collapse.
o Blue appears when the fingers, toes, or other areas are not getting enough oxygen-rich blood.
o The skin turns red and may become swollen when the attack subsides and blood returns.
• Throbbing and tingling sensations, stinging, pain, swelling of the affected area. This may occur at the end of the attack as blood flow increases and returns to the extremities.
People with secondary Raynaud's may experience other medical problems related to Raynaud's, such as:
• Skin thinning and ulcerations
• Gangrene (tissue death)
• Many other symptoms related to their underlying connective tissue disorder
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
Nailfold Capillaroscopy–study of the capillaries under a microscope
Blood Tests–to help distinguish between Raynaud's disease and phenomenon, and to help identify underlying autoimmune conditions:
• Antinuclear Antibody Test (ANA)
• Erythrocyte Sedimentation Rate (ESR)
Treatment
There are several ways to reduce the symptoms of Raynaud's during an attack:
Create Warmth for Fingers and Toes
• Run warm (not hot) water over fingers and toes as quickly as possible. However, do not place anything hot on your skin, as it may cause damage.
• If you are outside, move inside.
• Place your hands on a warm area of the body, such as under your armpits or on the abdomen.
Stimulate Blood Flow
Try to stimulate blood circulation by wiggling your fingers and toes, and making wide circles with your arms.
Medications
When the above measures fail, medications may help relieve symptoms, and even help begin to heal skin ulcers that have formed. Medications may include:
• Calcium channel blockers, such as nifedipine
• Alpha-blockers, such as prazosin
• Vasodilators, such as a nitriglycerin cream
Surgery
Rarely, surgery may be done when symptoms are persistent and debilitating. This involves cutting the sympathetic nerves that supply the affected fingers (called sympathetectomy). In extremely rare instances, a finger of toe that has suffered gangrene may require amputation.
Chemical Injection
Chemicals may be injected into the sympathetic nerve that is responsible for blood vessel constriction.
Treating Underlying Medical Condition
If you have Raynaud's phenomena, successful management of the underlying connective tissue or vascular disorder can help to relieve symptoms.
Prevention
There are no guidelines for preventing Raynaud's disease and phenomenon. To prevent symptoms of Raynaud's:
• Stay warm. Avoid cold temperatures when possible.
• Dress in layers.
• Always wear clothing that covers extremities (hats, gloves, socks, etc.).
• Learn to adapt to stressful situations.
• Avoid caffeine.
• Don't smoke. If you smoke, quit.
• Exercise regularly.
• Consider using biofeedback training to control body temperature.
• Avoid the use of medications known to exacerbate Raynaud’s.
To minimize the risk of complications from Raynaud's:
• Keep skin on fingers and toes lubricated and protected.
• Avoid injuries.

Rabies

2009-01-11T05:33:00.000-08:00

Rabies
Definition
Rabies is a viral infection of the central nervous system. Rabies is almost always fatal unless treated before symptoms appear.
The Nervous System

Causes
A virus found in infected, warm-blooded animals causes rabies. Animals in the U.S. that commonly carry the virus include:
• Bats
• Raccoons
• Skunks
• Foxes
• Coyotes
The rabies virus is present in the saliva, brain, or nerve tissue of infected animals. Usually, humans contract rabies through a bite or scratch from an infected animal. The virus may also be transmitted if infected tissue comes into contact with human mucous membranes, such as in the eyes, nose, or mouth.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. The only risk factor for contracting rabies is contact with an infected animal. In most parts of the U.S. any contact with a bat may be considered a rabies risk factor. Seek medical advice if you find a bat anywhere inside your home.
Symptoms
After exposure, the rabies virus may incubate for 10 days to one or more years in humans before symptoms appear. Usually symptoms develop within 3-7 weeks, after which treatment will not stall the progression of the infection. Death usually occurs within a week after symptoms appear.
Symptoms in humans may include:
• Pain, tingling, or itching at the site of the bite wound or other site of viral entry
• Stiff muscles
• Increased production of thick saliva
• Flu-like symptoms, such as headache, fever, fatigue, nausea
• Painful spasms and contractions of the throat when exposed to water (called "hydrophobia")
• Erratic, excited, or bizarre behavior
• Paralysis
Symptoms in animals may include:
• Erratic behavior (often overly aggressive or vicious)
• Disorientation (e.g., nocturnal animal such as a bat or fox appearing in daylight)
Diagnosis
If you think you have been exposed to rabies, see a doctor or contact a public health official immediately.
If the animal is available and appears well, it will be kept under observation for 7-10 days. If no symptoms develop, you are not at risk for rabies. If the animal is sick or dead, it's head will be shipped to a special facility where its brain will be examined for the presence of the virus. In the meantime, you may be advised to begin treatment.
If the animal is unavailable, treatment may often be recommended depending on the animal's species, where the encounter took place, and other factors.
Treatment
If an animal has bitten you, immediately do the following:
• Wash the wound immediately with plenty of soap and water to remove saliva; this is the most important first step you can take in preventing rabies
• Call your doctor or seek care in an emergency room
If it is likely that you have been exposed to rabies, your doctor will recommend post-exposure prophylaxis. This involves two injections:
Human Rabies Immune Globulin (HRIG)
This should ideally be given within 24 hours after exposure. It contains large quantities of antibodies to the rabies virus. In most cases, half of the dose should be injected into the wound and surrounding tissue. The remainder is given intramuscularly. If you have previously received rabies vaccine, you may not need the HRIG shot.
Other Rabies Vaccines
Unlike the HRIG, rabies vaccines cause your own immune system to develop protective antibodies against the rabies virus. These antibodies will live in your body for many years. There are three types of rabies vaccines available:
• Human diploid cell vaccine (HDCV)
• Rabies vaccine adsorbed (RVA)
• Purified chick embryo cell culture (PCEC)
Over the next four weeks, your doctor will give you five shots of one of these vaccines. The vaccine will be injected into your upper arm muscles.
Certain medications may interfere with your body's response to the rabies vaccine. Be sure to tell your doctor about all medications or herbs that you take on a regular basis.
Prevention
To help prevent rabies:
• Vaccinate house pets.
• Avoid contact with wild animals.
• Do not touch any wild animal, even if it appears to be dead.
• Seal basement, porch, and attic openings to prevent an animal from entering your home.
• Report any animal to your local animal control authorities that is acting strangely or appears sick.
• If you regularly come in contact with animals, have the rabies vaccine prior to any exposure to rabies (preexposure prophylaxis). Booster doses are often required.

Pyloric Stenosis

2009-01-11T05:32:00.000-08:00

Pyloric Stenosis
(Infantile Hypertrophic Pyloric Stenosis)
Pronounced: Py-loric sten-OH-sis
Definition
Pyloric stenosis is an enlargement of the pylorus (the muscle at the entrance to the stomach) that blocks movement of food into the stomach. Almost all cases of pyloric stenosis happen in very young babies (usually 3-12 weeks old). This problem happens about 2-4 times out of every 1,000 births. It is much more common in males than in females. The sooner pyloric stenosis is treated, the fewer problems will result and the healthier your baby will be, so if you think your child has this condition, contact your doctor immediately.
Pyloric Stenosis

Causes
Pyloric stenosis is rarely present at birth, but develops soon afterward. Its exact cause is unknown, but it is believed to be partly inherited, as cases of pyloric stenosis tend to run in families.
Risk Factors
The following factors increase your baby’s chance of developing pyloric stenosis. If your child has any of these risk factors, tell your doctor.
• Prematurity
• Family history of pyloric stenosis
• More common in male babies (particularly first-born males)
• More common in Caucasian than in Latino, Asian, or African-American babies
Symptoms
Symptoms of pyloric stenosis usually begin when babies are 3-5 weeks old. They include:
• Forceful vomiting of formula or milk
• Acting hungry most of the time
• Weight loss
• Signs of dehydration, such as less urination, dry mouth, and crying without tears
• Tiredness
• Fewer bowel movements
• Blood-tinged vomit (this happens when repeated vomiting irritates the stomach, causing mild stomach bleeding)
Diagnosis
Your doctor will ask about symptoms your child is experiencing and about his or her medical history. He or she will also perform a physical examination. An olive-shaped knot caused by the presence of pyloric stenosis is often felt by the experienced examiner. If your baby is diagnosed with pyloric stenosis, you and your family will be referred to a pediatric surgeon (a doctor specializing in surgery in children).
Tests may include the following:
• Abdominal Ultrasound–a procedure that uses sound waves to make detailed computer pictures of the inside of the abdomen
• Barium Upper Gastrointestinal X-ray Series–a medicine (barium) is swallowed to outline the esophagus and stomach. X-ray pictures of the abdomen can then tell if food is moving normally through the stomach.
Treatment
Pyloric stenosis is treated with a surgery called a pyloromyotomy, with your baby asleep under anesthesia. In a pyloromyotomy, the outside of the pylorus muscle is cut to relieve the blockage. Prior to surgery, fluids and electrolytes will be given intravenously to correct the dehydration and electrolyte imbalances that are common in babies with pyloric stenosis. After the operation, fluids are given by vein until the baby can take all of his or her normal feedings by mouth.
Prevention
There are no known ways of preventing pyloric stenosis, although it is possible that breastfeeding might reduce the risk.

Pulmonary Embolism

2009-01-11T05:30:00.000-08:00

Pulmonary Embolism
Definition
A pulmonary embolism is a blockage of an artery in the lungs caused by a clot that travels through the bloodstream to the lungs.
Pathway of Pulmonary Embolism

Causes
An embolism occurs when a clot moves through the bloodstream from the location where it was formed and becomes stuck in a blood vessel. The clot, called an embolus, can be a blood clot, air bubble, or piece of fat, bone marrow, or tumor tissue.
The embolus in a pulmonary embolism is usually a blood clot. A blood clot that forms and remains in a vein is called a thrombus. It most often starts in a vein in the legs or pelvis. Once the clot is stuck in a lung artery, it blocks the blood from nourishing that lung. The tissues on the other side of the blockage may die if it doesn't receive enough blood from other sources. The lung may become damaged and stop working properly. In severe cases this can lead to death.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for pulmonary embolism include:
• Blood clot in a deep vein of a leg or pelvis
• Increased levels of clotting factors in the blood. Usually caused by cancer (eg, pancreatic)
• Prolonged bed rest, such as during a serious illness
• Major surgery, especially after pelvic surgery, knee replacement, or heart surgery
• Injury to a vein in a leg or pelvis
• Fractures of the hip or thigh bone (femur)
• Heart attack, stroke
• Certain blood disorders
• Prolonged sitting, such as during a long trip
• Pregnancy
• Birth control pills
• Smoking
• Obesity
Symptoms
The symptoms of pulmonary embolism vary in type and severity depending on the size and location of the blockage, and the area affected by the lack of blood. Symptoms may include:
• Shortness of breath that starts suddenly for no obvious reason
• Chest pain, especially when breathing or coughing. It can mimic a heart attack.
• Feeling faint, lightheaded, dizzy
• Cough, sometimes with bloody phlegm
• Rapid heartbeat
• Rapid breathing
• Anxiety
• Feeling of impending doom
• Swollen, distended neck veins
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
Arterial Blood Gas Study—a blood test to identify oxygen levels and other gases that are indicators of lung function
Chest X-ray—a test that uses radiation to take a picture of structures inside the chest. A pulmonary embolism cannot be seen on the chest x-ray. Sometimes however it is associated with the lung infarct that can be visualized.
Lung Perfusion Scan—a test that uses radioactive isotopes to measure breathing and circulation in all areas of the lungs. The presence of an embolus will show as a mismatch between ventilation of the portion of the lung and its blood perfusion.
CT Scan of the Chest—a type of x-ray that uses a computer to make pictures of the inside of the chest. A spiral CT is a special type of a CT scan that is able to make tri-dimensional pictures. It is also a very fast scan that can be completed in a very short period of time. It has become highly popular in dignosisng pulmonary embolism.
Pulmonary Angiogram—x-rays taken after a dye is injected into the blood vessels in the lungs. The test shows areas of blockage in the lungs. It provides a clear picture of blood flow through the arteries but this test is associated with relatively high risks for a patient.
Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle. In case of pulmonary embolism, tachycardia (rapid heart beat) is frequently seen as well as several rhythm patterns that can help in making the diagnosis.
Additional tests may be done to check blood flow or look for clots in the veins, especially in the legs.
Also, there are a few blood tests available that can help in making the diagnosis:
• D-Dimer—a clot dissolving substance. Increased levels in the blood may suggest the presence of the clot. It is unfortunately a nonspecific test and a lot of different conditions may cause (eg, recent surgery) it to be elevated.
If you have a family history of blood clots, and had a few instances of blood clots for no apparent reason, your doctor may order additional blood tests to look for possible inherited defects in your clotting system.
Treatment
Treatment depends on the size and severity of the clot. Emergency treatment and hospitalization may be needed.
Treatments include:
Medicine
Options include:
• Thrombolytic medicine to dissolve clots, for example:
o Streptokinase
o Urokinase
o Tissue plasminogen activator (TPA)
• Anticoagulant medicine, called blood thinners, such as heparin or warfarin, to prevent more clots from forming
Surgery
In some cases when the blockage is very large, a type of surgery called embolectomy may be done to remove it.
Clot-trapping Filter
If you have a repeated problem with blood clots, surgery may be performed to place a filter in the main vein that leads from the legs to the heart and lungs. This filter traps clots before they can reach the lungs.
Prevention
Prevention of pulmonary embolism means preventing clots from forming.
You can help prevent clots with a healthful lifestyle:
• Eat a healthful diet, one that is low in total fat as well as saturated fat, and rich in whole grains, legumes, fruits, and vegetables.
• Exercise regularly.
• Walk or move your legs to break up long periods of sitting.
• Don't smoke.
• Unless you are on a fluid-restricted diet, be sure to drink lots of water.
People at high risk of developing blood clots can do the following:
• Take medicine, if your doctor recommends it. Anticoagulant drugs such as warfarin or heparin are most commonly used.
• Wear elastic stockings (also called support hose) to improve circulation in your legs.

Psoriasis

2009-01-11T05:28:00.000-08:00

Psoriasis
Definition
Psoriasis is a chronic, inflammatory skin disease. Knees, elbows, scalp, trunk, and nails are the most commonly affected areas. There are several types of psoriasis.
• Plaque--inflamed patches of skin topped with silvery, white scales (most common type)
• Guttate--small dot-like lesions
• Pustular--weeping lesions and intense scaling
• Erythrodermic--intense sloughing and inflammation of the skin
Psoriasis

Causes
The cause of psoriasis is unclear. Signals from a defect in the immune system may result in an overgrowth of skin cells. Because the cells grow faster than they can be shed, they ‘pile up' on the skin's surface. The excess skin cells are thought to cause the silvery white scales that are characteristic of plaque-type psoriasis.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
• Sex: Female
• Family history of psoriasis
• Rheumatoid arthritis
• Cold climates
• Suppression of the immune system, including AIDS
• Certain bacterial infections
• Certain medications, such as beta blockers and lithium
Symptoms
The red, thickened and rough patches of psoriasis may occur anywhere, but are commonly found on the scalp, elbows, knees, palms, and soles. Other symptoms include:
• Silvery white scales
• Pitted or dented fingernails and/or toenails
• Red lesion in the folds of the buttock
• Joint pain suggesting arthritis
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Your skin and nails will be examined. There are no specific blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy will be done to confirm the diagnosis.
Treatment
Treatment is based on:
• The severity of the disease
• The extent and location of the areas involved
• Responsiveness to the treatment
Topical Treatment
Many patients respond very well to treatments applied directly to the skin. Topical treatments include:
• Corticosteroid creams (most common treatment)
• Synthetic forms of vitamin D and retinoids (calcipotriene ointment 0.005??)
• Retinoids (tazarotene gel 0.05 and 0.1%)
• Coal tar preparations
• Bath solutions and moisturizers
Photo (Light) Therapy
If psoriasis covers more than 30% of the body it is difficult to treat with topical medications alone. Daily, short, nonburning exposure to sunlight clears or improves psoriasis in many people. Sunlight is often included among initial treatments. A more controlled form of artificial light treatment (UVB phototherapy) is often used in more widespread but mild cases. More severe psoriasis can be treated with ultraviolet A (UVA light) and psoralen. Psoralen is an oral or topical medication that makes the body more sensitive to light. This treatment is known as PUVA.
Phototherapy can be very effective in controlling psoriasis but it requires frequent treatments. It may cause side effects such as nausea, headache, fatigue, burning, and itching. Both UVB and PUVA may increase the person's risk for squamous cell and, possibly, melanoma skin cancers.
Systemic Treatment
For more severe types of psoriasis, doctors may prescribe a number of other powerful medications, which can be effective, but are associated with more serious side effects. These include:
• Methotrexate--should not be taken by pregnant women, women planning to become pregnant, or by their male partners.
• Cyclosporine--suppresses the immune system to slow the turnover of skin cells.
• Hydroxyurea--less toxic than methotrexate or cyclosporine, but may less effective.
• Systemic Retinoids--compounds with vitamin A-like properties taken internally (such as methotrexate) may be prescribed in severe cases. Retinoids can cause birth defects and women must diligently protect themselves from pregnancy for several years after completing treatment.
Newer systemic immunomodulators, so called because they affect some aspect of the body’s natural immune response, may also be quite effective. These treatments are generally the most expensive, however, and some can cause serious toxicity when given systemically (by mouth or injection). Topical preparations of immunomodulators are currently being tested and seem to have benefits. Other drugs called thiazolidinediones may show promise as future treatments for psoriasis but are not currently recommended.
Prevention
Although the condition of psoriasis cannot be prevented, people at increased risk for the condition (ie, family history of psoriasis) should try to avoid physical trauma to the skin, infections, and temperature extremes.
These measures may also help reduce flare-ups in people with the condition. Your doctor may advise you to avoid certain foods if they appear to make your psoriasis worse.

Prostitis

2009-01-11T05:26:00.000-08:00

Prostatitis
(Prostadynia)
Definition
Prostatitis is inflammation of the prostate gland. The prostate is a walnut-sized gland in men that surrounds the urethra. The prostate produces a fluid that is part of semen.
Anatomy of the Prostate Gland

There are four types of prostatitis:
• Acute bacterial (least common of the four types, but the most common in men under 35)
• Asymptomatic inflammatory prostatitis
• Chronic bacterial (not very common, but affects mostly men between 40-70)
• Chronic nonbacterial/prostadynia (most common type)
o Note: Prostadynia (also known as chronic pelvic pain syndrome) is a condition associated with similar symptoms as chronic nonbacterial prostatitis, but which has no evidence of prostatic inflammation.
Causes
Acute and some chronic bacterial prostatitis are caused by bacteria that infect the prostate gland. The bacteria usually come from the urinary tract or rectum. The causes of nonbacterial prostatitis can be difficult to identify, but some feel this may be caused by nonbacterial pathogens such as chlamydia, virus, fungus, or mycoplasma. The causes of prostatodynia can be even more difficult to identify, but can be associated with stress and/or disorders of pelvic floor muscle tension.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
• Medical procedures that involve inserting a catheter or other tubing into your urethra or rectum
• Engaging in anal intercourse
• Recent bladder infection
• Abnormalities in the anatomy of the urinary tract
• Diabetes
• Suppressed immune system
• Bladder outlet obstruction (eg, a tumor, a kidney stone, or enlargement of the prostate gland itself)
Symptoms
Symptoms of prostatitis can come on slowly or suddenly. They can be mild or quite severe. In nonbacterial prostatitis, symptoms often come and go.
Symptoms may include:
• Needing to urinate frequently and/or urgently (especially at night)
• Pain or burning while urinating
• Difficulty urinating
• Blood in the urine
• Psychological stress
• Lower abdominal pain or pressure
• Rectal or perineal discomfort
• Lower back pain
• Fever or chills
• Painful ejaculation
• Impotence (due to inflammation around the gland)
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis of prostatitis is usually based on the symptoms and massaging the prostate gland. In this test, the doctor places a lubricated, gloved finger into the rectum to feel the back wall of the prostate. In prostatitis, the prostate is usually tender and soft.
Other tests may include:
• Analysis of urine and prostate fluid expressed after massaging the prostate gland
• Bladder function tests
Treatment
Treatment depends on the type of prostatitis:
Infectious Prostatitis
Acute bacterial prostatitis is treated with oral antibiotics for 1-2 weeks.The commonly used drugs include quinolones (norfloxacin, ciprofloxacin, levofloxacin) or trimethoprim. In severe cases, treatment with intravenous antibiotics may be necessary. Chronic bacterial prostatitis is also treated with oral antibiotics for 4-12 weeks. Other medications include:
• Stool softeners
• Anti-inflammatory medications
• Other analgesics or pain medications
• Avoiding alcohol or caffeinated beverages
• Alpha-blockers such as Flomax
• 5-alpha reductase inhibitors such as Proscar or Avodart
Non-infectious Prostatitis
Often patients are initially given a course of antibiotics. This is just in case an infectious cause was missed. Other treatments include:
• Alpha-blockers such as Flomax
• 5-alpha reductase inhibitors such as Proscar or Avodart
• Anti-inflammatory medications such as ibuprofen
• Pain killers
• Warm sitz baths
• Repeated prostate massages
Prevention
There are no guidelines for preventing prostatitis.

Prostate Cancer

2009-01-11T05:24:00.000-08:00

Prostate Cancer
(Cancer of the Prostate)
Definition
Prostate cancer is a disease in which cancer cells grow in the prostate gland. The prostate is a walnut-sized gland in men that surrounds the urethra. The prostate produces a fluid that is part of semen.
Prostate Cancer

Cancer occurs when cells in the body (in this case prostate cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissue and spread to other parts of the body. A benign tumor does not invade or spread.
The sooner prostate cancer is treated, the more favorable the outcome. If you suspect your might have this condition, contact your doctor immediately.
Causes
The cause of prostate cancer is unknown. However, research shows that certain risk factors are associated with the disease.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
The following factors increase your chance of developing prostate cancer:
• Age: 55 or older
• Race: Black
• Family history of prostate cancer, especially father or brother
• Family history of prostate cancer diagnosed at a young age
• A high-fat diet
Symptoms
• A need to urinate frequently, especially at night
• Difficulty starting urination or holding back urine
• Inability to urinate
• Weak or interrupted flow of urine
• Painful or burning urination
• Difficulty having an erection
• Painful ejaculation
• Blood in urine or semen
• Frequent pain or stiffness in the lower back, hips, or upper thighs
These symptoms may also be caused by other, less serious health conditions, such as benign prostatic hyperplasia (BPH) or an infection. A man experiencing these symptoms should see a doctor.
Diagnosis
Your doctor will ask about symptoms and medical history, and perform a physical exam. Tests may include:
• Digital Rectal Exam–examination of the rectum with the doctor's gloved finger inserted into your rectum
• Urine Test–to check for blood or infection
• Blood Test–to measure prostate specific antigen (PSA) and prostatic acid phosphatase (PAP)
Other tests to learn more about the cause of your symptoms may include:
Transrectal Ultrasonography–a test that uses sound waves and a probe inserted into the rectum to find tumors
Intravenous Pyelogram–series of x-rays of the organs of the urinary tract
Cystoscopy–a procedure in which a doctor looks into the urethra and bladder through a thin, lighted tube
Biopsy–removal of a sample of prostate tissue to test for cancer cells
Treatment
Once prostate cancer is found, tests are performed to find out if the cancer has spread and, if so, to what extent. Treatment depends on the extent of the cancer. To understand your treatment options, you may want to consult with a urologist and a radiation oncologist for help deciding what is the best treatment plan for you. It is important to discuss your individual benefits and risks associated with each treatment option with your doctors. For some treatments, the expense and risks associated with the treatment may not outweigh the benefits.
Standard treatment options include:
Watchful Waiting
Watchful waiting involves no treatment, but your doctor tests periodically to see if the cancer is growing. Watchful waiting is suggested for::
• Early stage prostate cancer that seems to be growing slowly
• Older prostate cancer patients or those with serious medical problems that may make the risks of treatment outweigh the possible benefits
Surgery
Surgery for prostate cancer involves the removal of the cancerous tumor and nearby tissues, and possibly nearby lymph nodes. Surgery is generally offered to patients who are in good health and are younger than 70 years old. Types of surgery include:
• Pelvic Lymphadenectomy–removal of lymph nodes in the pelvis to determine if they contain cancer; if they do, removal of the prostate and other treatment may be recommended
• Radical Retropubic Prostatectomy–removal of the entire prostate and nearby lymph nodes through an incision in the abdomen
• Radical Perineal Prostatectomy–removal of the entire prostate through an incision between the scrotum and the anus; nearby lymph nodes are sometimes removed through a separate incision in the abdomen
• Transurethral Resection of the Prostate (TURP)–removal of part of the prostate with an instrument inserted through the urethra; a TURP is not a cancer surgery, but can be used to relieve the symptoms of obstruction when a patient has either prostate cancer or an enlarged gland due to other reasons
Prostate cancer surgery can result in impotence and leakage of urine from the bladder or stool from the rectum. Nerve-sparing surgery may reduce these risks, but very large tumors or tumors that are very close to nerves may not be treatable with nerve-sparing surgery.
In addition to traditional surgery, robotic surgery and laparascopic surgery may be options in your community. These minimally invasive techniques can help reduce side effects, blood loss, and recovery time over traditional “open” surgery.
Radiation Therapy
Radiation therapy involves the use of radiation to kill cancer cells and shrink tumors. Radiation may be:
• External Radiation Therapy–radiation directed at the tumor from a source outside the body
• Internal Radiation Therapy–dozens of tiny radioactive seeds are implanted directly into the prostate gland using needles; the seeds remain in the prostate gland permanently and harmlessly; this method delivers radiation directly to the affected area, and reduces the risk of damage to surrounding areas such as the rectum and bladder; internal radiation therapy is most often used for treating earlier stage cancers
Radiation therapy for prostate cancer may result in impotence and urinary problems. However, most studies show that rates of impotence are less for radiation therapy than for standard prostatectomy and slightly less than that for nerve-sparing procedures. Incontinence following radiation therapy is also less than following prostatectomy, but there is a slightly increased risk of cystitis due to radiation.
Hormone Therapy
Hormone therapy is often used for patients whose prostate cancer has spread beyond the prostate or has recurred after treatment. The goal of hormone therapy is to lower levels of the male hormones, also known as androgens. The main androgen is testosterone. Lowering androgen levels can cause prostate cancers to shrink or grow more slowly, but does not cure cancer. Methods of hormone therapy include:
• Orchiectomy–a surgical procedure to remove one or both of the testicles, which are the main source of male hormones; orchiectomy decreases hormone production, which can shrink or slow the growth of most prostate cancers
• Luteinizing Hormone-releasing Hormone (LHRH) Agonists–injections that can decrease the amount of testosterone produced by the testicles
• Antiandrogens (eg, flutamide, bicalutamide)–medications that can block the action of androgens; these medications are often used in combination with orchiectomy or LHRH agonists, a combination called total androgen blockade
• Drugs That Prevent Adrenal Glands From Producing Androgens (eg, ketoconazole, aminoglutethimide)
• Estrogens–drugs that can prevent the production of testosterone in the testicles; estrogens are rarely used today because of the risk of serious side effects
Hormone therapy for prostate cancer may result in hot flashes, impaired sexual function, loss of sexual desire, and weakened bones.
Other Treatment Options
In addition to standard treatments, other treatments are being investigated in clinical trials. Patients may want to consider taking part in a clinical trial when weighing treatment options. The treatments that are currently being tested include:
Cryosurgery
Cryosurgery uses an instrument to freeze and destroy prostate cancer cells.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms, including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body, killing mostly cancer cells, but also some healthy cells. Since chemotherapy in the treatment of prostate cancer is still being investigated, it is not clear whether it can prolong survival in men with prostate cancer.
Biological Therapy
Biological therapy is the use of medications or substances made by the body to increase or restore the body’s natural defenses against cancer. It is also called biological response modifier (BRM) therapy.
High-intensity Focused Ultrasound
This treatment uses an endorectal probe that produces ultrasound (high-energy sound waves), which can destroy cancer cells.
Conformal Radiation Therapy
Conformal radiation therapy uses three-dimensional radiation beams that are conformed into the shape of the diseased prostate. This treatment spares nearby tissue the damaging effects of radiation.
Intensity-Modulated Radiation Therapy (IMRT)
IMRT uses radiation beams of different intensities to deliver higher doses of radiation therapy to the tumor and lower doses to nearby tissues at the same time.
Prevention
Beginning at age 50, men should be offered a digital rectal exam and PSA blood test to screen for prostate cancer. Many, but not all professional organizations, recommend a yearly PSA blood test for men over age 50 to screen for prostate cancer. Black men and men with close family members who have had prostate cancer diagnosed at a young age should begin screening at age 45. All men should discuss PSA testing with their physician.

Primary Pulmonary Hypertension

2009-01-11T05:22:00.000-08:00

Primary Pulmonary Hypertension
(PPH, Unexplained Pulmonary Hypertension, Idiopathic Pulmonary Hypertension, Pulmonary Arterial Hypertension, Sporadic Primary Pulmonary Hypertension, Familial Primary Pulmonary Hypertension)
Pronounced: PRY-mair-ee PUL-mo-nair-ee hi-per-TEN-shun
Definition
Primary pulmonary hypertension (PPH) is a rare disease that causes high blood pressure in the blood vessels of the lungs. A person with PPH has extra muscle in the walls of those blood vessels. That extra muscle makes it more difficult for blood to flow through them. So, the right side of the heart, which pumps blood to the lungs, has to work harder. This additional strain can eventually lead to heart failure.
PPH is a serious condition that requires care from your doctor.
Heart and Lungs

Causes
The cause of PPH is unknown, but several factors may contribute to the development of the disease, including:
• Immune system disease
• Exposure to certain drugs or chemicals
• Genetic defects
Risk Factors
A risk factor is something that increases your chances of getting a disease or condition. The following factors increase your chances of developing PPH:
• Female between the ages of 20 and 40
• Family history of PPH
• Use of appetite suppressants – diet drugs
• Cocaine use
Symptoms
Initial symptoms of PPH may be minor, and will get progressively worse. If you experience any of these symptoms do not assume it is due to PPH. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.
• Shortness of breath, especially when you’re active
• Hyperventilation – abnormally rapid, deep breathing
• Fatigue – tiredness
• Progressive weakness
• Fainting spells
• Light-headedness during exercise
• Dizziness
• Coughing up blood
• Cyanosis – a bluish tint to the lips and skin
• Swelling of the legs and hands
• Chest pain
A physical exam by your doctor may show:
• Swelling of the veins in your neck
• Enlarged liver
• A heart murmur – an abnormal sound in the heart
Diagnosis
Diagnosis of PPH may be delayed because it is hard to detect until symptoms worsen. Evaluation should take place at a medical center with expertise in pulmonary hypertension.
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following:
• Electrocardiogram (ECG, EKG) – a test that records the heart’s activity by measuring electrical currents through the heart muscle.
• Chest x-ray – a test that uses radiation to take a picture of structures inside the body. A chest x-ray can show if the heart is enlarged.
• CT scan of the chest – a type of x-ray that uses a computer to make pictures of structures inside the chest.
• Echocardiogram – a test that uses high-frequency sound waves (ultrasound) to examine the size, shape and motion of the heart.
• Pulmonary function tests – non-invasive tests, like blowing into a tube, that measure how well your lungs are working.
• Cardiac catheterization – a tube-like instrument inserted into the heart through a vein or artery (usually in the arm or leg) to detect problems with the heart and its blood supply.
• Pulmonary arteriogram – a type of x-ray that takes pictures of the blood vessels in the lungs, to detect blood clots and other blockages.
• Nuclear lung scan – a special camera takes pictures of the lungs, to look for blockages in the blood vessels.
Treatment
There is no cure for PPH. Treatment is used to help alleviate and control the symptoms. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Medication
Calcium channel-blocking drugs – to relax the muscles in the blood vessels in the lungs
Anticoagulants – to decrease the chance of blood clots in the lungs
Diuretics – to reduce the amount of fluid in the body and in turn reduce strain on the heart
Vasodilators – to help reduce blood pressure in the blood vessels in the lungs
Supplemental oxygen
Delivered through a mask or tubes inserted into the nostrils, if breathing becomes difficult
Lung transplant or heart-lung transplant
Defective lungs and/or heart are replaced with donor organs. This option is used only in severe cases of PPH.
Prevention
There are no guidelines for preventing PPH because the cause is not known.

Polycythemia

2009-01-11T05:21:00.000-08:00

Primary Polycythemia
(Polycythemia Vera (PCV), Polycythemia Rubra Vera (PRV), Erythremia)
Pronounced: pol-ee-si-thee-me-a
Definition
Polycythemia is a condition that occurs when the bone marrow produces an abnormal and excessive amount of red blood cells and platelets in the blood. The abnormal increase of red blood cells in the blood can cause the blood to thicken and clot.
There are several forms of polycythemia—primary polycythemia, secondary polycythemia, and stress polycythemia—and each form has its own set of causes and risk factors.
Primary polycythemia is a serious and chronic condition that requires immediate care from your doctor. No cures exist for this condition, but there are treatment options. It is extremely important that you seek medical attention to establish a treatment plan.
Location of Active Bone Marrow in an Adult

Causes
The precise cause of primary polycythemia is unknown. There are no apparent genetic or environmental factors that can be attributed to causing primary polycythemia.
Risk Factors
A risk factor is something that increases your chances of getting a disease or condition. The following factors will increase your chances of developing primary polycythemia:
• Sex: Male. Men are twice as likely to be affected as women
• Age: Individuals over the age of 40 years old are far more likely to be affected; only very rarely are individuals under the age of 40 diagnosed with primary polycythemia
• Race: Caucasians are more likely to develop primary polycythemia than non-Caucasians
• A history of abnormal or increased production of platelets in the blood
• A history of an overall increase in the total number of red blood cells in the blood
• A history of blood clotting or thickening of the blood in the veins and major arteries
Symptoms
The symptoms of primary polycythemia occur gradually and vary from person to person. Some people are asymptomatic (showing no signs of the condition) while others are symptomatic (showing signs of the condition). If you experience any of the following symptoms, do not assume it is due to primary polycythemia. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.
• Abnormal and heavy bleeding due to a cut or a nosebleed
• Intense and frequent bone pain and/or muscle pain
• Headaches
• Difficulty or labored breathing
• The color of the skin appears reddish
• Fatigue (a state of weariness following a period of mental or physical activity)
• Inability to concentrate
• Intense itching after a warm or hot bath, shower, or any activity that requires soaking your skin in warm or hot water.
Diagnosis
Your physician will ask about your symptoms and medical history, and perform a physical exam. You may also be referred to a doctor who specializes in blood diseases and disorders (called a hematologist). The hematologist will perform a series (a set) of tests that may include:
• A complete blood count (CBC) test to measure your hematocrit level (the proportion of red blood cells in the blood).
• A bone marrow biopsy (where a hollow-needle is inserted into your pelvic bone to remove a sample of your bone marrow cells) is performed to determine the rate at which the bone marrow is overproducing red blood cells. This test is also used to help determine what type of medication and other treatment options will slow the production of red blood cell in the bone marrow.
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Phlebotomy
Phlebotomy is a technique that requires a person to periodically have blood removed from a vein to decrease the overall total proportion of red blood cells in the body. The frequency of the treatment is based on how quickly a person’s bone marrow produces an excessive amount of red blood cells.
Myelosuppressive Agents
Myelosuppressive agents are drugs taken orally (by mouth) to block or interfere with the formation of new cells. These drugs reduce bone morrow production of cells to decrease platelets and the overall proportion of red blood cells in the body.
Chemotherapy
Chemotherapy is a group of drugs that can be given orally (by mouth), by injection, or through a catheter (tubular device that is inserted into a duct or blood vessel) to slow the rapid development of red blood cells in the bone marrow.
Prevention
There are no known preventative measures that will reduce your chances of getting primary polycythemia. Primary polycythemia is not contagious. There is no cure for primary polycythemia. Recent research suggests that individuals who have primary polycythemia may significantly increase their overall life expectancy by seeking immediate and timely treatment for their condition.

Pressure Sores

2009-01-11T05:18:00.000-08:00

Pressure Sores
(Pressure Ulcers; Bed Sores; Decubitus Ulcers)
Definition
A pressure sore is a lesion that develops on the skin and underlying tissues due to unrelieved pressure usually over a bony prominence. The skin and tissues rely on an adequate blood supply for oxygen and nutrients. When tissues are compressed for an extended period from hours to days, blood supply can be cut off, leading to development of a sore.
Pressure Sore (Skin Ulceration)

Causes
Pressure sores result from lying or sitting in one position for too long a time. Prolonged pressure cuts off the blood supply to tissues that are compressed between a bony area and a mattress, chair, or other object. Without oxygen and nutrients, the tissue starts to die.
Several factors contribute to the development of pressure sores including:
• Pressure - Inability to change position or to feel discomfort caused by pressure (People with normal mobility and sensation change position automatically, without thinking.)
• Friction – Even friction from pulling someone across bed sheets can damage small blood vessels that supply the skin tissue.
• Poor nutrition
• Moisture – From sweating due to an elevated temperature (fever) or leakage of urine or stool.
• Obesity – Extra weight increases pressure on the skin over the bones and joints.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
• Immobility, such as being bed- or chair-bound
• Sensory loss
• Poor nutrition
• Incontinence, or leakage of urine or stool
• Advanced age
• Chronic or complex medical problems, such as:
o Anemia
o Infection
o Poor circulation
o Dementia
o Cancer
o Diabetes
o Stroke
o Spinal cord injury or paralysis
• Bone fracture
• Swelling or water retention
• Dry skin
• Fever
Symptoms
Symptoms of a pressure ulcer may include:
• Skin tissue that feels firm or boggy
• Local redness, warmth, tenderness or swelling
• Redish or purplish skin discoloration, often over a bony area
• Pain or itching of the skin
• Blistering, sores, skin breakdown or drainage
If the redness remains a half hour after the pressure has been removed, the skin will likely break down. The reddened area may blister and a shallow ulcer may develop. Fluid may drain. The wound can deepen and can extend through fat and muscle to the bone. The area may be painful. The wound can become infected, with redness, swelling, odor, pus, warmth and fever. If untreated, the infection can progress to gangrene, a blood infection, or an infection of the bone beneath.
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor will examine the ulcer and note the location, shape, size, depth, stage, and any formation of pockets or cavities. Pressure sores are staged according to the depth and tissues that are involved.
Tests may include:
• Wound Culture – taking a sample of material from a sore to be tested for bacteria
• Blood tests – to check for infection and nutritional status
• X-ray or Bone Scan – if bone infection is suspected
Treatment
Treatment aims to relieve pressure on the area, heal the wound, avoid complications, and prevent future pressure sores. In many cases, a caregiver will provide care for your pressure sores.
Treatment includes:
Positioning
• Avoid placing any weight or pressure on the wound.
• Change position at least every two hours, around the clock.
• Maintain good body alignment.
• Make sure bedclothes are clean and without wrinkles.
• You may need a special mattress.
• Use a “lift sheet” to move the patient rather than pull the bedsheet or the patient to move them.
Hygiene
Clean soiled skin after each bowel movement and urination. Wash with mild soap and warm water. Rinse well. Pat dry. Do not rub. Apply lotion as recommended by the doctor.
Wound Care
A nurse or doctor will teach you or your caregiver how to tend to the wound. Some basic instructions include:
• Clean the sore, remove dead tissue, and apply a dressing.
• Do not put anything else on the ulcer.
• Wash hands before and after performing wound care.
• Clean the wound every time the bandage is changed.
• You may need to take pain medication a half hour or hour before dressing changes.
Nutrition
Eat well-balanced meals. Your doctor may recommend vitamins, minerals or supplements.
Surgery and Other Procedures
The doctor may surgically remove dead tissue and skin grafts may be needed. In some situations, electrotherapy may be used to stimulate blood flow and promote healing.
Prevention
Most pressure ulcers can be prevented. Suggestions include:
• Repositioning
o Change position in bed at least every 2 hours or, in a wheelchair, at least hourly. If able to move yourself, shift position every 15 minutes.
o Maintain good body alignment.
o Do not elevate head of bed greater than 30 degrees, to prevent sliding.
o Find a sitting or lying position that is 30 degrees toward one side or the other, but not squarely on the hip.
o Place a pillow under calves, to keep the heels off the mattress.
o Place a pillow between the knees.
o Do not use donut-ring cushions, which can cut off circulation.
• Use a special bed mattress or wheelchair cushion.
• Wear special pads to protect skin that is resting against braces and other devices.
• When moving someone, lift rather than drag.
o Use assistive devices, such as transfer boards and mechanical lifts.
o Try placing a sheepskin under a body part to decrease friction.
• Keep the skin clean and dry.
• Do not massage bony areas.
• If incontinent, use a protective cream on skin that may come in contact with urine or stool. Frequently check the patient and do not let feces or urine remain for extended periods of time
• Check the skin at least daily for signs of pressure problems.
• Keep sheets clean and free of wrinkles
• Maintain good nutrition.

Presbyopia

2009-01-11T05:16:00.000-08:00

Presbyopia
Pronounced: Prez-bee-OH-pee-ah
Definition
Presbyopia is the inability to focus on and clearly see objects that are close by.
Causes
Presbyopia is caused by an age-related, gradual loss of flexibility within the lens of the eye. Because the lens is less elastic, it cannot adequately change its shape to sharply focus on objects close by.
Anatomy of the Eye

Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for presbyopia include:
• Age: over 40 years old
• Family members with early onset presbyopia
Symptoms
Symptoms include:
• Having to hold items further away (at arm's length) to focus on them
• Blurred vision when reading close up
• Eye fatigue, discomfort, or drowsiness when doing close-up work such as:
o Reading
o Needlepoint
o Computer work
• Symptoms often made worse by over-tiredness or stress
Diagnosis
A vision specialist will ask about your symptoms and medical history, and perform an eye exam. You will be asked to read materials at a distance that is typically comfortable while the doctor places different lenses in front of your eyes. This test determines the extent of your presbyopia.
Treatment
Presbyopia is usually treated with corrective lenses. Lens options include:
Glasses
If you already wear glasses, you may need a second set for reading and other close-up activities. Bifocals combine two prescriptions into one pair of glasses. The upper half of bifocals corrects distance vision and the bottom half corrects close-up vision. Trifocals are similar to bifocals, except that they have a medium range lens between the distance and near portions to help with intermediate vision tasks.
Another option is progressive lenses, which provide a gradual increase in reading prescription as you look down on the lens. This provides a range of correction for you to use depending on the distance between you and the object you are trying to look at. If you currently do not need vision correction for distance, then you will only need a pair of glasses to correct your up-close vision. However, some people with perfect distance vision still opt to wear bifocals that are clear on top and have the reading prescription on the bottom so that they can wear them all the time rather than having to put glasses on and off to read.
Contact Lenses
Bifocal contact lenses are available and act the same way as bifocal glasses, with an area for distance and an area for near vision correction. Another option is monovision contact lenses. One eye wears a lens to correct distance vision and the other to correct up-close vision.
Reading Glasses
If you do not need glasses for distance, you can sometimes buy reading glasses without a prescription. These are typically available in drug stores, discount stores, and vision centers. They are made in increments of .25 magnification. The typical range of correction needed is from +1.00 to + 3.00. However, even if you use these glasses, it is still important for you to get a comprehensive eye examination regularly. Also, these glasses are not custom made to correct for the specific distance between your eyes. While they work well for the “average” person, they may not work well for you. If you feel uncomfortable while wearing over-the-counter reading glasses, be sure to see your eye doctor.
Conductive Keratoplasty
Conductive keratoplasty (CK) is a procedure performed by an ophthalmologist to correct presbyopia in one eye. The surgeon places a small probe that emits radiofrequency energy into the cornea to reshape it. This is performed in one eye only, so that the other eye is dominant for distance vision and the eye receiving the CK is focused for near vision.
Multifocal Intraocular Lenses
Multifocal intraocular lenses can be placed inside the eye in place of the eye’s natural lens. This is typically performed at the time of cataract surgery. The multifocal lens focuses on both distant and near objects simultaneously, often eliminating the need for glasses.
Prevention
Presbyopia is thought to be an inevitable part of the aging process. Currently, there are no guidelines for preventing it or delaying its onset.

Presbycusis

2009-01-11T05:14:00.000-08:00

Presbycusis
(Presbyacusis, Age-Related Hearing Loss, Presbyacusia)
Pronounced: Pres-bih-CUE-sis
Definition
Presbycusis is gradual hearing loss in both ears that commonly occurs as people age. Nearly half of all people 75 years and older have this form of gradual hearing loss which can be mild, moderate, or severe. Presbycusis usually involves permanent hearing loss sometimes referred to as ‘nerve deafness.’ Certain medical problems can also lead to hearing loss. If you suspect you have presbycusis, contact your doctor.
The Ear

Causes
There are several causes of presybcusis including:
• Gradual degeneration of the eardrum or delicate structures within the inner ear (hair cells) due to age
• Changes in the hearing nerve pathways in the ear leading to the brain
• Repeated exposure to loud sounds, music, or equipment which can damage the fragile hair cells within the inner ear involved in hearing
• Hereditary or genetic influences
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
The following factors increase your chances of developing presbycusis:
• Family history of gradual hearing loss with advancing age
• Use of certain medications, including aspirin and some antibiotics and cancer medications
• Certain health conditions, including cardiovascular disease, high blood pressure , diabetes , and other circulatory problems
Symptoms
If you experience any of these symptoms do not assume it is due to presbycusis. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.
• Noticeable loss of hearing of higher-pitched sounds, such as female voices, telephone ringing, or bird calls
• Sounds appear less clear and sharp
• Difficulty understanding conversations, particularly in noisy places or while speaking on the telephone
• Ringing in one or both ears, a condition called tinnitus
• Background sounds appear overly loud or bothersome
• Ear fullness with or without dizziness
With presbycusis, hearing loss is usually very gradual, affecting both ears equally.
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam of your ear canal and eardrum with a lighted instrument called an otoscope. You will probably need to see a specialist, including an otolaryngologist, a doctor specially trained in disorders of the ear, nose, and throat. You may also see an audiologist who can do a complete hearing evaluation to determine the extent of hearing loss. Your primary care doctor can help refer you to an otolaryngologist who often works in association with an audiologist.
Tests may include the following:
• Rinne Test --involves a vibrating tuning fork placed on the bone behind your ear to test for hearing loss
• Weber Test --a tuning fork is placed on the forehead to determine one-sided hearing loss
• Audiometry --wearing headphones and listening for different tones of various pitch and loudness
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Hearing Aids and Assistive Listening Devices
If it is determined that a hearing aid may be useful, the audiologist will conduct several tests to determine the type of hearing aid that will best improve hearing of speech. The extent of benefit varies according to the cause and degree of hearing loss. Sometimes hearing aids will need to be replaced with other models if hearing loss progresses. Some people with presbycusis may benefit from telephone amplifiers that help hear speech on the telephone.
Cochlear Implants
For certain people with very severe hearing loss that is not improved by a simple hearing aid, a cochlear implant device may improve sound generation to the brain. It may provide partial hearing to the profoundly deaf.
Prevention
To help reduce your chances of developing presbycusis, take the following steps:
• Avoid repeated exposure to loud noises and sounds of any type, including those at work, home, and during recreation
• When working with loud machinery or in loud environments, wear protective ear plugs or ear muffs

Premature Ventricular Contractions

2009-01-11T05:12:00.000-08:00

Premature Ventricular Beats
(Ventricular Premature Beats, Premature Ventricular Contractions, Ventricular Ectopic Beats)
Definition
A premature ventricular beat (PVB) is an extra heartbeat caused by abnormal electrical activity that starts in the ventricles (the lower chambers of the heart) before a normal heartbeat occurs. This type of beat may not be as effective in pumping blood as a normal heartbeat. Because the PVB interferes with the heart’s normal rhythm and there is a pause before the next heartbeat, it may feel like a heartbeat is skipped.
PVBs are common, especially among the elderly. They can occur in people who are healthy, in which case they are harmless. However, when they occur after a heart attack or heart surgery they can lead to dangerous heart rhythms, which in some cases can cause sudden death. You should contact your doctor right away if you have PVBs after a heart attack or heart surgery.
Anatomy of the Heart

Causes
The causes of PVBs include:
• Physical or emotional stress
• Physical exercise
• Caffeine, alcohol, tobacco, and other drugs (eg, cocaine, amphetamines)
• Certain medications, especially those that stimulate the heart
• Heart disease:
o Heart attack
o Coronary artery disease
o Disorders that cause the ventricles to get larger (eg, heart failure )
o Heart valve disorders
o Congenital heart disease
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
The following factors increase your chance of developing PVBs:
• Age: Frequency increases with age; PVBs are most common in the elderly
• Sex: More common in men than women
• Race: African Americans have a much higher risk than white people
• Heart disease
• Use of caffeine, alcohol, tobacco, or other drugs
Symptoms
In many cases, there are no symptoms. When symptoms do occur they can include:
• Feeling the heart beating (palpitations)
• Feeling of a skipped or missed heart beat
In people with heart disease, PVBs can cause decreased blood flow from the heart to other parts of the body. This can produce dizziness and fainting.
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. If you have heart disease, you should see a cardiologist.
Tests may include:
• Lab Tests :
o For electrolyte levels, especially potassium and magnesium
o For medication levels in people taking medication that may affect heart rhythms
• Electrocardiogram (ECG –shows the electrical activity of the heart rhythm and rate
• Continuous Cardiac Monitoring (eg, Ambulatory or Holter Monitoring) –this may be used if you have symptoms but heart rhythm disturbance does not show up on an ECG; this type of monitoring is helpful because it measures heart activity over a longer period of time (eg, 24 hours)
• Echocardiogram –shows an image and function of heart structures using ultrasound (high-frequency sound waves)
Treatment
In most cases, no treatment is needed. However, it can be helpful to reduce stress and avoid caffeine, alcohol, and tobacco. If a medication you are taking may be causing the PVBs, talk with your doctor about whether you should reduce the dose or change medications.
You may need to take medication to control the PVBs if you have significant symptoms from PVBs, if you have heart disease, or if the pattern of the PVBs indicates a risk of developing more serious heart rhythm problems. Beta-blockers are generally tried first since they are relatively safe medications. Antiarrhythmic drugs may be used, but they may also increase the chances of developing dangerous heart rhythms. Other medications that may be used include calcium channel blockers. Talk with your doctor about the best treatment for you.
Prevention
To help reduce your chances of having PVBs:
• If you smoke, quit
• If you consume caffeine and/or alcohol, do so in moderation

Premature Ejaculation

2009-01-11T05:04:00.000-08:00

Premature Ejaculation
(Rapid Ejaculation)
Definition
Ejaculation occurs when a man reaches sexual climax and semen is ejected from his penis. Premature ejaculation is:
• Ejaculation occurs before the man wishes it to occur.
• Ejaculation occurs too quickly to sexually satisfy his partner.
Causes
Many men experience premature ejaculation at one time or another. For example, some men experience it after not having had sex for a long period of time. Premature ejaculation is only a problem when it becomes a persistent condition. Persistent premature ejaculation usually results from a man's inability to recognize that he is about to ejaculate. (Ejaculation occurs automatically after a certain degree of sexual stimulation.) This inability prevents him from taking steps to delay the process.
Psychological factors that may contribute include:
• Guilt about sex
• Fear of causing pregnancy
• Fear of getting a sexually transmitted disease
• Concerns about sexual performance
• Interpersonal difficulties between sexual partners
• Early sexual experiences that condition a man to rapid ejaculation. This includes fear of "being caught" having sex.
In rare cases, premature ejaculation can be caused by:
• Prostate problems, such as prostatitis
• A neurological problem
• Medications that increase sexual stimulation
• Certain medical conditions (eg, thyroid problems)
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for premature ejaculation include:
• Lack of sexual experience
• Lack of knowledge of male and female sexual responses
• Fear of:
o Causing pregnancy
o Contracting a sexually transmitted disease
o Poor sexual performance
• Interpersonal problems between sexual partner
• Early sexual experiences that precondition a man to rapid ejaculation
Symptoms
The primary symptom is persistent episodes of premature ejaculation during sex. Secondary symptoms may include:
• Feelings of guilt, inadequacy, or self-doubt
• New or increased interpersonal problems with a sexual partner
Diagnosis
Most men experiencing premature ejaculation will notice the condition themselves. If you see a doctor about the condition, the doctor will ask about your symptoms and medical history, and perform a physical exam.
The doctor may search for an underlying medical cause if:
• You suddenly developed persistent premature ejaculation and have never experienced it before.
• You have other neurological symptoms.
• You are taking medication that may cause premature ejaculation.
• The condition is getting much worse or causing severe problems for you.
Treatment
Treatments may include:
Behavior Therapy
This aims to improve your ability to:
• Recognize when you are about to ejaculate
• Take steps to delay it
It may include:
Start and Stop Method— stopping sexual stimulation for 30 seconds when nearing climax, then resuming.
Squeeze Method— same as start and stop method, but includes gently squeezing the base of penis before the 30-second stop period.
Biofeedback— electrical feedback that helps you learn to control the muscles that cause ejaculation.
Sexual Positions— trying different sexual positions that may allow greater control over the muscles that cause ejaculation.
Psychological Counseling
Counseling may be offered for an individual or for a couple. It is aimed at identifying and treating:
• Fears or guilt
• Interpersonal problems with your partner that may contribute to the condition
Medication
In some cases, a doctor may prescribe a desensitizing cream that a man can apply to his penis to lessen sexual stimulation. In other cases, a doctor may prescribe an antidepressant medicine such as Zoloft or Prozac, since such antidepressants have been found to delay orgasm in both men and women. However, these drugs do not cure the underlying cause of premature ejaculation.
Prevention
To help prevent premature ejaculation:
• Learn how male and female sexual responses work.
• Improve communication with your partner before engaging in sexual activity.
• Have sex in situations that are private and relaxed.

Poliomyelitis

2009-01-11T05:03:00.000-08:00

Poliomyelitis
(Polio)
Definition
Poliomyelitis is a very contagious viral infection that can lead to paralysis.
Polio epidemics in the United States were once common throughout the summer months. Because of very effective vaccination programs, polio is now extremely rare in the Western world. However, polio is still a significant problem in parts of Africa and Asia.
Causes
Polio is caused by the poliovirus. You can get the virus from contact with:
• An infected person
• Infected saliva or feces
• Contaminated water or sewage
Poliovirus enters the body through the mouth. It travels to the intestines and reproduces quickly. The virus then travels through the blood and lymph fluid to attack and destroy areas of the nervous system.
Risk Factors
The following factors increase your chances of developing polio:
• Lack of vaccination or incomplete vaccination
• Travel to countries where polio is still common (areas of Africa and Asia)
• Preschool child with immune disorder, exposed to polio virus through vaccination
• Young adult exposed to poliovirus through contact with someone recently vaccinated
• Elderly adult
• Pregnancy
• Strenuous exercise
• Recent tonsillectomy or dental procedure
• Immunodeficiency
Symptoms
If you experience any of these symptoms do not assume it is due to polio. These symptoms may be caused by other, less serious health conditions. Contact your physician if you experience these symptoms.
• Minor illness
o Headache
o Fever
o Sore throat
o Illness lasts about a week
• Major illness
o Fever
o Headache
o Nausea and vomiting
o Diarrhea
o Stiff neck
o Neck pain
o Severe muscle pain
o Muscle spasms
o Muscle weakness
o Paralysis
o Usually asymmetric (affecting each side to varying amounts, or only affecting a single side)
o Muscles become flaccid (loose, floppy)
o Legs more commonly affected than arms
o Muscles required for breathing may be come paralyzed
o Urinary retention
o Decades later, previously stable muscle weakness may worsen due to post-polio syndrome
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include the following:
• Identifying the virus in material from throat swabs, rectal swabs, stool samples, or cerebrospinal fluid
• Immunological tests to prove that the body has responded to the presence of poliovirus by producing antibodies designed to fight the virus
Treatment
Talk with your doctor about the best treatment plan for you. There are no treatments available to rid your body of the poliovirus. Treatment is designed to be supportive, to treat your symptoms, and to help you avoid complications.
Bed Rest
While you still have a fever during the initial phase of illness, you’ll rest in bed. You may be fitted with splints to prevent your joints from becoming too stiff (contractures). You may receive physical therapy during which your limbs will be moved for you (passive exercises).
Fever Control
Analgesic medications such as acetaminophen or nonsteroidal anti-inflammatory agents can be given to lower fever and decrease muscle pain.
Assisted Ventilation
If the muscles you need to breathe become too weak or paralyzed, you may require a period of time on a mechanical ventilator which will take over the work of breathing for you.
Rehabilitation
As soon as possible after your fever passes, you will be given exercises and physical therapy to help you regain mobility and to improve your muscle strength.
Prevention
Two types of vaccines are available to prevent polio. Oral polio vaccine is given by mouth and uses weakened live viruses. Injected vaccine is in shot form and uses killed viruses. Although the risk is very small, there is a tiny chance of actually acquiring polio due to exposure to the live viruses used in the oral polio vaccine. Therefore, the Centers for Disease Control and Prevention now recommend that only injected vaccine be used.
Current immunization recommendations from the Centers for Disease Control and Prevention include:
• Children should receive a series of four immunization injections, at
o Two months
o Four months
o 6-18 months
o 4-6 years
• Adults who have never been immunized should receive a series of three injections if they are at high risk of contracting polio. Risk is increased in adults who
o travel to areas where poliovirus is still common,
o care for individuals with polio, or
o are laboratory workers in labs where poliovirus is handled.

Pneumothorax

2009-01-11T04:58:00.000-08:00

Pneumothorax
Pronounced: Noom-oh-THOR-ax
Definition
Pneumothorax is a condition in which air or gas collects in the "pleural space" or "pleural cavity," which is the space between the lungs and the chest cavity. This can cause the lung to collapse.
Normally, the lungs sit next to the inner surface of the chest wall. Thin membranes called pleura cover both the lungs and the chest wall. A pneumothorax occurs when air either escapes the lung or leaks in through the chest wall and builds up in the pleural space between them. This build-up of air can result in the collapse of the affected lung.
There are different types of pneumothorax, and each one is defined by its cause.
Causes
Primary Spontaneous Pneumothorax occurs when there is no other underlying lung disease. It is often caused by the rupture of an air-filled sac in the lung, called a bleb or bulla.
Smoking is associated with a higher incidence of spontaneous pneumothorax.
Secondary Spontaneous Pneumothorax occurs as a complication of another lung disease. Lung diseases which are associated with the development of pneumothorax include:
• COPD (Chronic Obstructive Pulmonary Disease)
• Asthma
• Cystic Fibrosis
• TB (tuberculosis)
• Pertussis (whooping cough)
Traumatic Pneumothorax occurs as a result of a traumatic injury to the chest. The injury could be penetrating, such as a bullet or stab wound, or blunt, such as a blow to the chest or automobile accident. A traumatic pneumothorax can complicate other medical procedures that may be necessary following a traumatic injury.
Rib Fractures With Pneumothorax

Tension Pneumothorax occurs when excessive pressure builds up around the lung and forces it to collapse. This pressure can also affect the heart’s ability to pump blood. For this reason, tension pneumothorax is considered the most serious type.
Risk Factors
The following factors increase your chances of developing pneumothorax:
• Spontaneous pneumothorax occurs most often in tall, thin men who are between the ages of 20-40
• Smoking
• Having a family history of pneumothorax
• Having other lung diseases such as COPD, asthma, cystic fibrosis, tuberculosis, or pertussis
• Suffering a trauma injury to the chest
• Infants who require ventilator assistance are at a higher risk of developing tension pneumothorax
• More men than women experience pneumothorax
Symptoms
If you experience any of the symptoms listed below do not assume it is due to pneumothorax. These symptoms are often caused by other, less serious health conditions. If you experience any of them, see your physician.
Symptoms of pneumothorax may occur while you are awake or while you are asleep. They can include:
• Sudden, sharp pain in the chest that becomes worse during coughing or taking deep breaths
• Acute shortness of breath
• Fever
• Fatigue
• Tightness in the chest
• Rapid heartbeat
• Bluish color of the skin due to a lack of oxygen
• Flaring of the nostrils
• Feelings of anxiety, stress, and tension
• Hypotension, or low blood pressure
• A distended abdomen
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. He or she may notice that the affected side of your chest has reduced or absent breath sounds during the stethoscope examination. Other tests may be performed, such as the following:
• A chest x-ray may be performed to determine if there is air outside the lung. In some cases, a CT scan may be performed instead. Both of these procedures involve taking pictures of your chest. Ultrasound is an alternative option for those who can’t be moved, commonly used in trauma cases.
• Pulse oximetry is a noninvasive way to measure your oxygen status.
Since the development of pneumothorax can be delayed in the case of traumatic pneumothorax, repeating x-rays the day after the injury may be needed.
Treatment
While a small pneumothorax will usually resolve itself without intervention in a week or two, a larger pneumothorax often requires treatment. Oxygen is commonly administered.
Treatment focuses on removing the air from the pleural space so the lung can again expand to its full capacity. This can be accomplished by inserting a needle and syringe or inserting a chest tube.
Chest Tube Insertion
• In this procedure, the doctor will insert a small tube between the ribs into the pleural cavity where the pneumothorax is located. Before the procedure, you may receive sedation, your doctor will then numb the area where the tube is to be inserted using local anesthesia. Next, he or she will make an incision, insert the tube, and connect it to a bottle or canister that contains sterile liquid. A suction mechanism is also attached to encourage drainage. The tube is held in place by a suture or a piece of surgical tape.
• The chest tube will remain in place until x-rays show that the air or gas has drained from the pleural space and the lung is once again fully expanded. This can take several days. No further medication is necessary, although sometimes antibiotics are prescribed to ward off possible infection from the tube.
Surgery to remove blebs or attach the lung permanently to the chest wall is sometimes needed to prevent recurrences.
Up to 50% of patients who experience pneumothorax have a recurrence, but there are no long-term consequences following treatment.
Prevention
There is no known way to prevent pneumothorax. However, you can lower your risk of developing pneumothorax by:
• Not smoking.
• Wearing a seatbelt when in a motor vehicle to help prevent accident-related chest trauma.
• Being aware of the symptoms associated with pneumothorax if you have another lung disease.
• If you have a history of pneumothorax, it is often recommended that you avoid SCUBA diving.

Pneumonia

2009-01-11T04:56:00.000-08:00

Pneumonia
Pronounced: Noo-MO-NEE-yah
Definition
Pneumonia is an infection of the lungs caused by a variety of different organisms.
Effects of Pneumonia on the Lungs

Causes
Pneumonia affects the lower respiratory tract (small bronchi and air sacs in the lungs). There are three main causes:
Bacterial Pneumonia— caused by bacteria, most commonly Streptococcus pneumoniae
Viral Pneumonia— caused by a virus. Viruses cause half of all pneumonias.
Atypical Bacterial Pneumonia— caused by mycoplasmas, chlamydias, or other tiny infectious agents that have traits of both bacteria and viruses. Walking pneumonia, as this type of pneumonia is often popularly called, implies a milder pneumonia. However, each of these infectious agents has the potential to cause a more serious or potentially fatal pneumonia.
Other causes of pneumonia include:
• Fungal infections, such as Pneumocystis cariniipneumonia (PCP)—a fungal infection common in people with AIDS
Pneumonias are sometimes divided on the basis of where it was acquired and how you were exposed to it:
• Community Acquired Pneumonia—this type of pneumonia is acquired, as the name suggests, in the community (ie, at school, work, gym etc.)
• Nosocomial Pneumonia—is acquired during a hospitalization. It can be very dangerous, especially for patients on a ventilator.
• Aspiration Pneumonia—it happens when a foreign matter (most frequently stomach content) is inhaled.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
• Age: 65 or older
• Flu or other respiratory illness
• Chronic illness, such as heart or lung disease
• Stroke (aspiration pneumonia due to difficult swallowing)
• Weakened immune system caused by AIDS or chemotherapy treatment
• Chronic bronchitis
• Malnutrition
• Pregnancy
• Infants and very young children
• Alcohol or drug abuse
• Smoking
• Chronic exposure to certain chemicals (eg, work in construction or agriculture)
Symptoms
Symptoms of pneumonia may include some or all of the following:
Bacterial Pneumonia Viral Pneumonia Atypical Pneumonia
Fever Fever Fever, often low-grade
Shaking chills Chills Chills
Cough that produces green, yellow, or rust-colored mucus Dry cough Coughing; may be violent at times; produces white mucus
Chest pain Headache Possible nausea or vomiting
Profuse sweating Muscle pain Weakness
Bluish color of the nails or lips due to diminished oxygen in the blood Bluish color of the nails or lips due to diminished oxygen in the blood
Confused mental state Weakness
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis of pneumonia is based on symptoms and listening to your chest with a stethoscope. In addition, tests may include:
• Chest X-ray —a test that uses radiation to take pictures of structures inside the body, in this case the chest
• CT Scan —a type of x-ray that uses a computer to make pictures of structures inside the chest
• Blood Tests
• Bronchoscopy —direct examination of airways
• Sputum Culture—testing mucus coughed up from deep in the lungs
• Pulse Oximetry—measures the amount of oxygen in the blood
• Arterial Blood Gas—measures oxygen, carbon dioxide, and acid in the blood
Treatment
Treatment of pneumonia depends on:
• The type of pneumonia
• Severity of symptoms
• Other factors
Common methods of treatment include:
Bacterial Pneumonia
Antibiotics.
Viral Pneumonia
• Rest and fluids
• Antiviral medicines—may be prescribed for young children and patients with weakened immune systems ( Note: Antibiotics are ineffective for treating viral pneumonia.)
Atypical Pneumonia
Usually treated with antibiotics.
General
• Over-the-counter medicines to reduce fever and aches, and soothe cough
• Hospitalization, for people with very severe symptoms
It is very important to take medicine exactly as prescribed. Stopping medicine midway may cause a relapse, or create a strain of bacteria resistant to drug treatment.
Prevention
Certain vaccines can help prevent pneumonia:
Flu Shot— for people at high risk, particularly the elderly, because pneumonia may be a complication of the flu
Pneumococcal Vaccine— recommended for people over age 65, or those who have a chronic illness, such as diabetes or sickle-cell disease
Other preventive measures include:
• Avoid smoking. Smoking weakens the lungs' resistance to infection.
• Avoid close contact with people who have respiratory infections.
• Wash hands often when coming in contact with infected people.
• Protect yourself from exposures on the job that affect the lungs.
• Eat a healthy diet.
• Get adequate rest.
• Exercise regularly.

Pneumocystis Pneumonia

2009-01-11T04:49:00.000-08:00

Pneumocystis Pneumonia
(PCP, Pneumocystis jiroveci)
Pronounced: new-mo-SIS-tis new-MOAN-ya
Definition
Pneumocystis Pneumonia (PCP) is a form of pneumonia that causes a lung infection. PCP is caused by a fungus called Pneumocystis jirovecii (P. jiroveci). This was previously called Pneumocystis carinii.
This infection affects people who have a weakened immune system. It is the most common serious infection among people with AIDS.
PCP can be prevented.
The Lungs (Cut-away View)

Causes
Most scientists believe that P jiroveci is spread in the air. It is not clear if it lives in soil or elsewhere. In healthy people, the fungus can exist in the lungs without causing pneumonia. However, in people who have a weakened immune system, PCP may cause a lung infection.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. People who are at increased risk for PCP include those who:
• Have AIDS
• Have cancer
• Are getting treatment for cancer
Symptoms
Symptoms of PCP usually develop over the course of a few weeks or months. The main symptoms of PCP are:
• Shortness of breath
• Fever
• Dry cough
• Tightness in the chest
• Weakness
See your doctor immediately if you experience these symptoms.
Diagnosis
To diagnose PCP, a sample of your sputum is examined under the microscope. Sputum is mucous material from your lungs that is produced when you cough. Your doctor will collect samples of your sputum by giving you either:
• A vapor treatment to make you cough
• A bronchoscopy, during which an instrument is inserted into your airway
Treatment
If you get PCP, your treatment will depend on how serious the infection is. If you have a mild case, you will be given medication in pill form. If you have a severe case, you will probably be treated in the hospital and receive medication intravenously.
There are several drugs used to treat PCP:
• Trimethoprim-sulfamethoxazole (TMP-SMZ): this is a combination of two medicines and has several brand names, such as Bactrim, Septra, and Cotrim. It is available in pill and liquid forms
• Dapsone plus trimethoprim
• Primaquine plus clindamycin
• Atovaquone
• Pentamidine (given intravenously)
• Trimetrexate plus folinic acid
• Corticosteroids: given in severe cases when blood oxygen pressure falls below a certain level
Most of these treatments have side effects which you and your doctor should take into account when considering treatment options.
Even when treatment is given for PCP, the death rate is 15%-20%. It’s best to avoid getting PCP in the first place.
Prevention
PCP can be prevented. If you are at risk for PCP because of a weakened immune system, your doctor may recommend that you take medicine to prevent getting it. In general, for those with HIV infection, preventing PCP with medication is recommended if your CD4 cell count falls below 200. Other conditions, like having a temperature above 100°F that lasts for more than two weeks, or getting a fungal infection in your mouth or throat, are reasons to start preventive therapy.
Some of the same drugs used to treat an infection can be taken regularly to prevent the infection:
• TMP-SMZ
• Dapsone
• Atovaquone
• Pentamidine aerosol
If you get PCP once, you are more likely to get it again. Each time you get it, it causes damage to your lungs and your body can suffer side effects from the drugs.
You may have heard of a pneumonia vaccine, but it only protects you from a different kind of pneumonia. It will not prevent you from getting PCP.

Pleurisy

2009-01-09T21:52:00.000-08:00

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Pleurisy
(Pleuritis)
Pronounced: PLUR-is-see
Definition
Pleurisy is an inflammation of the pleura, the double-layered membrane that surrounds each lung and the rib cage. The double-layered pleura protects and lubricates the surface of the lungs as they inflate and deflate within the rib cage. Healthy pleura have a thin, fluid-filled space between the two layers that lets them glide gently across each other. When they become inflamed, the diseased surfaces rub painfully together. This causes a characteristic sound called “friction rub.”
Pleurisy cases are defined as having pleural effusion or as being dry. Pleural effusion, an accumulation of fluid in the pleural space, is more common, and is essentially a side effect of numerous diseases or trauma. Dry pleurisy refers to cases where there is no fluid build-up. Pleural effusion is less painful due to the fluid forcing some separation of the membranes. However, the fluid puts pressure on the lungs which can lead to respiratory distress and even lung collapse.
Pleurisy is a potentially serious condition that can have long-term effects. The sooner you seek medical care, the more favorable the outcome. Contact your doctor if you think you may have pleurisy.
Pleura of the Lungs

Causes
There are several causes for either acute or chronic pleurisy.
• Viral infection
• Lung infections, such as pneumonia and tuberculosis
• Systemic lupus
• Asbestos
• Pancreatitis
• Rheumatoid arthritis
• Cancer metastases
• Liver and kidney disease
• Heart failure
• Pulmonary embolism
• Chest injury
• Drug reaction (nitrofurantoin, procainamide)
Risk Factors
The following factors increase your chances of developing pleurisy. If you have any of these risk factors, tell your doctor:
• Infection, injury, or tumor
• An underlying lung condition, such as pneumonia, tuberculosis, lung abscesses, or influenza
These are the most common causes, however, pleurisy can occur spontaneously.
Symptoms
If you experience any of these symptoms do not assume it is due to pleurisy. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.
• Sharp, stabbing pain towards the side and lower part of the chest
• Pain along the shoulders, neck, and abdomen
• Aggravated pain during any movement of the chest, such as breathing and coughing
• Dry coughing
• Weakness
• Headaches
• Loss of appetite
• Chills
• Fever
• Rapid pulse
• Rapid and shallow breathing
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. The distinctive pain associated with pleurisy can be enough to diagnose the condition. The doctor will use a stethoscope to listen for abnormal chest sounds, such as a friction rub. The next step is determining the illness that caused the pleurisy. Tests may include the following:
• Chest x-ray
• Blood test
• Computed tomography scan (CT scan)
• Ultrasound scan
• Fluid analysis after thoracentesis
o If a fluid analysis is not helpful, the physician may decide to perform a biopsy of the pleura with video-associated thoracic surgery (VATS)
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Pain Management
Analgesics and anti-inflammatory drugs, such as acetaminophen, ibuprofen, and indomethacin, are used to treat the pain. Some patients can reduce their pain by lying on the painful side, holding a pillow tightly, or wrapping chest with elastic bandages. The physician may prescribe codeine-based cough syrup to treat a painful cough.
Treating the Source of Infection
If pleurisy is the result of a bacterial infection, the physician can prescribe antibiotics. If it is the result of a viral infection, treatment is simply letting it run its course. If the cause is due to an autoimmune disease such as lupus, steroid treatment will quickly relieve pain.
Prevention
To help reduce your chances of getting pleurisy, take the following steps:
• Seek early medical attention for conditions that can cause pleurisy.
• Consider getting vaccinated for pneumonia, especially if you are elderly, have a chronic illness, or weakened immunity.

Pleural Effusion

2009-01-09T21:50:00.000-08:00

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Pleural Effusion
(Water on the Lungs)
Definition
Pleural effusion is the buildup of excess fluid in the space between the pleura. The pleura are two thin, moist membranes around the lungs. There are two layers of pleura:
• Inner layer – attached to the outside of the lungs
• Outer layer – lines the inside of the ribcage
There are two types of effusion: transudative and exudative, each having unique diagnostic properties. The two types have different causes, but in both cases, excess fluid prevents the lungs from fully expanding and causes shortness of breath.
Pleural Effusion

Causes
Effusion is usually caused by disease or injury. The two types have different causes:
Causes of Transudative Effusion:
• Heart failure
• Malnutrition
• Liver disease
• Kidney disease
Causes of Exudative Effusion::
• Tuberculosis
• Pneumonia
• Cancer
Risk Factors
A risk factor is something that increases your chances of getting a disease or condition.
• Pneumonia, tuberculosis, or other lung diseases
• Heart attack, heart failure, or infections such as pericarditis, recent cardiac surgery
• Inflammation or infection of the pleura
• Liver disease
• Tumors
• Pregnancy
• Connective tissue diseases, such as rheumatoid arthritis and lupus
• Certain medications:
o Nitrofurantoin
o Dantrolene
o Methysergide
o Bromocriptine
o Procarbazine
o Amiodarone
• Cancers, such as lung, breast, lymphoma, or mesothelioma
• Chest injury or trauma
• Radiation therapy
• Pulmonary embolus (blood clot in the lungs)
• Abdominal infections or pancreatitis
• Surgery, especially involving
o Heart
o Lungs
o Abdomen
o Organ transplantation
Symptoms
Some types of pleural effusion do not cause symptoms. Others cause a variety of symptoms, including:
• Shortness of breath
• Chest pain
• Stomach discomfort
• Cough
• Coughing up blood
• Shallow breathing
• Rapid pulse or breathing rate
• Weight loss
• Fever, chills, or sweating
• Hiccupping
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. This may include listening to or tapping on your chest.
Tests may include:
Chest x-ray – a test that uses radiation to take a picture of structures inside the chest
Ultrasound – a test that uses sound waves to examine structures inside the chest
CT Scan – a type of x-ray that uses a computer to make pictures of structures in the chest
Thoracentesis – fluid sample extracted from the pleural space around the lungs with a needle
Pulmonary Function Tests – to check breathing ability
Biopsy – removal of a sample of pleural tissue for testing
Treatment

Treatment is usually aimed at treating the underlying cause. If breathing is impaired, breathing treatments or supplemental oxygen may be given. The pleural effusion may be drained by inserting a needle into the area and withdrawing fluid (therapeutic thoracentesis) or by inserting a chest tube (tube thoracostomy) into the side of your chest and leaving it in place for several days, eventually attached to suction.
In some cases, the doctor may recommend chemical pleurodesis. During this procedure a chemical is injected into the pleural space to permanently seal the two layers of the pleura together. This may help prevent further fluid build-up.
Prevention
The best way to prevent pleural effusion is to get prompt treatment for any condition that may lead to pleural effusion.

Plantar Fascitis

2009-01-09T21:47:00.000-08:00

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Plantar Fasciitis
Pronounced: plan-tar fah-shee-eye-tis
Definition
Plantar fasciitis is inflammation of the plantar fascia. The plantar fascia is a thick band of tissue attached to the heel bone that supports the arch of the foot.
Plantar Fasciitis

Causes
Plantar fasciitis is caused by activity that puts extra stress on the foot, such as:
• Physical exertion, especially in sports that require running and jumping such as:
o Running
o Volleyball
o Tennis
• Sudden increase in exercise intensity or duration
Risk Factors
A risk factor is something that increases your chance of getting a disease, condition or injury. The main risk factor for plantar fasciitis is physical activity that stresses the plantar fascia. Other risk factors include:
• Obesity
• Weight gain
• Pre-existing foot problems, including an abnormally tight Achilles tendon (heel cord), flat feet, or unusually high arches
Symptoms
Symptoms of plantar fasciitis may come on gradually or suddenly. Symptoms include:
• Burning pain on the sole of the foot
• Heel pain when taking the first steps in the morning
• Tenderness when touching the sole or heel
• Pain when standing on tiptoe
Diagnosis
The doctor will ask about your symptoms and medical history, and examine your foot.
Tests may include:
• X-ray or bone scan of the foot – to help rule out stress fractures or bone spurs
Treatment
Treatments include:
Rest – Avoid running and other activities that may worsen pain.
Ice – Apply ice or a cold pack to the heel and arch for 15-20 minutes, 4 times a day to relieve pain. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
Medication – The following medications can relieve pain and inflammation:
• Ibuprofen (Motrin, Advil)
• Naproxen (Aleve, Naprosyn)
• Acetaminophen (Tylenol)
• Aspirin
• Corticosteroid injections (may be given by a doctor)
Night Splint – This splint will hold your foot in a neutral position while sleeping.
Orthotics – These special shoe inserts provide support for the mid-arch region of your foot.
Physical Therapy – Begin stretching exercises to lengthen the Achilles tendon and plantar fascia as recommended by a health care professional.
Surgery – In a few cases, basic treatments don’t help, and surgery is performed to cut the tight, swollen fascia.
Prevention
To reduce your risk of getting plantar fasciitis:
• Wear appropriate and well-fitted footwear during sports and exercise.
• Do stretching exercises for the Achilles tendon and plantar fascia.
• Increase intensity and duration of exercise gradually.
• Maintain an appropriate weight

Placent Abruptio

2009-01-09T21:46:00.000-08:00

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Placental Abruption
(Premature Separation of Placenta, Ablatio Placentae, Abruptio Placentae)
Definition
Placental abruption is a condition that occurs during pregnancy when the placenta separates from the uterus before the fetus is delivered. The placenta is the organ that provides nourishment for the fetus while it is still in the uterus.
In a healthy pregnancy, the placenta remains attached to the uterine wall until after the fetus is delivered.
Placental abruption is not a particularly uncommon condition, with some form (ranging from very mild to the most severe) of the condition affecting approximately one in every 150 births. In very severe forms, placental abruption can cause death to the fetus. This occurs in approximately one in every 500-750 deliveries.
Death of the mother from placental abruption is extremely rare. Infants who survive delivery with placental abruption have a 40%-50% chance of experiencing complications.
Placental abruption can cause premature delivery, low birth weight, and significant blood loss for the mother.
Causes
The cause of placental abruption is often difficult to diagnose. Some common causes of the condition include:
• Injury to the abdomen from an accident or a fall
• Sudden decrease in the volume of the uterus, from significant loss of amniotic fluid or from the delivery of a first twin
• Abnormally short umbilical cord
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
The following factors increase your chance of developing placental abruption:
• Previous placental abruption in a prior pregnancy
• High blood pressure during pregnancy
• Pregnancy during older age
• Multiple previous deliveries (greater than average number)
• Excessively distended uterus
• Diabetes
• Drug use (cocaine)
• Cigarette smoking during pregnancy
• Alcohol abuse during pregnancy (more than 14 drinks per week during the pregnancy)
Symptoms
Symptoms include:
(In early stages, no symptoms may be present)
• Vaginal bleeding
• Abdominal pain
• Back pain
• Rapid contractions
• Soreness in the uterus
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include the following:
• Pelvic examination
• Ultrasound—a test that uses sound waves to examine the abdomen
• Blood tests
o Prothrombin Time Test—tests time it takes for the plasma in the blood to clot
o Partial Thromboplastin Time Test—tests time it takes for the blood to clot
o Fibrinogen Test—tests blood levels of a protein that helps blood to clot
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include:
Intravenous Treatments
Fluids may be administered intravenously to replace lost fluids. Blood transfusions may also be given to replace lost blood supply.
The mother and fetus will be carefully monitored for signs of distress or shock, including abnormal heart rates.
Emergency Cesarean Delivery
If danger exists for mother or fetus, an emergency Cesarean delivery may be performed. If both the mother and fetus are at low risk of complications and the fetus is full-term, the mother may deliver vaginally.
Prevention
To help reduce your chance of getting placental abruption, take the following steps:
• Avoid drugs (especially cocaine), alcohol, and smoking during pregnancy.
• Receive proper and regular prenatal care throughout the pregnancy.
• Promptly treat conditions in the mother, including diabetes and high blood pressure.

Placenta Previa

2009-01-09T21:43:00.000-08:00

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Placenta Previa
Definition
The placenta is an organ that develops in the uterus during pregnancy. Its purpose is to nourish the baby. Oxygen and nutrients pass through the placenta to the baby, and waste products pass back out.
Placenta previa occurs when the placenta becomes implanted near or over the cervix. The cervix is the lower part of the uterus that opens into the vagina. With this condition, the placenta may cover part or all of the cervix. This condition is only diagnosed after 20 weeks of gestation.
The incidence of placenta previa is approximately 1 out of 200 births.
Placenta previa can cause problems in pregnancy and birth. These include:
• Abnormal bleeding, sometimes heavy
• Premature separation of the placenta from the uterus
• Premature birth
• Emergency cesarean (c-section) delivery
• Placental problem with penetration into the wall of the uterus (accrete, percreta)
Placenta Previa

Causes
Possible causes of placenta previa include:
• A scarred endometrium (the lining of the uterus)
• A large placenta
• An abnormal uterus
• Abnormal formation of the placenta
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
• Previous cesarean section
• Uterine problems, such as fibroids
• Multiple pregnancy (two or more fetuses)
• Multiple previous full-term pregnancies
• Increasing age
• Smoking
Symptoms
Placenta previa varies in severity depending on how much of the cervix is covered. The main symptom is painless bleeding from the vagina. This bleeding can range from light to very heavy. It usually occurs suddenly during late pregnancy. Spotting earlier in pregnancy may indicate placenta previa, but in most cases the placenta safely grows away from the cervical opening by the time of delivery.
Anything that disrupts the placenta, such as sexual intercourse or digital exam of the vagina and cervix, may cause bleeding.
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. He or she will not, however, perform a pelvic exam if placenta previa is a possibility. A pelvic exam may cause bleeding. Instead, an ultrasound will be done through the vagina or abdomen to view the placenta in the uterus. If placenta previa is detected early in pregnancy, with or without bleeding, another ultrasound will be done during the third trimester to be sure it has resolved.
Treatment
Treatment depends on several factors, including the amount of bleeding.
If placenta previa is diagnosed through an ultrasound but you have no bleeding, you do not need any treatment besides having the condition checked regularly. Your doctor may suggest that you take extra iron and folate in case you do have bleeding.
If only minor bleeding occurs and your pregnancy is 36 weeks or less, you may need to go on bed rest. If the bleeding stops, you may be allowed to get out of bed. However, you still need to be careful due to the risk of sudden bleeding. You should avoid intercourse and orgasm because they may start contractions and cause trauma to your cervix.
If the bleeding is heavy or your pregnancy is 37 weeks or more, the baby is delivered. You will most likely need a cesarean section.
Complications
Maternal potential complications include major hemorrhage, shock, and death.
The risk of infection and formation of blood clots or thromboembolism also increases, as does the likelihood of the need for a blood transfusion.
Prematurity, which occurs when an infant is less than 36 weeks gestation, is responsible for about 60% of infant deaths secondary to placenta previa.
Fetal blood loss or hemorrhage may occur because of the placenta tearing away from the uterine wall during labor. It may also occur with entry into the uterus during a cesarean delivery.
Prevention
There are no guidelines for preventing placenta previa. However, if you have it, you need to do the following to prevent bleeding:
• Have the condition checked regularly
• Carefully follow any instructions you are given regarding bed rest and what to do if you have bleeding or contractions

Phynelketonuria

2009-01-09T21:42:00.000-08:00

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Phenylketonuria
(PKU)
Pronounced: fen-ul-ke-to-NU-re-uh
Definition
Phenylketonuria (PKU) is an inherited metabolic disorder in which a person does not have the liver enzyme needed to break down phenylalanine, an amino acid found in proteins and some artificial sweeteners. Without this enzyme, phenylalanine can build up in the blood and become toxic to the brain. Approximately 1 in 15,000 infants in the US is born with PKU.
Causes
PKU is caused by a mutation of the gene responsible for making the enzyme that breaks down phenylalanine.
Risk Factors
The only way to get PKU is to inherit the defective gene from both parents. PKU appears to be more common in babies born to parents of Turkish, Yemenite Jewish, northern and eastern European, Italian, and Chinese ancestry.
Symptoms
If detected and treated early, PKU symptoms may never appear. If untreated, one or more of the following symptoms of PKU may appear by the first birthday:
• Mental retardation
• Seizures
• Hyperactivity and behavioral problems
• Small head size
• Vomiting
• Eczema or seborrhea rash
• Musty odor
• Light coloring
• Progressive development delay
• Self-mutilation
Diagnosis
PKU is diagnosed at birth by a routine newborn screening test which is required by law in all states. The hospital draws blood from the heel between 1-7 days after birth. If a high level of phenylalanine is detected in the blood, additional tests of the blood and urine may be done to confirm the diagnosis of PKU. If you have your baby at home, arrange for a PKU test and other standard screening tests to be done by a pediatrician after birth.
A baby with PKU will need to see a doctor who specializes in genetic disorders and a registered dietitian (RD) who can advise on the dietary treatment for the condition.
Treatment
PKU is not curable, but it is treatable with a special diet beginning at birth.
Women with PKU must follow the diet strictly both before and during pregnancy, maintaining a phenylalanine level < 6 mg/dL, to prevent brain damage in the unborn baby.
Low-phenylalanine Eating Pattern
This strict diet significantly reduces the intake of phenylalanine (also referred to as “phe”) to a level that a person with PKU can handle without seeing harmful effects. Newborns require 40-60 mg/kg/day of phenylalanine to maintain adequate growth. For most older children and adults with PKU the safe range is 200-400 milligrams of phenylalanine per day. The diet consists of:
• Drinking phenylalanine-free medical formula, which provides calories, protein, vitamins, and minerals without phenylalanine. Phenylalanine-free medical formulas are manufactured for infants, children, and adults and are the most important feature of the diet for PKU.
• Starches, including bread, potatoes, corn, and beans must be restricted.
• Eliminating high-protein foods such as milk, meat, fish, chicken, pork, eggs, beans, and nuts.
• Eliminating foods and beverages made with aspartame, an artificial sweetener that contains phenylalanine.
Part of the treatment plan for PKU is regular monitoring of the level of phenylalanine in the blood. During infancy, the pediatrician may monitor the blood very frequently, as often as once or twice a week. Over time, blood monitoring may not be needed as frequently. The treatment goal is to keep the level of phenylalanine in the blood in the safe range between 2-6 milligrams per deciliter (mg/dl). The doctor or registered dietitian may also perform an occasional diet analysis to calculate the amount of phenylalanine being consumed and to check for potential nutrient deficiencies.
Prevention
There is no way to prevent PKU, but proper management can prevent complications.

Pernicious Anemia

2009-01-09T21:36:00.000-08:00

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Pernicious Anemia
(Juvenile Pernicious Anemia, Congenital Pernicious Anemia)
Pronounced: Per-nish-us Ah-nee-mee-ah
Definition
Pernicious anemia develops when the body is unable to absorb the vitamin B-12 it needs from food because of a lack of a protein, called intrinsic factor, produced by the stomach. Intrinsic factor is required for absorption of vitamin B-12. Pernicious anemia is often associated with an autoimmune-mediated attack of parietal cells of the stomach and/or intrinsic factor. Anemia is the insufficient delivery of oxygen by red blood cells from the lungs to the cells of the body. The sooner pernicious anemia is treated, the better the outcome. If you suspect you have this condition, contact your doctor.
Red Blood Cells

Causes
There are many possible causes of pernicious anemia. Some are listed below.
• Atrophic gastritis (inflammation of the stomach)
• Removal of all or part of the stomach
• Immune system reaction to:
o Intrinsic factor–a protein necessary for vitamin B-12 absorption
o Cells that produce both intrinsic factor and hydrochloric acid in the stomach
• Genetics
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
The following factors increase your chance of developing pernicious anemia:
• Autoimmune disorders and other conditions, such as:
o Type 1 diabetes
o Addison’s disease
o Graves’ disease
o Myasthenia gravis
o Secondary amenorrhea
o Hypoparathyroidism
o Hypopituitarism
o Testicular dysfunction
o Chronic thyroiditis
o Vitiligo
o Idiopathic adrenocortical insufficiency
• Ancestry: northern European or Scandinavian
• Age: over 50 years old
Symptoms
The symptoms of pernicious anemia can vary from person-to-person. Symptoms may change or worsen over time. If you experience any of these symptoms do not assume it is due to pernicious anemia. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician. Symptoms can include:
• Sensation of pins and needles in feet or hands
• Alternating constipation and diarrhea
• Stinging sensation on the tongue, or a smooth red tongue
• Substantial weight loss
• Inability to distinguish the colors yellow and blue
• Tiredness
• Paleness
• Loss of hunger
• Altered sense of taste
• Confusion
• Depression
• Impaired sense of balance, especially in the dark
• Ringing in the ears
• Cracked lips
• Fever
• Inability to sense vibrations in feet or legs
• Dizziness when changing to standing position
• Rapid heart rate
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include the following:
• Complete Blood Count (CBC)–a count of the number of red and white blood cells in a blood sample
• Vitamin B-12 Level–a test that measures the amount of vitamin B-12 in the blood
• Methylmalonic Acid (MMA) Level–a measurement of the amount of methylmalonic acid in the blood; this test determines whether a vitamin B-12 deficiency exists
• Homocysteine Level–a test that measures the amount of homocysteine in the blood (homocysteine is a building block of protein)
• Schilling Test–a test in which a harmless amount of radiation is used to assess the amount of stored vitamin B-12 (rarely used)
• Red Blood Cell Folate Level–a measurement of the amount of a B vitamin called folate
• Intrinsic Factor Assay–a measurement of the amount of a protein called intrinsic factor normally produced by the stomach
• Bone Marrow Staining–a test that shows whether an iron deficiency exists
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Vitamin B-12 Injections
The treatment consists of injections of vitamin B-12 into a muscle. These injections are necessary because the intestines cannot absorb enough vitamin B-12 without an adequate supply of intrinsic factor from the stomach.
Oral Vitamin B-12 Supplement
Some doctors advise elderly patients to take oral B-12 supplements alone or in addition to injections of vitamin B-12.
Intranasal Vitamin B-12
The doctor gives the patient a supplement of vitamin B-12 that is placed in the nose.
Oral Iron Therapy
The physician will recommend this treatment when an iron deficiency exists. In this case, the doctor will tell the patient to take iron supplements before treating with vitamin B-12.
Prevention
To help reduce your chances of getting pernicious anemia, take the following steps:
• Avoid over-consuming alcohol.
• Have your doctor check you for signs of iron deficiency.
• Undergo testing if your doctor suspects you are infected with the bacterium Helicobacter pylori.

Peritonitis

2009-01-09T21:34:00.000-08:00

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Peritonitis
Pronounced: peh-rit-oh-NYE-tis
Definition
Peritonitis is an inflammation or infection of the peritoneum. The peritoneum is a thin tissue lining that covers the inside of the abdominal cavity. It also covers the outside of the intestines and other abdominal organs.
There are several types:
• Primary
• Secondary
• Peritoneal dialysis related
Peritonitis is a serious condition. It requires immediate treatment. If not promptly treated, it can be fatal.
Causes
Primary Peritonitis–occurs when there is a buildup of fluid in the abdomen. This is called ascites. It is caused by chronic liver disease, among other conditions.
Secondary Peritonitis–caused by bacteria that enter the abdominal cavity. Can be due to an injury or a condition, such as a ruptured appendix..
Secondary Peritonitis

Dialysis-related Peritonitis–caused by bacteria that enter the peritoneal cavity during or after peritoneal dialysis (a treatment for kidney disease).
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for peritonitis include:
• Abdominal penetration or trauma
• Immune compromise
• Blood in the abdomen
• Ruptured appendix
• Peptic ulcer
• Colitis
• Diverticulitis
• Gangrene of the bowel
• Pancreatitis
• Pelvic inflammatory disease
• Inflamed gallbladder
• Recent surgery
• Tubes or shunts in the abdomen
• Cortisone drugs
Symptoms
Symptoms may include:
• Severe pain or tenderness in the abdomen
• Pain in the abdomen that is worse with motion
• Bloating of the abdomen
• Constipation
• Fever
• Nausea and vomiting
• Weakness or dizziness
• Shortness of breath
• Rapid pulse or breathing rate
• Dehydration–signs include dry skin and lips, decreased urine production
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
• Blood tests
• Analysis of fluids from the peritoneum
• Abdominal x-rays to look for signs of inflammation
• Laparotomy–surgery to open and examine the abdomen
Treatment
Treatment depends on the cause. It may include:
• Surgery to repair openings in the skin surface or to remove damaged tissue
• Antibiotics to treat infection
• Replacement of fluids
Prevention
There are no guidelines for preventing peritonitis.

Peripheral Neuropathy

2009-01-09T21:29:00.000-08:00

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Peripheral Neuropathy
Definition
Peripheral neuropathy is damage to the peripheral nerves. Peripheral nerves are the nerves that connect your spinal cord to the rest of your body.
Peripheral Nerves of the Foot

Causes
Many diseases and conditions can cause peripheral neuropathy. The damage may occur due to:
• Lack of oxygen
• Malnutrition
• Compression
• Cancer
• Trauma
• Inflammation
• Toxins
• Medications
• Unknown causes
Diseases that can damage peripheral nerves include:
• Diabetes (type 1 or type 2)
• Alcoholism
• AIDS
• Lyme disease
• Rheumatoid arthritis
• Uremia from chronic kidney failure
Compression commonly occurs when nerves are pinched or trapped somewhere along their course. Examples include:
• Carpal tunnel syndrome (nerve in the wrist)
• Sciatica (nerve roots forming the sciatic nerve in the back of the legs as they exit the spine)
Toxins that can damage the peripheral nerves include:
• Lead
• Mercury
• Thallium
• Organic solvents (hexacarbons)
• Pesticides (organophosphates)
• Carbon disulfide
• Arsenic
• Acrylamide
• Diphtheria toxin
• Alcohol
Many medications can lead to peripheral neuropathy. A partial list includes:
• Chemotherapeutic agents to treat cancer (vincristine, paclitaxel, cisplatin, suramin)
• Anti-HIV medications (didanosine, zalcitabine)
• Anti-tuberculosis medications (isoniazid, ethambutol)
• Other antimicrobial drugs (dapsone, metronidazole, chloroquine, chloramphenicol)
• Psychiatric medications (lithium)
• Miscellaneous (amiodarone, aurothioglucose, phenytoin, thalidomide, colchicine, cimetidine, disulfiram, hydralazine, high levels of vitamin B6)
Other causes of peripheral nerve damage include:
• Vitamin deficiencies (thiamin and B12 deficiency, often related to alcoholism), Vitamin E defiency
• Injury
• A tumor pressing on a nerve
• Exposure to cold or radiation
• Leprosy
• Acute or chronic demyelinating polyneuropathy
• Porphyria
• Paraneoplatic syndromes
• Genetic disorders (Charcot-Marie-Tooth disease, Dejerine-Sottas disease, and Refsum’s disease)
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for peripheral neuropathy include:
• Diabetes–about 60% of people with diabetes have peripheral neuropathy
• Alcohol abuse
• Autoimmune diseases, such as rheumatoid arthritis or celiac sprue
• Family member with peripheral neuropathy
• Exposure to toxins or medications known to cause neuropathy
• Vitamin deficiency (thiamin and vitamin B12)
• HIV infection
• Pressure on a nerve (may occur with repetitive stress injuries)
Symptoms
Damage to the peripheral nerves often results in sensory (feeling) and motor (strength) symptoms in the arms, legs, hands, and feet. However, it can affect any part of the body. Symptoms vary, depending on which nerves are involved.
Symptoms may range from mild to severe and may seem worse at night. Sensations and pain may occur in the upper or lower limbs and progress toward the trunk, for instance from the feet to the calves.
Symptoms include:
• Numbness or reduced sensation
• Tingling
• Pain, often a burning or sharp, cutting sensation
• Sensitivity to touch
• Muscle twitches
• Muscle weakness
• Muscle cramping
• Difficulty with walking
• Loss of coordination or balance
If untreated, peripheral neuropathy can lead to:
• Loss of reflexes and muscle control
• Muscle atrophy (loss of muscle bulk)
• Foot deformities
• Foot ulcers
• Injuries to the feet that go unnoticed and become infected
• Autonomic dysfunction (sweating, bowel and bladder dysfunction, cardiovascular effects)
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. The physical exam will include tests of:
• Muscle strength
• Reflexes
• Balance
• Coordination
• Ability to feel vibration, temperature, and light touch
Additional tests may also include:
• Blood tests (including glucose, vitamin B12 level, and thyroid function tests)
• Electromyography (EMG)–measurement and recording of electrical activity generated in muscle in response to a nervous stimulation
• Nerve conduction studies
• Nerve or muscle biopsy (rarely)
• Evaluation of family members
• Genetic testing
• Serum/urine electrophoresis (protein evaluation)
• Spinal tap for demyelinating disorders
Treatment
Treatment may include:
Treating the Underlying Illness or Exposure
Treating the underlying illness can decrease or eliminate symptoms. For instance, if it is caused by diabetes, controlling blood sugar levels may help. In some cases, neuropathy caused by medications or toxins is completely reversed when these substances are stopped or avoided. Correction of vitamin B12 deficiency often improves symptoms.
Physical Therapy
Certain exercises may help stretch shortened or contracted muscles and increase joint flexibility. In long-standing cases, splinting the joint may be required to protect and rest it, while maintaining proper alignment.
Patients may also benefit from orthotics to help with deformities, balance issues, and muscle weakness. Maintaining physical ativity is also key.
Medications
Prescription and over-the-counter (OTC) pain medications are often used to ease discomfort.
Drugs to treat depression and prevent convulsions sometimes relieve neuropathy symptoms. These medications are often given at lower dosages than those prescribed for depression and seizures.
Commonly used antidepressants include:
• amitriptyline (Elavil)
• nortriptyline (Pamelor)
• desipramine (Norpramin)
• imipramine (Tofranil)
Commonly used anticonvulsants may include:
• gabapentin (Neurontin)
• carbamazepine (Tegretol)
A medication recently approved for peripheral neuropathy is pregabalin (Lyrica).
Some peripheral neuropathies that are severe and potentially life-threatening (such as Guillain-Barre syndrome) require treatment with steroids (such as prednisone) and intravenous immunoglobulins.
Nondrug Therapies
These therapies are aimed at reducing symptoms and may include:
• Relaxation training
• Biofeedback
• Walking
• Exercise
• Yoga
• Warm baths
• Massage
• Acupuncture
• TENS (transcutaneous electronic nerve stimulation)
Surgery
Surgery can relieve the pressure on nerves caused by compression or entrapment. For example, surgeons commonly release fibrous bands in the wrist to treat carpal tunnel syndrome.
Prevention
• Manage chronic medical conditions with the help of your physician. If you have diabetes, you should visit a podiatrist for yearly exams.
• Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
• Be sure to get recommended amounts of thiamin and vitamin B12.
• Avoid excessive consumption of alcohol.
• Avoid toxic chemicals.
• Avoid repetitive movements.
• Avoid prolonged pressure on joints, especially elbows and knees.

Peptic Ulcer

2009-01-09T21:26:00.000-08:00

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Peptic Ulcer
(Gastric Ulcer, Duodenal Ulcer)
Definition
Peptic ulcer is a sore in the lining of the stomach or the first part of the small intestine (called the duodenum). Ulcers in the stomach are often called gastric ulcers. Ulcers in the duodenum are called duodenal ulcers.
Gastric Ulcer

Causes
Most peptic ulcers are caused by the bacteria Helicobacter pylori (H. pylori) or by using nonsteroidal anti-inflammatory drugs (NSAIDs). People infected with H. pylori and people who take NSAIDs do not all develop ulcers, though.
Anything that upsets the balance of stomach acid and digestive juices can lead to an ulcer, such as the following:
• H. pylori bacteria
• NSAIDs, which hinder the body's ability to protect the stomach lining
• Diseases that cause an increase in acid production, such as Zollinger-Ellison syndrome
• Rare causes include radiation therapy, bacterial or viral infections, alcohol abuse, injury, and severe stress such as surgery, trauma, head injury, shock, or burns.
Risk Factors
A risk factor is something that increases your chances of getting a disease or condition.
Risk factors for ulcer from H. pylori infection include the following:
• Age: 60 or older
• Sex: Male
• Race: Black and Hispanic
• Lower socio-economic group
• A crowded and unsanitary living environment
• Cigarette smoking
• Stress
• Excess coffee drinking
• Family history of ulcer disease
• Type O blood
Risk factors for ulcer from anti-inflammatory drugs include the following:
• Age: 60 or older
• Sex: Male
• History of stomach upset from NSAIDs
• Prior peptic ulcer disease
• Cigarette smoking
• Alcohol abuse
• Stress
Symptoms
Peptic ulcers do not always cause symptoms. Symptoms may come and go. Food may increase gastric ulcer pain, but food usually relieves duodenal ulcer pain.
Symptoms include the following:
• Gnawing pain
o May awaken you from sleep
o May change when you eat
o May last for a few minutes or several hours
o Feels like unusually strong hunger pangs
• Nausea
• Vomiting
• Loss of appetite
• Bloating
• Burping
Ulcers can result in serious complications and severe abdominal pain. Complications include the following:
• Bleeding, which may occur with no other symptoms. Symptoms of bleeding include:
o Black, tarry stools
o Vomiting up what looks like coffee grounds
o Weakness
o Dizziness
o Anemia
• Breaking through the wall of the stomach or duodenum (called a perforated ulcer). Sudden and severe pain is a common symptom of a perforated ulcer.
• Scar tissue that narrows and eventually closes off the outlet of the stomach to the intestines. This blocks the passage of food through the digestive system. Symptoms of scar tissue blockage include the following:
o Vomiting
o Weight loss
o Intense pain
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Tell your doctor about all medications that you are taking.
Tests may include:
Rectal exam and stool guaiac test–to test for hidden blood.
Blood test or breath test–to check for H. pylori infection. A blood test can also check for gastrin levels if Zollinger-Ellison syndrome is suspected.
Upper GI series–a series of x-rays of the upper digestive system taken after drinking a barium solution.
Endoscopy–a thin, lighted tube inserted down the throat to look inside the digestive tract. During the procedure, the doctor can take tissue samples to test for H. pylori infection or for cancer. Endoscopy is also helpful to eliminate other serious causes of gastrointestinal symptoms.
Treatment
The goals of treatment are to eliminate the source of the problem and heal the ulcer. Gastric ulcers may take longer to heal than duodenal ulcers.
Treatments include the following:
Medication
Some medications block or reduce acid production and some coat the ulcer, protecting it. If H. pylori caused the ulcer, you will need to take a combination of drugs to eliminate the bacteria. This usually consists of at least 2-3 antibiotics and a bismuth-containing drug and/or a proton-pump inhibitor. It is very important to take these drugs exactly as directed. The doctor may order tests 6-12 months after treatment to verify that the bacteria are gone.
Medications may include the following:
• Antacids (don't heal ulcers, but may provide some relief from heartburn.)
• Antibiotics (amoxicillin, tetracycline, and clarithromycin)
• Bismuth-containing drug (Pepto-Bismol)
• Proton pump inhibitors (to decrease stomach acid production (omeprazole, lansoprazole)
• H2 blockers (to decrease stomach acid production (famotidine, ranitidine, cimetidine, nizatidine)
• Medications to protectively coat ulcer (sucralfate)
• Medications to protect stomach against NSAID damage (misoprostol)
Lifestyle Changes
• If you smoke, quit. Smoking interferes with ulcer healing.
• Do not drink alcoholic beverages.
• Avoid NSAIDS, including over-the-counter drugs like aspirin and ibuprofen.
• If spicy or fatty foods increase symptoms, you can temporarily stop eating them. Keep in mind they did not cause the ulcer and probably do not affect ulcer healing.
• If stress increases ulcer pain, learn and practice stress-management techniques.
Surgery
Surgery may be necessary if you have bleeding, a perforation, or an obstruction. Surgical options include the following:
• Endoscopic surgery–may be done to stop bleeding. In this procedure, a thin, lighted tube is inserted down the throat into the stomach or intestine. Then, heat, electricity, epinephrine, or a substance called “fibrin glue” can be applied to the area of bleeding to help stop the blood flow.
• Vagotomy and drainage–vagotomy is the cutting of branches of the vagus nerve. Cutting the vagus nerve can greatly reduce acid production. Cutting through the entire nerve, though, can also interfere with the stomach’s ability to empty itself. Therefore, a means of drainage must be created. Drainage may be done with one of the following:
o Pyloroplasty–widening of the opening between the stomach and the first part of the small intestine (called the duodenum), allowing stomach contents to flow more easily into the intestine.
o Gastroduodenostomy–creation of a new opening to connect the stomach and the duodenum.
o Gastrojejunostomy–creation of a new opening to connect the stomach and the jejunum (the second part of the small intestine).
• Highly elective vagotomy–a technique that cuts only part of the vagus nerve. This type of surgery does not require extra means of drainage.
• Vagotomy with antrectomy–cutting of the vagus nerve combined with removal of the lower part of the stomach (antrum). The antrum produces a chemical that promotes acid production. Without that chemical, acid production drops.
Prevention
To decrease risk of ulcer from H. pylori infection:
• Wash your hands after using the bathroom and before eating or preparing food.
• Drink water from a safe source.
• Don't smoke. Cigarette smoking increases the chances of getting an ulcer.
To decrease the risk of ulcer from NSAIDs:
• Use other drugs when possible for managing pain.
• Take the lowest possible dose.
• Do not take longer than needed.
• Do not drink alcohol while taking the drugs.
• Ask your doctor about switching to a newer NSAID that is less likely to cause ulcers, or about taking other drugs to protect your stomach and intestine lining.
• Don't smoke. Cigarette smoking increases the chances of getting an ulcer.

Patent Ductus Arteriosus

2009-01-09T21:24:00.000-08:00

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Patent Ductus Arteriosus
PA-tent DUC-tus Ar-Ter-e-O-sus
Definition
A patent ductus arteriosus (PDA) is a type of congenital (present at birth) heart problem. All babies have a small passageway (called the ductus arteriosis) connecting the pulmonary artery and the aorta, which is open at birth.
The pulmonary artery is a blood vessel that moves blood from the heart to the lungs. The aorta is a blood vessel that moves blood from the heart out to the rest of the body. Before birth the baby gets its oxygen from the mother, so its lungs are not used. The ductus arteriosus is a passageway between the pulmonary artery and the aorta that allows blood in the baby to bypass the unused lungs and carry oxygen to the other organs.
In most babies, the ductus arteriosus closes within a few hours of birth. This is normal. When the ductus arteriosis stays open (patent), blood travels in the wrong direction between the aorta and pulmonary artery. This can cause problems for a baby and often call for medical or surgical attention.
Patent Ductus Arteriosus

Causes
In most cases the cause is not known. However, in a small number of cases, PDA could be caused by exposure during pregnancy to a viral infection, rubella, drugs, or alcohol. In some children, congenital heart disease, including patent ductus arteriosis, may be caused by genetic factors.
Risk Factors
A risk factor is something that increases your chances of getting a disease or condition. Premature babies are at relatively high risk for PDA, although a patent ductus often closes when the baby becomes more mature. In most cases occurring in full term babies there are no known risk factors for PDA.
Symptoms
Symptoms vary with the size of the ductus and the amount of blood that flows through it. If the ductus is small, there may be no symptoms. When symptoms occur they include:
• Rapid breathing
• Increased work to breathe
• Getting tired quickly
• Poor growth
• Respiratory infections (e.g., colds, pneumonia) occurring more often
In some babies, symptoms may not occur until a few weeks or months after birth. Even when there are no symptoms, the baby is at higher risk for a serious infection called endocarditis.
Diagnosis
A PDA causes a heart murmur because of the blood flow from the aorta to the pulmonary artery. This characteristic sound can be heard during a physical exam. In premature babies, this heart murmur—accompanied by heart failure—is enough to diagnose PDA. A chest x-ray shows an enlarged heart and extra blood flow from the heart to the lungs.
In older children a chest x-ray is usually normal. An echocardiogram is done to confirm the diagnosis. It uses high-frequency sound waves called ultrasound to show the flow of blood through the PDA.
Treatment
In symptomatic newborns, if the heart failure can be managed easily, extra time may be allowed to see if the PDA will close on its own. Fluids may be restricted somewhat for 2-3 days to help it close. If the symptoms are serious or the PDA is not likely to close on its own, medicine or surgery is used to close it. The medicine, indomethacin, helps tighten the muscle in the wall of the PDA to close it. If this does not work, surgery is performed to tie off the PDA.
If a PDA is present after the newborn period, it usually will not close on its own or with indomethacin. Surgery is required to prevent complications.
In older children, small coils can be used in place of surgery to close a PDA. The coils are placed in the PDA during cardiac catheterization, a procedure in which a small hollow tube is inserted into the heart through a large vein. The coils pass through the tube, are placed directly into the ductus arteriosus, and are then expanded to block the flow of blood.
Surgery and coil placement are both quite safe, although the risk of complication rises if associated heart failure is very severe.
Prevention
There are no guidelines for preventing PDAs.

Patellar Tendonitis

2009-01-09T21:22:00.000-08:00

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Patellar Tendonitis
(Jumper's Knee)
Definition
Patellar tendonitis is inflammation of the patellar (knee) tendon. This tendon connects the patella (kneecap) to the lower leg bone (tibia).
Patellar Tendonitis

Causes
Patellar tendonitis occurs from overuse of the knee tendon. Overuse may be caused by any activity that requires:
• Intense running
• Jumping
• Frequent stops and starts
• Frequent impact to the knee
Patellar tendonitis is more common in the following sports:
• Basketball
• Soccer
• Volleyball
• Running
Risk Factors
A risk factor is something that increases your chance of getting a disease, condition or injury. Risk factors for patellar tendonitis include:
• An increase in the frequency of training
• A sudden increase in the intensity of training
• Changing from one sport to another
• Training on a hard surface
• Repeated improper movements while training
• Muscle weakness or imbalance
Symptoms
Symptoms include:
• Pain and tenderness in the patellar tendon below the knee
• Pain or "tightness" in the knee when bending, squatting, or straightening the leg
• Discomfort in the knee when jumping, running, or walking
Diagnosis
The doctor will ask about your symptoms, physical activity, and how the injury occurred. The doctor will also examine your knee, and may ask you to perform certain movements.
Tests may include:
• X-Ray –to rule out other conditions that may be causing your symptoms
Treatment
Treatment includes:
Ice– Apply ice or a cold pack to the knee for 15-20 minutes, every 4 hours, for 2-3 days. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
Medication– First consult your doctor if you have any questions about using medications. Over-the-counter (OTC) drugs that are commonly used to help reduce inflammation and pain include:
• Ibuprofen (Motrin, Advil)
• Naproxen (Aleve, Naprosyn)
• Acetaminophen (Tylenol)
• Aspirin
Infra-Patellar Strap– This strap (also called a counterforce brace) can help support the tendon and reduce pain. It is worn as a band just below the knee.
Physical Therapy– Physical therapy will help:
• Stretch and condition the quadriceps muscle, which attaches to the patella
• Maintain muscle strength, flexibility, and endurance
Cortisone Injections– If the treatments above do not reduce inflammation, some doctors may recommend that you consider a cortisone injection. (This should be reserved for chronic tendonitis that has not responded to other treatments that have been intensively tried for at least 2 months.) Check with your doctor to determine what is best in your case. Avoid repeated cortisone injections.
Resuming Exercise– Return to high-impact physical activity gradually. Sufficient healing has occurred when:
• The knee can bend and straighten without pain.
• You are able to jump on the injured leg without pain.
• You are able to jog in a straight line without pain.
• Swelling is gone.
• Normal strength of the quadriceps muscles has returned.
Surgery– Surgery may be necessary if there is:
• Advanced inflammatory damage to the tendon
• Little or no response to other treatments over a 6-12 month period
During surgery, the damaged portion of the patella tendon will be removed through a small incision in the skin. Eventually, scar tissue will form and repair this damaged area.
Prevention
Patellar tendonitis may be prevented by:
• Avoiding activities and sports that repeatedly stress the kneecaps
• Increasing the frequency and intensity of exercise gradually
• Regularly doing quadricep muscle stretching and strengthening exercises

Parotitis

2009-01-09T21:20:00.000-08:00

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Parotitis
(Sialadenitis, Salivary Gland Infection)
Pronounced: PEAR-uh-TIE-tiss
Definition
Parotitis causes swelling in one or both of the parotid glands. These are two large salivary glands that sit inside each cheek over the jaw in front of each ear. Usually, the problem goes away by itself, but some cases require treatment. See your doctor if you have swelling or other symptoms in this part of your face.
Parotid Gland

Causes
A variety of factors can lead to an inflamed parotid gland. They include:
• Viral infection
o Mumps is the main virus causing parotitis, but this virus is rare today because of vaccines
o AIDS can cause swelling and enlarged parotid glands
• A blockage may block saliva flow and lead to a bacterial infection, causes include:
o A salivary stone in the parotid gland
o A mucus plug in a salivary duct
o A tumor–usually benign
• Sjogren’s syndrome –an autoimmune disease
• Sarcoidosis
• Malnutrition
• Radiation treatment of head and neck cancer can lead to parotid gland inflammation
• Other conditions can cause the parotid glands to become enlarged, but not infected, including:
o Diabetes
o Alcoholism
o Bulimia
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Discuss these risk factors with your doctor:
• Lifestyle:
o Poor oral hygiene
o Not vaccinated against mumps
• Age: Older than age 65
• Medical conditions:
o HIV-positive or AIDS
o Sjogren’s syndrome
o Diabetes
o Malnutrition
o Alcoholism
o Bulimia
Symptoms
If you have any of these symptoms do not assume it is due to parotitis. These symptoms may be caused by other health conditions. To determine the cause of your symptoms see your doctor.
• Swelling in front of your ears, below your jaw, or on the floor of your mouth
• Dry mouth
• Strange or foul taste in your mouth
• Pus draining into the mouth
• Mouth or facial pain, especially when you are eating or opening your mouth
• Fever, chills, and other signs of infection
If parotitis recurs, it can cause severe swelling into the neck and can destroy the salivary glands.
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. This may be enough to make a diagnosis. Tests may include:
• Removing fluid from the gland and checking it for signs of infection
• X-ray–a test that uses radiation to take a picture of structures inside the body; used to see salivary stones
• Ultrasound –a test that uses sound waves to take pictures of the structures inside the body
• CT Scan –a type of x-ray that uses a computer to make pictures of structures inside the body
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include:
Good Oral Hygiene
Flossing and thorough tooth brushing at least twice a day may help with healing. Warm salt water rinses can help keep the mouth moist. It may also help to quit smoking, if you’re a smoker.
Medications
• Antibiotics–to control bacterial infections only; not effective for viral infections
• Medications–to treat underlying conditions, such as Sjogren’s syndrome or AIDS
• Anti-inflammatories–to manage swelling and pain
Blockage Removal
Your doctor may need to remove a stone, tumor, or other blockage. Increasing saliva flow may be all that’s needed to remove a mucus plug.
Prevention
To help reduce your chances of getting parotitis, take the following steps:
• Get treatment for infections.
• Get regular dental care.
• Drink plenty of fluids.
• Suck on sugarless candy or chew sugarless gum to increase the flow of saliva.

Paronchia

2009-01-09T21:17:00.000-08:00

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Paronychia
Pronounced: par-oh-NICK-ee-ah
Definition
Paronychia is inflammation of the skin that surrounds a fingernail or toenail. It may be acute or chronic and is most commonly caused by infection with either bacteria or fungi.
Infection Surrounding the Toenail

Causes
Paronychia occurs when a bacteria or fungus enters damaged skin surrounding the nail. The damaged skin can be torn cuticles, cuts, or cracks.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
The risk of paronychia increases with:
• Diabetes
• Work that requires frequent exposure to chemical solvents or water (eg, food service, cleaning, dentistry, bartending, hairdressing, nursing)
• Habitual nail-biting
• Overly aggressive manicuring
Symptoms
Symptoms include:
• Redness and swelling of the skin around the nail
• Pus formation near the nail
• Pain and tenderness to the touch
• Discoloration of the nail
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. If there is pus, your doctor may recommend that you have it drained. You should not try to drain the pus yourself. Your doctor may send a sample of the pus to the lab for testing.
Treatment
Treatments are different for acute and chronic paronychia.
Acute Paronychia
A mild case of acute paronychia (minor swelling or redness near the nail) may be treated by soaking the affected nail in warm water. This treatment can be repeated 2-4 times daily, for about 15 minutes each.
In most cases, this type of paronychia heals within 5-10 days. If your condition does not improve, your doctor may prescribe oral antibiotic medication. In cases where an accumulation of pus (abscess) is suspected, your doctor may also cut the area with a scalpel to drain it.
Chronic Paronychia
Since some chronic cases might be caused by fungi, your doctor may give you an antifungal medication– perhaps in a liquid formulation called ciclopirox, which is applied directly to the infected area. Studies have shown that oral treatment for fungi does not produce better results than simply applying cortisone cream (see below).
Chronic paronychia may also be caused by a mixed bacterial infection which can be treated with antibiotics. You may need to take the medication for several weeks. Some dermatologists believe that chronic paronychia are often caused by inflammation rather than by either bacterial or fungal infections. For such non-infectious paronychia the use of cortisone creams can be helpful.
Whatever treatment is prescribed, it is important to keep the skin clean and dry. It is also important to avoid getting irritating substances such as strong cleaners or certain foods on the area. Surgery may be recommended in some cases of chronic paronychia that do not respond to other treatments.
Symptoms may subside with treatment. However, permanent damage to the nail or surrounding tissues may sometimes result.
Prevention
To help prevent paronychia:
• Keep your hands and feet clean and dry.
• Wear rubber gloves if your hands are routinely exposed to water or chemicals.
• Avoid biting your nails.
• Avoid cutting, pulling, or tearing your cuticles.
• Avoid artificial nails, vigorous manicures, or treatments that remove the cuticles.
• If you have diabetes, maintain your blood sugar levels as close to normal as possible.

Parkinson

2009-01-09T21:16:00.000-08:00

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Parkinson's Disease
Definition
Parkinson's disease (PD) is a progressive movement disorder that causes:
• Muscle rigidity
• Tremor at rest
• Slowing down of movements (“bradykinesia”)
• Difficulty moving and gait instability
Causes
The symptoms of Parkinson's disease are caused by a loss of nerve cells in a part of the brain called the substantia nigra, resulting in a decrease in dopamine (a neurochemical) throughout the brain. This destruction occurs due to genetic, environmental, or a combination of both causes. The resulting lack of dopamine results in the symptoms associated with Parkinson’s disease.
Secondary parkinsonism is a condition with similar symptoms, but symptoms can be traced to several causes, including:
• Antipsychotic drugs, such as haloperidol (Haldol), fluphenazine (Prolixin), trifluoperazine (Stelazine), and chlorpromazine (Thorazine)
• Carbon monoxide poisoning
• Manganese poisoning
• Hydrocephalus
• Brain tumors
• Stroke
• Encephalitis
• Meningitis
• IV drug abuse of MPTP
• Reserpine
• Insecticide exposure
• Trauma
• AIDS
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
• Age: 50 or older
• Gender: Men are slightly more likely than women to develop Parkinson's disease.
• Family members with Parkinson's disease
• Nonsmokers
• Exposure to toxins, drugs, or conditions specified above
Symptoms
Symptoms of Parkinson's disease begin mildly and progressively worsen over time.
Symptoms include:
• "Pill-rolling" tremor in the hands
• Tremors are present at rest, improve with movement, and are absent during sleep.
• Stiffness and rigidity of muscles, usually beginning on one side of the body
• Difficulty and shuffling when walking
• Short steps
• Slowness of purposeful movements
• Trouble performing usual tasks, due to shaking in hands
• Trouble speaking
• Flat, monotonous voice
• Stuttering
• Shaky, spidery handwriting
• Poor balance
• Difficulty with rising from a sitting position
• “Freezing”
• Anxiety
• Seborrhea (abnormally increased secretion and discharge of sebum producing an oily appearance of the skin and the formation of greasy scales)
• Loss of smell
• Tendency to fall
• Stooped posture
• Increasingly mask-like face, with little variation in expression
• Trouble chewing and swallowing
• Depression
• Dementia
• Difficulty thinking, problems with memory
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. There are no tests to definitively diagnose Parkinson's disease. The doctor will ask many questions to rule out other causes of your symptoms.
Tests to rule out other medical conditions may include:
• Blood tests
• Urine tests
• CT, MRI, or PET (positron emission tomography) scans of the head
Treatment
Currently there are no treatments to cure Parkinson's disease or proven treatments to slow or stop its progression. A number of medications are used to improve symptoms. Over time, however, their side effects may become troublesome and they may begin to lose their effectiveness.
Medications
Medications include:
• Levodopa/carbidopa (Sinemet)
• Amantadine (Symmetrel)
• Anticholinergics: benztropine (Cogentin) and biperidin (Akineton)
• Selegiline (Eldepryl)
• Dopamine agonists: bromocriptine (Parlodel), pergolide (Permax), pramipexole (Mirapex), cabergoline (Dostinex), and ropinirole (Requip)
o Pergolide (Permax) was withdrawn from the market in March 2007 due to the risk of serious heart valve damage; cabergoline (Dostinex) has also been associated with a similar risk.*
• Apomorphine (Apokyn)
• COMT inhibitors: entacapone (Comtan) and tolcapone (Tasmar))
Surgery
A number of brain operations are available, and many more are being researched including:
• Destroying certain areas of the brain (thalamotomy and pallidotomy)—to improve tremor in patients for whom medication is not effective
• Deep brain stimulation—implanting a device to stimulate certain parts of the brain to decrease tremor and rigidity
• Nerve-cell transplants (research only)—to increase dopamine production within the brain
Physical Therapy
Physical therapy, exercise, and stretching can improve muscle tone, strength, and balance.
Psychological Support
Joining a support group with other people who are learning to live with the challenges of Parkinson's disease can be very helpful.
Prevention
There are no guidelines for preventing Parkinson's disease.

Pancreatitis

2009-01-09T21:14:00.000-08:00

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Pancreatitis
Definition
Pancreatitis is a disease in which the pancreas becomes inflamed. The pancreas is a long, flattened, pear-shaped organ located behind the stomach. It makes digestive enzymes and hormones including insulin. In pancreatitis, the digestive enzymes attack the tissue that produces them.
Acute Pancreatitis–occurs suddenly, with severe upper abdominal pain (This can be a serious, life-threatening illness if not treated.)
Chronic Pancreatitis–a progressive disorder that can destroy the pancreas
Pancreatitis

Causes
Causes include:
• Alcohol abuse (most common cause)
• Gallstones and other obstructions of the bile ducts
• Surgery or trauma to the pancreas
• Certain medications
• Unknown causes (approximately 15% of cases)
• Elevated blood triglyceride levels (hypertriglyceridemia)
• Infections (bacterial, viral, fundal, or parasitic)
• HIV infection
• Congenitally abnormal pancrease duct (pancrease divisum)
• Complication of ERCP (endoscopic retrograde cholangiopancreatography)
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
• Alcohol abuse
• Family history of pancreatitis
• Personal history of acute pancreatitis
• Medications including:
o Estrogens
o Sulfonamides
o Tetracyclines
o Thiazides
• Pancreatic cancer
• Hyperlipidemia (excessive levels of fat in the blood)
• Hypercalcemia (increased calcium in the blood)
• Viral infections, such as mumps
Symptoms
Symptoms include:
• Severe pain in the center of the upper abdomen that:
o Sometimes spreads into the upper back
o Is often made worse by eating, walking, or lying down on your back
o Is less severe in chronic pancreatitis, with a gradual onset that may be tolerable for weeks
• Nausea and vomiting
• Diarrhea
• Fever
• Jaundice (yellowing of the skin)
• Shock–a severe change in the body's vital processes (eg, rapid but weak pulse, rapid and shallow respiration, and low blood pressure) (in severe, acute cases)
• Unexplained weight loss
• Symptoms of diabetes:
o Increased thirst
o Increased urination
o Fatigue
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. There will be specific questions about how much alcohol you drink and what medications you take.
Other tests may include:
Blood Tests–to measure levels of certain digestive enzymes and check for biliary obstruction and complications of pancreatitis (eg, diabetes, kidney failure, infection).
Abdominal Ultrasound or Abdominal CT Scan–to look for gallstones and determine the extent of pancreatic inflammation.
Magnetic Resonance Cholangiopancreatography (MRCP)–a radiology test (MRI) that looks at the pancreas, pancreatic duct, and nearby bile ducts.
Endoscopic Retrograde Cholangiopancreatography (ERCP)–a lighted instrument passed through the mouth and into the pancreatic ducts to examine the damage from pancreatitis and diagnose ailments related to the pancreatic and biliary ducts.
Treatment
Acute Pancreatitis
Treatment for acute pancreatitis depends on the severity of the attack. Hospitalization may be necessary. The main goal is to rest the pancreas. In mild cases, this means you may not have food for 3-4 days. In severe cases, you may not be able to have food for 3-6 weeks. You will likely need strong pain medication during this time.
Treatment may also include:
• Intravenous (IV) fluids
• IV nutrients if you are unable to eat for an extended period of time
• Antibiotics if you have an infection
• Surgery to drain the fluid building up in the abdomen
Chronic Pancreatitis
The goals of treatment for chronic pancreatitis are to relieve pain and manage nutritional and metabolic problems. Specific steps include:
• Strict avoidance of alcohol
• Eating less fat
• Taking pills containing pancreatic enzymes to help with digestion
• Taking insulin to control blood sugar (if diabetes develops)
• Eating smaller meals more frequently
Surgery and/or ERCP may be needed to:
• Open a blocked pancreatic or biliary duct
• Remove part (or rarely all) of the pancreas
• Drain pancreatic cysts
Prevention
The best way to avoid pancreatitis is to limit your intake of alcohol to two drinks or less per day for men and one drink or less per day for women. If you have hyperlipidemia, restrict your intake of fat and follow your doctor’s treatment plan to lower your lipids.

Pancreatic Cancer

2009-01-09T21:12:00.000-08:00

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Pancreatic Cancer
(Cancer of the Pancreas)
Definition
Pancreatic cancer is a disease in which cancer cells grow in the pancreas. The pancreas is a long, flattened pear-shaped organ in the abdomen. The pancreas makes digestive enzymes and hormones including insulin.
The Pancreas

Cancer occurs when cells in the body (in this case pancreas cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissues and spread to other parts of the body. A benign tumor does not invade or spread.
Causes
The cause of pancreatic cancer is unknown. However, research shows that certain risk factors are associated with the disease.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
• Age: 40 or older
• Sex: Male
• Smoking
• Diabetes
• Chronic pancreatitis, hereditary pancreatitis, family nonpolyposis colon cancer syndrome
• Family or personal history of certain types of colon polyps or colon cancer
• Family history of pancreatic cancer (especially in Ashkenazi Jews with BRCA2 (breast cancer associated)) gene
• High-fat diet
Symptoms
Pancreatic cancer does not cause symptoms in its early stages. The cancer may grow for some time before it causes symptoms. When symptoms do appear, they may be very vague. In many cases, the cancer has spread outside the pancreas by the time it is discovered.
Symptoms will vary depending on the location and size of the tumor. Symptoms include:
• Nausea
• Loss of appetite
• Unexplained weight loss
• Pain–in the upper abdomen, sometimes spreading to the back (a result of the cancer growing and spreading)
• Jaundice–yellowness of skin and whites of the eyes; dark urine (if the tumor blocks the common bile duct); tan stool or stool that floats to the top of the bowl.
• Weakness, dizziness, chills, muscle spasms, diarrhea (especially if the cancer involves the islet cells that make insulin and other hormones)
These symptoms may also be caused by other, less serious health conditions. Anyone experiencing these symptoms should see a doctor.
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. In addition, the doctor may perform blood and urine tests, as well as checking for hidden blood in bowel movements.
Test may include:
Upper GI Series–a series of x-rays of the upper digestive system taken after drinking a barium solution
CT Scan–a type of x-ray that uses a computer to make pictures of structures inside the abdomen
MRI Scan–a test that uses magnetic waves to make pictures of structures inside the abdomen
Ultrasonography–a test that uses sound waves to find tumors
Endoscopic Retrograde Cholangiopancreatography (ERCP)–a type of x-ray that shows the pancreatic ductal system after dye has been sent through a tube down the throat and into the pancreas
PTC–a type of x-ray test that shows blockages in the bile ducts of the liver
Angiography–x-rays of blood vessels taken after an injection of dye that makes the blood vessels show up on the x-rays
Biopsy–removal of a sample of pancreatic tissue to test for cancer cells
Treatment
Once cancer of the pancreas is found, staging tests are performed to find out if the cancer has spread and, if so, to what extent. Treatments for pancreatic cancer depend on the stage of the cancer.
Treatments include:
Surgery–surgical removal of the cancerous tumor and nearby tissues, and possibly nearby lymph nodes. In pancreatic cancer, surgery may also be performed to relieve symptoms caused by the cancer. Surgeries include:
• Whipple Procedure–removal of the head of the pancreas, part of the small intestine, and some of the tissues around it
• Total Pancreatectomy–removal of the whole pancreas, part of the small intestine, part of the stomach, the bile duct, the gallbladder, spleen, and most of the lymph nodes in the area
• Distal Pancreatectomy–removal of the body and tail of the pancreas
• Radiation Therapy (Radiotherapy)–the use of radiation to kill cancer cells and shrink tumors. Radiation may be:
o External Radiation Therapy–radiation directed at the tumor from a source outside the body
o Internal Radiation Therapy–radioactive materials placed into the body in or near the cancer cells
• Chemotherapy–the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.
• Biological Therapy–the use of medications or substances made by the body to increase or restore the body's natural defenses against cancer. Also called biological response modifier (BRM) therapy.
• Combined Modality Therapy–most times, pancreatic cancer is discovered at an advanced stage and cannot be operated upon. Surgery would be appropriate in only 25% of patients with this disease in the early stage. In these cases, the patient would benefit from surgery. After surgery, follow-up chemotherapy and radiation therapy have been found to prolong survival when the cancer is relatively large or has involved the lymph nodes. If surgery cannot be performed, then chemotherapy and radiation are offered together to prolong survival.
Prevention
There are no guidelines for preventing this disease, because the cause of pancreatic cancer is unknown and symptoms are not present in the early stages. If you think you are at risk for pancreatic cancer, especially because of familial or genetic risks, talk to your doctor about ways to reduce your risk factors and figure out an appropriate schedule for check-ups.

Ovarian Cyst

2009-01-09T21:10:00.000-08:00

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Ovarian Cyst
Definition
An ovarian cyst is a fluid-filled sac that develops near the surface of the ovary. The ovaries are two small organs on each side of a woman's uterus that produce eggs and female hormones. Most ovarian cysts are small and benign (not cancerous). However, the larger ones can cause pain and other problems. A woman can develop one or many ovarian cysts.
Ovarian Cyst

Causes
Structures called follicles normally grow in the ovaries each month. They produce hormones and release an egg during ovulation. In some cases, follicles may become cysts. There are two main types:
• Functional Cyst–occurs when a normal monthly follicle does not mature properly and the egg is not released. These cysts often go away on their own within 1-3 menstrual cycles.
• Follicular Cyst–can occur after an egg is released. These cysts usually go away on their own in a few weeks. These are a type of functional cyst.
Most ovarian cysts are functional cysts and only occur during childbearing years. Many other, less common types of benign cysts can also develop from ovarian tissue. For example, women with endometriosis may develop endometriomas. Endometriosis is a condition in which tissue from the uterine lining grows outside the uterus. Endometriomas are cysts that grow from the uterine tissue on an ovary; they contain old blood.
Polycystic ovary syndrome is also associated with cysts. Women with this condition have several small cysts in their ovaries (more than 10).
A very small percentage of women have cysts that are caused by cancer.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
The main risk factor for ovarian cysts is being a woman of childbearing age.
Symptoms
Most ovarian cysts do not cause symptoms. When they do, pelvic pain and irregular menstrual bleeding are the two most common symptoms. Pain is usually caused by:
• Direct pressure from the cysts on the ovaries and surrounding structures. This causes chronic pelvic fullness or a dull ache.
• Bleeding from a cyst into and around the ovary. This causes more intense, sharp pain.
Pain may come and go on a regular basis. Or it may become more noticeable just before or after a period or during intercourse.
Other symptoms may include:
• Urinary discomfort associated with bladder pressure or irritation
• Nausea
• Diarrhea
In rare cases, an ovarian cyst may become twisted and cut off its own blood supply. This can cause severe abdominal pain, vomiting, and fever. This requires immediate medical attention.
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a pelvic exam. This includes feeling the ovaries. Ovarian cysts are often found during routine pelvic exams when there are no symptoms.
If a cyst is suspected or found on physical exam, the doctor may recommend a pelvic ultrasound. This is a test that uses sound waves to create images of the ovaries, from which the doctor can determine the type and size of the cyst, and if treatment is needed.
Other tests or procedures may be used if a cyst:
• Does not go away after several menstrual cycles
• Gets larger and more painful
• Does not appear to be a simple functional cyst (has atypical features or atypical blood flow on ultrasound and Doppler exam)
Other tests may include:
• Laparoscopy–a thin, lighted tube and other small instruments are inserted through several tiny incisions in the abdomen to look at the ovaries directly, drain fluid from a cyst, or take a sample for biopsy.
• Blood test for the protein CA-125–this test may be done when a cyst is suspected of being cancerous. CA-125 is often elevated in the case of ovarian cancer; but is also elevated in many benign situations.
Treatment
Treatment depends on your age, menstrual status, the size and type of the cyst, and your symptoms. The main types of treatment are:
Wait and See–this approach involves waiting a few months to see if the cyst goes away on its own.
Birth Control Pills–if you have a functional cyst, your doctor may prescribe birth control pills to help prevent other cysts from developing during the ‘wait and see’ period. If you get ovarian cysts often, birth control pills decrease the chance of new ones forming.
Laparoscopic Surgery–pelvic laparoscopy may be recommended to remove a cyst if it:
• Grows larger or reaches a size greater than two inches
• Has some solid material in it, or other atypical features
• Causes persistent or worsening symptoms
• Lasts longer than two or three menstrual cycles
If the cyst is not cancerous, often just the cyst can be removed. However, in some cases, your whole ovary may need to be removed. If the cyst is cancerous, you may have your ovary and uterus removed. This requires an open surgical procedure, rather than a laparoscopy.
Prevention
Since ovarian cysts are common, and are usually painless and benign, doctors do not routinely recommend any preventive interventions. Women who have recurrent symptomatic cysts may benefit from birth control pills over the long term. Taking oral contraceptive pills for more than five years has also been shown to reduce the risk of ovarian cancer.
The best way to catch cysts early is to:
• Tell your doctor about any changes in your monthly cycles or periods
• Report pelvic and abdominal pain

Ovarian Cancer

2009-01-09T21:07:00.000-08:00

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Ovarian Cancer
(Cancer of the Ovaries)
Definition
Ovarian cancer is a disease in which cancer cells grow in the ovaries. The ovaries are a pair of organs in the pelvic area of women. The ovaries produce eggs and female hormones.
Cancer occurs when cells in the body (in this case ovarian cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors , which can invade nearby tissues and can spread to other parts of the body. A benign tumor does not invade or spread.
The most common type of ovarian cancer is epithelial (serous, mucinous, transition, mixed, and Brenner). Many of these tumors are cystic and may grow to be very large without producing symptoms. Because of this, and because these tumors can be hard to find on physical examination, about 70% of these patients present with advanced disease.
Germ cell tumors (choriocarcinoma, yolk sac tumor, dysgerminoma, teratoma, and embryonal cell carcinoma) come from the reproductive tissue and account for about 20% of tumors. More rare are stromal (Sertoli, Leydig, and granulosa cell ) cancers, which arise from the connective cells of the ovary and typically produce hormones which produce symptoms (such as development of male patterns of hair growth, loss of menstrual periods, or increased menstrual bleeding).
Cancerous Mass in the Left Ovary

Causes
The causes of ovarian cancer are not known. However, research shows that certain risk factors are associated with the disease.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
• Family history of ovarian cancer, especially in mother, sister, or daughter
• Age: 50 or older
• Menstrual history—first period before age 12, no childbirth or first childbirth after age 30, and late menopause
• Personal history of breast cancer or colon cancer
• Presence of certain gene mutations, including BRCA1
Use of birth control pills for more than five years appears to decrease risk.
Symptoms
Ovarian cancer generally doesn't cause symptoms until the later stages.
Symptoms include:
• Abdominal discomfort and/or pain
• Gas, indigestion, pressure, swelling, bloating, or cramps
• Nausea, diarrhea, constipation, or frequent urination
• Loss of appetite
• Feeling of fullness even after only a light meal
• Unexplained weight gain or loss
• Abnormal bleeding from the vagina
• Hair growth, voice deepening, acne, loss of menstrual periods in some rare stromal tumors
Note: These symptoms may also be caused by other, less serious health conditions. Anyone experiencing these symptoms should see a doctor.
Diagnosis
Your doctor will ask you about your symptoms and medical history, and perform a physical examination.
Tests may include:
Pelvic Exam— use of a physician's gloved finger to examine the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum for lumps or a change in size or shape
Imaging Tests ( Ultrasound , CT scan , and MRI scan ) —tests that create pictures of the ovaries and surrounding tissues that will show if there is a tumor
Lower GI Series or Barium Enema — injection of fluid into the rectum that makes your colon show up on an x-ray so the doctor can see abnormal spots
CA-125 Assay— a blood test to measure the level of CA-125, a substance in the blood that may be elevated if ovarian cancer is present
Treatment
General Approach
The general approach to patients with ovarian cancer is to undergo as complete a surgical procedure as possible first. This must be performed by a qualified gynecologic oncologist.
During this first surgery, if ovarian cancer is found, staging tests are performed to find out if the cancer has spread and, if so, to what extent. Treatment for ovarian cancer depends on the extent of the cancer and the general health of the patient. Thereafter, and based on the findings, patients then receive chemotherapy usually. Sometimes, radiation therapy of the abdomen is offered. The most appropriate therapy is based on the experience of the treating physicians and the toxicities expected.
Treatments include:
Surgery
Surgical removal of a cancerous tumor and nearby tissues, and possibly nearby lymph nodes.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.
Radiation Therapy (Radiotherapy)
Radiation therapy (radiotherapy) is the use of radiation to kill cancer cells and shrink tumors. Radiation may be:
• External Radiation Therapy —radiation directed at the abdomen from a source outside the body
• Intrabdominal P32 —sometimes a radioactive solution may be introduced into the abdomen as part of treatment
In general, the more advanced the tumor at diagnosis, the poorer the prognosis. Unfortunately, 75% of all epithelial tumors are stage 3 or 4 at the time of diagnosis, and the overall five year survival rate is about 50%.
Prevention
There are no guidelines for preventing ovarian cancer, because the cause is unknown and symptoms are not present in the early stages. If you think you are at risk for ovarian cancer, talk to your doctor about ways to reduce your risk factors. Also schedule check-ups with your doctor if needed. All women should have regular physical examinations, including vaginal examination and palpation of the ovaries, as part of their routine medical care.

Otosclerosis

2009-01-09T21:06:00.000-08:00

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Otosclerosis
(Otospongiosis)
Pronounced: ot-oh-scle-ROW-sis
Definition
Otosclerosis occurs when abnormal new bone forms in the inner ear. This growth prevents proper functioning of other ear structures. This condition is a common cause of hearing loss.
The Inner Ear

Causes
The cause of otosclerosis is still unknown. However, otosclerosis tends to run in families, and may be hereditary. Otosclerosis has also been linked to hormonal changes (especially during pregnancy) and viral infections.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for otosclerosis include:
• Age: Late teens through late 40s
• Family history of otosclerosis
• Sex: Female
• Race: Caucasian or Asian
• Drinking nonfluoridated water: Some studies suggest that nonfluoridated water may cause a susceptible person to develop otosclerosis
• Pregnancy: May accelerate symptoms
Symptoms
Gradual hearing loss is the main symptom of otosclerosis. Hearing loss may be of two types:
• Conductive–involving the small bones of the inner ear
• Sensorineural–involving the following structures:
o Cochlea–the sensory organ in the inner ear
o The major nerve pathway (8th cranial nerve) and/or area of the brain responsible for hearing
Early in the disease, you may first notice trouble hearing low-pitched sounds or whispers. Other symptoms may include:
• Dizziness
• Balance problems
• Tinnitus or sensation of ringing, roaring, or buzzing in the ear
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
• Hearing tests by an audiologist
• CT scan–a type of x-ray that uses a computer to make pictures of the inside of the ear and head
• Examination of the middle ear at the time of surgery
Treatment
Treatments may include:
Hearing Aid
Hearing aids may be effective for conductive hearing loss.
Surgery
In many cases, a procedure called a stapedectomy may improve hearing. The purpose of this operation is to replace the diseased bone with an artificial device that can transmit sound waves to the inner ear. Stapedectomy is very effective and frequently returms hearing to a near normal level.
Oral Treatment
Fluoride tablets are sometimes prescribed to stabilize the condition and prevent further sensorineural hearing loss. This treatment remains controversial and unproven, however.
Prevention
Drinking fluoridated water may help prevent otosclerosis in people who are susceptible. There are no other known ways of preventing this condition.

Otitis Externa

2009-01-09T21:04:00.000-08:00

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Otitis Externa
(Swimmer’s Ear)
Definition
Otitis externa is an infection, inflammation, or irritation of the ear canal, the tube leading from the outer ear to the eardrum. Because it is often found in swimmers, particularly in warm, humid climates, it is often referred to as swimmer’s ear . This condition can easily be treated but can become serious, even life-threatening in some people, if left untreated. This can be very serious particularly in diabetics , where the infection can spread to the middle and inner ears, and cause an infection in the bone ( osteomyelitis ).Contact your doctor if you think you may have otitis externa.
The Ear Canal

Causes
Otitis externa can develop under the following circumstances:
• Following frequent swimming or bathing when the ears are repeatedly filled with water and not drained completely afterward
• After removal of protective ear wax, especially if the cleaning is painful and causes bleeding
• If cotton swabs are excessively used
• If the skin in the ear canal is injured
• As a consequence of skin conditions such as psoriasis , eczema , seborrhea, acne , or lupus erythematosus , that also can occur in the ear canal
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
The following factors increase your chance of developing otitis externa:
• Frequent swimming or showering, particularly in young children who have narrow ear canals
• Insertion of any object into the ear canal causing damage to the lining
• Skin conditions causing breaks in the skin of the ear canal
• Diabetes
• Medical conditions resulting in a compromised immune system
People with weak immune systems or who have a chronic illness, such as diabetes or AIDS , may suffer an aggressive form of the condition called malignant otitis externa. Malignant otitis externa is a disorder causing severe damage of the bones and cartilage of the base of the skull. It is caused by the spread of an untreated or poorly treated otitis externa infection in susceptible people. This life-threatening condition requires immediate treatment.
Symptoms
If you experience any of these symptoms do not assume it is due to otitis externa. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.
• Redness and/or itching inside the ear canal
• Pain in the ear, sometimes severe, that may worsen when chewing or talking, and with pulling on the ear
• Hearing loss or a plugged-up or pressure sensation of the ear
• Drainage from the ear
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a visual exam of the ear, including the ear canal and inner ear, using a lighted device called an otoscope.
Treatment
Treatment options include the following:
Drainage
Your doctor will remove any drainage or pus from the ear canal if present using a suction.
Drug Treatment
Prescription ear drops containing infection-fighting medications and inflammation reducers like antibiotics and corticosteroids are the usual treatment for otitis externa. Sometimes, antibiotic or antifungal pills are prescribed. With treatment, symptoms of otitis externa usually decrease in severity within 24 hours to three days.
Other Suggestions Your Doctor May Recommend:
• Keep the ear dry for 7-10 days.
• Take baths instead of showers.
• Avoid swimming.
• Do not rub or scratch the ear or inside the ear canal.
Prevention
To help reduce your chances of getting otitis externa, or from having the condition recur, take the following steps:
• Avoid swimming in unclean water.
• Thoroughly drain and dry the ear and ear canal after swimming or showering.
• When showering, gently place a cotton ball lightly coated with petroleum jelly into the outer ear to prevent water collection.
• Do not insert anything into the ear canal, including your finger or cotton swabs.
• Do not remove ear wax. If you are having problems hearing, see a doctor first.
• Avoid using ear plugs since they can irritate the lining of the ear canal and can trap water inside the ear.
• Consider using a tight-fitting swimming cap.
• Using a white vinegar/rubbing alcohol eardrop solution following swimming will help restore the natural healthy environment inside the ear canal.

Osteoporosis

2009-01-09T21:01:00.000-08:00

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Osteoporosis
Definition
Osteoporosis is a disease in which bones become weak and brittle. If left unchecked, osteoporosis can progress painlessly until a bone breaks (fracture). Any bone can be affected, but of special concern are fractures of the hip, spine, and wrist.
Causes
Throughout life, old bone is removed and new bone is added to the skeleton. During childhood and adolescence, new bone is added faster than old bone is removed. As a result, bones become heavier, larger and denser. Peak bone mass is reached at around age 30. From that point on, more bone is lost than is replaced. If not treated, bone losses may lead to osteoporosis. Osteoporosis is more likely to occur if optimal bone mass was not achieved during the bone-building years.
Bone density also plays a role in bone health. Bone density is determined in part by the amount of calcium, phosphorus, and other minerals contained within the framework of the bone. As the mineral content of a bone (especially calcium) decreases, the bone becomes weaker. Getting enough calcium and vitamin D and exercising regularly can help ensure that bones stay strong throughout life.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
• Sex: female
• Age: risk increases with age
• Body size: small, underweight women
• Race: Caucasian and Asian women
• Family members with osteoporosis
• Postmenopausal status
• Abnormal cessation of menstrual periods (amenorrhea) due to anorexia nervosa, rigorous exercise, or an endocrinological problem
• Low-calcium diet
• Medications:
o Immunosuppressants, such as prednisone and other steroids, methotrexate, cyclosporine
o Thyroid drugs
o Anticonvulsants
o Aluminum-containing antacids
o Cholesterol-lowering drugs
o Long-term heparin therapy
• Low estrogen levels in women
• Low testosterone levels in men
• Inactive lifestyle
• Too little sunlight
• Depression
• Anorexia
• Cigarette smoking
• Excessive use of alcohol, coffee, and tea
• Diseases including:
o Liver disease, including cirrhosis
o Hyperthyroidism
o Scurvy
o Alcoholism
o Marfan's and Ehler-Danlos syndromes
o Cushing's syndrome
o Hyperparathyroidism
o Cancer, including lymphoma
o Gastrointestinal disorders
Symptoms
Osteoporosis does not usually cause symptoms. Pain is the only symptom, and generally occurs when the bones have broken or collapsed.
Symptoms include:
• Severe back pain with fracture of the vertebrae, wrists, hips, or other bones
• Loss of height, with stooped posture (kyphosis)
Kyphosis

Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Early signs of osteoporosis can be detected with bone density testing.
Bone density testing techniques include:
• Dual-energy x-ray absorptiometry–measures bone density in the entire body
• Single-energy x-ray absorptiometry–measures bone density in the arm or heel
• Dental x-rays of bone
• Ultrasound bone density measurement–measures bone density in fingers, heels, and leg bones
Other tests may include:
• Blood and urine tests–to test for calcium levels or substances created when bone is broken down
Treatment
Treatment includes:
Nutrition
Eat a balanced diet rich in calcium and vitamin D. Consider decreasing your intake of caffeinated beverages and alcohol. Calcium is abundant in:
• Dairy products
• Green leafy vegetables
• Canned fish with bones
• Calcium-fortified products
Smoking
Do not smoke. If you smoke, quit.
Exercise
Exercise improves bone health and increases muscle strength, coordination, and balance. Maximum benefits are gained from doing weight-bearing exercises, including strength-training exercises. Balance training may help prevent falls and fractures.
Dietary Supplements
People who cannot consume enough calcium from food might want to consider calcium supplements. Other vitamins and minerals may be recommended, including vitamin D, magnesium, potassium, and vitamin K. A recent study showed that Japanese postmenopausal women who took vitamin K supplements experienced a reduced rate of fractures. Due to side effects and medication interactions, talk to your doctor or dietician before you begin taking dietary supplements. *
Medications
These include medications to prevent bone loss, increase bone density, and reduce the risk of spine and hip fractures.
Raloxifene (Evista)–one of a class of drugs known as selective estrogen receptor modulators (SERMS) that appears to prevent bone loss of the hip, spine, and total body. It is approved for both prevention and treatment of osteoporosis.
Bisphosphonates (alendronate [Fosamax]; risedronate [Actonel])–reduce bone loss, increase bone density, and reduce the risk of spine and hip fractures
Calcitonin–slow bone loss, increase spinal bone density, and may relieve pain from bone fractures
Fluoride–low doses of monofluorophosphate to decrease pain and fractures in the spine
Hormone Replacement Therapy (HRT)–Although HRT (including estrogen replacement therapy, or ERT) may cut the risk of osteoporosis in half, it’s important to note that recent research shows a strong association between longer-term ERT or HRT use and a significantly increased risk of invasive breast cancer, strokes, heart attacks, and blood clots. Be sure to discuss all of the health risks and benefits of hormone therapy with your doctor to determine if it is right for you.
HRT therapy may include:
• Estrogen alone (also referred to as Estrogen Replacement Therapy or ERT)
• Estrogen and Progestin–estrogen combined with progestin (frequently preferred for women with an intact uterus because ERT slightly increases the risk of uterine cancer)
• Foods containing soy–may improve bone mass because these foods contain plant estrogens
HRT can:
• Reduce bone loss
• Increase bone density
• Reduce the risk of hip and spinal fractures in postmenopausal women
Safety Measures
Because falls can increase the likelihood of fracture in someone with osteoporosis, the following measures are recommended:
• Use a cane or walker for added stability.
• Wear rubber soled shoes for traction.
• Use plastic or carpet runners when possible.
• Keep rooms free of clutter.
• Install grab bars in bathrooms.
Prevention
Building strong bones throughout the early years is the best defense against osteoporosis. There are four steps to prevent osteoporosis, none of which is likely to be effective by itself.
• A balanced diet rich in calcium and vitamin D
• Weight-bearing exercise
• Healthful lifestyle (no smoking and moderate alcohol)
• Bone density testing and medications where appropriate:
o Fosamax
o Actonel
o Evista

Osteomyelitis

2009-01-09T20:58:00.000-08:00

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Osteomyelitis
(Osteitis)
Pronounced: OS-tee-oh-my-uh-LITE-is
Definition
Osteomyelitis is an inflammation or infection of the bone.
Causes
Osteomyelitis can occur as a result of an injury to the bone, or an infection in the body carried by the blood to the bone. The infection may be acute or chronic.
In adults, the pelvis and vertebrae are the most common sites. In children, the long bones are most likely to be affected.
Necrotic (Dead) Tissue and Underlying Osteomyelitis

Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
• Age: Young children and older adults
• Sex: Male
• Trauma or injury to the bone or skin
• Broken bones, especially if open to or sticking through the skin
• Diabetes mellitus
• Kidney dialysis
• Intravenous drug abuse
• Weakened immune system
• Poor circulation
• Sickle cell anemia
• Artificial joints, such as a hip replacement
• Prosthetic bone devices, such as screws, plates, or wires
Symptoms
Symptoms include:
• Bone pain
• Fever or chills
• Tenderness, warmth, swelling, or redness of the skin or joint
• Drainage of pus
• Nausea
• Fatigue or irritability
• Restricted movement of the area
• A sore over bone that does not heal
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
• Blood Tests–to check for signs of infection
• Needle Aspiration–use of a needle to remove a sample for testing and culture
• Bone Biopsy–removal of a sample of bone to test for abnormal cells
• X-Ray–bone and tissue changes on x-ray may indicate osteomyelitis
• Bone Scan–a series of pictures of bones taken after injection of a small amount of radioactive material that highlights the bones
• CT or MRI–radiographic tests to evaluate for any bone changes that may indicate osteomyelitis
Treatment
Osteomyelitis is treated with antibiotics. They are given intravenously and sometimes orally. Acute osteomyelitis is treated for at least 4-6 weeks. Chronic osteomyelitis may require antibiotics for a longer period of time. The doctor may immobilize the affected area with a splint and recommend avoiding any weight bearing on the area.
Surgery
For chronic infection, surgery may be required to:
• Clean infected bone via scraping and irrigating the area
• Remove any fragments of dead bone or tissue that may prolong the infection
In severe cases, amputation may be necessary.
Skin Graft
In some situations, the doctor may recommend a skin graft. The skin in the affected area is replaced with healthy skin taken from another part of the body.
Prevention
To reduce your risk of getting osteomyelitis:
• Seek immediate medical care for infections or injuries.
• Keep diabetes under good control.
• Do not use illegal drugs.
• See your doctor for any sores that do not heal.

Optic Neuritis

2009-01-09T20:54:00.000-08:00

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Optic Neuritis
Pronounced: op-TIK nu-RI-tis
Definition
The optic nerve allows you to see by carrying images from your eye to your brain. Optic neuritis involves inflammation of the optic nerve, which may cause sudden decrease or loss of vision. Optic neuritis is a serious condition that requires immediate care from your doctor.
The Optic Nerve

Causes
The cause of optic neuritis is often unknown. Known causes of the diseases include:
• An attack on the optic nerve by a viral infection or by the body's own immune system
• Exposure to toxic substances such as lead
Risk Factors
The following factors increase your chance of developing optic neuritis. If you have any of these risk factors, tell your doctor:
• A personal or family history of multiple sclerosis
• A previous history of optic neuritis
Symptoms
Symptoms of optic neuritis include:
• A sudden decrease in vision. Patients may describe this as blurred, dark, or dim vision, or as loss of vision in the center of, part of, or all of the visual field. In mild cases, it may look like “the lights are turned down.”
• Abnormal color vision (dull and faded colors)
• Pain in or around the eye, often made worse by movement of the eye.
Eye pain will often go away, usually within a few days. Vision problems will improve in over 90% of patients, though some may be left with blurred, dark, dim, or distorted vision. Vision improvement usually takes place over several weeks or months.
Diagnosis
Optic neuritis may be difficult to diagnose, as your eye probably looks perfectly normal. Your doctor will ask about your symptoms and medical history, and will perform a physical examination. He or she should refer you to an ophthalmologist. Tests will include:
• Tests of color vision, side vision, visual acuity, and the reaction of the pupil to light
• A dilated eye examination to view the back of the eye (retina) with an instrument called an ophthalmoscope
• Magnetic resonance imagining (MRI) may also be performed to look for certain medical conditions
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include:
• Steroid medications to reduce inflammation of the optic nerve
• Certain other medications depending on other medical diagnoses
• Observation
Prevention
There is no known way to prevent a first episode of optic neuritis. The chance of having a repeat episode may be reduced if the first episode is treated with a steroid or other medication. It is very important to see an ophthalmologist immediately if you develop pain or decreased vision.

Narcolepsy

2009-01-09T20:53:00.000-08:00

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Narcolepsy
Definition
Narcolepsy, which affects approximately 140,000 Americans, is a neurologic disorder characterized by frequent, involuntary, episodes of sleeping during the day. Sleep attacks may occur while driving, talking or working.
Causes
The cause of narcolepsy is unknown, but it is thought to have a genetic component.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
• Family members with narcolepsy
Symptoms
Symptoms of narcolepsy usually start during the teenage years. Onset may range from 5 to 50 years old. Symptoms may worsen with aging, but may improve in women after menopause.
Symptoms include:
• Excessive daytime sleepiness
• Daytime involuntary sleep attacks
• Unrefreshing sleep
• Sudden loss of muscle tone without loss of consciousness (cataplexy)
• Temporary paralysis while awakening
• Frightening mental images that appear as one falls asleep
• Memory problems
• Symptoms may be triggered by:
o A monotonous environment
o A warm environment
o Eating a large meal
o Strong emotions
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. If narcolepsy is suspected, you may be referred to a specialist in sleep disorders.
Tests may include:
Sleep Latency Test – measures the onset of rapid eye movement sleep, which occurs earlier than normal in narcolepsy
General Sleep Lab Study – helps rule out other causes of daytime sleepiness. The following things are monitored while you sleep:
• Brain waves
• Eye movements
• Muscle activity
• Respiration
• Heart beat
• Blood oxygen levels
• Total nighttime sleep
• Amount of nighttime REM sleep
• Time of onset of REM sleep
• Degree of daytime sleepiness
Treatment
Treatment may include:
• Stimulant medications that increase levels of daytime alertness include:
o Methylphenidate
o Pemoline (requires regular blood testing for liver function)
o Dextoamphetamine
o Methamphetamine
o Modafinil
• Antidepressants – to help treat many symptoms of narcolepsy, include:
o Cataplexy
o Hallucinations
o Sleep paralysis
• Other treatment options include:
o Planned short naps throughout the day
o Counseling to cope with issues of self esteem
o Wearing a medical alert bracelet or pendant
Prevention
There are no guidelines for preventing narcolepsy itself. However, you can try to prevent symptoms.
• Avoid activities that carry a risk of injury from a sudden sleep attack, such as:
o Driving
o Climbing ladders
o Using dangerous machinery
• Exercise on a regular basis.
• Get adequate sleep at night.

Opthalmia Neonatorum

2009-01-08T20:53:00.000-08:00

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Ophthalmia Neonatorum
(Newborn Conjunctivitis, Neonatal Conjunctivitis)
Definition
Ophthalmia neonatorum is conjunctivitis (inflammation of the surface or covering of the eye because of infectious or non-infectious causes) that occurs in the newborn. Any eye infection that occurs in the first month of a baby’s life can be classified as ophthalmia neonatorum. While an infection has the potential to damage the delicate eye of an infant, there are a number of ways these infections can be prevented.
Additionally, effective treatment is available for infants that do develop an eye infection. If you suspect your baby may be at risk for an infection, or may have an eye infection, you should contact your doctor immediately.
Causes
The cause of the conjunctivitis may be simply an irritation in the eye, or a blocked tear duct. However, bacteria can also cause an infection in the eye. The most common types of bacteria that cause infection in the infant’s eye come from the mother’s birth canal, and are passed to the infant during delivery. These infections can include:
• Sexually transmitted diseases (STDs) : The most common bacteria passed to infants during delivery are due to STDs from the mother’s birth canal. If untreated, many of these infections can cause serious damage to the infant’s eye. STDs that can cause eye damage include:
o Chlamydia
o Gonorrhea
o The virus that causes oral and genital herpes
• Skin bacteria such as Staphylococcus aureus
• Bacteria from the mother’s gastrointestinal tract, such as Pseudomonas
Risk Factors
The biggest risk factor for developing ophthalmia neonatorum is a maternal infection or STD at the time of delivery. Unfortunately, with some infections, the mother may not have any symptoms during delivery and still be able to transmit the infection. If you are pregnant, it is important to discuss any STDs that you have, or had in the past. You and your doctor can develop a plan to protect your baby from infections during delivery.
Symptoms
The most common is redness and swelling of the conjunctiva in the newborn. If your baby has this or any of the other symptoms described below, see your baby's pediatrician. Some of the other symptoms of ophthalmia neonatorum include:
• Drainage and discharge from the eye; it may be watery or thick and pus-like
• Swollen eyelids
Diagnosis
If your baby’s pediatrician suspects ophthalmia neonatorum they will first perform an eye examination. The doctor will look at your baby’s eyes to check for anything that may be irritating the eye, and to see if any damage has occurred. The doctor may look at the baby’s tear ducts to see if they are blocked. The doctor may also want to take a sample of any discharge to determine what type of bacteria or virus is causing the infection.
Treatment
Since the potential for serious eye damage to the infant is so great, it is standard treatment in US hospitals to give infants antibiotic eye drops or ointment immediately following delivery. This helps prevent the development of an eye infection even if the mother shows no symptoms of infection.

In cases where conjunctivitis does develop, the treatment of ophthalmia neonatorum depends on the cause:
Blocked Tear Duct
In cases of ophthalmia neonatorum that are due to a blocked tear duct, the doctor may recommend warm compresses and gentle massage to the area to help unclog the duct.
Irritation
Ophthalmia neonatorum due to irritation usually resolves on its own in a few days. In some cases, the irritation may be due to the antibiotic given after delivery. Silver nitrate, which was often used in the past to prevent eye infection, can cause irritation in the baby’s eye. Many hospitals now use other types of antibiotics to avoid this irritation.
Bacteria
Infants that have an eye infection due to bacteria are given antibiotics. These antibiotics may be given as topical drops or ointments, orally, or as an injection. In addition, the eye may be irrigated to remove the discharge.
Fortunately, since hospitals today have such effective prevention measures, bacterial cases of ophthalmia neonatorum are rare. And when they do occur, they are usually identified quickly. Antibiotic treatment is very effective and generally, the infection resolves rapidly. If you suspect that your infant may have an infection in the eye, it is important to call your baby’s doctor as soon as possible to receive prompt treatment.
Prevention
The best prevention of ophthalmia neonatorum is treatment of any sexually transmitted diseases in the mother prior to labor and delivery.
• In most cases, effective treatment of the mother before the time of delivery can prevent the transmission of infection to the newborn.
• For mothers with active genital herpes lesions at the time of delivery, a cesarean section can prevent the infant from getting the infection.
An open, honest relationship with your doctor is important during your pregnancy. Disclosure of your full medical history can help protect your baby from infection.

Nephrotic Syndrome

2009-01-08T20:51:00.000-08:00

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Nephrotic Syndrome
Pronounced: Neh-frah-tik sin-drome
Definition
Nephrotic syndrome occurs when the kidneys let protein leak into the urine. When this happens, there is too little protein in the blood. Low protein in the blood allows fluid to leak out of the blood stream and into body tissues.
Nephrotic syndrome is a collection of the following signs and symptoms:
• High protein in the urine
• Low protein in the blood
• Swelling of body tissues
• High cholesterol in the blood
Nephrotic syndrome is not a disease itself. It is a set of signs and symptoms that indicate another disease has damaged the kidneys and they are no longer working properly.
This is a serious condition that requires care from your doctor. Contact your doctor if you think you may have nephrotic syndrome.
Anatomy of the Kidney

Causes
Nephrotic syndrome is caused by damage to tiny filters in the kidneys, called glomeruli. The glomeruli filter waste and excess water from the blood forming urine, which reaches the bladder via the ureters. Diseases that damage the glomeruli cause nephrotic syndrome.
Diseases that may lead to nephrotic syndrome include:
• Glomerulonephritis (inflammation of the glomeruli from infection or other causes)
• Diabetic nephropathy (kidney complications from long-standing diabetes)
• Membranous nephropathy
• Renal amyloidosis (abnormal protein deposits in the kidneys)
• Minimal change disease (usually in children when nephrotic syndrome occurs despite little or no change to the structure of glomeruli or surrounding tissues upon examination)
• Systemic lupus erythematosis
Risk Factors
The following factors increase your chances of developing nephrotic syndrome. If you have any of these risk factors, tell your doctor.
• Kidney disease
• Diabetes
• Lupus
Symptoms
Symptoms may include:
• Swelling around the following body parts:
o Eyes
o Face
o Feet
o Ankles
o Hands
o Abdomen
• Weight gain from excess fluids
• Shortness of breath
• Poor appetite
• Foamy urine
• Fatigue
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. High blood pressure may indicated kidney damage. A urine test will show if you have too much protein in your urine. A blood test will show if your blood contains too much cholesterol and not enough protein.
Other blood tests may be performed to determine the cause of the syndrome and to assess how well the kidney is functioning. If your doctor suspects nephrotic syndrome, he or she may refer you to nephrologist (kidney specialist).
In some cases, a biopsy of the kidney is necessary to determine the cause of the syndrome and the best way to treat it. Imaging tests of the kidneys may also be useful in selected cases. These include:
• Computed Tomography (CT) Scan: a type of x-ray that uses a computer to make pictures of structures inside the body
• Magnetic resonance imaging (MRI): a test that uses magnetic waves to make pictures of structures inside the body
• Ultrasound: a test that uses sound waves to examine structures inside the body
Treatment
Treatment depends on what is causing the nephrotic syndrome. Some cases are treatable with medication, while others lead to kidney failure despite treatment. Besides directly treating the underlying cause, if possible, steps are taken to:
• Adjust diet to replace protein lost in the urine
• Use ACE inhibitors to reduce protein loss (in some cases)
• Treat edema by restricting salt intake and taking diuretics (water pills)
• Lower cholesterol and blood pressure with diet, exercise, and medications
Treatment Options for Selected Underlying Kidney Diseases:
Minimal Change Disease
Most cases of nephrotic syndrome in children are caused by minimal change disease. This condition is treated with oral steroids, such as prednisone. If the child does not respond to treatment, the doctor may prescribe other medications. Most children outgrow minimal change disease in their teen years and don’t have any permanent kidney damage.
Membranous Nephropathy
The most common kidney disease leading to nephrotic syndrome in adults is membranous nephropathy. Treatment for this condition is controversial, though it usually involves medications to suppress the activity of the immune system.
Kidney Dialysis and Tranplants
If the kidneys stop functioning, dialysis or a kidney transplant is needed. A dialysis machine filters waste and excess water from the blood. Dialysis may be done until kidney function improves or a transplant is available.
Prevention
Most conditions that lead to nephrotic syndrome cannot be prevented. However, the risk of type 2 diabetes may be reduced through exercise and weight control.

Neonatal Sepsis

2009-01-08T20:49:00.000-08:00

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Neonatal Sepsis
Definition
Neonatal sepsis is a bacterial infection in the blood. It is a condition found in infants less than three months old. This is a potentially serious condition that requires care from your baby’s doctor. If you suspect your baby has this condition, contact the doctor immediately.
Spread of Infection Via the Blood to the Entire Body in an Infant

Causes
The cause of neonatal sepsis is related to the baby’s exposure to bacteria. Sepsis that develops within the first week is usually acquired from the mother, via the placenta or from passage through the birth canal. Sepsis that develops after one week is usually acquired from the caregiving environment.
The incidence of culture-proven sepsis is approximately 0.2%, but the mortality rate can be as high as 50% if not treated.
Some factors related to your pregnancy or health also add to the chance that your baby can get this condition. These include:
• You have labor complications resulting in traumatic or premature delivery.
• Your water has broken more than 18 hours prior to giving birth.
• You have a fever or other infection while you are in labor.
• You need to have a catheter for a prolonged period of time while you are pregnant.
Risk Factors
The following factors increase your child’s chances of developing neonatal sepsis:
• Your baby is born more than three weeks before your due date (premature).
• You go into labor more than three weeks before your due date.
• Your baby is in distress before being born.
• Your baby has a very low birth weight.
• Your baby has a bowel movement before being born, and meconium (fetal stool) is present in the uterus.
• The amniotic fluid surrounding the baby has a bad smell, or the baby has a bad smell right after being born.
• Male babies are at greater risk for neonatal sepsis than female babies.
Symptoms
In 85% of the cases, symptoms of neonatal sepsis are present within 24 hours of birth. In almost all cases, they will be present within 48 hours of birth. If your baby experiences any of these symptoms do not assume it is due to neonatal sepsis. These symptoms may be caused by other, less serious health conditions. However, if your baby does experience any one of them, see your doctor. Some of these symptoms are things the doctor will need to check for.
• Fever or frequent changes in temperature
• Poor feeding from breast or bottle
• Decreased or absent urination
• Bloated abdomen
• Vomiting yellowish material
• Diarrhea
• Extreme redness around the belly button
• Skin rashes
• Unexplained high or low blood sugar
• Difficulty waking the baby or unusual sleepiness
• Jaundiced or overly pale skin
• Abnormally slow or fast heartbeat
• Breathing rapidly, difficulty breathing, or periods of no breathing (apnea)
• Bruising or bleeding
• Seizures
• Cool, clammy skin
Diagnosis
Your doctor will ask about your baby’s symptoms and medical history, and perform a physical exam.
Tests may include the following:
• Complete blood count
• Cultures of:
o Blood
o Urine
o Cerebrospinal fluid
o Skin lesions
• X-rays of the chest or abdomen
Treatment
Talk with your doctor about the best treatment plan for your baby. Treatment for suspected neonatal sepsis depends on how severe the condition is. Treatment may last between 2-21 days. In general, neonates suspected of sepsis are hospitalized for a minimum of two days to wait for culture results.
A well-appearing infant may be monitored without antibiotics and sent home when cultures are negative. Infants who appear ill may receive antibiotics for a minimum of two days while awaiting culture results. Culture-proven sepsis is treated for 7-21 days, depending on the location of the infection. Many babies with neonatal sepsis are admitted to the NICU (Neonatal Intensive Care Unit).
Treatment options include:
Antibiotics
Antibiotic medication may have to be given intravenously (through an IV).
Intravenous Fluids
The baby may need to receive fluids, glucose, and electrolytes through an IV.
Oxygen
The baby may need to be given oxygen or have help with his or her ventilation (breathing).
Prevention
To help reduce your baby’s chances of getting neonatal sepsis, your doctor may take the following steps:
• If you have given birth to a baby with neonatal sepsis before, your doctor may give you antibiotics close to your due date. This can help kill dangerous bacteria in the birth canal before the baby is exposed to it.
• The doctor can test you for the bacteria before your due date and give you antibiotics to get rid of it if necessary.

Neonatal Seizure

2009-01-08T20:48:00.000-08:00

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Neonatal Seizure
Pronounced: Nee-oh-nay-tul see-zhur
Definition
A seizure is a change in behavior that is caused by sudden, abnormal, and excessive electrical activity in the brain. A neonatal seizure occurs in newborn babies.
Seizures may be severe or mild, and may cause physical changes like convulsions. Seizures may affect only part of the body or the entire body. A short seizure itself does not cause serious health conditions, however, it is often a symptom or side effect of a more serious health condition. In addition, prolonged seizures can lead to permanent damage, due to lack of sufficient oxygenation and excessive brain cell activity.
Causes
There are a variety of causes of seizures in children, which include:
• Conditions like epilepsy
• An injury or trauma to the head
• Infections, including meningitis and abscesses in the brain
• Brain tumor
• Stroke
• Accidental poisoning
• Certain medical conditions, including:
o Low blood sugar
o Very high fever (especially in children)
Sometimes seizures occur for unknown reasons.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. The following factors increase your child's chance of having a seizure:
• Having had a previous seizure
• Having a very high fever
• Having health conditions like:
o Epilepsy
o Brain tumors
o Brain infections
• Having a family history of seizures.
Symptoms
Symptoms of seizures vary based on the type of seizure that occurs, but may include:
• Confusion
• Unconsciousness
• Staring, or a dazed look
• Jerking movements of the limbs and/or body (convulsions)
• Abnormal brain activity reflected in a lab test or scan
• High fever (higher than 102 degrees Fahrenheit)
• Difficulty breathing
• Eyes rolling back in the head
• Crying or moaning
• Vomiting
• Urinating
Diagnosis
Your doctor will ask about your child‘s symptoms and medical history, and perform a physical exam.
Tests may include the following:
• CT Scan of the Head—a type of x-ray that uses a computer to make pictures of structures inside the head
• MRI Scan of the Head—a test that uses magnetic energy to make pictures of structures inside the head
• Electroencephalogram (EEG)—a test that records the brain’s activity by measuring electrical currents through the brain
• Lumbar Puncture—removal of a small amount of cerebrospinal fluid for testing
• Blood Tests
Treatment
Treatment for the seizures depends on the cause of the seizures. Some seizures require no treatment, while others may require treatment of the underlying condition responsible for the seizure. Talk with your doctor about the best treatment plan for your baby. Treatment options for various types of seizures include:
Medications
Anticonvulsant medication may be prescribed to help prevent the abnormal brain activity that causes seizures. Medications are not usually prescribed for febrile seizures.
Surgery
Surgery of the brain may help reduce seizures in some patients with epilepsy. Surgery may involve separating nerve fibers or removing a portion of the brain to reduce or eliminate seizures.
For febrile seizures, which are most common in children and caused by fever, treatment is rarely required. Your doctor may advise that you give your baby medicine to keep fever down whenever he/she gets sick.
Prevention
Seizures cannot be prevented, but you should take safety precautions if you notice your child’s behavior changing. You should get your child to a safe place and lay him down to avoid injury.

Myocarditis

2009-01-08T20:43:00.000-08:00

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Myocarditis
Definition
Myocarditis is an inflammation of the myocardium, which is the heart’s muscular wall. Although rare, it can be devastating. Myocarditis can occur with no symptoms and remain undiagnosed. It can also occur with great intensity and lead to congestive heart failure.
Heart Chambers and Great Vessels, Detail Cut-away View

Causes
A large percentage of myocarditis cases have no identifiable cause. This is called idiopathic myocarditis. When a cause is identified, it falls into one of the following categories: infectious, toxic, or immune-mediated.
Infectious:
• Viral infection, including:
o Measles virus
o Rabies virus
o HIV
• Bacterial infection, including:
o Diphtheria
o Mycobacterium
• Fungal infection, including:
o Aspergillus
o Candida
Toxic:
• Drugs, including:
o Chemotherapeutic drugs
o Lithium
o Cocaine
• Heavy metals, including:
o Copper
o Iron
o Lead
• Toxic substances, including:
o Arsenic
o Carbon monoxide
o Inhalants
• Physical agents, including:
o Electric shock
o Radiation
Immune-mediated:
• Allergens, including:
o Penicillin
o Streptomycin
• Alloantigens, including:
o Heart transplant rejection
• Autoantigens, including:
o Chagas’ disease
o Scleroderma
o Lupus
Risk Factors
There are no known risk factors for developing myocarditis.
Symptoms
The symptoms of myocarditis vary from person-to-person depending on the cause and the severity. Symptoms may appear slowly or come on suddenly. Some people have no symptoms (asymptomatic).
Symptoms include:
• Flu-like complaints, including fever, fatigue, muscle pain, vomiting, diarrhea, and weakness
• Rapid heart rate
• Chest pain
• Shortness of breath and respiratory distress
• Loss of consciousness
• Sudden, unexpected death
If you have any of these symptoms you should contact your doctor right away.
Diagnosis
The diagnosis of myocarditis is often difficult; there is no specific test to diagnose it. Many other causes of heart problems must be ruled out. To do this, your doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include the following:
• Electrocardiogram (ECG)–a test that records the heart’s activity by measuring electrical currents through the heart muscle
• Chest X-ray–a test that uses radiation to take pictures of structures inside the body
• Cardiac Enzyme –measured through blood tests; in some cases certain enzymes are elevated
• Echocardiogram–a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
• Biopsy–removal of a sample of heart tissue to test for infection
• Cardiovascular magnetic resonance–the use of magnetic waves to take pictures of structures inside the body
Treatment
The universally recommended therapy for myocarditis is bed rest, no physical activity, and supplemental oxygen. Corticosteroids may be given to help inflammation. You will most likely be admitted to a hospital.
Specific treatment is directed at the underlying cause if possible. For instance, if the cause is a bacterial infection, antibiotics are prescribed. If it is viral, antiviral agents will be prescribed. Immunosuppressive therapy may be recommended in people if myocarditis is due to an autoimmune disorder such as lupus or scleroderma.
If heart failure symptoms are present, medications are given to support the function of the heart. These include diuretics, ACE-inhibitors, beta-blockers, and antiarrhythmic agents. Additionally, a defibrillator, which helps maintain the normal rhythm of the heart, may be implanted into your chest. Severe cases may require a cardiac transplant.
Prevention
Myocarditis is hard to prevent. To help reduce your chances of getting myocarditis, reduce your exposure to identified causes. Some examples include:
• Practice good hygiene to avoid the spread of infection–for example, wash your hands regularly
• Always use latex condoms during sexual activity
• Have sex with only one partner (who has sex only with you)
• Do not use illegal drugs

Mumps

2009-01-08T20:38:00.000-08:00

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Mumps
Definition
Mumps is a highly contagious viral infection with fever and swelling of the parotid glands. Once a common childhood illness, it is now rarely seen in the United States. Widespread use of the mumps vaccine provides lifelong immunity.
The Parotid Gland

Causes
The virus that causes mumps is in the paramyxovirus family of viruses, which also includes measles. This virus is usually spread through contact with an infected person's saliva. The mumps virus is highly contagious, and spreads easily among people in close contact.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. It is unlikely to contract mumps if properly immunized in childhood.
Risk factors:
• Exposure of unvaccinated individuals to others infected with mumps
• Persons born after 1956 that have never had mumps or were not vaccinated after their first birthday
• Age: between 10 and 19
• Season: winter and spring
• People who have a weakened immune system, even if previously vaccinated
Symptoms
About one-third of cases have no symptoms at all. Symptoms generally occur 2-3 weeks following exposure to the virus.
Mumps may cause some or all of the following symptoms:
• Painful swelling of the parotid glands (under the cheeks and jaw)
• Fever
• Sore throat
• Headache
• Stiff neck
• Nausea and vomiting
• Drowsiness
Occasionally, other areas may also be affected, such as:
• Swelling and pain under the tongue, jaw, or front of the chest
• In males: painful inflammation of the testicles
• In females: inflammation of the ovaries, which results in pain or tenderness in the abdomen
Diagnosis
Diagnosis of mumps is determined by symptoms, personal medical history, and physical exam. Testing is rarely required although in certain situations it may be recommended.
Treatment
There are no medications or specific treatment for mumps. Mumps is caused by a virus, and therefore cannot be treated with antibiotics. Mumps should NOT be treated with aspirin.
Note: Aspirin is not recommended for children or teens with a current or recent viral infection. Check with your doctor before giving a child aspirin.
In general, mumps will last about 10-12 days. The following are general comfort measures:
• Apply hot or cold compresses to swollen areas.
• Gargle with warm salt water to soothe sore throat.
• Treat high fever with non-aspirin medication, such as acetaminophen or ibuprofen.
• Drink plenty of liquids, but avoid tart or acidic drinks, such as orange juice and lemonade.
• Eat a soft, bland diet.
Complications
In otherwise healthy, well-nourished children, complications from mumps are rare. These may include deafness (which may not be permanent) or swelling or infection of the brain, pancreas, heart or other organs. Up to 20% of adolescent boys and men develop testicular inflammation; fertility is impaired in 13%, but sterility is rare.
Prevention
Mumps can be prevented by vaccine. The vaccine is usually given as part of the mumps-measles-rubella (MMR) vaccine series. The MMR series is given to children beginning at 12-15 months, and again at 4-6 years old or 11-12 years old.
Check with your doctor or healthcare provider to learn about the exceptions and special circumstances regarding the MMR vaccine. In general, people who should not receive mumps vaccinations include:
• Those who have had severe allergic reactions to vaccines or vaccine components (such as gelatin or the antibiotic neomycin)
• Women who are pregnant (Women receiving the mumps vaccination should avoid pregnancy for three months after receiving the vaccination)
• People with a weakened immune system
• People with a high fever or severe upper respiratory tract infection (They should delay immunization until these symptoms have resolved)
Any unvaccinated person who has not had mumps should avoid contact with an infected person until all symptoms have subsided.

Multiple Myeloma

2009-01-08T20:36:00.000-08:00

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Multiple Sclerosis
Definition
Multiple sclerosis (MS) is a chronic, disabling disease of the central nervous system. The disease causes inflammation, destruction, and scarring of the sheath that covers nerve fibers (called myelin) in the brain and spinal cord. As a result, electrical signals from the brain are slowed or blocked from reaching the eyes, muscles, and other parts of the body.
Causes
Malfunction of the body's immune system seems to be the cause of MS, but the exact cause of this malfunction is not known.
The following conditions may contribute to MS:
• Viral or other infection
• Genetic factors (heredity)
• Environmental factors
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for MS include:
• Sex: female
• Age: 16-40 years old
• Exposure to certain viruses
• Family members who have MS
• Northern European descent, especially Scandinavian
• Growing up in a colder climate, as opposed to a tropical climate
Symptoms
Symptoms may range from mild to severe and may include:
• Numbness or tingling in the legs, arms, face, or extremities
• Impaired vision in one or both eyes, including:
o Blurred vision
o Double vision
o Loss of vision
• Pain around the affected eye
• Fatigue
• Dizziness
• Muscle stiffness
• Muscle spasms
• Muscle weakness
• Poor coordination or falling
• Trouble walking or maintaining balance
• Paralysis in one or more limbs
• Bladder problems including :
o Urgency
o Hesitancy
o Incomplete emptying
o Incontinence
• Bowel problems, including constipation
• Sexual dysfunction
• Slurred speech
• Difficulty swallowing
• Forgetfulness, memory loss, and confusion
• Trouble concentrating or solving problems
• Depression
Factors that may trigger or worsen symptoms include:
• Heat including:
o Hot weather
o Hot baths or showers
o Fever
• Overexertion
• Infection
There are several types of MS:
Relapsing-remitting MS–Symptoms suddenly reappear every few years, last for a few weeks or months, then go back into remission. Symptoms sometimes worsen with each occurrence.
Primary Progressive MS–Symptoms gradually worsen after symptoms first appear. Relapses and remissions usually do not occur.
Secondary Progressive MS–After years of relapses and remissions, symptoms suddenly begin to progressively worsen.
Progressive Relapsing MS–Symptoms gradually worsen after symptoms first appear. One or more relapses may also occur.
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include:
MRI Scan–a test that uses magnetic and radio waves to check for damage to the myelin sheath of the nerves in the brain and spinal cord
Evoked Responses–a test that records the electrical responses evoked in specific nerves after a repeated sensory stimulus
Lumbar Puncture (Spinal tap)–removal of a small amount of fluid from around the spinal cord to check for white blood cells, antibodies, and proteins
Electroencephalogram (EEG)–a test that records the brain's activity by measuring electrical currents through the brain
Treatment
The goals of MS treatment are to relieve symptoms, prevent relapses, and slow disease progression.
Treatments include:
Medications
Medications may include:
• Corticosteroids–to reduce nerve tissue inflammation and shorten MS flare-ups
• Beta interferon–an antiviral agent used to suppress the immune system
• Glatiramer acetate–to help prevent MS relapses by blocking the immune system from attacking myelin
• Other immunosuppressive drugs such as:
o Mitoxantrone
o Azathioprine (off-label treatment option)
o Methotrexate (off-label treatment option)
o Cyclophosphamide (off-label treatment option)
• Immunoglobulin injections
• Natalizumab–for relapsing MS under a mandatory registration program
• Muscle relaxants–to treat muscle spasms or stiffness
• Other drugs to treat:
o Fatigue
o Depression
o Pain
o Bladder or bowel problems
Physical Therapies and Lifestyle Changes
Therapies and changes may include:
• Regular moderate exercise with your doctor's permission (Swimming is especially beneficial.)
• Physical therapy–to help maintain muscle strength and tone, dexterity and walking ability
• Massage
• Healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
• High fiber diet–to prevent constipation problems
• Stress reduction techniques
Psychological Therapies
Individual or group therapy–to learn better coping strategies for physical symptoms and emotional stress
Prevention
There are no guidelines for preventing MS, because the cause is unknown.
To prevent flare-ups or worsening symptoms if you have MS:
• Take medications as prescribed.
• Avoid hot weather.
• Stay in air-conditioned places during periods of hot weather.
• Get adequate rest.
• Get regular, moderate exercise with your doctor's permission.
• Avoid hot showers or baths.
• Eat a healthful diet, one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
• Make sure to get enough fiber in your diet.
• Avoid rapid changes in your weight.
• Consider getting regular massages (to aid stress reduction).

Multiple Myeloma

2009-01-08T20:35:00.000-08:00

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Multiple Myeloma
(Primary Bone Marrow Cancer)
Definition
Multiple myeloma is a relatively rare cancer of the bone marrow. It results from the abnormal growth of plasma cells in the bone marrow. Plasma cells normally produce antibodies. As these abnormal or malignant plasma cells multiply, they produce enormous quantities of abnormal antibodies. These abnormal antibodies accumulate in the blood and urine. As the plasma cell tumor grows, it also destroys the surrounding bone. These events lead to bone pain, kidney damage, and a compromised immune system.
Cancer occurs when cells in the body (in this case plasma cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors , which can invade nearby tissues and can spread to other parts of the body. A benign tumor does not invade or spread.
Causes
The cause of multiple myeloma is unknown.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for multiple myeloma include:
• Age: 50 or older
• Race: Black
Symptoms
Symptoms of early stage multiple myeloma include:
• Persistent bone pain, often severe. It is most commonly in the back but also in the limbs or ribs.
• Fatigue
When the disease progresses, symptoms may include:
• Fatigue
• Weakness
• Broken bones
• Repeated infections
• Nausea and vomiting
• Constipation
• Difficulty urinating
• Abnormal bleeding
• Headache
• Visual problems
• Confusion
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis is based on:
• X-rays to check for any damage to bones
• Blood and urine tests to check for high levels of antibody proteins
• Bone marrow aspiration or biopsy –removal of a sample of bone marrow tissue to test for myeloma cells
In addition, other blood and urine tests will be ordered to assess the various conditions associated with multiple myeloma including:
• Anemia
• Low levels of other blood cells (white blood cells and platelets)
• Elevated calcium levels (blood and urine)
• Evidence of kidney damage and bone destruction
Treatment
Once cancer is found, staging tests are performed to find out if the cancer has spread and, if so, to what extent. While treatment is sometimes capable of slowing the progression of the multiple myeloma, complete remission is rare. Treatment is also important for the control of symptoms. Treatment depends on your symptoms and the stage of your cancer.
Treatments include:
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.
The most common initial chemotherapeutic agents are melphalan, prednisone, or a three drug combination called VAD. When young patients develop myeloma, some oncologists feel they should first receive the VAD chemotherapy followed by a bone marow transplant, if they have had a good response to the initial VAD. The two types of bone marrow transplant used include an autologous and allogeneic transplant.
An autologous transplant is one where the patient’s bone marrow is stunned with very high doses of chemotherapy, and it recovers with infused stem cells.
The allogeneic transplant is a more involved process requiring the donation of bone marrow cells from a donor (usually a first-degree relative). The bone marrow of the patient is stunned with very high doses of chemotherapy (and sometimes with low doses of radiation therapy) followed by the infusion of the donor’s cells into the blood of the patient. The stem cells then seek out the bone marrow and re-populate it.
Both techniques are potentially deadly and have significant side effects associated with them. However, these procedures (particularly the allogeneic transplant) are the only ones that have shown to result in a prolonged survival, or even a cure.
Immunomodulatory Treatments
Immunomodulatory treatments help alter the way the myeloma cells live, and ultimately makes it difficult for them to survive, reproduce, and produce the proteins that cause secondary symptoms. Drugs used for this treatment include thalidomide, lenalidomide, arsenic trioxide, neovastat, and velcade.
Other Medications
• Strong oral analgesics to relieve bone pain
• If anemia is present, erythropoietin to increase the amount of red blood cells
• Prednisone and biphosphonate drugs to treat high calcium levels
• Antibiotics to treat infections
Radiation Therapy (Radiotherapy)
Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. Radiation is most often given to relieve bone pain, and by itself is not considered curative.
Surgery
Surgery is done to remove a multiple myeloma tumor that causes pain or other debilitating symptoms, when radiation therapy is not considered feasible. Surgery is not curative.
Red Blood Cell Transfusion
Red blood cell transfusion is for patients with severe anemia.
Peripheral Stem Cell Transplant
Peripheral stem cell transplant involves giving patients immature, healthy blood cells to replace bone marrow cells that are destroyed during total body radiation and high-dose chemotherapy.
Lifestyle Measures
Lifestyle measures help reduce symptoms and maintain overall health:
• Stay as active as possible.
• Drink plenty of fluids to help avoid dehydration and kidney damage.
• Eat a balanced diet.
• Do not take high doses of vitamins.
Prevention
There are no guidelines for preventing multiple myeloma because the cause is unknown.

Mononucleosis

2009-01-08T20:33:00.001-08:00

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Mononucleosis
(Infectious Mononucleosis, Mono)
Definition
Mononucleosis is a viral disease characterized by fever, sore throat, swollen lymph glands, and fatigue.
Swollen Glands

Causes
Mononucleosis is usually caused by the Epstein-Barr virus (EBV). While other viruses can cause mono-like symptoms, EBV is generally thought to be the virus which causes mononucleosis. Found mainly in saliva and mucus, EBV is passed most efficiently from person-to-person by intimate behavior, such as kissing.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Many people contract EBV during their lifetime. Risk factors that increase the likelihood that EBV will develop into mononucleosis include:
• Contracting EBV after the age of 10
• Lowered immune resistance, due to other illness, stress, or fatigue
• Living in close quarters with a large number of people, such as in a college dormitory
One episode of mononucleosis usually produces permanent immunity, so in general you can only get mononucleosis once.
Symptoms
Signs of mononucleosis usually begin about 4-7 weeks after you were exposed to the virus. The initial symptoms may be a sense of general malaise that lasts about a week. This is followed by a set of signs and symptoms that may include:
• High fever
• Severely sore throat
• Swelling of the lymph nodes
• Fatigue
• Loss of appetite
• Muscle aches
• Enlargement of the spleen
• Swollen tonsils
• Mild jaundice
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Diagnosis is based on:
• Your age
• Four primary symptoms:
o Fever
o Swollen lymph nodes
o Sore throat
o Fatigue
• Two primary tests:
o Blood tests and "mono spot" tests
o Throat culture (to check for strep throat, which can complicate mono)
Treatment
There is no treatment to cure mononucleosis or to shorten the length of illness. It usually runs its course in 4-6 weeks, although the fatigue may linger.
During the first month after diagnosis, patients should avoid contact sports, since inflammation of the spleen from mononucleosis puts individuals at a high risk of splenic rupture.
Treatment includes:
Relief of Symptoms
• Nonprescription pain relievers to lessen aches and pains and control fever (avoid aspirin, especially in children)
• Gargling with warm, salty water to relieve sore throat
• Steroids are sometimes used if the swelling in the throat is interfering with breathing, or if a complication involving low platelet counts or anemia occurs
Comfort
• Rest and fluids
• No heavy lifting or exercise for at least one month after recovery (this decreases the risk of rupturing an enlarged spleen that may have developed as part of this illness)
Prevention
Most people contract the EBV virus sometime during their lives. Prevention is geared toward decreasing the likelihood that EBV will develop into mononucleosis. Follow these guidelines to decrease your risk:
• Avoid intimate contact (especially kissing) with anyone who has active mononucleosis
• Eat a healthful diet
• Avoid excess stress
• Get enough rest

Moles

2009-01-08T20:30:00.000-08:00

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Moles
(Nevi)
Definition
Moles are small growths on the skin that develop from pigment-producing cells in the skin called melanocytes. They typically appear as dark brown spots on the skin that are either flat or raised. Most people have benign moles, which are harmless.
Moles that become atypical (dysplastic nevi) can eventually become melanoma (a form of skin cancer). It may be hard even for experts to distinguish atypical moles from melanoma, so moles which change or look atypical need to be evaluated by a dermatologist or other physician skilled in skin diagnosis.
Causes
Benign moles develop from an excess accumulation of melanocytes. In rare cases, a benign mole, especially one that is large and varied, may turn into an atypical mole.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
• Moles present at birth (this increases the likelihood of more moles later in life)
• Family members who have moles
• Excessive exposure to sunlight, especially sunburn
Symptoms
Most people have some benign moles that appear at birth, or during childhood or adolescence.
Benign moles, which can appear anywhere on the body, are usually:
• Dark brown, but can also be yellow-brown or flesh tone
• One color
• Round or oval with distinct edges
• Flat and smooth, but may occasionally become raised, rough, grow hair, or change color over time
Signs that a mole may be atypical include:
• Sudden change in size, color, shape, texture, or sensation
• Large size (¼ inch or more across—about the size of an eraser at the end of a pencil). Remember though that many melanomas today are found when quite small–often even less than ¼ inch. While the majority of atypical moles of any size aren’t cancerous, don’t let small size keep you from seeking medical attention for a changing or irregularly shaped mole.
• A mixture of colors, often including black
• Irregular edges
• Abnormal surface that is:
o Scaling
o Flaking
o Oozing liquid
o Bleeding
o Open with a sore that won't heal
o Hard and raised lump
• Itchy, tender, or painful
• Abnormally colored skin around it
Irregular Border on Mole

Diagnosis
The doctor will examine your skin and moles and ask about your symptoms and medical history.
Tests may include:
• Biopsy–removal of all or part of the mole to be tested for cancer cells
Treatment
Benign moles do not need to be treated. However, surgery may be performed to remove those that are unsightly or irritated.
Treatment for atypical moles include:
Surgery
Atypical moles that are cancerous or suspected of being cancerous can be removed surgically with local anesthesia. The mole tissue is examined under a microscope. If cancer cells are found, additional surgery is performed to remove any remaining portion of the mole and surrounding tissue.
Prevention
To help prevent benign moles from becoming atypical (and possibly cancerous):
• Avoid excessive exposure to the sun.
• Take proper precautions when in the sun:
o Wear a broad-brimmed hat and protective clothing.
o Wear sunscreen with a minimum sun protection factor (SPF) of 15. Reapply sunscreen every two hours during long periods of sun exposure.
Sometimes there is no way to prevent a benign mole from becoming atypical or cancerous. The key to successful treatment is early detection. To detect atypical or cancerous moles early:
• Monitor your moles, especially atypical moles.
• Report any sudden changes in a mole to your doctor.
• Have your doctor check and monitor atypical moles every 12 months. Have them checked more frequently based on your doctor’s recommendation if you have:
o A large number of atypical moles
o A family or personal history of atypical moles that develop into melanoma
Have an atypical mole removed if your doctor suggests it.

Mitral Valve Prolapse

2009-01-08T20:27:00.000-08:00

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Mitral Valve Prolapse
(Floppy Valve Syndrome, Barlow's Syndrome, Click-Murmur Syndrome)
Definition
Mitral valve prolapse (MVP) is a common, usually benign heart disorder. The mitral valve controls blood flow between the upper (atrium) and lower (ventricle) chambers on the left side of the heart. Normally, blood should only flow in one direction, from the upper chamber into the lower chamber. In MVP, the valve flaps don’t work properly; part of the valve balloons into the atrium, allowing blood to leak the wrong direction, back into the atrium.
Prolapsed Mitral Valve

Causes
In most cases, the cause of MVP is unknown. In some cases, it appears to be an inherited genetic condition. Rarely, MVP may be caused by:
• Rheumatic fever
• Coronary heart disease
• Cardiomyopathy
• Atrial septal defects
Risk Factors
A risk factor is something that increases your chances of getting a disease or condition.
• Family history of mitral valve prolapse
• Sex: Female
• Age: 14–30
• Scoliosis
• Thin chest diameter
• Low body weight
• Low blood pressure
• Chest wall deformities
• Marfan syndrome
• Grave’s disease
Symptoms
People with mitral valve prolapse often have no symptoms at all. If symptoms do occur, however, they may include one or more of the following:
• Irregular heart beat
• Fatigue
• Chest pain
• Panic attacks or anxiety
• Rapid heart beat (palpitations)
• Sensation of missed heart beats
• Shortness of breath
• Dizziness
• Intestinal problems (such as irritable bowel syndrome)
Diagnosis
Mitral valve prolapse can be heard through a stethoscope. A small blood leakage will sound like a murmur. When the mitral valve balloons backward, it may produce a clicking sound. Both murmurs and clicks are telltale signs of MVP. An echocardiogram can confirm the diagnosis. You may also be asked to wear a Holter monitor for a day or two, to continuously record the electrical activity of your heart (EKG).
Treatment
In most cases, no treatment is necessary. Speak with your doctor about whether you should take antibiotics prior to dental work or surgery. Antibiotics may help to prevent endocarditis, an infection of the membrane that covers the inside of the heart.
If symptoms include chest pain, anxiety, or panic attacks, a beta-blocker medication can be prescribed. Ask your doctor whether you may continue to participate in your usual athletic activities.
In very rare cases, the blood leakage may become severe. In these few cases, the mitral valve may need to be surgically repaired or replaced.
Prevention
There are no guidelines for preventing MVP of unknown or genetic origin.
You may be able to prevent symptoms, however, through certain lifestyle changes:
• Limit your intake of caffeine
• Avoid medications (such as decongestants) that speed up your heart rate
• Exercise regularly, following your healthcare provider’s recommendations for intensit

Mitral Stenosis

2009-01-08T20:22:00.000-08:00

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Mitral Stenosis
Definition
Mitral stenosis is a narrowing of the mitral valve in the heart. This valve is located between the atrium (upper chamber) and the ventricle (lower pumping chamber) of the left side of the heart. Blood must flow from the atrium, through the mitral valve, and into the ventricle before being pumped out into the rest of the body. Mitral stenosis results in inadequate blood flow between the two left chambers, and therefore too little blood and oxygen being pumped throughout the body.
Mitral Valve Stenosis

Causes
The most common cause of mitral stenosis is rheumatic fever, which scars the mitral valve. A less common cause is a congenital defect, usually part of a complex of multiple heart defects present at birth. Very rare causes include blood clots, tumors, or other growths that block blood flow through the mitral valve.
Risk Factors
A risk factor is something that increases your chances of getting a disease or condition. The main risk factor for mitral stenosis is rheumatic fever. Other risk factors include:
• Sex: Female
• Age: 30–50
Symptoms
Symptoms may include:
• Difficulty breathing, especially during exercise and when lying flat
• Awakening in the middle of the night, short of breath
• Fatigue
• Chest pain, such as squeezing, pressure, or tightness (rare)
• Sensation of rapid or irregular heartbeat (palpitations)
• Cough with exertion
• Coughing up blood
• Swelling of the legs or feet
• Frequent respiratory infections
• Dizziness, fainting
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. The doctor may be alerted to mitral stenosis by the following:
• Abnormal chest sounds, such as a heart murmur or snap
• Distention of the jugular vein in the neck
• Signs of fluid in the lungs
Tests may include:
• Chest X-ray – a test that uses radiation to take pictures of structures inside the chest
• Electrocardiogram (ECG, EKG) – a test that records the heart's activity by measuring electrical currents through the heart muscle
• Echocardiogram – a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart; in this test, the sound waves are passed through a transducer that is placed onto your chest
• Transesophageal Echocardiogram – uses the same ultrasound techniques to create an image of your heart, but gives a more detailed image. In this test, the transducer is passed down your esophagus (the tube in your throat that runs from your mouth into your stomach), to allow a better examination of the mitral valve.
• Cardiac Catheterization – an x-ray of the heart's circulation that is done after injection of a contrast dye
• Holter Monitor – a portable EKG device that you wear for 24 or more hours, to detect heart rhythm abnormalities that often accompany mitral stenosis
Treatment
If you have mitral stenosis, you will need antibiotics when you have certain infections (i.e., beta-strep infections, usually of the throat) or are having procedures (such as dental work) that may put you at risk for heart infections. This will help prevent further damage to your heart.
If you have mild mitral stenosis, your condition will need to be monitored, but may not need immediate treatment for symptoms associated with mitral stenosis. When symptoms become more severe, you may need to limit exertion and avoid high-salt foods. In addition, treatments may include:
Medications
Drugs may be prescribed to treat specific symptoms associated with mitral stenosis. These medications include:
• Drugs that lower the heart rate and improve the heart's function (beta-blockers and calcium channel blockers)
• Water pills (diuretics)
• Blood-thinning drugs (because mitral stenosis can lead to blood clots that can go to the brain, causing strokes, or to the limbs, causing severe problems)
• Beta-blockers
• Drugs to control heart arrhythmias
Surgery
Common types of heart valve surgery include:
Mitral Valvulotomy – A surgical cut or enlargement is made in the stenotic mitral valve to relieve the obstruction.
Balloon Valvuloplasty – A balloon device is inserted into the blocked mitral valve to open or enlarge the valve. This may provide temporary relief of symptoms. However, the valve may become blocked again.
Mitral Valve Replacement – This is the surgical replacement of a defective heart valve. This surgery is usually delayed until symptoms are severe or the patient can no longer be helped by other procedures.
Prevention
Most cases of mitral stenosis can be prevented by preventing rheumatic fever:
• Treat strep throat infections promptly to avoid rheumatic fever, which can cause scarring of the heart valve; always finish all of the antibiotics prescribed, even if you feel better before taking all of the doses.
In addition, there are several things you can do to try to avoid some of the complications of mitral stenosis:
• Get regular medical care, including checkups and periodic electrocardiograms.
• Take antibiotics before any dental cleaning, dental work, or other invasive procedures. This will help prevent infection of the heart valve.
• If your valve problem was caused by rheumatic fever, talk to your doctor about antibiotic treatment to prevent future episodes of rheumatic fever.
• Avoid caffeine, alcohol, and drugs (like decongenstants) that speed up your heart rate; these will only worsen your symptoms.
• Maintain a healthy weight.
• Follow your doctor’s recommendations for exercise.
• Ask your doctor about cutting back on salt; this may help decrease the pressure in your heart, and improve your symptoms.
• Monitor your blood pressure, and inform your healthcare provider if you seem to be developing high blood pressure, which can worsen your symptoms.

Mitral Regurgitation

2009-01-08T20:14:00.000-08:00

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Mitral Regurgitation
(Mitral Insufficiency)
Definition
Mitral regurgitation is the leaking of blood from the left ventricle across the mitral valve, and into the left atrium. The flow of blood pumped by the heart is controlled by one-way valves. These valves assure that blood moves in only one direction. When the mitral valve leaks, some of the blood that should be pumped into the body instead goes backward into the left atrium. If the amount of blood that leaks is severe, mitral regurgitation can be a serious condition that requires care from your doctor. The sooner it is treated, the more favorable the outcome. If you suspect you have this condition, contact your doctor immediately.
Function of the Mitral Valve in the Heart

Mitral Valve Regurgitation

Causes
There are several causes for leaky heart valves. Birth defects can deform them. Infections can scar them. Heart attacks can damage them, and the mechanics of an enlarged heart can stretch out the opening so that the valve is no longer large enough to work effectively.
• Rheumatic Fever–infectious diseases of several kinds can afflict the inside of the heart, leading to scarring of the heart’s valves. Rheumatic fever used to be a common cause of mitral valve damage but is seen infrequently today in the United States.
• Heart Attack–inadequate blood supply to the heart can weaken the small muscles that hold the mitral valve in place, causing it to leak.
• Congenital Deformity–several different types of congenital heart defects distort the mitral valve.
• Heart Muscle Disease–not only infections, but many other types of disease can weaken the heart muscle, stretching out the mitral valve ring so that the valve no longer closes. Among these causes are alcohol, certain drugs, radiation, muscular dystrophies, malnutrition, cancer, and a long list of inflammatory and metabolic disorders.
Risk Factors
The following factors increase your chance of developing mitral regurgitation. If you have any of these risk factors, tell your doctor:
• A history of rheumatic fever or other serious infectious disease
• Inflammatory diseases such as lupus and rheumatoid arthritis
• Storage diseases such as hemochromatosis and glycogen storage disease
• Heart disease
• Muscle disease
• Malnutrition
• Alcoholism
• Radiation exposure
• Exposure to certain drugs (eg, lithium, sulfonamides, cancer chemotherapy, phenothiazines)
Symptoms
These symptoms may be caused by mitral regurgitation or other serious health conditions. If you experience any one of them, see your physician.
• Chronic, progressive fatigue
• Shortness of breath
• Worsening shortness of breath when you lie down
Diagnosis
Your doctor will ask about your symptoms and medical history and perform a physical exam. Leaking heart valves usually make sounds that can be heard through a stethoscope. You will likely be referred to a cardiologist.
Tests may include the following:
• Chest x-ray
• Electrocardiogram
• Cardiac ultrasound (echocardiogram)
• Cardiac catheterization
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Treat Underlying Disease
Treating heart failure and heart disease may render the mitral valve competent.
Surgery
There are several open heart surgical procedures that can fix leaking valves. The type chosen will depend upon the particular nature of the valve.
Prevention
To help reduce your chance of getting mitral regurgitation, take the following steps:
• Prevent heart disease by controlling weight and blood pressure, exercising, eating heart-healthy foods, and watching your cholesterol levels
• Avoid contact with streptococcal diseases including strep throat, tonsillitis, scarlet fever, and rheumatic fever
• Limit alcohol intake

Miscarriage

2009-01-08T20:12:00.000-08:00

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Miscarriage
(Spontaneous Abortion)
Definition
Miscarriage refers to the premature end of a pregnancy before the developing baby is able to survive outside the womb. Miscarriage can occur during the first or second trimester, before 20 weeks. Most occur in the first 12 weeks of pregnancy and most miscarriages are unexpected and isolated events. About 15%-20% of recognized pregnancies end this way.
Fetus in First Trimester

Causes
Some miscarriages cannot be explained. Miscarriages often occur for the following reasons:
• Chromosomal abnormality (advancing maternal age)
• Uterine defects
• Fibroids
• Scar tissue from a past surgery
• Insufficient progesterone (a female hormone needed to support pregnancy)
• Infection in the genital tract
• Immunologic factors that may cause blood-clotting problems or rejection of the fetus
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
• Advancing maternal age
• Smoking
• Drinking alcohol at a level beyond two drinks per day
• Using illicit drugs (street drugs)
• Exposure to certain environmental toxins
• Infection, such as cytomegalovirus (CMV) and HIV
• Chronic maternal illness, eg, autoimmune diseases, such as lupus and insulin-dependent diabetes with uncontrolled blood sugar
After one miscarriage early in the pregnancy, you are not at increased risk for subsequent miscarriages. If you've had multiple miscarriages (at least three), you may benefit from a medical evaluation to determine the cause.
Recurrent Miscarriage
While miscarriage usually is a one-time occurrence, up to one in twenty couples experience two miscarriages in a row, and one in one hundred have three or more. In some cases, these couples have an underlying problem that is causing the losses. Couples who have experienced two or more miscarriages should have a complete medical evaluation to learn the cause of the miscarriages, and how they can prevent another one. Testing can reveal the cause of repeat miscarriages in at least 75 percent of couples.
• Chromosome problem in one member of the couple in 5 %
• Uterine abnormalities in 10%-15%
• Hormone problems in 5%-40%
• Immune system problems in 5%-10%
• Unknown causes in 25%
Symptoms
Symptoms include some or all of the following:
• Vaginal bleeding
• Pink or brown discharge
• Cramping
• Discharge of the products of conception
• Fever
Diagnosis
You will be asked about your symptoms, the length of your pregnancy, and when you first noticed a change in your condition. The doctor will perform physical and pelvic exams.
Tests may include:
Ultrasound Testing—to assess the health of the fetus or detect an ectopic pregnancy (a pregnancy in which development occurs outside the uterus)
Tissue Examination—to examine tissue that has been expelled and check for chromosome defects
Other tests check the degree of blood loss and for fetal and maternal blood types:
Blood Tests—to check for a chromosomal error in the man or the woman or to check hormone and antibody levels; and to check the exact amount of the pregnancy hormone (quantitative beta-HCG).
Imaging Tests—x-rays or an ultrasound to identify a problem with your uterus
Endometrial Biopsy—reveals the suitability of your uterine lining to accept and sustain an embryo
Hysteroscopy—looking inside your uterus, using a thin, lighted fiberoptic instrument. The hysteroscope is inserted in your vagina and passed through your cervix. The doctor can check for problems with the shape or size of your uterus, and examine and sample the endometrial lining. During the procedure, the doctor also may be able to correct a uterine problem.
Treatment
Immediate care usually involves observation only, especially in early or first trimester miscarriages. Medication may be indicated in the event of heavy bleeding or cramping. A dilation and evacuation (D&E) may be needed if all uterine contents are not spontaneously expelled. During a D&E, the doctor dilates the cervix, inserts a tool into the uterus, and suctions out remaining material. Women may need professional counseling to recover emotionally from the loss.
The goal of long-term treatment is to prevent future miscarriages. This is geared toward whatever caused past losses.
Medications
Medications to decrease the chance of miscarriage may include:
• Antibiotics for infection
• Progesterone supplements (if this hormone is believed to be suboptimal)
• Aspirin and other medications to treat blood-clotting problems caused by immunologic disorders
Surgery
Many physical abnormalities can be corrected to decrease the chance of another miscarriage. If the cervix is weak, the doctor can place a stitch ('cerclage'), usually at the beginning of the second trimester of the next pregnancy, to keep it closed until you are ready to deliver. If fibroids are a contributing factor, removing them may prevent another loss.
Support Services
Talking with a professional counselor often helps women deal with their loss. Some people benefit from participating in a support group.
Prevention
Before you start to plan your next pregnancy consider the following regarding your health:
• Is your diet ready to support another pregnancy?
• Are there habits you should change prior to another pregnancy?
• What medications are you taking and will they affect a pregnancy?
• How is your health?
• Are there issues you should resolve before trying another pregnancy?
• Seek help to learn about your risks and what you can do to minimize them.