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Dizziness (Dizzy)

2012-02-24T19:12:00.001-08:00

Introduction to dizziness (feeling dizzy)

Dizziness is one of the most common symptoms that will prompt a person to seek medical care. The term dizziness (or dizzy) means different things to different people, so it is difficult to define. Does "feeling dizzy" mean lightheadedness or the feeling of weakness and almost passing out? Or does it refer to the sensation of vertigo, in which a person feels as if they have just gotten off a merry-go-round?

Dizziness (lightheadedness) is often caused by a decrease in blood supply to the brain, while vertigo may be caused by disturbances of the inner ear and the balance centers of the brain. It is important that the health care practitioner understand what you mean when you complain of dizziness. You may be asked additional questions so that the proper direction can be taken for a diagnosis and treatment.

What are some common causes of dizziness?

While classifying dizziness into lightheadedness and vertigo categories may help understand how the body works, sometimes it is worthwhile to review common reasons why people might complain of dizziness.

Low blood pressure

Dizziness, lightheadedness, and the feeling of passing out is a common complaint in people who have low blood pressure. When the blood pressure is too low, not enough oxygen-rich blood is being delivered to the brain, and its function can be affected. If the brain's blood supply is decreased too much, the person may pass out (syncope).

In addition to feeling dizzy, associated symptoms may include:

Low blood pressure may be the result of an underlying illness or disease, or it may be a normal physiologic condition. Some common reasons for low blood pressure include the following:

Anemia (decreased red blood cell count)
Bleeding
Dehydration (loss of water in the body) often occurs with infections that cause vomiting and diarrhea. Fever also can cause a significant amount of water loss due to increased metabolic rate and excessive sweating as the body tries to cool itself.
Heat-related illnesses associated with dehydration such as heat cramps, heat exhaustion, or heat stroke (a medical emergency).
Side effects of certain medications used to control blood pressure and heart rate. Examples include:
- beta blockers (propranolol [Inderal, Inderal LA], atenolol [Tenormin], metoprolol, [Lopressor, Toprol XL]), which block adrenalin receptors in the heart and may limit the ability of the heart rate to increase in response to changes of position, decreased red blood cell count, or dehydration.
- Nitroglycerin and isosorbide mononitrate (Imdur), a long acting nitroglycerin, are medications that are prescribed to dilate blood vessels in the heart to treat angina. However, these medications may also cause other blood vessels in the body to dilate and be unable to respond to the body's needs.
- Diuretics that can cause dehydration
- ACE inhibitors that slow the heart rate, and
- medications for erectile dysfunction that can dilate blood vessels.
Alcohol use
Pregnancy

Postural or orthostatic hypotension

In individuals who are dehydrated or anemic, blood pressure readings may be normal when they are lying flat, however, the lack of fluid is unmasked when they stand up quickly. The lack of blood to the brain causes dizziness and lightheadedness. This feeling may pass in a few seconds as the body adapts. However, if dehydration or medications (for example, beta blockers) prevent the body from reacting by constricting blood vessels and increasing the heart rate, the dizziness may persist to the point at which the patient passes out (faints, syncope).

Some diseases are associated with an inability to compensate for changes in body position (autonomic dysfunction). Normally when a person stands, blood vessels contract to increase blood pressure slightly, and the heart rate increases to push blood up to the brain (pushing against gravity). In autonomic dysfunction, a person may become dizzy when they move from a lying position to sitting or standing up. Examples of these diseases include diabetes, Addison's disease, or Parkinson's disease).

Orthostatic hypotension is a common symptom with Shy-Drager syndrome. Shy-Drager syndrome is a rare disease in which the autonomic nervous system degenerates and cannot provide the routine control mechanisms for the body including heart rate, blood pressure, and bowel and bladder function.

High blood pressure

High blood pressure, or hypertension, is known as the "silent killer" since it often has no symptoms, even if blood pressure readings are markedly elevated. On occasion, a person may complain of headache, nausea, or dizziness, although the complaints don't necessarily correlate with the degree of blood pressure elevation.

However, if the blood pressure is elevated and the person has symptoms, there is a need to bring the blood pressure under control relatively quickly. The more severe the symptoms, the quicker blood pressure control needs to be achieved. For example, if a person is having chest pain or stroke symptoms associated with high blood pressure, the blood pressure needs to be controlled immediately.

Diabetes

Dizziness is a common complaint in persons with diabetes, and may be caused by low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), or autonomic dysfunction (see previously).

Hypoglycemia or low blood sugar (hypo=low +glyc=sugar =emia=blood) occurs because of an inadequate amount of glucose in the blood. A person with diabetes can develop hypoglycemia from an inadequate amount of food intake, or from taking too much medication (insulin or oral tablets), which results in low blood sugar levels. In this situation the person experiences dizziness or lightheadedness because the brain lacks glucose to function properly. Persons with diabetes and their families need to recognize the symptoms of hypoglycemia, including dizziness, sweating, confusion, and coma as treatment needs to be given immediately. Oral sugar-containing foods or a glucagon injection may be life-saving for the patient.
Hyperglycemia (hyper=high +glyc=sugar +emia=blood) also causes dizziness. High blood sugar levels occur because there is not enough insulin available to allow cells to use glucose for energy metabolism. (Interestingly, brain cells do not need insulin to use glucose.) High blood sugars cause a variety of metabolic responses in the body leading to dehydration, anaerobic metabolism, and changes in the acid-based balance. This may result in a life-threatening condition referred to as diabetic ketoacidosis.

Endocrine diseases

Diabetes (discussed previously) if not well controlled is one of the main endocrine diseases that may cause dizziness.
Thyroid disease: Abnormalities of the thyroid may also cause dizziness as one of its symptoms.
- Hyperthyroidism (too much thyroid hormone) may cause palpitations, shortness of breath, lightheadedness, and dizziness.
- Hypothyroidism (too little thyroid hormone) may cause low blood pressure and a decreased heart rate leading to dizziness, weakness, lethargy, and chills.
Addison's disease: Addison's disease occurs when the adrenal glands do not produce enough cortisol to meet the needs of the body. Cortisol is a naturally occurring steroid produced by the body and is part of the stress response (often termed the "fight or flight" response). If cortisol levels are low, a patient may experience weakness, fatigue, dizziness, lightheadedness, low blood sugar, and low blood pressure.

Hyperventilation

While the body may use hyperventilation or rapid breathing to help with acid-base balance, it may also occur as a response to an emotionally stressful situation. In hyperventilation syndrome, the rapid breathing blows off some of the body's carbon dioxide, leading to a tingling sensation in the hands and feet, and around the mouth. Dizziness and lightheadedness are associated symptoms. The symptoms may increase the perceived emotional stress and cause even more hyperventilation. In severe hyperventilation, carbon monoxide levels drop enough to cause carpopedal spasm, in which the hands and feet become claw-like and difficult to move. Symptoms of hyperventilation resolve relatively quickly once the breathing rate returns to normal.

Heart conditions

The heart is an electrical pump and for it to work, the electrical conduction system must be operating properly to stimulate the heart muscle to squeeze in a coordinated fashion and pump blood to the body. The heart muscle itself must be strong enough to pump blood, and the valves in the heart must work properly to allow blood to flow in the direction intended during contraction.

Conduction disturbances: Electrical conduction disturbances may make the heart beat too quickly (tachycardia) or too slowly (bradycardia), and either of these situations may result in an inadequate blood supply to the brain, causing dizziness or lightheadedness.
Cardiomyopathy: Dizziness is also a symptom of cardiomyopathy (cardio=heart +myo=muscle + pathy= disease), a disease of the heart muscle, resulting in muscle that doesn't beat properly. Most commonly the weakness is due to atherosclerotic heart disease or ischemic cardiomyopathy (ischemic=decreased blood supply), in which the heart muscle itself doesn't get enough blood supply to work properly. Other cardiomyopathies may be due to diabetes, alcohol use, and viral infections.

Vasovagal syncope

Vasovagal syncope is a common cause of dizziness, lightheadedness, and fainting. The vagus nerve is overstimulated and causes the body's blood vessels to dilate and the heart to slow down. This anti-adrenaline effect decreases the ability of the heart to pump blood upward to the brain. Without blood flow, the brain turns off. In Victorian England, when this happened because young ladies' sensibilities were easily offended, this was called a swoon.

Some people faint at the sight of blood. Some parents faint when their child gets immunized. Many types of emotional and physical stressors can overstimulate stimulate the vagus nerve, thus causing dizziness, lightheadedness, and at times fainting (passing out).

Fainting is not normal. If a person is unconscious, the emergency medical system should be activated (call 911 if available), and medical care should be sought.

Dizziness and vertigo

Vertigo is often described as feeling dizzy, or a sensation of spinning. A person may specifically mention that the room seems to be spinning around them. Sometimes the complaint is loss of balance or loss of equilibrium. This often occurs because of irritation in the inner ear (the part of the ear that involves balance, not hearing).

The inner ear has two parts that help the body determine its position in space relative to gravity; 1) the semicircular canals and 2) the vestibule.

There are three semicircular canals that are aligned at right angles to each other. These canals are filled with fluid and are lined with a nerve-filled, crystal-encrusted membrane that transmits information to the cerebellum (the part of the brain that controls balance and coordination). The cerebellum collects information from the eyes (visual stimuli) and the nerve endings in muscles associated with proprioception (the perception of movement), to assist the brain in assessing where the body is in relationship to gravity and its surroundings.

Normally, when the head moves, fluid in the semicircular canals shift, and that information is relayed to the brain. When the head stops moving, the fluid stops as well, and that information is relayed to the brain.

In some cases there may be a short delay in the transmission of this information to the brain. For example, when a person rides on a merry-go-round or spins quickly around in circles, the fluid in the canals develop momentum and even though the body stops spinning, the fluid in the semicircular canals may continue to move. This causes vertigo, or a sensation of spinning, and may cause the person to fall or stumble. It also may be associated with vomiting. While these are symptoms attempt to provoke in play, they can be debilitating for an adult.

Inflammation: In patients with vertigo, inflammation of the fluid or irritation of the crystals on the membrane that lines the walls of the semicircular canals may cause the spinning sensation even without much head movement. Often, only one canal is involved and the patient may be symptom-free if they don't move.
Benign paroxysmal positional vertigo (BPPV): BPPV may be caused when the crystals in the inner ear become dislodged and irritate the semicircular canals. Often the cause is not found, but there may be an association with unusual positioning or movement of the head, for example, moving the head up and down while working on a computer. It is frequently seen in people older than 60 years of age.
Labyrinthitis: Labyrinthitis (labyrinth=inner ear + itis=inflammation) may follow a viral infection which causes inflammation within the middle ear.
Meniere's disease: This condition is a disorder of the flow of fluids of the inner ear; symptoms include vertigo, hearing loss, and tinnitus (ringing in the ears).
Acoustic neuroma: This is a benign tumor of the ear that can be present with vertigo.
Brain: Much less commonly, the cause of vertigo may arise in the brain. Stroke, tumors, seizures and multiple sclerosis may be associated with vertigo.

What are the symptoms experienced when a person feels dizzy?

Lightheadedness is the feeling of weakness and faintness as if you are about to pass out. The symptoms tend to be short-lived, depending on the cause. There may be associated nausea, sweating, and blurred vision.
If the cause is dehydration or bleeding, the symptoms may be brought on by standing quickly and may resolve somewhat by lying down (orthostatic hypotension)
Heart rhythm disturbances may occur without warning and may be associated with palpitations. This may come and go or it may persist. The heart beat may be felt as too fast (often described as a pounding), too slow, and/or irregular.
Vertigo is the sensation of spinning and may present without warning and be associated with nausea and vomiting. People with inner ear problems may be unable to move without generating symptoms.
People with a cerebellar cause of vertigo such as a stroke or tumor may have associated coordination problems or difficulty walking.

When should I call the doctor for dizziness?

Dizziness is a common complaint and often has resolved by the time the patient arrives to see a health care practitioner. Usually there is no rush to seek care. However, while the complaint of dizziness is not often an emergency, care should be sought immediately if it is accompanied by any of the following:

Chest pain, shortness of breath, or palpitations. These symptoms should not be ignored as they suggest the heart may be the source of the dizziness.
Dehydration. Often there may be an associated illness including fever, vomiting, or diarrhea.
People with diabetes may have dizziness due to low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia), and may need emergent care to stabilize their insulin and medication requirements.
Bleeding from any source.
Altered mental status or thinking. This may include symptoms such as confusion, change in vision, change in speech, facial droop, weakness of one side of the body, or headache. These may be signs of stroke, bleeding in the brain, or tumor.
Vertigo may cause significant problems with vomiting and may be debilitating. Often, medical care is needed to control symptoms even though the underlying problem is not serious.

How is dizziness diagnosed?

The diagnosis of dizziness begins with the health care practitioner evaluating whether the complaint of dizziness refers to lightheadedness or vertigo. Further direction continues once this distinction is made.

The key to the diagnosis of dizziness is a thorough history and physical examination. Often the diagnosis is made by listening to the patient's story. The health care practitioner may ask about triggers that cause and relieve the symptoms of dizziness, such as:

"Is it related to changing positions quickly?" and
"Does it resolve on its own or does the patient have to do something, like lie down to make it better?"

A review of systems is a series of questions that review the patient's body functions. Questions may be asked about associated symptoms including fever, vomiting, diarrhea, chest pain, shortness of breath, palpitations, or abnormal bleeding. The past medical history may be reviewed, and this includes reviewing medications the patient is currently taking.

A thorough physical examination will likely be done, this may include:

Vital signs: Taking the patient's blood pressure and pulse rate lying down and standing (called orthostatic or postural vital signs) often will indicate the fluid status of the body. In patients who are dehydrated or bleeding, the vital signs may rise on changing position. However, patients taking medications such as beta blockers will not generate in increased pulse rate.

Tailored physical examination: Often, the physical examination is tailored to the patient based upon the information provided in the patient's medical history. For example, a woman with a heavy menstrual period may need a pelvic examination, or a patient with cough and shortness of breath may need a closer examination of the heart and lungs.

Imaging studies and blood tests: The need for imaging studies and/or and blood tests will depend on the concerns the health care practitioner and patient have in regard to the cause of the dizziness. Common tests that may be ordered include:

complete blood count (CBC) to screen for anemia or infection,
evaluation of electrolytes,
blood sugar tests,
kidney function tests, and
thyroid tests.

X-rays, CT scans, and MRI may be indicated depending upon the patient's needs.

How is vertigo diagnosed?

The diagnosis of vertigo is most often made based upon history and clinical presentation. If the patient is experiencing a spinning sensation that worsens by a change in position, and lessens by lying still, the health care practitioner can confirm the cause of dizziness as vertigo.

Further history may be taken to make certain that the symptom of vertigo is isolated to an inner ear condition and not due to a problem in the brain (for example, a stroke).

Neurological examination

Physical examination will focus on the neurologic examination and may involve looking at eye movements. With vertigo, nystagmus may be present. This is an involuntary movement of the eyes, slow and smooth in one direction with fast twitches in the other. It is the eyes' attempt to compensate for the abnormal signals being created in the inner ear.

The patient's hearing may be tested to assess potential hearing loss. This may be seen in Meniere's Disease or with an acoustic neuroma, but not necessarily with labyrinthitis or benign positional vertigo.

The rest of the neurologic examination may be done to look for one-sided weakness, loss of coordination, or loss of balance as potential signs of stroke.

Evaluation for BPPV or labyrinthitis is often complete at this point, although depending upon the health care practitioner's concerns, further testing may be indicated. Referral may be made to a physical therapist specially trained in vestibular therapy.

If there is confusion as to the potential cause of vertigo, imaging of the brain may be needed. Magnetic resonance imaging (MRI) may be indicated since this test evaluates the cerebellum more accurately. Computerized tomography (CT scan) may be used in an emergency to assess bleeding

How is dizziness treated?

Dizziness treatment

Dizziness is a symptom, not a disease, and treatment will be directed to the underlying cause. For example, dizziness or lightheadedness due to dehydration from gastroenteritis may require intravenous fluids and medications to stop the vomiting and diarrhea, while dizziness or lightheadedness from a heart rhythm condition may require admission to the hospital and specialized testing and treatment.

Vertigo treatment

Vertigo from inner ear problems may often be treated with maneuvers to reposition the crystals and debris in the semicircular canals.
Depending upon the reason for the inner ear inflammation, oral steroid medications to decrease that inflammation might be prescribed.
Over-the-counter or prescription medication is occasionally recommended or prescribed to help with vertigo. Meclizine (Antivert) may help with control of mild symptoms.
In patients with intractable symptoms and vomiting, intravenous diazepam (Valium) may be considered.
Patients with Meniere's Disease or acoustic neuroma are usually referred to an ear, nose, and throat specialist (otolaryngologist, ENT physician) for further evaluation and care.

Dizziness At A Glance

Dizziness is a symptom that is often applies to a variety of sensations including lightheadedness and vertigo. Vertigo is the sensation of spinning, while lightheadedness is typically considered near fainting, and weakness.
Conditions that may cause dizziness in a patient include low blood pressure, high blood pressure, dehydration, medications, postural or orthostatic hypotension, diabetes, endocrine disorders, hyperventilation, heart conditions, and vasovagal syncope.
Vertigo is most often caused by a problem in the balance centers of the inner ear called the vestibular system and causes the sensation of the room spinning. It may be associated with vomiting. Symptoms often are made worse with position changes. Those with significant symptoms and vomiting may need intravenous medication and hospitalization.
Vertigo is also the presenting symptom in patients with Meniere's Disease and acoustic neuroma, conditions that often require referral to an ENT specialist.
Most often, dizziness or lightheadedness is a temporary situation that resolves spontaneously without a specific diagnosis being made.

Hyperthyroidism

2012-02-24T06:00:00.000-08:00

What is hyperthyroidism?

Hyperthyroidism is a condition in which an overactive thyroid gland is producing an excessive amount of thyroid hormones that circulate in the blood. ("Hyper" means "over" in Greek). Thyrotoxicosis is a toxic condition that is caused by an excess of thyroid hormones from any cause. Thyrotoxicosis can be caused by an excessive intake of thyroid hormone or by overproduction of thyroid hormones by the thyroid gland. Because both physicians and patients often use these words interchangeably, we will take some liberty by using the term "hyperthyroidism" throughout this article.

What are thyroid hormones?

Thyroid hormones stimulate the metabolism of cells. They are produced by the thyroid gland. The thyroid gland is located in the lower part of the neck, below the Adam's apple. The gland wraps around the windpipe (trachea) and has a shape that is similar to a butterfly formed by two wings (lobes) and attached by a middle part (isthmus).

The thyroid gland removes iodine from the blood (which comes mostly from a diet of foods such as seafood, bread, and salt) and uses it to produce thyroid hormones. The two most important thyroid hormones are thyroxine (T4) and triiodothyronine (T3) representing 99.9% and 0.1% of thyroid hormones respectively. The hormone with the most biological activity (for example, the greatest effect on the body) is actually T3. Once released from the thyroid gland into the blood, a large amount of T4 is converted to T3 - the more active hormone that affects the metabolism of cells.

Thyroid hormone regulation--the chain of command

The thyroid itself is regulated by another gland located in the brain, called the pituitary. In turn, the pituitary is regulated in part by thyroid hormone that is circulating in the blood (a "feedback" effect of thyroid hormone on the pituitary gland) and in part by another gland called the hypothalamus, also a part of the brain.

The hypothalamus releases a hormone called thyrotropin releasing hormone (TRH), which sends a signal to the pituitary to release thyroid stimulating hormone ( TSH). In turn, TSH sends a signal to the thyroid to release thyroid hormones. If overactivity of any of these three glands occurs, an excessive amount of thyroid hormones can be produced, thereby resulting in hyperthyroidism.

Hypothalamus - TRH

Pituitary- TSH

Thyroid- T4 and T3

The rate of thyroid hormone production is controlled by the pituitary gland. If there is an insufficient amount of thyroid hormone circulating in the body to allow for normal functioning, the release of TSH is increased by the pituitary in an attempt to stimulate the thyroid to produce more thyroid hormone. In contrast, when there is an excessive amount of circulating thyroid hormone, the release of TSH is reduced as the pituitary attempts to decrease the production of thyroid hormone.

What causes hyperthyroidism?

Some common causes of hyperthyroidism include:

Graves' Disease
Functioning adenoma ("hot nodule") and toxic multinodular goiter (TMNG)
Excessive intake of thyroid hormones
Abnormal secretion of TSH
Thyroiditis (inflammation of the thyroid gland)
Excessive iodine intake

Graves' Disease

Graves' disease, which is caused by a generalized overactivity of the thyroid gland, is the most common cause of hyperthyroidism. In this condition, the thyroid gland usually is renegade, which means it has lost the ability to respond to the normal control by the pituitary gland via TSH. Graves' disease is hereditary and is up to five times more common among women than men. Graves' disease is thought to be an autoimmune disease, and antibodies that are characteristic of the illness may be found in the blood. These antibodies include thyroid stimulating immunoglobulin (TSI antibodies), thyroid peroxidase antibodies (TPO), and TSH receptor antibodies. The triggers for Grave's disease include:

stress,
smoking,
radiation to the neck,
medications, and
infectious organisms such as viruses.

Graves' disease can be diagnosed by a standard, nuclear medicine thyroid scan which shows diffusely increased uptake of a radioactively-labeled iodine. In addition, a blood test may reveal elevated TSI levels.

Grave's disease may be associated with eye disease (Graves' ophthalmopathy) and skin lesions (dermopathy ). Ophthalmopathy can occur before, after, or at the same time as the hyperthyroidism. Early on, it may cause sensitivity to light and a feeling of "sand in the eyes." The eyes may protrude and double vision can occur. The degree of ophthalmopathy is worsened in those who smoke. The course of the eye disease is often independent of the thyroid disease, and steroid therapy may be necessary to control the inflammation that causes the ophthalmopathy. In addition, surgical intervention may be required. The skin condition (dermopathy) is rare and causes a painless, red , lumpy skin rash that appears on the front of the legs.

Functioning Adenoma and Toxic Multinodular Goiter

The thyroid gland (like many other areas of the body) becomes lumpier as we get older. In the majority of cases, these lumps do not produce thyroid hormones and require no treatment. Occasionally, a nodule may become "autonomous," which means that it does not respond to pituitary regulation via TSH and produces thyroid hormones independently. This becomes more likely if the nodule is larger that 3 cm. When there is a single nodule that is independently producing thyroid hormones, it is called a functioning nodule. If there is more than one functioning nodule, the term toxic, multinodular goiter is used. Functioning nodules may be readily detected with a thyroid scan.

Excessive intake of thyroid hormones

Taking too much thyroid hormone medication is actually quite common. Excessive doses of thyroid hormones frequently go undetected due to the lack of follow-up of patients taking their thyroid medicine. Other persons may be abusing the drug in an attempt to achieve other goals such as weight loss. These patients can be identified by having a low uptake of radioactively-labelled iodine (radioiodine) on a thyroid scan.

Abnormal secretion of TSH

A tumor in the pituitary gland may produce an abnormally high secretion of TSH (the thyroid stimulating hormone). This leads to excessive signaling to the thyroid gland to produce thyroid hormones. This condition is very rare and can be associated with other abnormalities of the pituitary gland. To identify this disorder, an endocrinologist performs elaborate tests to assess the release of TSH.

Thyroiditis (inflammation of the thyroid)

Inflammation of the thyroid gland may occur after a viral illness (subacute thyroiditis). This condition is association with a fever and a sore throat that is often painful on swallowing. The thyroid gland is also tender to touch. There may be generalized neck aches and pains. Inflammation of the gland with an accumulation of white blood cells known as lymphocytes (lymphocytic thyroiditis) may also occur. In both of these conditions, the inflammation leaves the thyroid gland "leaky," so that the amount of thyroid hormone entering the blood is increased. Lymphocytic thyroiditis is most common after a pregnancy and can actually occur in up to 8% of women after delivery. In these cases, the hyperthyroid phase can last from 4 to 12 weeks and is often followed by a hypothyroid (low thyroid output) phase that can last for up to 6 months. The majority of affected women return to a state of normal thyroid function. Thyroiditis can be diagnosed by a thyroid scan.

Excessive iodine intake

The thyroid gland uses iodine to make thyroid hormones. An excess of iodine may cause hyperthyroidism. Iodine-induced hyperthyroidism is usually seen in patients who already have an underlying abnormal thyroid gland. Certain medications, such as amiodarone (Cordarone), which is used in the treatment of heart problems, contain a large amount of iodine and may be associated with thyroid function abnormalities.

What are the symptoms of hyperthyroidism?

Hyperthyroidism is suggested by several signs and symptoms; however, patients with mild disease usually experience no symptoms. In patients older than 70 years, the typical signs and symptoms also may be absent. In general, the symptoms become more obvious as the degree of hyperthyroidism increases. The symptoms usually are related to an increase in the metabolic rate of the body.

Common symptoms include:

Excessive sweating
Heat intolerance
Increased bowel movements
Tremor (usually fine shaking)
Nervousness; agitation
Rapid heart rate
Weight loss
Fatigue
Decreased concentration
Irregular and scant menstrual flow

In older patients, irregular heart rhythms and heart failure can occur. In its most severe form, untreated hyperthyroidism may result in "thyroid storm," a condition involving high blood pressure, fever, and heart failure. Mental changes, such as confusion and delirium, also may occur.

How is hyperthyroidism diagnosed?

Hyperthyroidism can be suspected in patients with:

tremors,
excessive sweating,
smooth velvety skin,
fine hair,
a rapid heart rate, and
an enlarged thyroid gland.

There may be puffiness around the eyes and a characteristic stare due to the elevation of the upper eyelids. Advanced symptoms are easily detected, but early symptoms, especially in the elderly, may be quite inconspicuous. In all cases, a blood test is needed to confirm the diagnosis.

The blood levels of thyroid hormones can be measured directly and usually are elevated with hyperthyroidism. However, the main tool for detection of hyperthyroidism is measurement of the blood TSH level. As mentioned earlier, TSH is secreted by the pituitary gland. If an excess amount of thyroid hormone is present, TSH is "down-regulated" and the level of TSH falls in an attempt to reduce production of thyroid hormone. Thus, the measurement of TSH should result in low or undetectable levels in cases of hyperthyroidism. However, there is one exception. If the excessive amount of thyroid hormone is due to a TSH-secreting pituitary tumor, then the levels of TSH will be abnormally high. This uncommon disease is known as "secondary hyperthyroidism."

Although the blood tests mentioned previously can confirm the presence of excessive thyroid hormone, they do not point to a specific cause. If there is obvious involvement of the eyes, a diagnosis of Graves' disease is almost certain. A combination of antibody screening (for Graves' disease) and a thyroid scan using radioactively-labelled iodine (which concentrates in the thyroid gland) can help diagnose the underlying thyroid disease. These investigations are chosen on a case-by-case basis.

How is hyperthyroidism treated?

The options for treating hyperthyroidism include:

Treating the symptoms
Antithyroid drugs
Radioactive iodine
Surgery treating symptoms

Treating the symptoms

There are medications available to immediately treat the symptoms caused by excessive thyroid hormones, such as a rapid heart rate. One of the main classes of drugs used to treat these symptoms is the beta-blockers [for example, propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor)]. These medications counteract the effect of thyroid hormone to increase metabolism, but they do not alter the levels of thyroid hormones in the blood. A doctor determines which patients to treat based on a number of variables including the underlying cause of hyperthyroidism, the age of the patient, the size of the thyroid gland, and the presence of coexisting medical illnesses.

Antithyroid Drugs

There are two main antithyroid drugs available for use in the United States, methimazole (Tapazole) and propylthiouracil ( PTU). These drugs accumulate in the thyroid tissue and block production of thyroid hormones. PTU also blocks the conversion of T4 hormone to the more metabolically active T3 hormone. The major risk of these medications is occasional suppression of production of white blood cells by the bone marrow (agranulocytosis). (White cells are needed to fight infection.) It is impossible to tell if and when this side effect is going to occur, so regular determination of white blood cells in the blood are not useful.

It is important for patients to know that if they develop a fever, a sore throat, or any signs of infection while taking methimazole or propylthiouracil, they should see a doctor immediately. While a concern, the actual risk of developing agranulocytosis is less than 1%. In general, patients should be seen by the doctor at monthly intervals while taking antithyroid medication. The dose is adjusted to maintain the patient in as close to a normal thyroid state as possible (euthyroid). Once the dosing is stable, patients can be seen at three month intervals if long-term therapy is planned.

Usually, long-term antithyroid therapy is only used for patients with Graves' disease, since this disease may actually go into remission under treatment without requiring treatment with thyroid radiation or surgery. If treated from one to two years, the data shows remission rates of 40%-70%. When the disease is in remission, the gland is no longer overactive, and antithyroid medication is not needed.

Recent studies also have shown that adding a pill of thyroid hormone to the antithyroid medication actually results in higher remission rates. The rationale for this may be that by providing an external source for thyroid hormone, higher doses of antithyroid medications can be given, which may suppress the overactive immune system in persons with Graves' disease. This type of therapy remains controversial, however. When long-term therapy is withdrawn, patients should continue to be seen by the doctor every three months for the first year, since a relapse of Graves' disease is most likely in this time period. If a patient does relapse, antithyroid drug therapy can be restarted, or radioactive iodine or surgery may be considered.

Radioactive Iodine

Radioactive iodine is given orally (either by pill or liquid) on a one-time basis to ablate a hyperactive gland. The iodine given for ablative treatment is different from the iodine used in a scan. (For treatment, the isotope iodine 131 is used, while for a routine scan, iodine 123 is used.) Radioactive iodine is given after a routine iodine scan, and uptake of the iodine is determined to confirm hyperthyroidism. The radioactive iodine is picked up by the active cells in the thyroid and destroys them. Since iodine is only picked up by thyroid cells, the destruction is local, and there are no widespread side effects with this therapy.

Radioactive iodine ablation has been safely used for over 50 years, and the only major reasons for not using it are pregnancy and breast-feeding. This form of therapy is the treatment of choice for recurring Graves' disease, patients with severe cardiac involvement, those with multinodular goiter or toxic adenomas, and patients who cannot tolerate antithyroid drugs. Radioactive iodine must be used with caution in patients with Graves' related eye disease since recent studies have shown that the eye disease may worsen after therapy. If a woman chooses to become pregnant after ablation, it is recommended she wait 8-12 months after treatment before conceiving.

In general, more than 80% of patients are cured with a single dose of radioactive iodine. It takes between 8 to 12 weeks for the thyroid to become normal after therapy. Permanent hypothyroidism is the major complication of this form of treatment. While a temporary hypothyroid state may be seen up to six months after treatment with radioactive iodine, if it persists longer than six months, thyroid replacement therapy (with T4 or T3) usually is begun.

Surgery

Surgery to partially remove the thyroid gland (partial thyroidectomy) was once a common form of treatment for hyperthyroidism. The goal is to remove the thyroid tissue that was producing the excessive thyroid hormone. However, if too much tissue is removed, an inadequate production of thyroid hormone (hypothyroidism) may result. In this case, thyroid replacement therapy is begun. The major complication of surgery is disruption of the surrounding tissue, including the nerves supplying the vocal cords and the four tiny glands in the neck that regulate calcium levels in the body (the parathyroid glands). Accidental removal of these glands may result in low calcium levels and require calcium replacement therapy.

With the introduction of radioactive iodine therapy and antithyroid drugs, surgery for hyperthyroidism is not as common as it used to be. Surgery is appropriate for:

pregnant patients and children who have major adverse reactions to antithyroid medications.
patients with very large thyroid glands and in those who have symptoms stemming from compression of tissues adjacent to the thyroid, such as difficulty swallowing, hoarseness, and shortness of breath.

What's best for you?

If you are concerned that you may have an excess amount of thyroid hormone, you should mention your symptoms to your doctor. A simple blood test is the first step in the diagnosis. From there, both you and your doctor can decide what the next step should be. If treatment is warranted, it is important for you to let your doctor know of any concerns or questions you have about the options available. Remember that thyroid disease is very common, and in good hands, the diseases that cause an excess of thyroid hormones can be easily diagnosed and treated.

Hyperthyroidism At A Glance

Hyperthyroidism is a condition in which there is an excessive amount of thyroid hormones.
Thyroid hormones regulate the metabolism of the cells.
Normally, the rate of thyroid hormone production is controlled by the brain at the pituitary gland.
There are many possible causes of hyperthyroidism.
Common symptoms of hyperthyroidism include restlessness, tremors, weight loss despite an increased appetite, sweating, rapid heart rate, intolerance to heat, and frequent bowel movements.
Treatments for hyperthyroidism include medications, ablation, and surgery.

Sciatica

2012-02-23T20:13:00.000-08:00

What is sciatica?

Sciatica is pain in the lower extremity resulting from irritation of the sciatic nerve. The pain of sciatica is typically felt from the low back (lumbar area) to behind the thigh and radiating down below the knee. The sciatic nerve is the largest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb. The pain of sciatica is sometimes referred to as sciatic nerve pain.

What are causes of sciatica?

While sciatica is most commonly a result of a lumbar disc herniation directly pressing on the nerve, any cause of irritation or inflammation of the sciatic nerve can reproduce the symptoms of sciatica. This irritation of nerves as a result of an abnormal intervertebral disc is referred to as radiculopathy. Aside from a pinched nerve from a disc, other causes of sciatica include irritation of the nerve from adjacent bone, tumors, muscle, internal bleeding, infections, injury, and other causes. Sometimes sciatica can occur because of irritation of the sciatic nerve during pregnancy.

What are risk factors for sciatica?

Risk factors for sciatica include degenerative arthritis of the lumbar spine, lumbar disc disease, and trauma or injury to the lumbar spine.

What are sciatica symptoms?

Sciatica causes pain, a burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. The result is lumbar pain, buttock pain, hip pain, and leg pain. Sometimes the pain radiates around the hip or buttock to feel like hip pain. While sciatica is often associated with lower back pain (lumbago), it can be present without low back pain. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down. The pain relief by changing positions can be partial or complete.

How is sciatica diagnosed?

Sciatica is diagnosed with a physical exam and medical history. The typical symptoms and certain examination maneuvers help the health care professional to diagnose sciatica. Sometimes, X-rays and other tests, such as CT scan, MRI scan, and electromyogram, are used to further define the exact causes of sciatica.

What are treatment options for sciatica?

Bed rest has been traditionally advocated for the treatment of acute sciatica. But how useful is it?

To study the effectiveness of bed rest in patients with sciatica of sufficient severity to justify treatment with bed rest for two weeks, a research team in the Netherlands led by Dr. Patrick Vroomen randomly assigned 183 such patients to bed rest or, alternatively, to watchful waiting for this period.

To gauge the outcome, both primary and secondary measures were examined. The primary outcome measures were the global assessments of improvement after two and 12 weeks by the doctor and the patient. The secondary outcome measures were changes in functional status and in pain scores, absenteeism from work, and the need for surgical intervention. Neither the doctors who assessed the outcomes nor those involved in data entry and analysis were aware of the patients' treatment assignments.

The results, reported in the New England Journal of Medicine, showed that after two weeks, 64 of the 92 (70%) patients in the bed-rest group reported improvement, as compared with 59 of the 91 (65%) of the patients in the control (watchful-waiting) group. After 12 weeks, 87% of the patients in both groups reported improvement. The results of assessments of the intensity of pain, the aggravation of symptoms, and functional status revealed no significant differences between the two groups. The extent of absenteeism from work and rates of surgical intervention were similar in the two groups.

The researchers concluded that "among patients with symptoms and signs of a lumbosacral radicular syndrome, bed rest is not a more effective therapy than watchful waiting." Sometimes, conventional wisdom is not as wise as research!

Other treatment options for sciatica include addressing the underlying cause, medications to relieve pain and inflammation (including oral and injectable cortisone) and relax muscles, and physical therapy. A variety of low back conditioning and stretching exercises are employed to help people recover from sciatica. Surgical procedures can sometimes be required for persisting sciatica that is caused by nerve compression at the lower spine. Sometimes pain management specialists help with chronic sciatica conditions.

What is the outlook (prognosis) for patients with sciatica?

Depending on the precise cause of the sciatica and the duration of symptoms, the outlook for recovery from sciatica ranges from excellent to having long-term chronic symptoms.

Can sciatica be prevented?

Sciatica can be prevented only to the extent that low back trauma injuries can be avoided can sciatica.

Mental Health and Mental Illness

2012-02-23T20:01:00.000-08:00

Mental health and mental illness facts

Mental health is more than just being free of a mental illness. It is more of an optimal level of thinking, feeling, and relating to others.
Mentally healthy individuals tend to have better medical health, productivity, and social relationships.
Mental illness refers to all of the diagnosable mental disorders and is characterized by abnormalities in thinking, feelings, or behaviors.
Some of the most common types of mental illness include anxiety, depressive, behavioral, and substance-abuse disorders.
There is no single cause for mental illness. Rather, it is the result of a complex group of genetic, psychological, and environmental factors.
While everyone experiences sadness, anxiety, irritability, and moodiness at times, moods, thoughts, behaviors, or use of substances that interfere with a person's ability to function well physically, socially, at work, school, or home are characteristics of mental illness.
There is no one test that definitively indicates whether someone has a mental illness. Therefore, health-care practitioners diagnose a mental disorder by gathering comprehensive medical, family, and mental-health information.
Talk therapy (psychotherapy) is usually considered the first line of care in helping a person with a mental illness. It is an important part of helping individuals with a mental disorder achieve the highest level of functioning possible.
Psychotherapies that have been found to be effective in treating many mental disorders include family focused therapy, psycho-education, cognitive therapy, interpersonal therapy, and social rhythm therapy.
Medications may play an important role in the treatment of a mental illness, particularly when the symptoms are severe or do not adequately respond to psychotherapy.
A variety of factors can contribute to the prevention of mental-health disorders.
Individuals with mental illness are at risk for a variety of challenges, but these risks can be greatly reduced with treatment, particularly when it is timely.

What is mental health?

Although it might seem easy to define mental health as the absence of mental illness, most experts agree that there is more to being mentally healthy. The U.S. Surgeon General has defined mental health as "a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with people, and the ability to adapt to change and to cope with adversity." The state of being mentally healthy is enviable given the advantages it affords. For example, mentally healthy adults tend to report the fewest health-related limitations of their routine activities, the fewest full or partially missed days of work, and the healthiest social functioning (for example, low helplessness, clear life goals, high resilience, and high levels of intimacy in their lives).

What is mental illness?

Mental illness refers to all of the diagnosable mental disorders. Mental disorders are characterized by abnormalities in thinking, feelings, or behaviors. Highly common, about 46% of Americans can expect to meet the formal diagnostic criteria for some form of anxiety, depressive, behavioral, thought, or substance-abuse disorder during their lifetime.

What are common types of mental illness?

Some of the most common types of mental illness include anxiety, depressive, behavioral, and substance-abuse disorders. Examples of anxiety disorders include phobias, panic disorder, generalized anxiety disorder (GAD), social anxiety disorder, and obsessive compulsive disorder (OCD). Anxiety disorders are characterized by excessive worry to the point of interfering with the sufferer's ability to function. Examples of anxiety disorders include the following:

Phobias: involve severe, irrational fear of a thing or situation. Examples of phobias include fear of heights (acrophobia), spiders (arachnophobia), and of venturing away from home (agoraphobia).
Social anxiety disorder is the fear of being in social situations or feeling scrutinized, like when speaking in public.
Generalized anxiety disorder (GAD) tends to result in the person either worrying excessively about many aspects of their life (like about money, family members, the future) or having a free-floating anxiety that is otherwise hard to describe. GAD is quite common, affecting about 10% of the population.
Panic disorder is characterized by recurring episodes of sudden, severe, debilitating anxiety (panic) attacks that are immobilizing. Those episodes usually include symptoms like racing heart beat, shortness of breath, stomach upset, and trouble thinking. In order to be diagnosed as having panic disorder, the person must also either worry about having another attack or about what the attack means (for example, wondering if the symptoms of panic indicate they are having a heart attack).

Behavioral disorders (like attention deficit hyperactivity disorder [ADHD], oppositional defiant disorder, or conduct disorder) are characterized by problems conforming to the tenets of acceptable behavior. The most common behavior disorder is ADHD; this condition includes symptoms of inattention and/or hyperactivity and impulsivity. While it used to be considered primarily a disorder of boys, it is now understood to be just as likely to occur in girls and that it can persist into adulthood in about half of children with ADHD.

Dementia, including Alzheimer's dementia, is characterized by a problem with thinking, involving both memory problems and other forms of thinking. These are also known as cognitive problems and include difficulties with language or with identifying or recognizing things despite having no medical cause for these issues such as stroke or a brain tumor.

Depressive disorders involve feelings of sadness that interfere with the individual's ability to function or, as with adjustment disorder, persist longer than most people experience in reaction to a particular life stressor. Examples of depressive disorders include the following:

Major depression involves the sufferer feeling depressed most days and for most of each day for at least two weeks in a row. Along with sadness, the individual with major depression experiences a number of other associated symptoms, like irritability, loss of motivation or interest in activities they usually enjoy, hopelessness, and increased or decreased sleep, appetite, and/or weight. The person might also exhibit thoughts, plans, or attempts to harm themselves. Women with postpartum depression tend to experience many of the above symptoms for weeks to months after giving birth.
Dysthymia sufferers experience depression and milder levels of the symptoms of major depression. In dysthymia, the symptoms are fairly consistent for more than two years in adults and one year in children and adolescents.
Bipolar disorder, also called manic depression, is a mental illness that is characterized by severe mood swings, repeated episodes of depression, and at least one episode of mania in the person's lifetime. Bipolar disorder is one kind of mood disorder that afflicts more than 1% of adults in the United States, up to as many as 4 million people.

Substance use disorders, like substance abuse and substance dependence, involve the use of a substance that interferes with the social, emotional, physical, educational, or vocational functioning of the person using it. These disorders afflict millions of people and a variety of legal (for example, alcohol and inhalants like household cleaners) and/or illegal (for example, marijuana in most states, cocaine, Ecstasy, and opiates) substances may be involved.

Developmental disorders, like a learning disability, Asperger's disorder, or mental retardation, are often included in diagnostic manuals for mental disorders, but this group of conditions does not by definition mean the person involved has a problem with their mood.

It is important to understand that the list of conditions above is by no means exhaustive. This article focuses on the more common mental illnesses; illnesses like eating disorders and schizophrenia, that are less common but perhaps quite devastating to the life of the person with the condition, are omitted.

What are the causes and risk factors for mental illness?

One frequently asked question about mental illness is if it is hereditary. Most mental disorders are not directly passed from one generation to another genetically, and there is no single cause for mental illness. Rather, it is the result of a complex group of genetic, psychological, and environmental factors. Genetically, it seems that more often than not, there seems to be a genetic predisposition to developing a mental illness. Everything from mood, behavioral, developmental, and thought disorders are thought to have a genetic risk for developing the condition.

Medical conditions may predispose an individual to developing a mental illness. For example, depression is more likely to occur with certain medical illnesses. These "co-occurring" conditions include heart disease, stroke, diabetes, cancer, hormonal disorders (especially perimenopause or hypothyroidism, known as "low thyroid"), Parkinson's disease, and Alzheimer's disease. While it does not appear that allergies cause depression or visa versa, people who suffer from nonfood allergies have been found to be somewhat more vulnerable to also having depression compared to people who do not have allergies. Some medications used for long periods, such as prednisone, certain blood pressure medicines, sleeping pills, antibiotics, and even birth control pills, in some cases, can cause depression or make an existing depression worse. Some antiseizure medications, like lamotrigine (Lamictal), topiramate (Topamax), and gabapentin (Neurontin), may be associated with a higher risk of suicide. Despite the impact that taking certain medications or having a medical illness can have on a person's emotional state, clinical depression should not be considered a normal or natural reaction to either issue. It should therefore always be aggressively treated.

Environmentally, the risks of developing mental illness can even occur before birth. For example, the risk of schizophrenia is increased in individuals whose mother had one of certain infections during pregnancy. Difficult life circumstances during childhood, like the early loss of a parent, poverty, bullying, witnessing parental violence; being the victim of emotional, sexual, or physical abuse or of physical or emotional neglect; and insecure attachment have all been associated with the development of schizophrenia as well. Even factors like how well represented an ethnic group is in a neighborhood can be a risk or protective factor for developing a mental illness. For example, some research indicates that ethnic minorities may be more at risk for developing mental disorders if there are fewer members of the ethnic group to which the individual belongs in their neighborhood.

Stress has been found to be a significant contributor to the development of most mental illnesses, including bipolar disorder. For example, gay, lesbian, and bisexual people are thought to experience increased emotional struggles associated with the multiple social stressors associated with coping with reactions to their homosexuality or bisexuality in society. Unemployment significantly increases the odds ratio of an individual developing a psychiatric disorder. It almost quadruples the odds of developing drug dependence and triples the odds of having a phobia or a psychotic illness like schizophrenia. Being unemployed more than doubles the chances of experiencing depression, generalized anxiety disorder (GAD), and obsessive-compulsive disorder.

What are symptoms and signs of mental illness?

While everyone experiences sadness, anxiety, irritability, and moodiness at times, moods, thoughts, behaviors, or use of substances that interfere with a person's ability to function well physically, socially, at work, school, or home are characteristics of mental illness. Mental illness can have virtually any physical symptom associated with it, from insomnia, headaches, stomach upset to even paralysis. Socially, the person with a mental illness may avoid or have trouble making or keeping friends. Emotional problems can result in the person being unable to focus and therefore perform at work or school.

How is mental illness diagnosed?

There is no one test that definitively indicates that someone has a mental illness. Therefore, health-care practitioners diagnose a mental disorder by gathering comprehensive medical, family, and mental-health information. Patients tend to benefit when the professional takes into account their client's entire life and background. This includes but is not limited to the person's gender, sexual orientation, cultural, religious and ethnic background, and socioeconomic status. The symptom sufferer might be asked to fill out a self-test that the professional will review if the person being evaluated is able to complete it. The practitioner will also either perform a physical examination or request that the individual's primary-care doctor or other medical professional perform one. The medical examination will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition that might produce psychological symptoms.

In asking questions about mental-health symptoms, the counselor or other mental-health professional often explores if the individual suffers from hallucinations or delusions, depression and/or manic symptoms, anxiety, substance abuse, as well as some personality disorders (for example, schizotypal personality disorder) and developmental disorders (for example, autism spectrum disorders). Since some of the symptoms of any one mental disorder can also occur in other mental illnesses, the mental-health screening is to determine if the individual suffers from a psychotic depressive, bipolar, anxiety, behavioral, substance abuse, or personality disorder.

In addition to providing treatment that is appropriate to the diagnosis, determining the presence of mental illnesses that may co-occur (be comorbid) and addressing those issues is important when trying to improve the life of individuals with a mental illness. For example, people with schizophrenia are at increased risk of having a substance abuse, depressive, or anxiety disorder and of committing suicide.

What is the treatment for a mental health problem?

Psychotherapies

Talk therapy (psychotherapy) is usually considered the first line of care in helping a person with a mental illness. It is an important part of helping individuals with a mental disorder achieve the highest level of functioning possible. These interventions are therefore seen by some as being forms of occupational therapy for people with mental illness. While medication can be quite helpful in alleviating and preventing overt symptoms for many psychiatric conditions, they do not address the many complex social and psychological issues that can play a major role in how the person with such a disease functions at work, at home, and in his or her relationships. For example, since about 60% of people with bipolar disorder take less than 30% of their medications as prescribed, any support that can promote compliance with treatment and otherwise promote the health of individuals in the mentally disordered population is valuable.

Psychotherapies that have been found to be effective in treating many mental disorders include family focused therapy, psycho-education, cognitive therapy, interpersonal therapy, and social rhythm therapy. Family focused therapy involves education of family members about the disorder and how to help (psycho-education), communication-enhancement training, and teaching family members problem-solving skills training. Psycho-education services involve teaching the person with the illness and their family members about the symptoms of the sufferer, as well as any warning signs (for example, change in sleep pattern or appetite, increased irritability) that the person is beginning to experience another episode of the illness, when applicable. In cognitive behavioral therapy, the mental-health professional works to help the person with a psychiatric condition identify, challenge, and decrease negative thinking and otherwise dysfunctional belief systems. The goal of interpersonal therapy tends to be identifying and managing problems the sufferers of a mental illness may have in their relationships with others. Social rhythm therapy encourages stability of sleep-wake cycles, with the goal of preventing or alleviating the sleep disturbances that may be associated with a psychiatric disorder.

Medications

Medications may play an important role in the treatment of a mental illness, particularly when the symptoms are severe or do not adequately respond to psychotherapy. For example, treatment of bipolar disorder with medications tends to address two aspects: relieving already existing symptoms of mania or depression and preventing symptoms from returning. Medications that are thought to be particularly effective in treating manic and mixed symptoms include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), and asenapine (Saphis). These medications belong to a group of medications called neuroleptics and are known for having the ability to work quickly compared to many other psychiatric medications. As a group of medications, side effects that occur most often include sleepiness, dizziness, and increased appetite. Weight gain, which may be associated with higher blood sugar, higher lipid levels, and sometimes increased levels of a hormone called prolactin may also occur. Although older medications in this class that were not mentioned here are more likely to cause muscle stiffness, shakiness, and very rarely uncoordinated muscle twitches (tardive dyskinesia) that can be permanent, health-care practitioners appropriately monitor the people they treat for these potential side effects as well. Mood-stabilizer medications like lithium, divalproex (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal) can be useful in treating active (acute) symptoms of manic or mixed episodes. These medications may take a bit longer to work compared to the neuroleptic medications, and some (for example, lithium, divalproex, and carbamazepine) require monitoring of medication blood levels. Further, some of these medications can be associated with birth defects when taken by pregnant women.

Antidepressant medications are the primary medical treatment for the anxiety characterized by anxiety disorders, as well as the depressive symptoms of depressive disorders and bipolar disorder. Examples of those medications that are commonly prescribed for those purposes include serotonergic (SSRI) medications like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro) and combination serotonergic/adrenergic medications (SNRIs) like venlafaxine (Effexor) and duloxetine (Cymbalta), as well as buproprion (Wellbutrin), which is a dopaminergic antidepressant.

Medications like clonazepam (Klonopin) and lorazepam (Ativan) from the benzodiazepine group are often used to treat anxiety, particularly when it is sudden and severe, as in panic attacks. Medications from the beta-blocker family (for example, propranolol [Inderal]) are sometimes used to treat the physical symptoms associated with anxiety as well.

Alzheimer's and other forms of dementia are often treated with medications like memantine (Namenda), galantamine (Razadyne), donezepil (Aricept), rivastigmine (Exelon), and tacrine (Cognex). These medications tend to slow the progression of dementia, thereby helping sufferers of dementia remain functional longer than they would without treatment.

Despite its stigmatized history, electroconvulsive therapy (ECT) can be a viable treatment for people whose symptoms of depression, bipolar, or thought disorder have inadequately responded to psychotherapies and a number of medication trials. Although alternative treatments for mood disorders like St. John's wort or ginkgo biloba are not recognized standard care for bipolar disorder, as many as one-third of some patients being treated for a mental illness use them.

Can mental health disorders be prevented?

A variety of factors can contribute to the prevention of mental-health disorders. For example, people who feel less isolated and alone tend to be less likely to develop a mental-health disorder. Those who engage in regular practice of endurance exercise seem to have a more favorable self-image, more resistance to drug and alcohol addiction, and a higher sense of general physical and psychological well-being compared to those who do not exercise regularly. Adolescents who engage regularly in physical activity are characterized by lower levels of anxiety and depression compared to their more sedentary counterparts.

Clear communication by parents about the negative effects of alcohol, as well as about their expectations regarding drug use, has been found to significantly decrease alcohol and other drug use in teens. Adequate parental supervision has also been found to be a deterrent to substance use in children and adolescents. Alcohol and other drug use has been found to occur most often between the hours of 3 p.m. and 6 p.m., immediately after school and prior to parents' arrival home from work. Teen participation in extracurricular activities has therefore been revealed to be an important measure in preventing use of alcohol in this age group. Parents can also help educate teens about appropriate coping and stress-management strategies. For example, 15- to 16-year-olds who use religion to cope with stress tend to use drugs significantly less often and have less problems as a result of drinking than their peers who do not use religion to cope.

What is the prognosis for mental-health problems?

Individuals with mental illness are at risk for a variety of challenges. For example, children who have either a father or mother who have been psychiatrically hospitalized seem to be at higher risk of dying from sudden infant death syndrome (SIDS). Depression in adults can lead to a significantly greater likelihood of health risk factors such as a lack of physical activity, smoking, binge drinking, obesity, high blood pressure, high cholesterol, and poor health. Fortunately, treatment for mental illness can go a long way to restoring the emotional and behavioral health of individuals with mental illness.

Physical therapy

2012-02-23T19:50:00.001-08:00

Overview

Physical therapy involves the interaction between physical therapist, patients/clients, other health care professionals, families, care givers, and communities in a process where movement potential is assessed and diagnosed, goals are agreed upon, using knowledge and skills unique to physical therapists. Physical therapy is performed by a physical therapist (PT) or physiotherapist (physio), and sometimes services are provided by a physical therapist assistant (PTA) acting under their direction. In some cases, physical rehabilitation technicians may provide physiotherapy services. PTs are healthcare professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions, illnesses, or injuries that limit their abilities to move and perform functional activities as well as they would like in their daily lives. PTs use an individual's history and physical examination to arrive at a diagnosis and establish a management plan and, when necessary, incorporate the results of laboratory and imaging studies. Electrodiagnostic testing (e.g., electromyograms and nerve conduction velocity testing) may also be of assistance. PT management commonly includes prescription of or assistance with specific exercises, manual therapy, education, manipulation and other interventions. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness and wellness-oriented programs for healthier and more active lifestyles, providing services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. This includes providing services in circumstances where movement and function are threatened by aging, injury, disease or environmental factors. Functional movement is central to what it means to be healthy.

Physical therapy has many specialties including sports, wound care, EMG, cardiopulmonary, geriatrics, neurologic, orthopaedic and pediatrics. PTs practice in many settings, such as outpatient clinics or offices, health and wellness clinics, inpatient rehabilitation facilities, skilled nursing facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial and this workplaces or other occupational environments, fitness centers and sports training facilities.

Physical therapists also practice in non-patient care roles such as health policy, health insurance, health care administration and as health care executives.Physical therapists are involved in the medical-legal field serving as experts, performing peer review and independent medical examinations.

Education qualifications vary greatly by country. The span of education ranges from some countries having little formal education to others having doctoral degrees and post doctoral residencies and fellowships.

History

Physicians like Hippocrates and later Galenus are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 BCE.After the development of orthopedics in the eighteenth century, machines like the Gymnasticon were developed to treat gout and similar diseases by systematic exercise of the joints, similar to later developments in physical therapy.^[14]

The earliest documented origins of actual physical therapy as a professional group date back to Per Henrik Ling, “Father of Swedish Gymnastics,” who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise. The Swedish word for physical therapist is sjukgymnast = someone involved in gymnastics for those who are ill. In 1887, PTs were given official registration by Sweden’s National Board of Health and Welfare.

Other countries soon followed. In 1894 four nurses in Great Britain formed the Chartered Society of Physiotherapy. The School of Physiotherapy at the University of Otago in New Zealand in 1913, and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."

Modern physical therapy was established in Britain towards the end of the 19th century. Soon following American orthopedic surgeons began treating children with disabilities and began employing women trained in physical education, massage, and remedial exercise. These treatments were applied and promoted further during the Polio outbreak of 1916. During the First World War women were recruited to work with and restore physical function to injured soldiers, and the field of physical therapy was institutionalized. In 1918 the term "Reconstruction Aide" was used to refer to individuals practicing physical therapy. The first school of physical therapy was established at Walter Reed Army Hospital in Washtington D.C. following the outbreak of World War I.

Research catalyzed the physical therapy movement. The first physical therapy research was published in the United States in March 1921 in "The PT Review." In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA). In 1924, the Georgia Warm Springs Foundation promoted the field by touting physical therapy as a treatment for polio.^[19]

Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s.^[20]^[21] Later that decade, physical therapists started to move beyond hospital-based practice to outpatient orthopedic clinics, public schools, colleges/universities healthcentres, geriatric settings (skilled nursing facilities), rehabilitation centers and medical centers.

In 1921 in the United States physical therapists formed the first professional association called the American Women's Physical Therapeutic Association. This gave birth to what is known today as the APTA (American Physical Therapy Association), and currently represents approximately 76,000 members throughout the United States. The APTA defines physical therapy as: "clinical applications in the restoration, maintenance, and promotion of optimal physical function."

Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in orthopaedics. In the same year, the International Federation of Orthopaedic Manipulative Physical Therapists was formed,which has ever since played an important role in advancing manual therapy worldwide.

[edit] Education

Main article: Physical therapy education

World Confederation of Physical Therapy (WCPT) recognises there is considerable diversity in the social, economic, cultural, and political environments in which physical therapist education is conducted throughout the world. WCPT recommends physical therapist entry-level educational programs be based on university or university-level studies, of a minimum of four years, independently validated and accredited as being at a standard that accords graduates full statutory and professional recognition. [2] WCPT acknowledges there is innovation and variation in program delivery and in entry-level qualifications, including first university degrees (Bachelors/Baccalaureate/Licensed or equivalent), Masters and Doctorate entry qualifications. What is expected is that any program should deliver a curriculum that will enable physical therapists to attain the knowledge, skills, and attributes described in these guidelines. Professional education prepares physical therapists to be autonomous practitioners, that may work in collaboration with other members of the health care team.[7]

Physical therapist entry-level educational programs integrate theory, evidence and practice along a continuum of learning. This begins with admission to an accredited physical therapy program and ending with retirement from active practice.[2]

Two hundred eight (208) of two hundred thirteen (213) of accredited physical therapy programs in the US are accredited at the doctoral level offering the Doctor of Physical Therapy degree (DPT)

The physical therapist professional curriculum includes content and learning experiences in the clinical sciences (e.g., content about the cardiovascular, pulmonary, endocrine, metabolic, gastrointestinal, genitourinary, integumentary, musculoskeletal, and neuromuscular systems and the medical and surgical conditions frequently seen by physical therapists).

Curriculum related to Patient/Client Management^[24] includes:

Screening to determine when patients/clients need further examination or consultation by a physicaltherapist or referral to another health care professional.
Examination: Examine patients/clients by obtaining a history from them and from other sources. Examine patients/clients by performing systems reviews. Examine patients/clients by selecting and administering culturally appropriate and age related tests and measures. Tests and measures include, but are not limited to, those that assess: a. Aerobic Capacity/Endurance, b. Anthropometric Characteristics, c. Arousal, Attention, and Cognition, d. Assistive and Adaptive Devices, e. Circulation (Arterial, Venous, Lymphatic), f. Cranial and Peripheral Nerve Integrity, g. Environmental, Home, and Work (Job/School/Play) Barriers, h. Ergonomics and Body Mechanics, i. Gait, Locomotion, and Balance, j. Integumentary Integrity, k. Joint Integrity and Mobility, l. Motor Function (Motor Control and Motor Learning), m. Muscle Performance (including Strength, Power, and Endurance), n. Neuromotor Development and Sensory Integration, o. Orthotic, Protective, and Supportive Devices, p. Pain, q. Posture, r. Prosthetic Requirements, s. Range of Motion (including Muscle Length), t. Reflex Integrity, u. Self-Care and Home Management (including activities of daily living [ADL] and instrumental activities of daily living [IADL]), v. Sensory Integrity, w. Ventilation and Respiration/Gas Exchange, x. Work (Job/School/Play), Community, and Leisure Integration or Reintegration (including IADL)
Evaluation: Evaluate data from the examination (history, systems review, and tests and measures) to make clinical judgments regarding patients/clients.
Diagnosis: Determine a diagnosis that guides future patient/client management.
Prognosis: Determine patient/client prognoses.
Plan of Care: Collaborate with patients/clients, family members, payers, other professionals, and other individuals to determine a plan of care that is acceptable, realistic, culturally competent, and patient-centered.
Intervention:Provide physical therapy interventions to achieve patient/client goals and outcomes. Interventions include: a. Therapeutic Exercise, b. Functional Training in Self-Care and Home Management, c. Functional Training in Work (Job/School/Play), Community, and Leisure Integration or Reintegration, d. Manual Therapy Techniques (including Mobilization/Manipulation Thrust and Nonthrust Techniques), e. Prescription, Application, and, as Appropriate, Fabrication of Devices and Equipment, f. Airway Clearance Techniques, g. Integumentary Repair and Protection Techniques, h. Electrotherapeutic Modalities,
Provide effective culturally competent instruction to patients/clients and others to achieve goals and outcomes.
Prevention, Health Promotion, Fitness, and Wellness: Provide culturally competent physical therapy services for prevention, health promotion, fitness, and wellness to individuals, groups, and communities. Apply principles of prevention to defined population groups.
Students completing a Doctor of Physical Therapy program are also required to successfully complete clinical internships prior to graduation.

Specialty areas

Because the body of knowledge of physical therapy is quite large, some PTs specialize in a specific clinical area. While there are many different types of physical therapy, the American Board of Physical Therapy Specialties list eight specialist certifications.

Cardiovascular & Pulmonary

Cardiovascular and pulmonary rehabilitation respiratory practitioners and physical therapists treat a wide variety of individuals with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing endurance and functional independence. Manual therapy is used in this field to assist in clearing lung secretions experienced with cystic fibrosis. Disorders, including heart attacks, post coronary bypass surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis, treatments can benefit from cardiovascular and pulmonary specialized physical therapists.

Clinical Electrophysiology

This specialty area encompasses electrotherapy/physical agents, electrophysiological evaluation (EMG/NCV), physical agents, and wound management.

Geriatric

Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders, incontinence, etc. Geriatric physical therapists specialize in treating older adults.

Integumentary

Integumentary (treatment of conditions involving the skin and related organs). Common conditions managed include wounds and burns. Physical therapists utilize surgical instruments, mechanical lavage, dressings and topical agents to debride necrotic tissue and promote tissue healing. Other commonly used interventions include exercise, edema control, splinting, and compression garments.

Neurological

Neurological physical therapy is a field focused on working with individuals who have a neurological disorder or disease. These include Alzheimer's disease, Charcot-Marie-Tooth disease (CMT), ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Common impairments associated with neurologic conditions include impairments of vision, balance, ambulation, activities of daily living, movement, muscle strength and loss of functional independence. Physiotherapy can address many of these impairments and aid in restoring and maintaining function, slowing disease progression, and improving quality of life.

In layman's terms, neurological massage is directed toward correcting and healing out-of-normative body systems, unlike traditional massages, such as Swedish massage, that are directed toward comfort and relaxation.

Orthopedic

Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system including rehabilitation after orthopaedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post-operative orthopedic procedures, fractures, acute sports injuries, arthritis, sprains, strains, back and neck pain, spinal conditions, and amputations.

Joint and spine mobilization/manipulation, therapeutic exercise, neuromuscular reeducation, hot/cold packs, and electrical muscle stimulation (e.g., cryotherapy, iontophoresis, electrotherapy) are modalities often used to expedite recovery in the orthopedic setting. Additionally, an emerging adjunct to diagnosis and treatment is the use of sonography for diagnosis and to guide treatments such as muscle retraining. Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons will benefit from assessment by a physical therapist specialized in orthopedics.

Pediatric

Pediatric physical therapy assists in early detection of health problems and uses a wide variety of modalities to treat disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases. Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration. Children with developmental delays, cerebral palsy, spina bifida, or torticollis may be treated^{[citation needed]} by pediatric physical therapists.^[26]^{[verification needed]}

[edit] Sports

Physical therapists can be involved in the care of athletes from recreational to professional and Olympians. This area of practice includes athletic injury management, including acute care, treatment and rehabilitation, prevention, and education. Physical therapists are also active in sports medicine programs.

Women's health

Women's health physical therapy addresses women's issues related to child birth, and post partum. These conditions include lymphedema, osteoporosis, pelvic pain, prenatal and post partum periods, and urinary incontinence.

Remuneration and Career Advancement

Physiotherapists are relatively poorly remunerated, given the stringent standards of entry to training institutions, the level of tertiary education and supervised training required, high standards of practice demanded, and time and effort devoted. In addition, clinical practice can be highly physically demanding. People considering a career in physiotherapy would be well advised to thoroughly research possible career opportunities and conditions of service prior to committing to a career limited in scope of practice and promotion opportunities.

DRINK WATER ON EMPTY STOMACH

2012-02-23T19:44:00.002-08:00

DRINK WATER ON EMPTY STOMACH
It is popular in Japan today to drink water immediately after waking up every morning. Furthermore, scientific tests have proven its value. We publish below a description of use of water for our readers. For old and serious diseases as well as modern illnesses the water treatment had been found successful by a Japanese medical society as a 100% cure for the following diseases:
Headache, body ache, heart system, arthritis, fast heart beat, epilepsy, excess fatness, bronchitis asthma, TB, meningitis, kidney and urine diseases, vomiting, gastritis, diarrhea, piles, diabetes, constipation, all eye diseases, womb, cancer and menstrual disorders, ear nose and throat diseases.
METHOD OF TREATMENT
1. As you wake up in the morning before brushing teeth, drink 4 x 160ml glasses of water
2. Brush and clean the mouth but do not eat or drink anything for 45 minute
3.. After 45 minutes you may eat and drink as normal.
4. After 15 minutes of breakfast, lunch and dinner do not eat or drink anything for 2 hours
5. Those who are old or sick and are unable to drink 4 glasses of water at the beginning may commence by taking little water and gradually increase it to 4 glasses per day.
6. The above method of treatment will cure diseases of the sick and others can enjoy a healthy life.
The following list gives the number of days of treatment required to cure/control/reduce main diseases:
1. High Blood Pressure (30 days)
2. Gastric (10 days)
3. Diabetes (30 days)
4. Constipation (10 days)
5. Cancer (180 days)
6. TB (90 days)
7. Arthritis patients should follow the above treatment only for 3 days in the 1st week, and from 2nd week onwards – daily..
This treatment method has no side effects, however at the commencement of treatment you may have to urinate a few times.
It is better if we continue this and make this procedure as a routine work in our life. Drink Water and Stay healthy and Active.
This makes sense .. The Chinese and Japanese drink hot tea with their meals ..not cold water. Maybe it is time we adopt their drinking habit while eating!!! Nothing to lose, everything to gain...
For those who like to drink cold water, this article is applicable to you.
It is nice to have a cup of cold drink after a meal. However, the cold water will solidify the oily stuff that you have just consumed. It will slow down the digestion.
Once this 'sludge' reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food. It will line the intestine.
Very soon, this will turn into fats and lead to cancer. It is best to drink hot soup or warm water after a meal.
A serious note about heart attacks:
· Women should know that not every heart attack symptom is going to be the left arm hurting,
· Be aware of intense pain in the jaw line.
· You may never have the first chest pain during the course of a heart attack.
· Nausea and intense sweating are also common symptoms.
· 60% of people who have a heart attack while they are asleep do not wake up.
· Pain in the jaw can wake you from a sound sleep. Let's be careful and be aware. The more we know, the better chance we could survive...
A cardiologist says if everyone who gets this mail sends it to everyone they know, you can be sure that we'll save at least one life.
Please be a true friend and send this article to all your fr

Canker Sores

2012-02-23T19:37:00.000-08:00

What are canker sores?

Canker sores are small ulcer craters in the lining of the mouth that are frequently painful and sensitive. Canker sores are very common. About 20% of the population (one out of five people) have canker sores at any one time. Canker sores are also medically known as aphthous ulcers or aphthous stomatitis.

Women are slightly more likely than men to have recurrent canker sores. It can occur at any age, but it is more commonly seen in teenagers. Genetic studies show that susceptibility to recurrent outbreaks of the sores is inherited in some patients. This partially explains why family members often share the condition.

Canker sores are generally classified into three groups based on size.

Minor sores have a diameter of 1millimeter (mm) to 10mm. They are the most common (80% of all canker sores) and usually last about 7-10 days.
Major sores (10% of all canker sores) have a diameter of greater than 10mm and they may take anywhere between 10-30 days to heal. They may leave a scar after they heal.
Herpetiform ulcers (10% of all canker sores) are formed by a cluster of multiple small individual sores (less than 3mm). They also usually heal within 7-10 days.

What are symptoms of canker sores?

Canker sores are usually found on the movable parts of the mouth, such as the tongue or the inside lining of the lips and cheeks, and at the base of the gums. The ulcers begin as small oval or round reddish swellings that usually burst within a day. The ruptured sores are covered by a thin white or yellow membrane and edged by a red halo. Generally, the sores heal within two weeks without scarring. Fever is rare, and the sores are rarely associated with other diseases. Usually, a person has only one or a few canker sores at a time.

Most people experience their first bout with canker sores between the ages of 10 and 20. Children as young as 2 years old, however, can develop the condition. The frequency of canker sore recurrences varies considerably. Some people have only one or two episodes a year, while others may have a continuous series of canker sores.

What are the causes of canker sores?

The cause of canker sores is not well understood. More than one cause is likely, even for individual patients. Canker sores do not appear to be caused by viruses or bacteria, although an allergy to a type of bacterium commonly found in the mouth may trigger them in some people. The sores may be an allergic reaction to certain foods. In addition, there is research suggesting that canker sores may be caused by a faulty immune system that uses the body's defenses against disease to attack and destroy the normal cells of the mouth or tongue.

British studies show that in about 20 percent of patients, canker sores are due partly to nutritional deficiencies, especially lack of vitamin B12, folic acid, and iron. Similar studies performed in the United States, however, have not confirmed this finding. In a small percentage of patients, canker sores occur along with gastrointestinal problems, such as an inability to digest certain cereals. In these patients, canker sores appear to be part of a generalized disorder of the digestive tract. Vitamin C deficiency has also been associated with canker sores.

Emotional stress and local trauma or injury to the mouth, such as sharp metal braces, brushing with hard toothbrushes, and hot foods can lead to canker sores. Smoking and dentures can also contribute to the problem. Some studies have shown a connection with toothpaste containing sodium lauryl sulfate in some individuals, although, other studies have not found any connection.

Other possible causes of canker sores include illnesses in which the immune system causes swelling or inflammation of the body tissues (autoimmune disorders). Examples of autoimmune disorders are systemic lupus erythematosus, Crohn's disease, and Behçet's disease.

Female sex hormones also apparently play a role in causing canker sores. Many women experience bouts of the sores only during certain phases of their menstrual cycles. Additionally, most women experience improvement or remission of their canker sores during pregnancy. Researchers have used hormone therapy successfully in clinical studies to treat some women.

Are canker sores the same thing as fever blisters?

The simple answer is no. Canker sores are generally inside the mouth or the oral cavity and are not contagious. However, fever blisters mostly occur on the lips and outside of the mouth and are very contagious. Fever blisters, or cold sores, are infections caused by the herpes simplex virus (HSV).

What steps can be taken to help canker sores?

If you have canker sores:

Avoid abrasive foods such as potato chips that can stick in the cheek or gum and aggravate the sores.
Take care when brushing your teeth not to stab the gums or cheek with a toothbrush bristle.
Avoid acidic and spicy foods.
Canker sores are not contagious, so patients do not have to worry about spreading them to other people.
A toothpaste free of sodium lauryl sulfate and other ingredients that are irritating to the tissues inside the mouth can be helpful in some patients, as can a toothpaste that inhibits the growth of irritating plaque. Therefore, something as simple as changing toothpastes may help with recurrent canker sores.

What is the treatment for canker sores?

Canker sores typically resolve without any specific treatment. But measures can be taken to alleviate the pain and discomfort and to hasten the course. Therapies include topical medications (applied directly on), mouthwashes, and oral medications.

What kind of topical medications (gels or ointments) are available for canker sores?

Topical medications include numbing ointments, such as benzocaine (Oragel), which are available in drug stores without a prescription. The ointment should be applied a few times daily directly to the sore in order to reduce irritation form eating, drinking, or brushing. Topical 2% lidocaine (an anesthetic) gel has also been used effectively in some patients, but it may associated with some toxicity, especially in children. In very painful cases, injection of local anesthetics may help relieve the symptoms effectively, but it is usually temporary. However, in April 2011 the U.S. FDA issued a warning about an association between benzocaine and methemoglobinemia, a rare but serious condition in which oxygen delivery to tissues is compromised. Because of this association, the FDA has stated that benzocaine products should not be used on children less than two years of age, except under the advice and supervision of a healthcare professional. Further, adults who use benzocaine gels or liquids to relieve pain in the mouth should follow the recommendations in the product label. Benzocaine products should be stored out of reach of children, and FDA encourages consumers to talk to their healthcare professional about using benzocaine.

Anti-inflammatory (steroid) gels may also be applied locally to reduce the inflammation. These products are generally provided by prescription from a physician or a dentist. The main ingredient in these medications is usually fluocinonide (Lidex) or triamcinolone. Topical antibiotics (for example, tetracycline (Achromycin]) may also be recommended by your doctor.

Can mouthwash solutions be used to treat canker sores?

Yes, there are several mouthwash solutions you can use. One type of mouthwash used for canker sores is diphenhydramine suspension (Benadryl Allergy liquid and others). This liquid medication can be used as a mouth rinse in adults to provide temporary relief from the pain caused by canker sores. Patients should not swallow the diphenhydramine, but simply use it as a mouth rinse. This is generally available over the counter.

Furthermore, steroid anti-inflammatory mouth rinses can be prescribed for patients with severe sores. Steroid mouth rinses have been shown to reduce the inflammation and number of recurrences and are reserved for more severe cases due to potential side effects. These potent drugs can cause many undesirable side effects, and should be used only under the close supervision of a dentist or physician.

There are also mouth rinses containing the antibiotic tetracycline that may reduce the unpleasant symptoms of canker sores and speed healing by preventing bacterial infections in the sores. Clinical studies at the National Institute of Dental Research have shown that rinsing the mouth with tetracycline several times a day usually relieves pain in 24 hours and allows complete healing in five to seven days. The U.S. Food and Drug Administration warns, however, that tetracycline given to pregnant women and young children can permanently stain the children's teeth.

Both steroid and tetracycline treatments require a prescription and care of a dentist or physician.

What oral medications are available to help canker sores?

Oral pain medications such as, ibuprofen (Advil) or acetaminophen (Tylenol) may be taken for pain relief if the sores are intolerable. Some patients may get relief from sucking on zinc lozenges, or taking vitamin B and C complex.

There is no evidence that antibiotics taken orally are helpful. If the canker sores are caused by a yeast infection, a topical anti-fungal medication can be used, [for example, nystatin (Mycostatin, Nystatin)]. Some people with AIDS (HIV infection) who have repeated bouts of canker sores respond well to thalidomide (Thalomid oral). This medication can also be used for severe canker sores not related to AIDS. Thalidomide is associated with very severe birth defect and, therefore, its use is very limited.

Patients with severe recurrent and non-healing canker sores may also need to take steroid or other immuno-suppressant drugs orally. But they are associated with major side effects if taken long term and their use should be closely monitored by the prescribing doctor.

In other situations, if the presumed cause is another illness, such as lupus, treating the underlying illness often results in healing the ulcers. Vitamins and other nutritional supplements often prevent recurrences or reduce the severity of canker sores in patients with a nutritional deficiency. L-lysine over-the-counter is used as a preventative treatment. Patients with food allergies can reduce the frequency of canker sores by avoiding those foods.

What should I do if I get canker sores frequently?

Contact your healthcare professional. Most cases of canker sores do not reflect an underlying illness. However, if you are having canker sores frequently, your healthcare professional can take a patient history and order tests to assure you there isn't a serious underlying cause. Certain diseases are sometimes associated with recurrent canker sores. Examples include Crohn's disease, celiac disease, Behçet's disease, lupus, or even AIDS. It should be mentioned that these are complex diseases and canker sores may be only a part of the disease and not the only feature of the disease. Canker sores also may not be present at all in some persons with these conditions.

Most doctors also recommend that patients who have frequent bouts of canker sores undergo blood and allergy tests to determine if their sores are caused by a nutritional deficiency, an allergy, or some other preventable cause.

What research is being done in the area of canker sores?

Researchers are trying to identify the malfunctions in patients' immune systems that make them susceptible to repeated bouts of canker sores. By analyzing the blood of people with and without canker sores, scientists have found several differences in the immune function between the two groups. Whether these differences cause canker sores is not yet known and more research may need to be performed.

Researchers also are developing and testing new drugs designed to treat repeated canker sores in patients with possible immune causes of canker sores. Most of these drugs alter the patient's immune function. Although some of the drugs appear to be effective in treating canker sores in some patients, the data are still inconclusive. Until these drugs are proven to be absolutely safe and effective, they will not be available for general use.

One of the new medications which has been tested is called amlexanox (Aphthasol topical paste). This is an anti-inflammatory and an anti-allergic drug. It has shown some promise in treatment of symptoms and healing of canker sores.

More invasive treatment options for canker sores are being investigated, but for now they remain somewhat limited, controversial, and impractical. These options include laser therapy, low intensity ultrasound, silver nitrate, and surgical removal. More studies are necessary before these options can be recommended for treatment of canker sores.

Fever

2012-02-23T05:12:00.000-08:00

What is a fever?

Fever refers to an elevation in body temperature. Technically, any body temperature above the normal oral measurement of 98.6 F (37 C) or the normal rectal temperature of 99 F (37.2 C) is considered to be elevated. However, these are averages, and one's normal body temperature may actually be 1 F (0.6 C) or more above or below the average of 98.6 F. Body temperature can also vary up to 1 F (0.6 C) throughout the day.

Fever is not considered medically significant until body temperature is above 100.4 F (38 C). Anything above normal but below 100.4 F (38 C) is considered a low-grade fever. Fever serves as one of the body's natural defenses against bacteria and viruses which cannot live at a higher temperature. For that reason, low fevers should normally go untreated, unless accompanied by troubling symptoms.

Also, the body's defense mechanisms seem to work more efficiently at a higher temperature. Fever is just one part of an illness, many times no more important than the presence of other symptoms such as cough, sore throat, fatigue, joint pains or aches, chills, nausea, etc.

Fevers of 104 F (40 C) or higher demand immediate home treatment and subsequent medical attention, as they can result in delirium and convulsions, particularly in infants and children.

Fever should not be confused with hyperthermia, which is a defect in your body's response to heat (thermoregulation), which can also raise the body temperature. This is usually caused by external sources such as being in a hot environment.

How should I take a temperature for fever?

Digital thermometers can be used to measure rectal, oral, or axillary (under the armpit) temperatures. The American Academy of Pediatrics does not recommend use of mercury thermometers (glass), and they encourage parents to remove mercury thermometers from their households to prevent accidental exposure to this toxin.

Measuring an axillary (under the armpit) temperature for fever:

Axillary temperatures are not as accurate as rectal or oral measurements, and these generally measure 1 degree lower than a simultaneously obtained oral temperature.

Place the tip of the digital thermometer in your child's armpit.

Leave in place about one minute or until you hear a beep to check a digital reading.

Measuring fever by eardrum temperature:

Tympanic (ear) thermometers must be placed correctly in your child's ear to be accurate. Too much earwax can cause the reading to be incorrect.

Eardrum temperature measurements are not accurate in small children and should not be used in children under 3 years (36 months) of age. This is especially true in infants below 3 months of age when obtaining an accurate temperature is very important.

Measuring fever by oral temperature:

People 4 years old and older can have their temperature taken with a digital thermometer under the tongue with their mouth closed.

Clean the thermometer with soapy water or rubbing alcohol and rinse.

Turn the thermometer on and place the tip of the thermometer as far back under the tongue as possible.

The mouth should remain closed, as an open mouth can cause readings to be inaccurate.

The thermometer should remain in place for about one minute or until you hear the beep. Check the digital reading.

Avoid hot or cold drinks within 15 minutes of oral temperature measurement to ensure correct readings.

Measuring fever by rectal temperature:

The American Academy of Pediatrics recommends rectal temperature measurements for children under 3 years of age, as this gives the most accurate reading of core temperature.

Clean the thermometer with soapy water or rubbing alcohol and rinse with cool water.

Use a small amount of lubricant, such as petroleum jelly, on the end.

Place the child prone (belly-side down) on a firm surface, or place your child face up and bend his legs to his chest.

After separating the buttocks, insert the thermometer approximately ½ to 1 inch into the rectum. Do not insert it too far.

Hold the thermometer in place, loosely keeping your hand cupped around your child's bottom, and keep your fingers on the thermometer to avoid it accidently sliding further into the rectum. Keep it there for about one minute, until you hear the beep.

Remove the thermometer, and check the digital reading.

Label the rectal thermometer so it's not accidentally used in the mouth.

A rectal temperature will read approximately 1 degree higher than a simultaneously obtained oral temperature.

What is the treatment for a fever?

Generally, if the fever does not cause discomfort, the fever itself need not be treated. It is not necessary to awaken an adult or child to treat a fever unless instructed to do so by your health-care practitioner.

The following fever-reducing medications may be used at home:

Acetaminophen (Tylenol and others) can be used to lower a fever. The recommended pediatric dose can be suggested by the child's health-care provider. Adults without liver disease or other health problems can take 1,000 mg (two "extra strength" tablets) every four to six hours or as directed by your physician.

Ibuprofen (Motrin/Advil) can also be used to break a fever in patients over 6 months of age. Discuss the best dose with your doctor. For adults, 400-600 mg (two to three 200 mg tablets) can be used every six hours.

Aspirin should not be used for fever in children or adolescents. Aspirin use in children and adolescents during a viral illness (especially chickenpox and influenza, or flu) has been associated with Reye syndrome. Reye syndrome is a dangerous illness which causes prolonged vomiting, confusion, and even coma and liver failure.

An individual with a fever should be kept comfortable and not overdressed. Overdressing can cause the temperature to rise further. Tepid water (85 F [30 C]) baths are a home remedy that may help bring down a fever. Never immerse someone in ice water. This is a common misconception. Never sponge a child or an adult with alcohol; the alcohol fumes may be inhaled, causing many problems.

When should I seek medical care for a fever?

Any child below 3 months of age who has a temperature of 100.4 F (38 C) or greater should be seen by a physician or other health-care worker. If a child or adult has a history or diagnosis of cancer, AIDS, or other serious illness, such as heart disease, diabetes, or is taking immunosuppressant drugs, medical care should be sought for a fever.

Otherwise, observe the person with the fever. If they appear sick or have symptoms that would suggest a major illness, such as meningitis (headache, stiff neck, confusion, problems staying awake), urinary tract infection (shaking chills, burning with urination), pneumonia (shortness of breath, cough), or any other signs of a serious illness, contact your health-care provider.

Other symptoms that may be indicative of a severe illness include repeated vomiting, severe diarrhea, or skin rashes (could be a sign of dengue fever, Rocky Mountain spotted fever, scarlet fever, rheumatic fever, or chickenpox).

Fever blisters (herpangina) are small blisters that turn into ulcers, usually on the lips, mouth or tongue, that are caused by a virus. When a child contracts this virus for the first time, the symptoms and the fever blisters can be quite severe. If the child is not eating or drinking, contact your child's health-care provider.

On the other hand, if the fever accompanies a simple cold or virus, you can treat the fever as described above and be assured that the fever is only a symptom of the illness. This is not to say that you should ignore a fever. If there are other associated symptoms that are bothersome, you should contact your health-care professional.

Some vaccines given in childhood can cause a low-grade fever within a day or two of getting the injection. This fever is usually self-limited and short-lived. If the reaction seems severe or the skin at the injection site is red, hot, and painful, contact your child's doctor.

About 3% of all children between 18 months to 3 years of age will have a seizure (convulsion) with a high fever. Of those with a history of febrile seizure, approximately one-third will have another seizure associated with another febrile episode. Febrile seizures, while frightening to the parents, are not associated with long-term nervous-system side effects. Children used to be prescribed phenobarbital following a febrile seizure as a preventive measure (prophylaxis). This has not been shown to be beneficial and possibly may be harmful, so it is not always recommended.

Common Cold

2012-02-23T05:07:00.000-08:00

What is the common cold, and what causes it?

The common cold is a self-limited contagious illness that can be caused by a number of different types of viruses. The common cold is medically referred to as a viral upper respiratory tract infection. Symptoms of the common cold may include cough, sore throat, nasal congestion, runny nose, and sneezing. More than 200 different types of viruses are known to cause the common cold, with rhinovirus causing approximately 30%-35% of all adult colds. Other commonly implicated viruses include coronavirus, adenovirus, respiratory syncytial virus, and parainfluenza virus. Because so many different viruses can cause a cold and because new cold viruses constantly develop, the body never builds up resistance against all of them. For this reason, colds are a frequent and recurring problem. In fact, children in preschool and elementary school can have six to 12 colds per year while adolescents and adults typically have two to four colds per year. The common cold occurs most frequently during the fall and winter months.

The common cold is the most frequently occurring illness in the world, and it is a leading cause of doctor visits and missed days from school and work. It is estimated that individuals in the United States suffer 1 billion colds per year, with approximately 22 million days of school absences recorded annually.

How is the common cold transmitted?

The common cold is spread either by direct contact with infected secretions from contaminated surfaces or by inhaling the airborne virus after individuals sneeze or cough. Person-to-person transmission often occurs when an individual who has a cold blows or touches their nose and then touches someone or something else. A healthy individual who then makes direct contact with these secretions can subsequently become infected, often after their contaminated hands make contact with their own eyes or nose. A cold virus can live on objects such as pens, books, telephones, computer keyboards, and coffee cups for several hours and can thus be acquired from contact with these objects.

What are the symptoms and signs of the common cold in adults, children, and infants?

The symptoms of the common cold typically begin two to three days after acquiring the infection (incubation period). Symptoms and signs of the common cold vary depending on the virus responsible for the infection and may include the following

• nasal stuffiness or drainage,

• sore or scratchy throat,

• sneezing,

• hoarseness,

• cough,

• watery eyes,

• low-grade fever,

• headache,

• body aches, and

• fatigue.

The signs and symptoms of the common cold in infants and children are similar to those seen in adults. The cold may begin with a runny nose with clear nasal discharge, which later may become yellowish or greenish in color. Infants and children may also become more fussy and have decreased appetite.

The symptoms of the common cold will typically last anywhere from four to 14 days, with most individuals improving in one week.

Does it have anything to do with exposure to cold weather?

Though the common cold usually occurs in the fall and winter months, the cold weather itself does not cause the common cold. Rather, it is thought that during cold-weather months people spend more time indoors in close proximity to each other, thus facilitating the spread of the virus. For this same reason, children in day care and school are particularly prone to acquiring the common cold.

What is the difference between the common cold and influenza (the flu)?

Many people confuse the common cold with influenza (the flu). Influenza is caused by the influenza virus, while the common cold generally is not. While some of the symptoms of the common cold and influenza may be similar, patients with the common cold typically have a milder illness. Patients with influenza usually appear more ill and have a more abrupt onset of illness with fever, chills, headache, substantial muscle and body aches, dry cough, and extreme weakness.

Though differentiating between the common cold and influenza can be difficult, there is laboratory testing available to confirm the diagnoses of influenza.

How is the common cold diagnosed?

Your physician or health-care practitioner will generally diagnose the common cold based on the description of your symptoms and the findings on your physical exam. Laboratory testing and imaging studies are generally not necessary unless there are concerns about another underlying medical condition or potential complications.

What is the treatment for the common cold? Are there any home remedies for the common cold?

There is no cure for the common cold. The common cold is a self-limited illness that will resolve spontaneously with time. Home remedies and treatments are directed at alleviating the symptoms associated with the common cold while the body fights off the infection.

Home treatment for the common cold includes getting rest and drinking plenty of fluids. In older children and adults, over-the-counter medications such as throat lozenges, throat sprays, cough drops, and cough syrups may help relieve symptoms, though they will not prevent or shorten the duration of the common cold. Gargling with warm saltwater may help those with a sore throat. Decongestants such as pseudoephedrine (Sudafed) or antihistamines may be used for nasal symptoms, while saline nasal sprays may also be beneficial. It is important to note that over-the-counter medications may cause undesirable side effects, therefore they must be taken with care.

Acetaminophen (Tylenol and others) and ibuprofen (Advil, Motrin) can help with fever, sore throat, and body aches.

The treatment for infants and small children with the common cold is supportive as well. It is especially important to allow rest and encourage plenty of fluids in order to prevent dehydration. Nasal drops and bulb suctioning may be used to clear nasal mucus in infants. Medications such as acetaminophen and ibuprofen may be taken for pain or fever based on the package recommendations for age and weight. Do not use aspirin or aspirin-containing medications in children or teenagers because it has been associated with a rare, potentially fatal condition called Reye's syndrome. Finally, over-the-counter cough and cold medications for infants and children are not recommended (see WARNING below).

WARNING: The United States Food and Drug Administration (FDA) recommends that over-the-counter cough and cold medications not be used in children younger than 4 years of age because serious and potentially life-threatening side effects can occur.

Are antibiotics a suitable treatment for the common cold?

No. Antibiotics play no role in treating the common cold. Antibiotics are effective only against illnesses caused by bacteria, and colds are caused by viruses. Not only do antibiotics not help, but they can rarely also cause severe allergic reactions that can sometimes be fatal. Furthermore, using antibiotics when they are not necessary has led to the growth of several strains of common bacteria that have become resistant to certain antibiotics. For these and other reasons, it is important to limit the use of antibiotics to situations in which they are medically indicated.

Though occasionally a bacterial infection, such as sinusitis or a middle ear infection, can develop following the common cold, the decision to treat with antibiotics should be determined by your physician or health-care practitioner.

When should a physician or other health-care practitioner be consulted?

Generally, the common cold can be treated at home and managed with over-the-counter medications. However, if you develop more severe symptoms such as shaking chills, high fever (greater than 102 F), severe headache, neck stiffness, vomiting, abdominal pain, difficulty breathing, chest pain, confusion, or failure to improve after 10 days, you should consult your physician or health-care practitioner immediately. Infants 3 months of age or younger who develop a cold or fever should consult their health-care practitioner as well.

If you have a sore throat and a fever with no other cold symptoms, you should also be evaluated by your physician. This illness may be strep throat, a bacterial infection requiring treatment with antibiotics.

Finally, if you notice facial pain or yellow/green drainage from your nose accompanied by a fever, it is possible that you have a sinus infection (sinusitis) that would benefit from a medical evaluation and a possible course of antibiotics.

Strep Throat

2012-02-23T04:58:00.000-08:00

Strep Throat Symptoms

Strep Throat Symptoms and Signs

Throat infection with strep bacteria is contagious and can cause a variety of symptoms associated with inflammation of the throat and its nearby structures. Symptoms usually begin within a few days (1-4 days) after contracting the infection (incubation period).
Typical signs of strep throat infection are:

fever;
swollen, tender lymph nodes on the sides of the neck;
white patches seen on the tonsils and throat.

Some other more non-specific signs and symptoms of strep throat which can also be seen in strep throat due to other causes are:

sudden onset of sore throat,
headache,
odynophagia (painful swallowing),
nausea, vomiting, abdominal pain,
red, swollen soft palate (uvula), and/or
rash (diffuse red patchy rash).

Read more of the symptoms and signs of strep throat »

What is strep throat?

While many people use the terms sore throat, tonsillitis, and strep throat interchangeably, there are significant clinical differences between these conditions. Understanding the differences can give patients a better idea of how and when to be concerned and when to seek advice from a physician.

Strep throat is only one of many possible causes of throat infection and sore throat. While strep throat is most common in children and adolescents, it can affect people of all ages.

What causes sore throat?

Sore throat has many causes. The most common causes of sore throat are infections of the throat and the surrounding structures. Any inflammation or infection of the pharynx, tonsils, esophagus (the food pipe), or larynx (the top opening part of the windpipe) may cause sore throat.

What are the tonsils and tonsillitis?

The tonsils are red, oval clumps of tissue located at the back and to the sides of the throat. This location allows the tonsils to intercept germs as they enter the body through the nose and throat. They contain infection-fighting cells and antibodies (infection-fighting proteins in the body) that stop the spread of the germs further into the body.

Tonsillitis refers to conditions in which the tonsils become red, sore, and swollen because of inflammation. This is not a specific term, as there are many causes of inflammation of the tonsils. Tonsillitis is a common cause of sore throat.

What are the pharynx and pharyngitis?

The pharynx is the area in the back of the throat shared by the oral cavity and the nasal cavity behind the palate. An infection or inflammation of the pharynx is called pharyngitis. The infectious causes are similar to those causing tonsillitis, which are mainly related to viruses and less commonly to bacterial infection.

Because it is difficult to always distinguish exactly between pharyngitis and tonsillitis, throat infections are commonly referred to as tonsillopharyngitis, which signifies an infection of the tonsils, or pharynx, or both.

Viral causes of throat infection

Viruses are the most common cause of throat infection in children and in adults. Many types of viruses are known to cause throat infection, and their symptoms may be difficult to distinguish from those of a bacterial infection.

Throat infections caused by viruses usually occur in non-winter months.

Bacterial causes of throat infection

Bacterial causes of throat infections (tonsillopharyngitis) require further attention from individuals (and their parents or caregiver if the sick person is a child) and physicians.

Streptococcus, or strep, is the most frequently found bacterial cause of sore throat.

The commonly known strep throat is due to only one member of the Streptococcus family of bacteria. This certain streptococcus (Streptococcus pyogenes) belongs to the Group A Streptococcus bacteria (GAS for short). This group of bacteria is also known to cause infections other than strep throat such as skin infections, soft tissue infections, and pneumonia (lung infection).

There are many other bacteria that may also cause throat infections. Group A Streptococcus is the most common cause in children and adolescents. Mycoplasma, Neisseria, Corynebacterium, Yersinia, and non-Group A Strep bacteria are some of the other bacterial causes of throat infection.

Bacterial throat infections typically occur in the winter months.

How common is strep throat?

Group A streptococcus is the most common bacterial cause of throat infection. Approximately 15% to 30% of tonsillopharyngitis in children between 5 to 15 years of age is caused by group A strep. This age group (5 to 15) has the peak incidence of strep throat infection. In adults, 5% to 10% of cases of pharyngitis are estimated to be caused by strep bacteria.

Some reports suggest that over 600 million cases of strep throat occur annually worldwide.

Is strep throat contagious?

Yes, strep throat is contagious. The most common way to catch strep throat is by contact with an infected person.

Close contact with airborne droplets of an infected individual is the most common way of catching Streptococcus infection. Close quarters such as college dormitories, day care centers, military facilities, schools, and families provide ideal conditions for transmission of strep throat from one person to another. The risk of acquiring strep throat from an affected family member nears 40%. Spread through food-borne outbreaks is less common, but possible.

The risk of being contagious with strep throat diminishes substantially after initiation of proper antibiotic treatment.

What are the signs and symptoms of strep throat?

Throat infection with strep bacteria can cause a variety of symptoms associated with inflammation of the throat and its nearby structures. Symptoms usually begin within a few days (1-4 days) after contracting the infection (incubation period).

With strep throat infection, the throat can become red and swollen. White patches may be visible on the back of the throat and the tonsils, suggesting the presence of pus. The presence of fever, swollen lymph nodes on the sides of the neck, and white patches on the tonsils along with the absence of cough raise the suspicion for strep pharyngitis. Not all of these signs need to be present with strep tonsillopharyngitis. On the other hand, their presence is not specific only to strep throat.

Typical signs of strep throat infection are:

fever;
swollen, tender lymph nodes on the sides of the neck (cervical lymphadenopathy);
white patches seen on the tonsils and throat (tonsillar exudates).

Some other more non-specific signs and symptoms of strep throat which can also be seen in tonsillopharyngitis due to other causes are:

sudden onset of sore throat,
headache,
odynophagia (painful swallowing),
nausea, vomiting, abdominal pain,
red, swollen soft palate (uvula), and/or
rash (diffuse red patchy rash).

The strep throat rash is caused by toxins released from the bacteria, and not necessarily because of the spread of infection to the skin. This rash is also known as scarlet fever, which can occur in about 10% children with strep throat infection, and typically starts around the face and neck area and can spread to the rest of the body. It has a raised, rough "sand-paper" quality. The rash may start within 12 to 24 hours of the onset of fever and may last for several days.

Other features that are more likely to be seen in tonsillopharyngitis due to viral causes include the following:

conjunctivitis (eye redness),
runny nose (coryza),
skin rash (exanthem or small spotted rash),
generalized weakness and malaise,
muscle aches and pains,
cough,
hoarseness,
diarrhea, and/or
oral ulcers.

Are strep throat symptoms different in children compared to adults?

Some of the general and constitutional symptoms of strep throat infection may vary quite a bit depending on the patient's age.

Infants primarily experience a thick "colorful" (yellow or green) drainage from the nose and possibly a low-grade fever, with fussiness, irritability, and a decrease in appetite.
Children aged one to three ("toddlers") may complain of a sore throat, trouble swallowing, poor appetite, crankiness, and swollen glands (lymph nodes) beneath the jaws.
Older children and adolescents generally look and feel awful with strep throat. They can have high fevers, very painful throats, often severe difficulty swallowing, and pus, which can sometimes be seen covering the tonsils.
Adults with strep throat may have milder symptoms, and in some cases the illness may be undetected. Symptoms vary; adults may also have severe pain and trouble swallowing.

When should I be concerned about a possible strep throat?

Parents should be concerned about a sore throat that does not improve after a sip of water after arising from sleep, or one that is accompanied by a headache, high fever, stomachache, vomiting, or severe tiredness. The presence of a red, somewhat rough-to-the-touch rash is also a concern, known as scarlet fever (but this is no more dangerous than strep throat without a rash).

An urgent call to the doctor's office or emergency room visit is appropriate, especially in a child who has extreme difficulty swallowing that causes drooling or difficulty breathing.

How is strep throat diagnosed?

Throat culture

During the doctor's physical examination, a throat culture might be taken by touching a soft cotton swab to the throat and tonsil area. Germs from the swab are smeared onto a special plate and sent to the laboratory for evaluation of strep or other bacteria. After 24-48 hours, the rapidly-growing strep germs can be identified if present in the sample. Throat culture is the gold standard in diagnosing strep throat infection.

A culture for strep throat may not be done as a screening test in an individual without any symptoms suggestive of strep throat. This is because bacteria may be present without causing an infection. A person may be a carrier of the bacteria but not infected.

Rapid strep test

Rapid strep tests (also called the Rapid Antigen Detection Test or RADT) are available that can give results in minutes. A sample from the back of the throat or tonsils is taken using a swab similar to the sample for culture. Using a RADT kit, the doctor can determine within a few minutes if strep is the likely cause of sore throat. This test is less precise than throat cultures. Therefore, if the health care practitioner has a high suspicion for strep throat, both tests (RADT and throat culture) may be performed, and treatment should be started as soon as possible even if the rapid test is negative for strep while waiting for the definitive culture results.

Taking any "self prescribed" antibiotic prior to seeing the doctor should be avoided because even a single dose of antibiotic can interfere with the culture results and the health care practitioner's ability to correctly diagnose and treat the infection.

Blood test for strep throat infection

Streptococcus infection can be detected by measuring the antibodies produced by the body against the bacteria. This is called the Anti-streptolysin O or ASO titer. This antibody may not be present in the blood for a few weeks after an infection, and therefore its measurement may not be accurate to detect an active or acute infection. ASO titers also may not be detectable if the person had been appropriately treated with antibiotics.

This test may be useful in detecting prior infections and evaluating a person with complications of strep throat infection such as rheumatic fever or glomerulonephritis (see below).

Who should be tested for strep throat?

There is not an easy system to decide who should be tested for strep throat. However, there are certain predictors that make the possibility of strep tonsillopharyngitis likely. These include:

Children and adolescents between the ages of five and 15
Illness occurring in the late fall, winter, or early spring months
Clinical evidence of acute pharyngitis:

redness and swelling in throat, white discharge on the tonsils

fever of 101 F to 103 F (38 C to 39.4 C)

large and tender lymph nodes in the neck

Absence of upper respiratory infection symptoms, such as runny nose, nasal congestion, and cough

Some clinical studies suggest that if all of these points are present, then the likelihood of strep throat may be up to 85%. The doctor may decide if testing is necessary based on these or other clinical factors.

How is strep infection treated?

Because of potential significant complications (described below), if strep throat is detected, it must be treated adequately with antibiotics. It is important to take the full course of antibiotics as prescribed and not to stop the medication when symptoms resolve. Prematurely discontinuing antibiotics can result in the infection being inadequately treated, with potentially adverse consequences or relapse of the infection.

Antibiotics

Streptococcus is highly responsive to penicillin and the cephalosporin antibiotics. Penicillin has shown good effectiveness, and it is reliable and cheap.

Oral penicillin V (Pen-Vee-K, Veetids) is the preferred oral form of penicillin for strep throat. The usual dose is 250 milligrams three times a day or 500 milligrams twice a day. A full 10 day course must be completed even though patients usually feel better only after two to three days.

Injectable penicillin G (Bicillin) is also very effective and may be used in individuals who may not reliably take 10 days of antibiotics orally. The drug may last in the body for up to 21 days and can therefore adequately treat the infection.

Other penicillin derivatives such as amoxicillin (Amoxil), amoxicillin-clavulanate (Augmentin), cloxacillin (Cloxapen, Tegopen), and dicloxacillin (Dynapen) are all adequate treatments for strep. They may be even slightly more effective than penicillin because of better absorption and greater potency.

Cephalosporin antibiotics are also a very effective in treating group A streptococcus. In some studies, they were found to be better than penicillin, and there is some suggestion that they may be the first choice antibiotic for this infection. For now, they remain a very good choice in patients with mild penicillin allergies.

Some examples of cephalosporin antibiotics used to treat strep throat are:

cephalexin (Keflex, Keftabs),
cefadroxil (Duricef),
cefaclor (Celcor),
cefixime (Suprax),
cefprozil (Cefzil),
cefuroxime axetil (Cefitn),
loracarbef (Lorabid),
cefpodoxime (Vantin), and
cefdinir (Omnicef).

Other options are macrolides, such as erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), azithromycin (Zithromax), and clarithromycin (Biaxin). These antibiotics have shown similar to superior effectiveness compared to penicillin for the treatment of group A streptococcus. Erythromycin is thought to be the optimum choice for people with severe penicillin allergy.

The current recommendations still list penicillin as the first choice for the treatment of group A streptococcus. Erythromycin is recommended as the first choice in penicillin-allergic individuals. First generation cephalosporins such as cephalexin and cefadroxil, are alternatives to erythromycin.

How can viral throat infection be treated?

For viral infections, generally no antibiotic is needed (unless the infection becomes complicated by a subsequent bacterial infection). Most viral infections can be expected to run a four-to-six day course. During this period, the child or other infected individuals can be treated with lots of fluids, rest, and "feel better" medicines that reduce pain and/or fever, such as acetaminophen (Tylenol, Tempra, Liquiprin, etc.) or ibuprofen (Motrin, Advil, etc.). It is important to note that these measures do not treat the viral infection and only provide some relief of the symptoms. These measures can also be helpful in treating the symptoms of bacterial throat infection, such as strep throat.

Are there any recommended strep throat remedies?

Recommended home remedies for sore throat and tonsillopharyngitis (both strep throat and non-strep throat) are easily available in most circumstances. These remedies are generally geared towards relieving symptoms of sore throat and should not replace antibiotics in cases of proven strep infection.

Saltwater gargle is an old therapy for sore throat symptom relief. Typically, ¼ to ½ teaspoon of salt is added to a cup (8 ounce) of warm water. Portions of the solution are used for each gargle. Gargling can be repeated a few times daily. Children younger than 8 years of age are not capable of gargling and this therapy should be avoided in this age group.
Hard candies can be used to treat sore throat symptoms. Sucking on a hard candy is as beneficial as some of the other listed therapies.
Lozenges (cough drops, troches, or pastilles) are also available for symptomatic relief of sore or dry throat. Cooling (Menthol), anesthetic (phenol or benzocaine), antiseptic, or anti-inflammatory agents may be used in these products to provide adequate symptom relief. The use of lozenges is not recommended for children under 4 years old.
Other home remedies for symptomatic relief of sore throat and strep throat include warm tea with honey, lemon tea, chicken soup, cold beverages, ice cream, and Popsicles. Honey should be avoided in children less than 1 year of age because of increased risk of botulinum toxicity and paralysis.

It cannot be overemphasized that despite these therapies, antibiotics are the most important treatment for adequately diagnosed strep throat because of the dreaded complications of untreated strep infection.

When should the tonsils be taken out?

Surgical removal of the tonsils is much less common today thanks to the present ability to rapidly and accurately diagnose strep infection, and thanks to the excellent antibiotics currently available. But occasionally, your doctor might suggest the need for surgical removal of the tonsils (tonsillectomy) if an individual:

is experiencing frequent episodes of tonsillitis (especially those caused by the strep bacteria),
has tonsils that are so large, even when the individual is well, that they cause not just "snoring" but significant obstruction or blockage of the airway during sleep (sleep apnea), or
develops an uncommon but serious deep-seated infection within and surrounding one or both of the tonsils, called a "peri-tonsillar abscess."

Why is it very important to detect and treat a strep throat?

Studies have shown that if treated within the first 48 hours of symptoms, the duration of the symptoms is reduced by one to two days. If untreated, the body will generally clear the infection within two to five days, and this is the usual course of the illness.

Another reason to treat strep infection early is that there is a 35% reduction in transmitting the disease by contact. There are reports that within 24 hours of starting antibiotics for strep throat such as penicillin, individuals become minimally contagious.

More importantly, there are many potential sequelae of untreated strep infection, as described in the following section.

What are the potential complications of untreated strep throat infection?

Possible complications of untreated or partially treated strep throat infection are:

rheumatic fever (described below);
glomerulonephritis (described below);
otitis media (spread of infection to the middle ear);
meningitis (spread of infection to the lining of brain and spinal canal);
pneumonia (lung infection);
toxic shock syndrome (a rare but severe complication of strep pharyngitis, causing severe widespread infection and organ failure); and/or
abscess formation around the tonsils and behind the throat (peri-tonsillar abscess and retro-pharyngeal abscess).

Formation of an abscess behind the throat (retro-pharyngeal abscess) due to untreated or under-treated strep throat infection can lead to severe illness causing pain in throat and neck, difficulty swallowing, and potential respiratory compromise. These abscesses may need to be drained by an ear-nose-throat (ENT) specialist urgently, and hospitalization may be required.

There is also a condition called Pediatric Autoimmune Neuropsychiatric Disorder associated with group A Streptococcus infection (PANDAS). This is a theoretical and somewhat controversial condition linking group A strep infection with possible exacerbation of obsessive compulsive disorders or tic disorders (Tourette's syndrome) in children.

Rheumatic fever

Acute rheumatic fever is a known and serious complication of strep throat. It is thought that if the strep throat infection is untreated or inadequately treated by antibiotics, the bacteria remain in the tonsils and promote a persistent immune response from the body. Certain strains of the bacteria are more likely to cause this response. At times, this ongoing immune response may trigger the immune system to mistakenly attack other organs in the body including the joints (causing inflammation of the joints or arthritis) and the heart valves. The involvement of heart valves can cause damage of the heart valves and potential heart failure.

Treatment with appropriate antibiotics, even if started several days after the resolution of the infection, may prevent acute rheumatic fever. Fortunately, it is now uncommon in the current antibiotic era.

Kidney problems

Theoretically, a similar immune process to acute rheumatic fever may involve the kidneys and result in kidney inflammation called glomerulonephritis (or post-streptococcal glomerulonephritis). There is however, no evidence to support the use of antibiotics to prevent this condition. Children under the age of seven are at the highest risk of developing this condition after an episode of strep throat. This condition is less common and less severe than rheumatic fever. It typically resolves spontaneously after a few weeks and generally does not lead to permanent kidney damage.

Is there a vaccine for strep throat?

Currently, there are no vaccines available against group A streptococcus bacteria. There are currently concerns about whether a vaccine may initiate immune responses similar to those causing rheumatic fever and glomerulonephritis.

Can strep throat be prevented?

The important aspect of preventing strep throat infection is to prevent its spread to others. Simple steps can be taken in order to limit the spread of strep throat:

Covering mouth and nose when sneezing or coughing
Washing hands frequently
Washing dishes and utensils used by the infected individual frequently
Keeping dishes, utensils, and other household items used by the infected person separate from those used by other family members
Do not share food or drinks with the infected individual

Strep Throat At A Glance

Most throat infections are caused by viruses.
The symptoms of strep throat include fever, sore throat, and swollen lymph glands in the neck.
The diagnosis of strep throat is confirmed by a throat culture or rapid-strep test.
Strep throat is treated with antibiotics.
If left untreated, strep throat may cause heart and kidney problems.

Gout

2012-02-22T19:12:00.000-08:00

What is gout? What is hyperuricemia?

Gout is a disease that results from an overload of uric acid in the body. This overload of uric acid leads to the formation of tiny crystals of urate that deposit in tissues of the body, especially the joints. When crystals form in the joints, it causes recurring attacks of joint inflammation (arthritis). Gout is considered a chronic and progressive disease. Chronic gout can also lead to deposits of hard lumps of uric acid in the tissues, particularly in and around the joints and may cause joint destruction, decreased kidney function, and kidney stones (nephrolithiasis).

Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history. It is often related to an inherited abnormality in the body's ability to process uric acid. Uric acid is a breakdown product of purines that are part of many foods we eat. An abnormality in handling uric acid can cause attacks of painful arthritis (gout attack), kidney stones, and blockage of the kidney-filtering tubules with uric acid crystals, leading to kidney failure. On the other hand, some people may only develop elevated blood uric acid levels (hyperuricemia) without having manifestations of gout, such as arthritis or kidney problems. The state of elevated levels of uric acid in the blood without symptoms is referred to as asymptomatic hyperuricemia. Asymptomatic hyperuricemia is considered a precursor state to the development of gout. The term gout refers the disease that is caused by an overload of uric acid in the body, resulting in painful arthritic attacks and deposits of lumps of uric acid crystals in body tissues.

Gouty arthritis is typically an extremely painful attack with a rapid onset of joint inflammation. The joint inflammation is precipitated by deposits of uric acid crystals in the joint fluid (synovial fluid) and joint lining (synovial lining). Intense joint inflammation occurs as the immune system reacts, causing white blood cells to engulf the uric acid crystals and chemical messengers of inflammation to be released, leading to pain, heat, and redness of the joint tissues. As gout progresses, the attacks of gouty arthritis typically occur more frequently and often in additional joints.

Who is affected by gout?

Approximately 5 million people in the United States suffer from gout. (Did you know that none other than Benjamin Franklin had terribly painful gouty arthritis?) Gout is nine times more common in men than in women. It predominantly attacks males after puberty, with a peak age of 75. In women, gout attacks usually occur after menopause.

While an elevated blood level of uric acid may indicate an increased risk of gout, the relationship between hyperuricemia and gout is unclear. Many patients with hyperuricemia do not develop gout (asymptomatic hyperuricemia), while some patients with repeated gout attacks have normal or low blood uric acid levels. In fact, the blood level of uric acid often lowers during an acute attack of gout. Among the male population in the United States, approximately 10% have hyperuricemia. However, only a small portion of those with hyperuricemia will actually develop gout.

What are gout causes and risk factors?

In addition to an inherited abnormality in handling uric acid, other risk factors for developing gout include obesity, excessive weight gain (especially in youth), moderate to heavy alcohol intake, high blood pressure, and abnormal kidney function. Certain drugs, such as thiazide diuretics (hydrochlorothiazide [Dyazide]), low-dose aspirin, niacin, cyclosporine, tuberculosis medications (pyrazinamide and ethambutol), and others can also cause elevated uric acid levels in the blood and lead to gout. Furthermore, certain diseases lead to excessive production of uric acid in the body. Examples of these diseases include leukemias, lymphomas, and hemoglobin disorders.

Interestingly, one study demonstrated an increased prevalence of abnormally low thyroid hormone levels (hypothyroidism) in patients with gout.

In patients at risk of developing gout, certain conditions can precipitate acute attacks of gout. These conditions include dehydration, injury to the joint, fever, excessive eating, heavy alcohol intake, and recent surgery. Gout attacks triggered by recent surgery are probably related to changes in the body-fluid balance as patients temporarily discontinue normal oral fluid intake in preparation for and after their operation.

What are gout symptoms and signs?

The small joint at the base of the big toe is the most common site of an acute gout attack of arthritis. An acute attack of gouty arthritis at the base of the big toe is medically referred to as podagra. Other joints that are commonly affected include the ankles, knees, wrists, fingers, and elbows. Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. Tenderness can be intense so that even a blanket touching the skin over the affected joint can be unbearable. Patients can develop fever with the acute gout attacks. These painful attacks usually subside in hours to days, with or without medication. In rare instances, an attack can last for weeks. Most patients with gout will experience repeated attacks of arthritis over the years.

Uric acid crystals can deposit in tiny fluid-filled sacs (bursae) around the joints. These urate crystals can incite inflammation in the bursae, leading to pain and swelling around the joints (a condition called bursitis). In rare instances, gout leads to a more chronic type of joint inflammation that mimics rheumatoid arthritis.

In chronic (tophaceous) gout, nodular masses of uric acid crystals (tophi) deposit in different soft-tissue areas of the body. Even though they are most commonly found as hard nodules around the fingers, at the tips of the elbows, in the ears, and around the big toe, tophi nodules can appear anywhere in the body. They have been reported in unexpected areas such as in the vocal cords or (rarely) even around the spinal cord. When tophi appear in the tissues, the gout condition is felt to represent a substantial overload of uric acid within the body.

How is gouty arthritis diagnosed?

Gout is suspected when a patient reports a history of attacks of painful arthritis, particularly at the base of the toes. Ankles and knees are the next most commonly involved joints in gout. Gout usually attacks one joint at a time, while other arthritis conditions, such as systemic lupus and rheumatoid arthritis, usually attack multiple joints simultaneously.

The most reliable test for gout is finding uric acid crystals in a sample of the joint fluid obtained by joint aspiration (arthrocentesis). Arthrocentesis is a common office procedure performed under local anesthesia. Using sterile technique, fluid is withdrawn (aspirated) from the inflamed joint using a syringe and needle. The joint fluid is then analyzed for uric acid crystals and for infection. Shiny, needle-like uric acid crystals are best viewed with a special polarizing microscope. The diagnosis of gout can also be made by finding these urate crystals from material aspirated from tophi nodules and bursitis fluid. Although many doctors can do the procedure, rheumatologists are specialists who are particularly trained in this evaluation.

Sometimes, patients with a classic history and symptoms of gout can be successfully treated and presumed to have gout without undergoing arthrocentesis. However, establishing a firm diagnosis is still preferable since other conditions can mimic gout. These include another crystal-induced arthritis called pseudogout, psoriatic arthritis, rheumatoid arthritis, and even infection in the joint.

X-rays can sometimes be helpful and may show tophi-crystal deposits and bone damage as a result of repeated bouts of inflammation. X-rays can also be helpful for monitoring the effects of chronic gout on the joints.

What is the treatment for gout?

There are two key concepts essential to treating gout. First, it is critical to stop the acute inflammation of joints affected by gouty arthritis. Second, it is important to address the long-term management of the disease in order to prevent future gouty arthritis attacks and shrink gouty tophi crystal deposits in the tissues.

The treatment of an acute attack of gouty arthritis involves measures and medications that reduce inflammation. Preventing future acute gout attacks is equally as important as treating the acute arthritis. Prevention of acute gout involves maintaining adequate fluid intake, weight reduction, dietary changes, reduction in alcohol consumption, and medications to lower the uric acid level in the blood (reduce hyperuricemia).

Maintaining adequate fluid intake helps prevent acute gout attacks. Adequate fluid intake also decreases the risk of kidney stone formation in patients with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism to cause hyperuricemia. Therefore, alcohol has two major effects that worsen gout by impeding (slowing down) the excretion of uric acid from the kidneys as well as by causing dehydration, both of which contribute to the precipitation of uric acid crystals in the joints.

Gout diet

Dietary changes can help reduce uric acid levels in the blood. Since purine chemicals are converted by the body into uric acid, purine-rich foods are avoided. Examples of foods rich in purines include shellfish and organ meats such as liver, brains, kidneys, and sweetbreads. Researchers have reported, in general, that meat or seafood consumption increases the risk of gout attacks, while dairy food consumption seemed to reduce the risk. Protein intake or purine-rich vegetable consumption was not associated with an increased risk of gout. Total alcohol intake was strongly associated with an increased risk of gout (beer and liquor were particularly strong factors). Fructose from the corn syrup in soft drinks also increases the risk of gout.

Weight reduction can be helpful in lowering the risk of recurrent attacks of gout. This is best accomplished by reducing dietary fat and calorie intake, combined with a regular aerobic exercise program.

Gout medications

There are three aspects to the treatment of gout with medications. First, pain relievers such as acetaminophen (Tylenol) or other more potent analgesics are used to manage pain. Secondly, anti-inflammatory agents such as nonsteroidal anti-inflammatory drugs (NSAIDS), colchicine, and corticosteroids are used to decrease joint inflammation. Finally, medications are considered for managing the chronic underlying metabolic derangement that causes hyperuricemia and gout. This means treating the elevated levels of uric acid in the blood with medications that reduce these levels.

NSAIDS such as indomethacin (Indocin) and naproxen (Naprosyn) are effective anti-inflammatory medications for acute gout. These medications are tapered after the arthritis resolves. Common side effects of NSAIDS include irritation of the gastrointestinal system, ulceration of the stomach and intestines, and even intestinal bleeding. People who have a history of allergy to aspirin or nasal polyps should avoid NSAIDS because of the risk of an intense allergic (anaphylactic) reaction. Colchicine (Colcrys) for acute gout is administered by mouth to reduce inflammation as well as to prevent gouty arthritis attacks while correcting hyperuricemia with medications such as allopurinol (Zyloprim) or febuxostat (Uloric). For acute attacks, it is given hourly or every two hours until there is significant improvement in pain or the patient develops gastrointestinal side effects such as severe diarrhea. For prevention, it is given once or twice daily. Other common side effects of colchicine include nausea and vomiting.

Corticosteroids such as prednisone, given in short courses, are powerful anti-inflammatory agents for treating acute gout. They can be administered orally or injected directly into the inflamed joint. Corticosteroids can be prescribed to patients who have accompanying kidney, liver, or gastrointestinal problems. Long-term chronic use of corticosteroids is discouraged because of serious long-term side effects.

In addition to medications for acute gout attacks, other drugs can be taken over prolonged periods to lower blood uric acid levels. Lowering blood uric acid levels reduces the risk of recurrent attacks of arthritis, kidney stones, and kidney disease, and also slowly dissolves hard tophi deposits. Medicines used to lower blood uric acid level work either by increasing the kidney's excretion of uric acid or by decreasing the body's production of uric acid from the purines in foods. These medicines are generally not started until after the inflammation from acute gouty arthritis has subsided because they can worsen the attack. If they are already being taken prior to the attack, they are continued and only adjusted after the attack has resolved.

Probenecid (Benemid) and sulfinpyrazone (Anturane) are medications that are commonly used to decrease uric acid blood levels by increasing the excretion of uric acid into the urine. Since these drugs can, in rare instances, cause kidney stones, they should be avoided by those patients with a history of kidney stones. These medications should be taken with plenty of fluid so as to promote the rapid passage of uric acid out of the urinary system in order to prevent kidney stone formation.

Allopurinol lowers the blood uric acid level by preventing uric acid production. It actually blocks the metabolic conversion from purines in foods to uric acid. This medication is used with caution in patients with poor kidney function, as they are at a particular risk of developing side effects, including severe rash and liver damage.

Febuxostat was approved by the U.S. Food and Drug Administration (FDA) for the chronic management of hyperuricemia from gout in 2009. Febuxostat has been shown to be more effective than allopurinol in preventing acute attacks of gouty arthritis and is effective in shrinking tophi deposits of uric acid in the tissues such as the fingers, elbows, and ears. Because febuxostat is not significantly metabolized by the kidneys, it may have advantages over allopurinol in patients with underlying kidney disease. While taking febuxostat, patients have uric acid levels and liver function blood tests monitored regularly.

Again, uric acid-lowering medications such as allopurinol and febuxostat are generally not started in patients who are having acute attacks of gout. These medications, when started during an acute attack, actually can worsen the acute inflammation. Therefore, uric acid-lowering drugs are usually instituted only after complete resolution of the acute arthritis attacks, but if patients are already taking these medications, they are maintained at the same doses during the acute attacks. In some patients, increasing the dose of uric-acid-lowering medications can precipitate gout attacks. In these patients, low doses of colchicine can be given to prevent the precipitation of acute gout.

A new intravenous medication that is used to lower uric acid blood levels in certain patients with chronic gout is PEGylated uricase (pegloticase or Krystexxa). This infused medication (given every two weeks) is to be considered only for those patients with gout that has failed treatment with conventional uric-acid-lowering medications as it can cause anaphylactic reactions and infusion reactions. Pre-medicating with antihistamines and cortisone medications can decrease the risk of these reactions.

It is essential to monitor the blood level of uric acid regularly once uric-acid-lowering medications are used for optimal maintenance, as the uric acid metabolism can change over time.

Home remedies which can alleviate the symptoms of acute gout include resting and elevating the inflamed joint. Ice-pack applications can sometimes make the inflammation worse by causing more uric acid to form crystals in the involved area. Patients should avoid aspirin-containing medications, when possible, because aspirin prevents kidney excretion of uric acid.

What does the future hold for patients with gout and hyperuricemia?

Active research is ongoing in a variety of fields related to gout and hyperuricemia. The management of the chronic gouty disease and its relationship to improving blood pressure and kidney function is becoming better defined.

Scientists recently reported that high animal protein intake slightly increased the risk for gout. Others found that dietary calcium intake may protect patients from getting gout attacks. Vitamin C may also lower blood uric acid levels.

New medications to increase the elimination of uric acid in the urine (such as benzbromarone) are being evaluated in clinical trials. Researchers are also reporting on experimental drugs that can affect chemical messengers involved in gouty inflammation called interleukins.

The optimal regimens for the treatment of acute gout attacks and chronic gout conditions still require further long-term studies. Research scientists will continue to develop less toxic and more effective medications to battle this "scourge of the ages."

Anxiety

2012-02-22T19:03:00.000-08:00

Introduction to Anxiety

Generalized anxiety disorder (or GAD) is characterized by excessive, exaggerated anxiety and worry about everyday life events with no obvious reasons for worry. People with symptoms of generalized anxiety disorder tend to always expect disaster and can't stop worrying about health, money, family, work, or school. In people with GAD, the worry often is unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear, and dread. Eventually, the anxiety so dominates the person's thinking that it interferes with daily functioning, including work, school, social activities, and relationships.

What Are the Symptoms of GAD?

GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well. Symptoms of GAD can include:

Excessive, ongoing worry and tension
An unrealistic view of problems
Restlessness or a feeling of being "edgy"
Irritability
Muscle tension
Headaches
Sweating
Difficulty concentrating
Nausea
The need to go to the bathroom frequently
Tiredness
Trouble falling or staying asleep
Trembling
Being easily startled

In addition, people with GAD often have other anxiety disorders (such as panic disorder, obsessive-compulsive disorder, and phobias), suffer from depression, and/or abuse drugs or alcohol.

What Causes GAD?

The exact cause of GAD is not fully known, but a number of factors -- including genetics, brain chemistry and environmental stresses -- appear to contribute to its development.

Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families.
Brain chemistry: GAD has been associated with abnormal levels of certain neurotransmitters in the brain. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety.
Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol, caffeine, and nicotine, can also worsen anxiety.

How Common Is GAD?

About 4 million adult Americans suffer from GAD during the course of a year. It most often begins in childhood or adolescence, but can begin in adulthood. It is more common in women than in men.

How Is GAD Diagnosed?

If symptoms of GAD are present, the doctor will begin an evaluation by asking questions about your medical history and performing a physical examination. Although there are no laboratory tests to specifically diagnose anxiety disorders, the doctor may use various tests to look for physical illness as the cause of the symptoms.

The doctor bases his or her diagnosis of GAD on reports of the intensity and duration of symptoms -- including any problems with functioning caused by the symptoms. The doctor then determines if the symptoms and degree of dysfunction indicate a specific anxiety disorder. GAD is diagnosed if symptoms are present for more days than not during a period of at least six months. The symptoms also must interfere with daily living, such as causing you to miss work or school.

How Is GAD Treated?

If no physical illness is found, you may be referred to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses like GAD. Treatment for GAD most often includes a combination of medication and cognitive-behavioral therapy.

Medication: Drugs are available to treat GAD and may be especially helpful for people whose anxiety is interfering with daily functioning. The medications most often used to treat GAD in the short-term are from a class of drugs called benzodiazepines. These medications are sometimes referred to as "tranquilizers," because they leave you feeling calm and relaxed. They work by decreasing the physical symptoms of GAD, such as muscle tension and restlessness. Common benzodiazepines include Xanax, Librium, Valium and Ativan. Antidepressants, such as Paxil, Effexor, Prozac, Lexapro, and Zoloft, are also being used to treat GAD. These antidepressants may take a few weeks to start working but they're more appropriate for long-term treatment of GAD.
Cognitive-behavioral therapy: People suffering from anxiety disorders often participate in this type of therapy, in which you learn to recognize and change thought patterns and behaviors that lead to anxious feelings. This type of therapy helps limit distorted thinking by looking at worries more realistically.

In addition, relaxation techniques, such as deep breathing and biofeedback, may help to control the muscle tension that often accompanies GAD.

Are There Side Effects of GAD Treatment?

Dependency on anti-anxiety medications (benzodiazepines) is a potential complication of treatment. Side effects of antidepressants vary by specific drug and the person taking them. Common side effects can include sleepiness, weight gain, and sexual problems.

What Is the Outlook for People With GAD?

Although many people with GAD cannot be cured and symptoms can return from time to time, most people gain substantial relief from their symptoms with proper treatment.

Can GAD Be Prevented?

Anxiety disorders like GAD cannot be prevented. However, there are some things that you can do to control or lessen symptoms, including:

Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate.
Ask your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
Exercise daily and eat a healthy, balanced diet.
Seek counseling and support after a traumatic or disturbing experience.
Practice stress management techniques like yoga or meditation.

Acquired Immunodeficiency Syndrome (AIDS)

2012-02-22T18:59:00.000-08:00

What does AIDS stand for? What causes AIDS?

AIDS stands for "acquired immunodeficiency syndrome." AIDS is a disease that weakens the immune system to the point where an affected person is vulnerable to a wide range of infections and cancers that result in death if not treated. AIDS is caused by the human immunodeficiency virus (HIV). The virus is spread through contact with infected blood or secretions. At first (stage 1 HIV infection), there is little evidence of harm. Over time, the virus attacks the immune system, focusing on special cells called "CD4 cells" which are important in protecting the body from infections and cancers, and the number of these cells starts to fall (stage 2). Eventually, the CD4 cells fall to a critical level and/or the immune system is weakened so much that it can no longer fight off certain types of infections and cancers. This advanced stage of infection (stage 3) with HIV is called AIDS. HIV is a very small virus that contains ribonucleic acid (RNA) as its genetic material. (Animal cells, plant cells, bacteria, parasites, and some viruses use deoxyribonucleic acid [DNA] as their primary genetic material rather than RNA.) When HIV infects animal cells, it uses a special enzyme, reverse transcriptase, to turn (transcribe) its RNA into DNA which, in turn, directs the formation of HIV RNA that can be used to form new HIV. This is different from the way human cells reproduce (directly transcribing their DNA into RNA), so HIV is classified as a "retrovirus." When HIV reproduces, it is prone to making small genetic mistakes or mutations, resulting in viruses that vary slightly from each other. This ability to create minor variations allows HIV to evade the body's immunologic defenses, essentially leading to lifelong infection, and has made it difficult to make an effective vaccine. The mutations also allow HIV to become resistant to medications.

What is the history of AIDS?

Careful investigation has helped scientists determine where AIDS came from. Studies have shown that the human immunodeficiency virus first arose in Africa. It spread from primates to people decades ago, possibly when humans came into contact with infected blood during a chimpanzee hunt. By testing stored blood samples, scientists have found evidence of human infection as long ago as 1959. Once introduced into humans, HIV was spread through sexual intercourse from person to person. As infected people moved around, the virus spread from Africa to other areas of the world. In 1981, U.S. physicians noticed that a large number of young men were dying of unusual infections and cancers. Initially, U.S. victims were predominately homosexual men, probably because the virus inadvertently entered this population first in this country and because the virus is transmitted easily during anal intercourse. However, it is important to note that the virus also is efficiently transmitted through heterosexual activity and contact with infected blood or secretions. In Africa, which remains the center of the AIDS pandemic, most cases are heterosexually transmitted.
In the years since the virus was first identified, AIDS has spread to every corner of the globe. Statistics from the World Health Organization show that approximately 2 million people die each year from AIDS, resulting in 15 million new orphan children. Worldwide, half of HIV-infected people are women and 6% are children under 15 years of age. Two-thirds of current cases are in sub-Saharan Africa.
In the U.S., more than 1 million people have been diagnosed with AIDS since the start of the epidemic. There are approximately 430,000 people currently living with AIDS in the U.S. Each year, another 37,000 people are newly diagnosed with AIDS. Over the years, more than half a million people in the U.S. have died from AIDS, many of them during what should have been their most productive years of life.

What are symptoms and signs of AIDS?

AIDS is an advanced stage of HIV infection. Because the CD4 cells in the immune system have been largely destroyed, people with AIDS develop symptoms and signs of unusual infections or cancers. When a person with HIV infection gets one of these infections or cancers, it is referred to as an "AIDS-defining condition." Examples of AIDS-defining conditions are listed in Table 1. Significant, unexplained weight loss is also an AIDS-defining condition. It is possible for people without AIDS to get some of these conditions, especially the more common infections like tuberculosis.
People with AIDS may develop symptoms of pneumonia due to Pneumocystis jiroveci, which is rarely seen in people with normal immune systems. They also are more likely to get pneumonia due to common bacteria. Globally, tuberculosis is one of the most common infections associated with AIDS. In addition, people with AIDS may develop seizures, weakness, or mental changes due to toxoplasmosis, a parasite that infects the brain. Neurological signs also may be due to meningitis caused by the fungus Cryptococcus. Complaints of painful swallowing may be caused by a yeast infection of the esophagus called candidiasis. Because these infections take advantage of the weakened immune system, they are called opportunistic infections.
The weakening of the immune system in AIDS can lead to unusual cancers like Kaposi's sarcoma. Kaposi's sarcoma develops as raised lesions on the skin which are red, brown, or purple. Kaposi's sarcoma can spread to the mouth, intestine, or respiratory tract. AIDS also may cause lymphoma (a type of cancer) of the brain or other types of lymphomas.
In people with AIDS, HIV itself may cause symptoms. Some people experience relentless fatigue and weight loss, known as "wasting syndrome." Others may develop confusion or sleepiness due to infection of the brain with HIV, known as HIV encephalopathy. Both wasting syndrome and HIV encephalopathy are AIDS-defining illnesses.

What are risk factors for AIDS?

Because AIDS is caused by HIV, the risk factors for developing AIDS are the same as for HIV. Specifically, behaviors that result in contact with infected blood or secretions pose the main risk of HIV transmission. These behaviors include sexual intercourse and injection drug use. The presence of sores in the genital area, like those caused by herpes, makes it easier for the virus to pass from person to person during intercourse. HIV also has been spread to health-care workers through accidental sticks with needles contaminated with blood from HIV-infected people, or when broken skin has come into contact with infected blood or secretions. Blood products used for transfusions or injections also may spread infection, although this has become extremely rare (less than one in 2 million transfusions in the U.S.) due to testing of blood donors and blood supplies. Finally, infants may acquire HIV from an infected mother either while they are in the womb, during birth, or by breastfeeding after birth.
The risk that HIV infection will progress to AIDS increases with the number of years since the infection was acquired. If the HIV infection is untreated, 50% of people will develop AIDS within 10 years. This time is shortened if the person already has a weak immune system or if HIV was acquired through transfusion. Of people with HIV, the risk of progressing to AIDS is increased if there is evidence that the immune system is weakening as shown by falling levels of CD4 cells or if the virus is reproducing rapidly as shown by a high number of viral particles in the blood (high viral load).
Treatment substantially reduces the risk that HIV will progress to AIDS. In developed countries, use of highly active antiretroviral therapy (HAART) has turned HIV into a chronic disease that may never progress to AIDS. Conversely, if infected people are not able to take their medications or have a virus that has developed resistance to several medications, they are at increased risk for progression to AIDS. If AIDS is not treated, 50% of people will die within nine months of the diagnosis.

How is AIDS diagnosed?

To diagnose AIDS, the doctor will need (1) a confirmed, positive test for HIV and (2) evidence of an AIDS-defining condition or severely depleted CD4 cells.
Testing for HIV is a two-step process involving a screening test and a confirmatory test. The first step is a screening test that looks for antibodies against the HIV virus. Specimens for rapid testing come from blood obtained from a vein or a finger stick, oral swab, or urine sample. Results can come back as soon as 20 minutes. These rapid HIV tests are available in most emergency rooms as well as HIV counseling centers and public clinics. If the screening HIV test is positive, the results are confirmed by a special test called a Western Blot or indirect immunofluorescence assay test. The confirmatory test is necessary because the screening test is less accurate and occasionally can miss HIV infection or, more likely, diagnose HIV when it is not present.
Another way to diagnose HIV infection is to do a special test to determine how many viral particles are in the blood. This is not usually used for screening or confirmation but is helpful in guiding treatment.
Merely having HIV does not mean a person has AIDS. AIDS is an advanced stage of HIV infection and requires that the person have evidence of a damaged immune system. That evidence might come from the presence of an AIDS-defining condition. Evidence might also come from directly measuring the CD4 cells in the body and showing that there are fewer than 200 cells per milliliter of blood or that fewer than 14% of lymphocytes are CD4 cells since a healthy person generally has more than 800 CD4 cells per milliliter of blood. It is important to remember that any diagnosis of AIDS requires a confirmed, positive test for HIV.

What is the treatment for HIV/AIDS?

Medications that fight HIV are called anti-retroviral medications. Different anti-retroviral medications attack the virus in different ways. When used in combination with each other, they are very effective at suppressing the virus. These effective combinations are called highly active anti-retroviral therapy or HAART. It is important to note that there is no cure for AIDS or for HIV. HAART only suppresses reproduction of the virus.
All people with a diagnosis of AIDS should receive HAART therapy. Of course, it is even better to give the medications earlier in HIV infection to prevent progression to AIDS. Current Department of Health and Human Services guidelines recommend starting HAART when CD4 falls below 350 cells per milliliter. Most experts would also consider therapy if the viral load is more than 100,000 copies per milliliter or if the CD4 count is falling rapidly. Recent studies suggest that starting treatment earlier, at CD4 counts from 350 to 500 and possibly even when greater than 500 per milliliter, may be beneficial.
There are five major classes of anti-retroviral medications: (1) nucleoside reverse transcriptase inhibitors (NRTIs), (2) non-nucleoside reverse transcriptase inhibitors (NNRTIs), (3) protease inhibitors (PIs), (4) entry inhibitors, and (5) integrase inhibitors. These drugs are used in different combinations according to the needs of the patient and depending on whether the virus has become resistant to a specific drug or class of medications. Treatment regimens usually consist of three to four medications at the same time. The most commonly recommended regimen includes two medications from the NRTI class in combination with either a protease inhibitor or an NNRTI or, less commonly, an integrase inhibitor. Entry inhibitors and integrase inhibitors are relatively newer classes of anti-retroviral medications and are useful for those patients who have failed to respond to other agents or who have a resistant virus. Combination treatment with HAART is essential because using only one class of medication by itself allows the virus to become resistant to the medication.
Before starting HAART, blood tests are usually done to make sure the virus is not already resistant to the chosen medications. These resistance tests may be repeated if it appears the drug regimen is not working or stops working. Patients are taught the importance of taking all of their medications as directed and are told what side effects to watch for. Noncompliance with medications is the most common cause of treatment failure and can cause the virus to develop resistance to the medication. Because successful therapy often depends on taking several pills, it is important for the patient to understand that this is an "all or nothing" regimen. If the person cannot tolerate one of the pills, then he or she should call their physician, ideally prior to stopping any medication. Taking just one or two of the recommended medications is strongly discouraged because it allows the virus to mutate and become resistant. It is best to inform the doctor quickly about any problems so that a better-tolerated combination can be prescribed. To reduce the number of pills needed each day, there are pills that contain multiple medications.

What is the treatment for HIV during pregnancy?

There are two goals of treatment for pregnant women with HIV infection: to treat maternal infection and to reduce the risk of HIV transmission from mother to child. Women can pass HIV to their babies during pregnancy, during delivery, or after delivery by breastfeeding. Without treatment of the mother and without breastfeeding, the risk of transmission to the baby is about 25%. With treatment of the mother before and during birth and with treatment of the baby after birth, the risk decreases to less than 2%. Some anti-retroviral medications cannot be used in pregnancy and others have not been studied in pregnancy. For example, the medication efavirenz (Sustiva) is usually avoided in early pregnancy or in women who are likely to become pregnant. Fortunately, there are treatment regimens that have been shown to be well-tolerated by most pregnant women, significantly improving the outcome for mother and child. The same principles of testing for drug resistance and combining anti-retrovirals that are used for nonpregnant patients are used for pregnant patients. All pregnant women with HIV should be treated with HAART regardless of their CD4 cell count, although the choice of drugs may differ slightly from nonpregnant women.
Compliance with medications is important to provide the best outcome for mother and child. Even though a physician might highly recommend a medication regimen, the pregnant woman has a choice of whether or not to take the medicines. Studies have shown that compliance is improved when there is good communication between the woman and her doctor, with open discussions about the benefits and side effects of treatment. Compliance also is improved with better social support, including friends and relatives.
Medications are continued throughout pregnancy, labor, and delivery. Some medicines, such as zidovudine (also known as AZT), can be given intravenously during labor. Other medications are continued orally during labor to try to reduce the risk of transmission to the baby during delivery. If the mother's HIV viral load is more than 1,000 copies near the time of delivery, scheduled cesarean delivery is done at 38 weeks gestation because of a higher risk for transmitting the virus during vaginal delivery. Women with HIV who otherwise meet criteria for starting anti-retroviral therapy should continue taking HAART after delivery for their own health. In the U.S., breastfeeding is not recommended if the mother has HIV.
If a pregnant woman with HIV infection does not take HAART during pregnancy and goes into labor, medications are still given during labor. This reduces the risk of transmission of HIV.
If the mother has AIDS, the infant is treated with zidovudine for six weeks after birth. Other medications may be added to the infant's regimen, especially if the virus is known to be resistant to some medications.

What is the treatment for non-HIV-infected people who are exposed to the genital secretions or blood of someone with HIV?

Blood and genital secretions from people with HIV are considered infectious and the utmost care should be taken in handling them. Fluids that are contaminated with blood also are potentially infectious. The most commonly reported exposures are an inadvertent needle stick (usually when drawing blood from someone with AIDS) or having mucous membranes or skin abrasions or open skin sores come into contact with infectious fluid. Mucous membranes include the mouth, rectum, or genital area. The average risk of HIV infection after a needle-stick injury is around 0.3% and after mucous-membrane exposure to blood is approximately 0.09%. For abraded skin exposure, the risk is estimated to be less than mucous membrane exposure. There also are some factors that may affect the risk for HIV transmission such as the amount of blood from the infected source. Deep injury from a needle, visible blood in the needle, or a needle that was being placed in an artery or vein are examples of higher-risk situations. The risk of transmission also depends on the number of virus particles in the blood, with higher viral loads leading to an increased risk of transmission.
If an exposure occurs, the exposed person can reduce the risk of getting HIV by taking anti-retroviral medications. Current recommendations suggest two or more anti-retroviral medications, depending on the risk of transmission and type of exposure. Medications should be started as soon as possible, preferably within hours of exposure and should be continued for four weeks, if tolerated. People who have been exposed should be tested for HIV at the time of the injury and again at six weeks, 12 weeks, and six months after exposure.
It is important to document that an exposure has occurred or was likely. A needle stick from a person with HIV or a person likely to have HIV constitutes a significant exposure. Medications should be started immediately. If it is unknown whether the person who is the source of the potentially infected material has HIV, the source person can be tested. Medications that were started immediately in the exposed person can be discontinued if the source person does not carry HIV. Potentially infectious material splashed in the eye or mouth, or coming into contact with non-intact skin, also constitutes an exposure and should prompt immediate evaluation to determine if medications should be started.
Other potential exposures include vaginal and anal sexual intercourse and sharing needles during intravenous drug use. There is less evidence for the role of anti-retroviral post-exposure prophylaxis after these exposures. Nevertheless, the U.S. Communicable Disease Center (CDC) recommends treatment for people exposed through sexual activity or injectable drug use to someone who is known to carry HIV. If the HIV status of the source is not known, the decision to treat is individualized. Concerned people should see their physician for advice. If a decision to treat is made, medications should be started within 72 hours of the exposure.
For every exposure, especially with blood, it is important to test for other blood-borne diseases like hepatitis B or C, which are more common among HIV-infected patients. Reporting to a supervisor, in the case of health-care workers, or seeking immediate medical consultation is advisable. For sexual exposures, testing for syphilis, gonorrhea, chlamydia, and other sexually transmitted diseases (STDs) usually should be done because individuals with HIV are more likely to have other STDs. Patients also should be counseled about how to prevent exposure in the future.

What are the complications of HIV?

The complications of HIV infection result mainly from a weakened immune system. This makes the person more vulnerable to certain types of conditions and infections (see table). Treatment with HAART can reverse or mitigate the effects of HIV infection. Some patients on HAART may be at risk for developing cholesterol or blood-sugar problems.
Although many effective medications are on the market, the virus can become resistant to any drug. This can be a serious complication if it means that a less effective medicine must be used. To reduce the risk of resistance, patients should take their medications as prescribed and call their physician immediately if they feel they need to stop one or more drugs.

What is the prognosis for HIV infection?

Left untreated, HIV is almost always a fatal illness with half of people dying within nine months of diagnosis of an AIDS-defining condition. The use of HAART has dramatically changed this grim picture. People who are on an effective HAART regimen have life expectancies that are similar to or only moderately less than the uninfected population. Unfortunately, many people with AIDS have social issues, substance-abuse issues, or other problems that interfere with their ability or desire to take medications.

Can AIDS be prevented?

AIDS can be prevented. The best means of prevention is not to get HIV in the first place. Sexual abstinence is completely effective in eliminating sexual transmission, but educational campaigns have not been successful in promoting abstinence in at-risk populations. Monogamous sexual intercourse between two uninfected partners also eliminates sexual transmission of the virus. Using barriers, such as condoms, during sexual intercourse reduces but does not eliminate the risk of viral transmission.
Needle-stick injuries can be prevented by touching syringes with only one hand and by using more modern needles that have retractable sleeves. Use of gowns, gloves, masks, and eye protection can reduce the risk of exposure to infected secretions in high-risk settings. For intravenous-drug abusers, use of clean needles and elimination of needle sharing reduces the risk of transmission.
If a person already has HIV, he or she can reduce the risk of progressing to AIDS by taking an effective HAART regimen. A pregnant woman with HIV can reduce the risk of passing the infection to her baby by taking medications during pregnancy and labor and avoiding breastfeeding

Is there a vaccine for HIV?

To date, there is no effective vaccine for HIV. Several attempts have been made to make a vaccine but all have failed. One recent trial is more promising, but the vaccine being tested was not very effective.

What research is being done to find a cure for HIV?

The search for a cure for HIV began as soon as the virus was identified. HIV is probably one of the most studied viruses in history. Scientists have a detailed knowledge of the virus' genes, proteins, and understand how it functions. In fact, the combinations of drugs that make up HAART therapy were chosen because they attack different parts of the virus life cycle, causing it to malfunction. However, HAART therapy is not a cure and the drugs must be taken for life. Even when viral levels are low, the virus is still present in the body.
One of the problems with finding a cure is that the virus can hide in areas that are difficult for drugs to reach, like the brain. New research is helping us understand how to effectively treat viruses in these secluded areas of the body. In addition, the virus can become dormant or "latent," which means that it is not very metabolically active and cannot be attacked by medicines. Latent viruses can reactivate if drugs are stopped. Research is being done now to determine how latency occurs and how the virus reactivates.

Where can a person find information about clinical trials for HIV and AIDS?

There are a large number of studies currently under way that involve HIV-infected patients. These studies are registered in a central database that can be searched at http://clinicaltrials.gov.

AIDS At A Glance

AIDS stands for "acquired immunodeficiency syndrome."
AIDS is an advanced stage of infection with the human immunodeficiency virus (HIV). HIV is spread from person to person through contact with infected secretions or infected blood.
People with AIDS have weakened immune systems that make them vulnerable to selected conditions and infections.
For people infected with HIV, the risk of progression to AIDS increases with the number of years the person has been infected. The risk of progression to AIDS is decreased by using highly effective treatment regimens called HAART.
In people with AIDS, HAART therapy improves the immune system and substantially increases life expectancy. Many patients who are treated with HAART have near-normal life expectancies.
HAART is a treatment that must be continued for life. It is not a cure.
It is possible for HIV to become resistant to some of the HAART medications. The best way to prevent resistance is for the patient to take their HAART medications as directed. If the patient wants to stop a drug because of side effects, he or she should call the physician immediately.
If a person is exposed to blood or potentially infectious fluids from a source patient with HIV, the exposed person can take medications to reduce the risk of getting HIV.
Research is under way to try to find a vaccine and a cure for HIV.

Skin Conditions: Stretch Marks

2012-02-05T20:21:00.000-08:00

Skin does not bounce back if it's been stretched by rapid growth due to pregnancy, weight gain, or extreme weight loss. Instead, it becomes decorated by a form of scarring called stretch marks, or striae. Stretch marks often start off as reddish or purplish in color and then become glossy skin that appears streaked in silver or white.
Stretch marks occur in the dermis, the elastic middle layer of skin that allows it to retain its shape. However, when constantly stretched, the dermis can break down leaving behind stretch marks.
Men and women can get stretch marks on several areas of their bodies, including the abdominal area, thighs, hips, breasts, upper arms or lower back.

Stretch Mark Prevention

After working out for two months, I've noticed that I have small stretch marks on my arms from lifting. How can I prevent them?

Stretch marks occur when the elastic middle layer of skin called the dermis is stretched. Stretching leads to a breakdown of connective tissue, inflammation, and then scar formation as the injury heals. It's the scarring that causes stretch marks to appear. Stretch marks are common during puberty and rapid growth spurts in adolescence (they typically heal by the late teens or early 20s), pregnancy, excessive weight gain and obesity, when muscle mass increases rapidly and stretches the skin (like during bodybuilding), and sometimes when individuals use topical or high doses of ingested steroids for many weeks or months. Stretch marks are not a health risk but can be cosmetically unappealing.
Learn more about prevention of stretch marks

Top Searched Stretch Marks Terms:

dermabrasion, chemical peel, plastic surgery, microdermabrasion

What Can I Do About Stretch Marks?

There are some treatment options for stretch marks, none of which work very well. The degree of success with any treatment will be impacted by your age, your skin tone and even your diet. Treatment options include:

Prescription Methods

Tretinoin cream or laser therapy can be used to address unwanted stretch marks.

Over-the-Counter Products

Over-the-counter stretch mark treatments are available but not particularly effective. Moisturizers can help with appearance and itchiness. Sunless tanning products can help mask stretch marks.
It's best to be in the care of a cosmetic surgeon or dermatologist. He or she can determine which treatment approach is best for you.

Does Insurance Cover Stretch Mark Treatment?

Insurance may not cover stretch mark treatment because it is a cosmetic procedure (even if the stretch marks are severe). Talk to your particular provider to see what is covered under your plan.

Hair Loss in Men and Women

2012-02-01T07:41:00.000-08:00

What are causes of hair loss?

There are many causes of scalp hair loss, and they do differ in men and women. This article will cover the common ones. Studies show that losing up to 100-150 hairs per day is normal. Human hair naturally grows in three phases: anagen, catagen, and telogen. Anagen is the active or growing phase. Catagen is a fairly short phase of the natural hair cycle during which hairs begin to break down. Telogen is the resting phase. The hairs that are shed daily are often in the resting or late phase in the hair cycle. Normally, about 10% of the scalp hairs are in the resting or telogen phase at any time. These hairs are not growing and are getting prepared for cyclic shedding.
In general, most hair loss is not associated with systemic or internal disease, nor is poor diet a frequent factor. Frequently, hair may simply thin as a result of predetermined genetic factors, family history, and the overall aging process. Many men and women may notice a mild and often normal physiologic thinning of hair starting in their thirties and forties. Other times, normal life variations including temporary severe stress, nutritional changes, and hormonal changes like those in pregnancy, puberty, and menopause may cause a reversible hair loss.
Notably, several health conditions, including thyroid disease and iron deficiency anemia, can cause hair loss. While thyroid blood tests and other lab tests, including a complete blood count (CBC), on people who have ordinary hair loss are usually normal, it is important to exclude underlying causes in sudden or severe hair loss. If you are concerned about some other underlying health issues, you may start by seeing your family physician, internist, or gynecologist for basic health screening. Dermatologists are doctors who specialize in problems of skin, hair, and nails and may provide more advanced diagnosis and treatment of hair thinning and loss. Sometimes a scalp biopsy may be taken to help in diagnosis of severe or unexplained hair loss.
Although many medications list "hair loss" among their potential side effects, drugs are also not overall common causes of thinning or lost hair. On the other hand, with cancer treatments and immune suppression medications including chemotherapy, hair loss is a very common side effect. Complete hair loss often occurs after a course of major chemotherapy for cancer. Usually, hair regrows after six to 12 months.

How is hair loss classified?

There are numerous ways to classify hair loss. One useful way has been to classify hair loss by whether the loss is localized (small area) and patchy or whether it affects large areas or the whole scalp (diffuse). Other medical classifications for hair loss include scarring versus non-scarring hair loss and are beyond the scope of this article.
Patchy hair loss
Some conditions produce small areas of hair loss, while others affect large areas of the scalp. Common causes of patchy hair loss are

alopecia areata (small circular or coin size patches of scalp baldness that usually grow back within months),

traction alopecia (thinning from tight braids or ponytails),

trichotillomania (the habit of twisting or pulling hair out),

and tinea capitis (fungal infection).

What is alopecia areata?

A common condition, alopecia areata usually starts as a single quarter-sized circle of perfectly smooth baldness. Alopecia patches usually regrow in three to six months without treatment. Sometimes, hair grows back in white. In another variant, alopecia can produce two or three bald patches. When these grow back, they may be replaced by others. The most extensive form is called alopecia totalis, in which the entire scalp goes bald. It's important to emphasize that patients who have localized hair loss generally don't go on to lose hair all over the scalp. Alopecia can affect hair on other parts of the body, too -- for example, the beard or eyebrow.
Alopecia areata is generally considered an autoimmune condition, in which the body attacks itself (in this case its own hair follicles). Most alopecia patients, however, do not have systemic problems and need no medical tests. While alopecia areata has frequently been blamed on "stress," in fact, it may be the other way around; that is, having alopecia may cause stress.
Treatments for alopecia areata include injecting small amounts of steroids like triamcinolone into affected patches to stimulate hair growth. Although localized injections may not be practical for large areas, often this is a very effective treatment in helping the hairs return sooner. Other treatments such as oral steroids, immunosuppressives, or ultraviolet light therapy are available for more widespread or severe cases but may be impractical for some because of potential side effects or risks. In most mild cases, patients can easily cover up or comb over the affected areas. In more severe and chronic cases, some patients wear hairpieces; nowadays, some men shave their whole scalp now that this look has become fashionable.

What is traction alopecia?

This is a small or localized hair loss area caused by repetitive or persistent pulling or force on hair roots. Tight braids and ponytails can pull hard enough on hairs to make them fall out. If this happens, it's best to choose hairstyles that put less pressure on hair roots. The sooner this is done the better to avoid permanent damage.

What is trichotillomania?

This refers to the habit of someone voluntarily pulling at their own hairs or twisting them, sometimes without realizing it. The scalp and eyelashes are often affected. Unlike alopecia areata patches, which are perfectly smooth, hair patches in trichotillomania show broken-off hairs. Treatment is often entirely behavioral: You have to notice that you're doing it and then consciously stop. Severe or resistant cases may require stress counseling with a therapist or psychologist or medical treatment with a psychiatrist. Several antidepressant or anxiety medications have been shown to potentially help with this condition.

What is tinea capitis?

Tinea is the medical word for fungal infection, and capitis means head. Tinea capitis is fungal infection of the scalp that for the most part affects school-age children. Tinea capitis is more common in black African or African-American scalps. This condition is rare in healthy adults. Bald spots usually show broken-off hairs. Oral antifungals are needed to penetrate the hair roots and cure the infection after which hair grows back. It is contagious from sharing hats or combs and brushes.

What is generalized (diffuse) hair loss?

This is an overall hair thinning without specific bald spots or patterns. While this type of hair loss may not be noticeable to others, often the individual will feel their hair is not as thick or full as it previously was. Common conditions in this category are

telogen effluvium (rapid shedding after childbirth, fever, or sudden weight loss);

androgenetic or androgenic hair loss ("male-pattern baldness," "female-pattern baldness").

What is telogen effluvium?

Under normal conditions, scalp hairs live for about three years (the anagen, or growing, phase); they then enter the telogen, or resting, phase. During the three-month telogen period, the hair root shrivels up into a small white "club," then the hair falls out. It is therefore normal to lose about 100 hairs every day, more of them on days when shampooing loosens the hairs that are ready to fall out. The hairs are then replaced by the body.
Sometimes people worried about losing their hair start noticing hairs on their pillow or in the sink, not realizing that they've always been there. A close look at these will usually reveal the white club at the end, showing that these hairs were already dead. Normally, about 10% of scalp hairs are in the telogen phase.
There are several circumstances that produce a "shock to the system" that alters the hair growth rhythm. As a result, as much as 30%-40% of the hairs can cycle into telogen. Three months later, hairs come out in a massive shedding (effluvium), especially near the front of the scalp. These include

childbirth,

high fever,

sudden weight loss (crash dieting),

surgery,

severe illness,

and severe stress or loss (death in family, announcing change in sexual preference "coming out of the closet," divorce, etc.).

None of these has to be life-threatening, nor does hair loss always follow them. (It can happen after one pregnancy but not the next.) But when the hair falls out, it's all over the place -- covering the pillow, clogging the drain, and so forth. Paradoxically, the more dramatic the hair loss, the better the prognosis, because when the body gets back into normal rhythm, most if not all of that hair comes back. No special treatment is needed. Normal shampooing can continue, because this only loosens hairs that were going to come out anyway.

What is androgenetic or androgenic alopecia ("male-pattern baldness," "female-pattern baldness")?

This type of alopecia is often attributed to genetic predisposition and family history. Traditionally, this was originally described only in men, but we now know it is seen in both men and women. The hair loss in men is often faster, earlier onset, and more extensive.
Doctors refer to common baldness as "androgenetic alopecia" or "androgenic alopecia," which implies that a combination of hormones and heredity (genetics) is needed to develop the condition. The exact cause of this pattern is unknown. (The male hormones involved are present in both men and women.)
Male-pattern baldness
Even men who never "go bald" thin out somewhat over the years. Unlike those with reversible telogen shedding, those with common male-pattern hair loss don't notice much hair coming out; they just see that it's not there anymore. Adolescent boys notice some receding near the temples as their hairlines change from the straight-across boys' pattern to the more "M-shaped" pattern of adult men. This normal development does not mean they are losing hair.
Some "myths" about male-pattern baldness

You inherit baldness through your mother's male relatives. Actually, baldness can come from either side of the family or both. Looking at your family can give you at best an educated guess about how you'll turn out. Studies are ongoing in this field, and current research has been inconclusive about the inheritance patterns.

Longer hair puts a strain on roots. It doesn't. And hats don't choke off the circulation to the scalp to cause hair loss either.

Shampooing does not accelerate balding.

"Poor circulation" does not cause hair loss, and massaging doesn't stop it.

Male-pattern baldness

What treatment is there for hair loss in men?

There are very few scientifically proven and FDA-approved treatments for hair loss. There are thousands of unproven claims and products to help with hair regrowth. Many conditioners, shampoos, vitamins, and other products claim to help hair grow in some unspecified way. Nioxin has been a popular brand of shampoo for hair loss, but there is no definite evidence showing it is any more effective than regular shampoos. These products are usually harmless but generally not scientifically proven and therefore potentially useless. To slow down hair loss, there are at least four potentially effective, basic options. These include medications like Minoxidil, Propecia, and Avodart which are maintenance-type medications and are for long-term use. Stopping these drugs does not seem to worsen or exacerbate the prior hair loss. In other words, stopping the medication will not leave you worse than you started out prior to the medication.

Minoxidil (Rogaine): This topical medication is available over the counter and no prescription is required. It can be used in men and women. It works best on the crown, less on the frontal region. Minoxidil is available as a 2%solution, 4% solution, an extra-strength 5% solution, and a new foam or mousse preparation. Rogaine may grow a little hair, but it's better at holding onto what's still there. There are few side effects with Rogaine. The main problem with this treatment is the need to keep applying it once or twice a day, and most men get tired of it after a while. In addition, minoxidil tends to work less well on the front of the head, which is where baldness bothers most men. Inadvertent application to the face or neck skin can cause unwanted hair growth in those areas.

Finasteride (Propecia): This medication is FDA approved for use in only men with androgenic hair loss. Although not FDA approved in women, it has been used "off label" in women with androgenic hair loss who are not pregnant or planning to become pregnant while on the medication. Finasteride is in a class of medications called 5-alpha reductase inhibitors. It is thought to help reduce hair loss by blocking the action of natural hormones in scalp hair follicles. Propecia is a lower-dose version of a commercially available drug called Proscar that helps shrink enlarged prostates in middle-aged and older men. Women, especially those who are or may become pregnant, should not handle finasteride capsules. Touching the contents of the capsules may potentially harm a male fetus and females who accidentally touch leaking capsules should wash the area to avoid side effects. Propecia 1 mg tablets are available by prescription and taken once daily. Propecia may grow and thicken hair to some extent for some people, but its main use is to keep (maintain) hair that's still there. Studies have shown that this medication works well in some types of hair loss and must be used for about six to 12 months before full effects are determined. This medication does not "work" in days to weeks, and its onset of visible improvement tends to be gradual. It may be best for men who still have enough hair to retain but also can help some regrow hair. Possible but very unlikely side effects include impotence or a decreased sex drive (libido). Studies have shown that these side effects were possibly slightly more common than seen in the general population and are reversible when the drug is stopped. Taking Propecia once a day seems to be easier than applying minoxidil, but the prospect of taking a pill daily for years doesn't sit well with some. There's also the cost, about $70-$100/month, which is generally not reimbursed by most health insurers.

Dutasteride (Avodart) has recently been used as "off label" to treat hair loss in men. It is FDA approved and primarily used to treat an enlarged prostate (benign prostatic hyperplasia, or BPH) only in men. Dutasteride is similar to finasteride (Propecia, Proscar) and is in a class of medications called 5-alpha reductase inhibitors. Dutasteride may help in hair loss by blocking the production or binding of a natural substance in the scalp hair follicles. Although not FDA approved in women, it has been used "off-label" in women with androgenic hair loss who are not pregnant or planning to become pregnant while taking the medication. Women, especially those who are or may become pregnant, should not handle dutasteride capsules. Touching the contents of the capsules may potentially harm a male fetus and females who accidentally touch leaking capsules should wash the area with soap and water immediately. There is a six-month clearance time required after taking this medication before being permitted to donate blood.

A group of topical medications called prostaglandin analogs have recently began undergoing testing for potential hair regrowth. They may be used in men and women. These drugs are not currently FDA approved for scalp hair loss. Currently these are primarily used for eyelash enhancement. One of the new medications is called bimatoprost. Further testing and studies are required to assess the efficacy of these products in scalp hair loss.

Bimatoprost solution (Latisse) has just been started to be used off-label for help in selected cases of hair loss. It is currently FDA approved for cosmetic eyelash enhancement. Studies have shown it can treat hypotrichosis (short or sparse) of the eyelashes by increasing their growth, including length, thickness, and darkness. This medication is also commercially available as Lumigan, which is used to treat glaucoma. It is not known exactly how this medication works in hair regrowth, but it is thought to lengthen the anagen phase (active phase) of hair growth.

Interestingly, during routine medical use of Lumigan eye drops for glaucoma patients, it was serendipitously found that eyelashes got longer and thicker in many users. This led to clinical trials and the approval of cosmetic use of Latisse for eyelashes.

What other options do I have for hair loss?

There are many options and alternative cosmetic treatments for hair loss. Some of these are listed here and include hair fiber powders, hairpieces, synthetic wigs, human hair wigs, hair extensions, hair weaves, laser, and surgery.

Hair fiber powders: Colored, powdery fiber sprinkles are commercially available and may work really well to cover up thinning hair areas. These colored sprinkles have special properties that help them attach to hair and give a fuller appearance. Toppik is one manufacturer of these products and can be found online. These cosmetic products are available without a prescription, are fairly inexpensive ($20-$40 range), and quite safe with minimal risk. Often these may be used in addition to medical treatments like Rogaine, Propecia, and hair transplants, and they are a great temporary measure to tie you over for special occasions.

Hairpieces: Among the time-honored ways to add hair temporarily are hairpieces or hair weaving, in which a mesh is attached to your remaining hair and artificial or human hair of similar color and texture is woven with existing hair. Quality varies considerably with price; also, hairpieces and weaves may stretch, oxidize, and loosen.

Surgery or hair transplants: Surgical hair restoration approaches include various versions of hair transplantation (taking hair from the back and putting it near the front) or scalp reduction (cutting away bald areas and stitching the rest together). Transplant procedures have improved greatly in recent years. They can produce much more attractive and natural-looking results than older methods that sometimes leave a "checkerboard" or hair plug look. Many transplant patients now take Propecia to maintain or keep what they've transplanted. When considering a hair transplant, check the surgeon's credentials and experience carefully. Micrografts are some of the newest techniques whereby single one to two hair follicles are transplanted. Hair transplants may be very expensive and time-consuming procedures ranging widely anywhere from $1000-$20,000, depending on the number of hair grafts transplanted. Typically 500 or more hairs may be transplanted in a session.

Is hair loss in women different than men?

Female-pattern baldness
Women lose hair on an inherited (genetic) basis, too, but the female pattern tends to be more diffuse, with less likelihood of the crown and frontal hairline being lost. Although some women may notice hair thinning as early as their 20s, the pace of hair loss tends to be gradual, often taking years to become obvious to others. There seems to be a normal physiologic thinning that comes with age and occurs in many women in their early to mid 30s. More women have underlying causes of hair loss than men. These include treatable conditions like anemia and thyroid disease. In particular, women with a form of thyroid disease called Hashimoto's autoimmune thyroiditis may have hair loss. These conditions are diagnosed by blood tests. Although a few studies have suggested that baldness may be inherited through the mother's family genes, these theories require further testing. Current studies are inconclusive.
While stories about hats choking off follicles or long hair pulling on the roots may be more folklore, repeat hair trauma like tightly woven hair pulled back and consistent friction can potentially worsen or cause localized hair loss in some individuals. Black individuals who pull their hair tightly back in a rubber band can develop a localized hair loss at the front of the scalp.
Hair loss "myths" of special concern to women:

Longer hair does not necessarily put a strain on roots.

Shampooing does not accelerate hair loss; it just removes those that were ready to fall out anyway.

Coloring, perming, and conditioning the hair do not usually cause hair loss. Burns or severe processing may cause hair loss and breakage. Styles that pull tight may cause some loss, but hair coloring and "chemicals" usually don't.

What about pregnancy hair loss?

Pregnancy may cause many changes in the scalp hair. As the hormones fluctuate during pregnancy, a large number of women feel their hair thickens and becomes fuller. This may be related to change in the number of hairs cycling in the resting phase of hair growth, but the exact reason is unknown. Quite often, there may be a loss of hair after delivery or six months later. Prevention of this often, natural post pregnancy hair loss is unknown. It is also not known if this loss is just a return to the pre-pregnancy volume of hair.

What specific treatments are there for hair loss in women?

Female hair loss treatments include minoxidil (Rogaine), hair transplants, hair powder fibers like Toppik, wigs, hair extensions, and weaves. Non-FDA-approved and off-label use of Propecia may be discussed with your doctor.

Minoxidil (Rogaine) is available over the counter and available in 2%, 4%, and 5% concentrations. It may be something of a nuisance to apply twice daily, but it has been shown to help conserve hair and may even grow some. Minoxidil tends to grow very fine small hairs wherever it is applied. It is important to avoid running the liquid onto the face or neck where it can also grow hair. It is marketed for women at the 2% concentration but may be used in higher strengths as directed by your doctor.

Propecia is a drug that is currently FDA approved only in men for help in hair loss. It has undergone extensive safety testing on women and it was found to be safe in postmenopausal women. It is unsafe for women of childbearing to take this drug or even handle tablets. (It is, however, safe for their husbands to take it while they are trying to become pregnant.) Propecia may be used as an off-label use in women who are not pregnant or planning to become pregnant while taking the medication. Studies have been inconclusive with effectiveness of Propecia in some women and not in others. Although it is not consistently effective, it may be a good option for postmenopausal women or women who are not pregnant or considering pregnancy. Newer studies suggest that Propecia may be somewhat helpful and worth considering in treatment of women's hair loss.

Surgical procedures like hair transplants can be useful for some women as well as men to "fill in" thinned-out areas.

What vitamins are good for hair loss?

A good daily multivitamin containing zinc, vitamin B, folate, iron, and calcium is a very reasonable choice. Newer studies suggest that vitamin D may be somewhat helpful and worth considering. Specific vitamin and mineral deficiencies like iron or vitamin B12 may be diagnosed by blood tests and treated.
Multiple vitamins including biotin have been promoted for hair growth, but solid scientific studies for many of these claims are lacking. While taking biotin and other supplements marketed for hair, skin, and nails probably won't worsen anything, it may also not necessarily help the situation. Therefore, advertised hair-regrowth supplements should be approached with mild caution.

Can itchy scalp cause hair loss?

Itchy scalp may cause mild, reversible hair loss. Causes may include seborrheic dermatitis (dandruff). Treatments may include medicated shampoos like ketoconazole (Nizoral) and topical cortisone creams and lotions to help decrease itching.

How do I prevent hair loss?

Hair loss prevention involves several factors depending on the underlying cause. Good hair hygiene with regular shampooing is a basic step. Good nutrition, especially adequate levels of iron and vitamin B, is helpful. Treatment of underlying medical conditions like thyroid disease, anemia, and hormonal imbalances may useful in prevention.

Hair Loss At A Glance

Hair loss is a very common condition and affects most people at some time in their lives.
Androgenetic hair loss is seen in both men and women but is worse in men.
Health issues like thyroid disease, anemia, and low vitamin levels may cause hair loss.
Alopecia areata is a very common, coin-shaped temporary hair loss patch that usually resolves on its own.
Medications for hair regrowth include minoxidil (Rogaine), finasteride (Propecia), and dutasteride (Avodart).
Prevention includes good hair hygiene, regular shampooing, and good nutrition.
Medical health screening for hair loss may include tests like complete blood count (CBC), iron level, vitamin B, and thyroid function tests (TFT).
The outlook for hair loss is improving and research is ongoing.

What Not to Eat When Pregnant

2012-02-01T07:22:00.000-08:00

So Long, Soft Cheeses

Eating Mexican queso blanco or other soft cheeses during pregnancy can be risky. Those made with unpasteurized milk can harbor Listeria bacteria, which has been linked to miscarriage, premature delivery, and death. It's best to avoid brie, camembert, feta, blue cheese, queso blanco, queso fresco, and Panela – unless the label says it's pasteurized. When in doubt or dining out, ask before you eat.

Skip Undercooked Meat

You might like your filet mignon rare, but pregnancy is a time to order all steaks and burgers well done. Raw or undercooked meat can harbor toxoplasma and a variety of bacteria. When dining out, make sure your meat is steaming hot and thoroughly cooked. At home, the temperature should reach at least 145° F for whole cuts, 160° F for ground meats like hamburger, and 165°F for chicken breasts.

Beware Fresh Juice

Fresh-squeezed juice in restaurants, juice bars, or farm stands may not be pasteurized to protect against harmful bacteria, including salmonella and E. coli. Some markets also sell raw, unpasteurized juice in the refrigerated case – look for the required warning label and steer clear. Pregnant women should opt for juice that is pasteurized. Shelf stable juice in boxes and bottles is also safe.

Sayonara, Sushi

Sorry, sushi fans, but it's time for a 9-month hiatus from this treat. Although seafood is a great source of protein, raw seafood can be a source of harmful parasites and bacteria. The FDA recommends pregnant women only eat fish and other seafood that has been cooked thoroughly.

Raw Cookie Dough

When you're baking cookies, you may be tempted to pop a bit of raw dough in your mouth. But even a taste can be risky if the dough contains raw eggs. The CDC estimates one in 20,000 eggs is tainted with salmonella bacteria. To be safe, resist tasting unbaked cookie dough, batter, or filling made with raw eggs. The good news is store-bought cookie dough ice cream is safe.

Homemade Caesar Dressing

Raw eggs are also used in many homemade dressings and sauces, such as:

    Caesar salad dressing
    Béarnaise sauce
    Hollandaise sauce
    Mayonnaise

Pregnant women should opt for store-bought versions, which are made with pasteurized eggs.

Homemade Tiramisu

Many homemade desserts, including mousse, meringue, and tiramisu, also contain raw eggs. If a store-bought version won't do, there is a safe way to prepare your favorite recipe. Some supermarkets sell pasteurized eggs, which are OK to eat raw. Make sure the label on the eggs specifically states "pasteurized."

Fresh Pre-Stuffed Poultry

A pre-stuffed turkey or chicken offers a short-cut to a guest-worthy meal. But the juice from fresh, raw poultry can mix with the stuffing and promote bacterial growth. Cooking protects most people, but pregnancy makes it harder to fight off infections. A safe alternative is buying frozen pre-stuffed poultry. Be sure to cook it directly from frozen – don't let it defrost first. The thigh meat should hit 180 �F.

Fish With Mercury

Swordfish, tilefish, king mackerel, and shark contain high levels of methylmercury. This metal can harm an unborn baby's development. Pregnant women should choose fish that are low in mercury, such as catfish, salmon, and canned light tuna. If you prefer albacore (white) tuna, limit yourself to 6 ounces per week. Check with your doctor before taking fish oil or any other supplements while pregnant.

Deli Meats

Unlike many other foodborne germs, listeria can grow at the temperatures inside your fridge. For this reason, pregnant women should avoid perishable, ready-to-eat meats, such as cold cuts and hot dogs. You can make these foods safe by heating them until they are steaming hot and eating them promptly.

Pâtés or Meat Spreads

Pâtés contain perishable meats, so they may harbor listeria as well. Keeping your fridge at or below 40° F will slow the growth of this bacteria, but won't stop it completely. Because pregnant women are particularly vulnerable to listeria, it's best to avoid any type of refrigerated meat spread. Spam lovers can breathe easy. Canned and shelf-safe meat spreads are OK during pregnancy, if not exactly a healthy food.

Unwashed Fruits/Veggies

Pregnancy is no time to skimp on fresh fruits and vegetables. Just be sure to rinse them thoroughly under running water. A parasite called toxoplasma can live on unwashed fruits and veggies. It causes an illness called toxoplasmosis, which can be very dangerous to an unborn baby. Don't use soap to wash produce. Instead, scrub the surface with a small vegetable brush. Cut away any bruised areas, since these may harbor bacteria.

Raw Sprouts

Pregnant women should not eat raw sprouts of any kind, including alfalfa, clover, and radish. Bacteria can get into the seeds before the sprouts begin to grow, and these germs are nearly impossible to wash away. At the deli, check sandwiches to make sure they don't contain raw sprouts. At home, cook sprouts thoroughly to destroy any bacteria.

Smoked Seafood

During pregnancy, it's best to skip the lox when you enjoy your morning bagel. Like ready-to-eat meats, refrigerated smoked seafood is vulnerable to listeria. This includes smoked salmon (often labeled nova or lox), as well as smoked trout, whitefish, cod, tuna, or mackerel. It is safe to use smoked seafood in a cooked meal, such as a casserole.

Fish from Local Waters

Unless you know your local streams, bays, and lakes are unpolluted, avoid eating fish you catch yourself. Some lakes and rivers are contaminated with industrial chemicals. Locally caught bluefish, striped bass, salmon, pike, trout, and walleye may be affected. Check with your state's fish and wildlife department for more information.

Potluck Foods

You may not want to insult your friends by avoiding their potluck offerings. But there's reason for concern if the food is left unrefrigerated for too long. Follow the 2-Hour Rule: Don't eat potluck dishes that have been sitting at room temperature for longer than two hours. When temperatures are above 90° F, the cut-off should be one hour.

Unpasteurized Milk

Have you ever dreamed of visiting a farm and tasting milk fresh from a cow? If you're pregnant, it's best to postpone that outing. Freshly collected milk has not yet been through the pasteurization process that protects it from listeria. Only buy milk, cheese, or dairy products from a local farm, if the label says "pasteurized."

The Caffeine Question

Good evidence now shows that a moderate amount of caffeine is safe during pregnancy. But the jury is still out on whether higher amounts of caffeine can increase the odds of a miscarriage. The March of Dimes recommends women who are pregnant or trying should limit caffeine to 200 mg per day. That's one 12-ounce cup of coffee. But remember, caffeine is also found in soda, tea, chocolate, and many energy drinks.

Alcohol

You already know that heavy drinking during pregnancy can lead to serious birth defects. What you may not know is that even small amounts of alcohol could be harmful. No amount of drinking has been found to be safe during pregnancy, so it's best to avoid all forms of alcohol. This includes wine, beer, coolers, and traditional egg nog, which contains alcohol and raw eggs.

Doggie Bags

Unless you're headed straight home from the restaurant, it's best to skip the doggie bag. The inside of a car can get warm quickly, allowing bacteria to multiply. If you do take home leftovers, put them in the fridge within two hours of when the meal was originally served.

Breast Cancer

2012-02-01T01:41:00.001-08:00

Breast Cancer Today

Breast cancer today is not what it was 20 years ago. Survival rates are climbing, thanks to greater awareness, more early detection, and advances in treatment. For roughly 200,000 Americans who are diagnosed with breast cancer each year, there are plenty of reasons to be hopeful.

Breast Cancer Symptoms

There are often no symptoms of breast cancer, but sometimes women may discover a breast problem on their own. Signs and symptoms to be aware of may include:

    A painless lump in the breast.
    Changes in breast size or shape.
    Swelling in the armpit.
    Nipple changes or discharge.

Breast pain can also be a symptom of cancer, but this is not common.

Signs of Inflammatory Breast Cancer

Inflammatory breast cancer is a rare, fast-growing type of cancer that often causes no distinct lump. Instead, breast skin may become thick, red, and may look pitted -- like an orange peel. The area may also feel warm or tender and have small bumps that look like a rash.

Breast Cancer & Mammograms

The earlier breast cancer is found, the easier it is to treat. And mammograms, X-rays of the breast, can detect tumors before they are large enough to feel. The American Cancer Society recommends yearly mammograms beginning at age 40 for women at average risk. While the U.S. Preventive Services Task Force recommends a screening mammogram every two years from age 50 to 74. It also notes that before age 50, each woman should check with a doctor to find out what screening schedule is right for her, considering the potential benefits and harms from screening.

Breast Ultrasound and MRI

Besides a mammogram, your doctor may order additional imaging with breast ultrasound. An ultrasound can help determine the presence of cysts, fluid-filled sacs that are not cancer. An MRI may be recommended along with a mammogram for routine screening in certain women who have a higher risk of breast cancer.

What If You Find a Lump?

First, don't panic. Eighty percent of breast lumps are not cancerous. Lumps often turn out to be harmless cysts or tissue changes related to your menstrual cycle. But you should let your doctor know right away if you find anything unusual in your breast. If it is cancer, the earlier it's found the better. And if it's not, testing can give you peace of mind.

Hormone-Sensitive Breast Cancer

Some types of breast cancer are fueled by the hormones estrogen or progesterone. A biopsy can reveal whether a tumor has receptors for estrogen (ER-positive) and/or progesterone (PR-positive). About two out of three breast cancers are hormone sensitive. There are several medications that keep the hormones from promoting further cancer growth.

The image shows a molecular model of an estrogen receptor.

HER2-Positive Breast Cancer

In about 20% of patients, breast cancer cells have too many receptors for a protein called HER2. This type of cancer is known as HER2-positive, and it tends to spread faster than other forms of breast cancer. It's important to determine whether a tumor is HER2-positive, because there are special treatments for this form of cancer.

A HER2-positive breast cancer cell is illustrated here, with abnormal growth signals shown in green.

Breast Cancer Stages

Once breast cancer has been diagnosed, the next step is to determine how big the tumor is and how far the cancer has spread. This process is called staging. Doctors use Stages 0-4 to describe whether cancer is localized to the breast, has invaded nearby lymph nodes, or has spread to other organs, such as the lungs. Knowing the stage and type of breast cancer will help your health care team formulate a treatment strategy.

Breast Cancer Survival Rates

The odds of surviving breast cancer are strongly tied to how early it is found. According to the American Cancer Society, 100% of women with Stage 1 breast cancer live at least five years, compared to women without cancer – and many women in this group remain cancer-free for good. The more advanced the cancer, the lower this figure becomes. By Stage 4, the five-year relative survival rate declines to 20%. But these rates can improve as more effective treatments are found.

Breast Cancer Surgery

There are many types of breast cancer surgery, from taking out the area around the lump (lumpectomy or breast-conservation surgery) to removing the entire breast (mastectomy.) It's best to discuss the pros and cons of each of these procedures with your doctor before deciding what's right for you.

Radiation Therapy for Breast Cancer

Radiation therapy uses high-energy rays to kill cancer cells. It may be used after breast cancer surgery to wipe out any cancer cells that remain. It can also be used along with chemotherapy for treatment of cancer that has spread to other parts of the body. Side effects can include fatigue and swelling or a sunburn-like feeling in the treated area.

Chemotherapy for Breast Cancer

Chemotherapy uses drugs to kill cancer cells anywhere in the body. The drugs are often given by IV, but are sometimes taken by mouth or shot. Chemotherapy may be done after surgery to lower the odds of the cancer coming back. In women with advanced breast cancer, chemotherapy can help control the cancer's growth. Side effects may include hair loss, nausea, fatigue, and a higher risk of infection.

Hormone Therapy for Breast Cancer

Hormone therapy is an effective treatment for women with ER-positive or PR-positive breast cancer. These are cancers that grow more rapidly in response to the hormones estrogen or progesterone. Hormone therapy can block this effect. It is most often used after breast cancer surgery to help keep the cancer from coming back. It may also be used to reduce the chance of breast cancer developing in women who are at high risk.

Life After Diagnosis

There's no doubt that cancer is a life-changing experience. The treatments can wear you out. You may have trouble managing daily chores, work, or social outings. This can lead to feelings of isolation. It's crucial to reach out to friends and family for support. They may be able to go with you to treatments, help out with chores, or just remind you that you are not alone. Many people choose to join a support group -- either locally or online.

Breast Forms

An alternative to breast reconstruction is to be fitted for a breast form. This is a breast-shaped prosthesis that fits inside your bra. Wearing a breast form allows you to have a balanced look when you are dressed -- without undergoing additional surgery. Like reconstructive surgery, breast forms are often covered by insurance.

Breast Cancer: Why Me?

The most obvious risk factor for breast cancer is being a woman. Men get the disease, too, but it is about 100 times more common in women. Other top risk factors include being over age 55 or having a close relative who has had the disease. But keep in mind that up to 80% of women with breast cancer have no family history of the illness.

Breast Cancer Genes

Some women have a very high risk of breast cancer because they inherited changes in certain genes. The genes most commonly involved in breast cancer are known as BRCA1 and BRCA2. Women with mutations in these genes have up to an 80 percent chance of getting breast cancer at some point in life. Other genes may be linked to breast cancer risk as well.

Risk Factors in Your Control

Being overweight, getting too little exercise, and drinking more than one alcoholic beverage per day can raise the risk of developing breast cancer. Birth control pills and some forms of postmenopausal hormone therapy can also boost your risk. But the risk goes back to normal after these medications are stopped. Among survivors, good lifestyle choices may be helpful. Recent studies suggest that physical activity may help lower the risk of a recurrence and it's a proven mood-booster.

Breast Cancer Research

Doctors continue to search for more effective and tolerable treatments for breast cancer. The funding for this research comes from many sources, including advocacy groups throughout the country. Many of the 2.5 million breast cancer survivors and their families choose to participate in walk-a-thons and other fundraising events. This links each individual fight against cancer into a common effort for progress.

Wrinkles

2012-01-31T22:36:00.001-08:00

Introduction

Although wrinkles can signify wisdom, most people nowadays would rather not have them.
Many products and procedures promise to reduce wrinkles. Some do little or nothing (like the products that claim they reduce "the appearance of fine lines," which means that they don't reduce the lines themselves). Others can achieve a fair amount of success.
Skin ages all over the body, but much more so where there has been sun exposure. Changes brought on by sun damage (photoaging) include "dryness" (really roughness), sagginess, skin growths like keratoses ("liver spots"), and wrinkles.
Most wrinkles appear on the parts of the body where sun exposure is greatest. These especially include the face, neck, the backs of the hands, and the tops of the forearms. Wrinkles come in two categories: fine surface lines and deep furrows. Wrinkle treatments are in general much more effective for fine lines. Deeper creases may require more aggressive techniques, such injection of fillers or plastic surgery.

What factors promote wrinkles?

Factors that promote wrinkling include:

Smoking
Light skin type (people with blue eyes and easily burned skin are more prone to sun damage)
Heredity (some families wrinkle more)
Hairstyle (some styles provide cover and protection against sun damage)
Dress (hats, long sleeves, etc.)
Occupational and recreational habits (farming, sailing, golfing, using tanning booths, and so forth)

Some of these factors are beyond our control. The main preventive measures we can take are to minimize sun exposure and not smoke.
SPF numbers on sunscreen labels refer to protection against UVB radiation (shortwave ultraviolet light, the "sunburn rays"). More and more sunscreens offer protection against UVA radiation (longer-wave ultraviolet light) as well. UVA rays are the ones you get in tanning salons; they may not cause immediate sunburn but do promote sun damage and skin cancer risk over time. (Sorry, but there is no such thing as a "safe tan.") Sunscreens that block UVA indicate this on the label and include such ingredients as Parsol 1789. The FDA has recently approved Mexoryl, another UVA-blocking ingredient, which has been available in Europe for some time. For more, please read the articles, Sunburn and Sun Sensitizing Drugs and Sun Protection and Sunscreens.

What medical treatments and cosmetic procedures are available for wrinkles?

There are several medical (topical medicines and creams) and cosmetic techniques available for reducing wrinkles. They include both medical and surgical methods:
Medical treatments

Vitamin A Acid (tretinoin, Retin-A, Renova). This ingredient, available by prescription, has the longest track record of success in treating aging skin and fine lines. Creams containing tretinoin must be used on an ongoing basis. They may produce redness and peeling at first, but discomfort can usually be minimized by lowering the cream's concentration or applying it less often until the skin gets used to it.
Alpha-hydroxy acids. These so-called "fruit acids" include glycolic and lactic acid. Preparations containing these fruit acids are quite safe and cause no more than mild and temporary irritation. They produce only subtle improvement, though.
Antioxidants. These include preparations that contain the vitamins A, C, and E, as well as beta-carotene. Such creams may provide a certain amount of sun protection as well as mild improvement of fine wrinkles.
Ordinary moisturizers. Creams that don't contain any of the above substances can only make wrinkles look temporarily less prominent ("reduce the appearance of fine lines").

Cosmetic procedures

Glycolic acid peels. These superficial peels can make a very slight difference in the intensity of fine wrinkles.
Deeper peels. These peels use ingredients like salicylic acid and trichloroacetic acid and penetrate somewhat deeper into the skin. Deeper peels do a better job of smoothing fine lines. The deeper the peel, however, the greater the risk of side effects, such as long-lasting pigment changes (changes in the color of the skin) and scarring. Such peels do not require anesthesia. Mild sedation helps ease short-term but fairly intense discomfort.
Microdermabrasion.

This refers to "sanding the skin" with a machine containing silica or aluminum crystals; many estheticians offer this service, usually in "packages" of six or seven sessions. Microdermabrasion does not change skin anatomy, though it may make the face feel smoother. Cosmetic products marketed as "home microdermabrasion" are just mild exfoliants, harmless but not likely to produce any meaningful change in wrinkles.

Dermabrasion. This is a true surgical procedure, often performed under general anesthesia. The treating physician uses a rotating instrument to sand the skin down. Depending a great deal on the skill and experience of the operator, dermabrasion can result in excellent improvement, but can also produce significant side effects, including scarring and permanent changes in skin color.
Laser resurfacing. Using instruments such as the carbon dioxide and erbium lasers, physicians can achieve results similar to those of dermabrasion with greater reliability and precision. The laser is passed several times over the area to be treated until the peel reaches the middle of the dermis, the skin's second layer. This helps stimulate the body's natural collagen synthesis (production), which plumps up sagging skin and wrinkles. Some doctors perform laser resurfacing under "conscious sedation," in which the patient remains awake and receives intravenous medications to calm and ease pain. This sedation is combined with the application of topical anesthetic creams such as EMLA, as well as injections of local anesthetics like lidocaine. Procedures may need to be repeated to maximize improvement. Skin takes a long time to heal (weeks to months) after resurfacing. In addition, this procedure, like dermabrasion can cause permanent pigment changes and scarring.
Fractional resurfacing.

Newer lasers work through a modification of traditional laser resurfacing. Treatments affect not the whole skin but instead only evenly spaced spots surrounded by undamaged skin. Healing is much faster than traditional resurfacing, with less "downtime" afterward. Several treatments are needed to achieve full benefit.

Non-ablative laser resurfacing. Newer lasers attempt to stimulate collagen synthesis under the skin without peeling or damaging the epidermis. Studies and clinical experience suggest that such procedures can improve fine wrinkles, though not as much as laser resurfacing. Several treatments may be necessary. These procedures are almost painless and there is little or no redness, peeling, or downtime afterward.
Heat and radiofrequency.

Another variation of noninvasive facial rejuvenation is to heat tissue using radiofrequency devises and infrared light sources. Techniques are still being developed, but results to date suggest that such treatments are safe and can produce visible and lasting improvement, though not as much as surgical techniques like facelifts.

Plastic surgical procedures. Surgical facelifts, brow lifts, and similar operations can be very helpful for selected patients.
Botox. Injection of botulinum toxin, the muscle poison, can paralyze muscles that produce the "frown lines" on the forehead, fine lines around the eyes, and other wrinkles. Improvement lasts several months and must be repeated to sustain improvement. Injected properly, Botox is quite safe: The muscle poison does not spread through the body to do damage elsewhere.
Fillers.

Fillers are injected into the skin to increase volume and flatten wrinkles and folds. For a long time, the most popular filler was collagen, whose effect only lasts a few months. More recently, new filler substances, such as hyaluronic acid (Restylane, Juvederm) and calcium hydroxylapatite (Radiesse), have become popular, because their effect can last six to nine months, or even longer.

Anyone considering any of the cosmetic procedures should be sure to consult doctors who have experience in one or several of these techniques. Patients should fully inform themselves about the risks and potential benefits of the procedure they are considering before going forward.

Wrinkles At A Glance

Skin ages all over the body, but much more so where there has been sun exposure. Changes brought on by sun damage (photoaging) include "dryness" (really roughness), sagginess, skin growths like keratoses ("liver spots"), and wrinkles.
Wrinkles in turn can be divided into two categories; fine surface lines and deep furrows. Wrinkle treatments are in general much more effective for fine lines. Deeper creases may require more aggressive techniques, such as plastic surgery.
Factors that promote wrinkling include smoking; skin type (people with light-colored skin and blue eyes are more susceptible to sun damage); heredity (some families wrinkle more); hairstyle (depending on how much skin is covered by hair and protected from the sun); dress (again, by determining which skin is exposed); and occupational and recreational sun exposure over the course of many years.
Treatments available for wrinkles include medical treatments (such as vitamin A acid, alpha hydroxy acids, antioxidants, and moisturizer) and cosmetic procedures (such as glycolic acids peels, deep peels, dermabrasion, laser resurfacing, surgical procedures, and Botox).

Amblyopia and Your Child's Eyes

2012-01-31T22:36:00.000-08:00

Amblyopia is a condition that occurs in children when one eye has poorer vision than the other. If amblyopia is left untreated, a child's vision will not develop correctly. The child's brain, as it matures, will start "ignoring" the image coming from the bad eye. This causes vision in the affected eye to become even worse as the child becomes a teenager. Because amblyopia can result in permanent vision loss in one eye, it is important to have a child with amblyopia regularly tested by an eye doctor.

What Causes Amblyopia?

Amblyopia is usually starts when one eye has much better focus than the other eye. For example, one eye might be very nearsighted or have a lot of astigmatism , while the other does not. When the child's brain is confronted with both a blurry image and a clear image, it will begin to ignore the blurry image. If this goes on for months or years, the vision in the eye that sees the blurry image will start to deteriorate even further. Another possible result of the brain ignoring the poorly functioning eye is a change in the alignment of the eyes, with the poorly seeing eye turning inwards or outwards. This is why amblyopia is sometimes called "lazy eye."

Another form of lazy eye that can cause amblyopia is called strabismus. Strabismus or ocular misalignment prevents the eyes from focusing together on an image. This can cause double vision. In order to combat this, the child's brain generally chooses to ignore the image from the deviated eye, causing the vision in that eye to eventually deteriorate.

Other children cannot see well in one eye because there something blocks light from getting through. This could be due, among other causes, to a cataract or a small amount of blood or other material in the back of the eye.

How Is Amblyopia Diagnosed?

Your child's pediatrician or the vision program at school will check three aspects of your child's eye health:

That your child's eyes let light all the way through
That both eyes see equally well
That the eyes are moving normally.

If there's a problem in any of those three areas, the pediatrician or school nurse may recommend a visit to an eye specialist.

How Is Amblyopia Treated?

The most common treatment for amblyopia is to force the brain to start using the "bad" eye by putting a patch over the "good" eye. At first, the child will have a hard time seeing with just the weaker eye. However, it is very important that your child wear the patch diligently because this will eventually improve vision. It can take weeks, months, or even a year for an eye patch to improve vision.

As the child keeps using only the eye with amblyopia, his or her vision will continue to improve. After the doctor determines that vision is back to normal, your child will not have to wear the patch. In cases of mild amblyopia, the doctor might recommend using an eye drop called atropine in the "good" eye instead of a patch. Atropine makes it impossible for that eye to focus close-up, forcing the "bad" eye to do most of the work while the child is playing with toys, eating, drawing or reading.

If there is something blocking light from getting into the eye, the doctor might recommend surgery to remove the blockage. If strabismus is preventing the eyes from moving together correctly, your doctor might recommend surgery on the muscles of the eye. And if the focus of one eye is very different from the other, eyeglasses or contact lenses might be necessary.

Your doctor will discuss with you what treatment is most appropriate for your child.

What Is the Outlook for Children With Amblyopia?

If existing underlying problems are treated and the amblyopia is detected and treated early, most children will regain normal vision. Amblyopia becomes much more difficult to treat after about 6 years of age. Also, if there is too much vision lost in the eye with amblyopia, it might be impossible to get it all back.

It is important that you follow your doctor's advice about treatment. This can be very difficult, because many children do not want to wear an eye patch every day. But with the establishment of atropine as an alternative method of treatment, success is now possible in a larger proportion of children with amblyopia.

Skin Cancer

2012-01-31T03:25:00.000-08:00

Introduction

Skin cancer is the most common form of human cancer. It is estimated that over 1 million new cases occur annually. The annual rates of all forms of skin cancer are increasing each year, representing a growing public concern. It has also been estimated that nearly half of all Americans who live to age 65 will develop skin cancer at least once.
The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal.
The term "skin cancer" refers to three different conditions. From the least to the most dangerous, they are:

basal cell carcinoma (or basal cell carcinoma epithelioma)
squamous cell carcinoma (the first stage of which is called actinic keratosis)
melanoma

The two most common forms of skin cancer are basal cell carcinoma and squamous cell carcinoma. Together, these two are also referred to as nonmelanoma skin cancer. Melanoma is generally the most serious form of skin cancer because it tends to spread (metastasize) throughout the body quickly. Skin cancer is also known as skin neoplasia.
This article will discuss the two kinds of nonmelanoma skin cancer.

Basal cell carcinoma

What is basal cell carcinoma?
Basal cell carcinoma is the most common form of skin cancer and accounts for more than 90% of all skin cancer in the U.S. These cancers almost never spread (metastasize) to other parts of the body. They can, however, cause damage by growing and invading surrounding tissue.

Skin Cancer

What are risk factors for developing basal cell carcinoma?
Light-colored skin, sun exposure, and age are all important factors in the development of basal cell carcinomas. People who have fair skin and are older have higher rates of basal cell carcinoma. About 20% of these skin cancers, however, occur in areas that are not sun-exposed, such as the chest, back, arms, legs, and scalp. The face, however, remains the most common location for basal cell lesions. Weakening of the immune system, whether by disease or medication, can also promote the risk of developing basal cell carcinoma. Other risk factors include

exposure to sun. There is evidence that, in contrast to squamous cell carcinoma, basal cell carcinoma is promoted not by accumulated sun exposure but by intermittent sun exposure like that received during vacations, especially early in life. According to the U.S. National Institutes of Health, ultraviolet (UV) radiation from the sun is the main cause of skin cancer. The risk of developing skin cancer is also affected by where a person lives. People who live in areas that receive high levels of UV radiation from the sun are more likely to develop skin cancer. In the United States, for example, skin cancer is more common in Texas than it is in Minnesota, where the sun is not as strong. Worldwide, the highest rates of skin cancer are found in South Africa and Australia, which are areas that receive high amounts of UV radiation.
age. Most skin cancers appear after age 50, but the sun's damaging effects begin at an early age. Therefore, protection should start in childhood in order to prevent skin cancer later in life.
exposure to ultraviolet radiation in tanning booths. Tanning booths are very popular, especially among adolescents, and they even let people who live in cold climates radiate their skin year-round.
therapeutic radiation, such as that given for treating other forms of cancer.

Basal Cell Carcinoma

What does basal cell carcinoma look like?
A basal cell carcinoma usually begins as a small, dome-shaped bump and is often covered by small, superficial blood vessels called telangiectases. The texture of such a spot is often shiny and translucent, sometimes referred to as "pearly." It is often hard to tell a basal cell carcinoma from a benign growth like a flesh-colored mole without performing a biopsy. Some basal cell carcinomas contain melanin pigment, making them look dark rather than shiny.
Superficial basal cell carcinomas often appear on the chest or back and look more like patches of raw, dry skin. They grow slowly over the course of months or years.
Basal cell carcinomas grow slowly, taking months or even years to become sizable. Although spread to other parts of the body (metastasis) is very rare, a basal cell carcinoma can damage and disfigure the eye, ear, or nose if it grows nearby.
How is basal cell carcinoma diagnosed?
To make a proper diagnosis, doctors usually remove all or part of the growth by performing a biopsy. This usually involves taking a sample by injecting a local anesthesia and scraping a small piece of skin. This method is referred to as a shave biopsy. The skin that is removed is then examined under a microscope to check for cancer cells.
How is basal cell carcinoma treated?
There are many ways to successfully treat a basal cell carcinoma with a good chance of success of 90% or more. The doctor's main goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person's age, general health, and medical history.
Methods used to treat basal cell carcinomas include:

Curettage and desiccation: Dermatologists often prefer this method, which consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette. Desiccation is the additional application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in non-crucial areas such as the trunk and extremities.
Surgical excision: The tumor is cut out and stitched up.
Radiation therapy: Doctors often use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery. Obtaining a good cosmetic result generally involves many treatment sessions, perhaps 25 to 30.
Cryosurgery: Some doctors trained in this technique achieve good results by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.
Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is better termed "microscopically controlled excision." The surgeon meticulously removes a small piece of the tumor and examines it under the microscope during surgery. This sequence of cutting and microscopic examination is repeated in a painstaking fashion so that the basal cell carcinoma can be mapped and taken out without having to estimate or guess the width and depth of the lesion. This method removes as little of the healthy normal tissue as possible. Cure rate is very high, exceeding 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. Such body parts include the scalp, forehead, ears, and the corners of the nose. In cases where large amounts of tissue need to be removed, the Mohs surgeon sometimes works with a plastic (reconstructive) surgeon to achieve the best possible postsurgical appearance.
Medical therapy using creams that attack cancer cells (5-Fluorouracil--5-FU, Efudex, Fluoroplex) or stimulate the immune system (imiquimod [Aldara]). These are applied several times a week for several weeks. They produce brisk inflammation and irritation. The advantages of this method is that it avoids surgery, lets the patient perform treatment at home, and may give a better cosmetic result. Disadvantages include discomfort, which may be severe, and a lower cure rate, which makes medical treatment unsuitable for treating most skin cancers on the face.

How is basal cell carcinoma prevented?
Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer. Regular surveillance of susceptible individuals, both by self-examination and regular physical examination, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.
Common sense preventive techniques include

limiting recreational sun exposure;
avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon);
wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun;
regularly using a waterproof or water resistant sunscreen with UVA protection and SPF 30 or higher;
undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of the doctor; and
avoiding the use of tanning beds and using a sunscreen with an SPF of 30 and protection against UVA (long waves of ultraviolet light.). Many people go out of their way to get an artificial tan before they leave for a sunny vacation, because they want to get a "base coat" to prevent sun damage. Even those who are capable of getting a tan, however, only get protection to the level of SPF 6, whereas the desired level is an SPF of 30. Those who only freckle get little or no protection at all from attempting to tan; they just increase sun damage. Sunscreen must be applied liberally and reapplied every two to three hours, especially after swimming or physical activity that promotes perspiration, which can weaken even sunscreens labeled as "waterproof."

Squamous cell carcinoma

What is squamous cell carcinoma?
Squamous cell carcinoma is cancer that begins in the squamous cells, which are thin, flat cells that look like fish scales under the microscope. The word squamous came from the Latin squama, meaning "the scale of a fish or serpent" because of the appearance of the cells.
Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Thus, squamous cell carcinomas can actually arise in any of these tissues.
Squamous cell carcinoma of the skin occurs roughly one-quarter as often as basal cell carcinoma. Light-colored skin and a history of sun exposure are even more important in predisposing to this kind of cancer than to basal cell carcinoma. Men are affected more often than women. Patterns of dress and hairstyle may play a role. Women, whose hair generally covers their ears, develop squamous cell carcinomas far less often in this location than do men.
The earliest form of squamous cell carcinoma is called actinic (or solar) keratosis. Actinic keratoses appear as rough, red bumps on the scalp, face, ears, and backs of the hands. They often appear against a background of mottled, sun-damaged skin. They can be quite sore and tender, out of proportion to their appearance. In a patient with actinic keratoses, the rate at which one such keratosis may invade deeper in the skin to become a fully-developed squamous cell carcinoma is estimated to be in the range of 10%-20% over 10 years, though it may take less time. An actinic keratosis that becomes thicker and more tender raises the concern that it may have transformed into an invasive squamous cell carcinoma.
A rapidly-growing form of squamous cell carcinoma that forms a mound with a central crater is called a keratoacanthoma. While some consider this not a true cancer but instead a condition that takes care of itself, most pathologists consider it to be a form of squamous cell cancer and clinicians treat is accordingly.
Other forms of squamous cell carcinoma that have not yet invaded deeper into the skin include

actinic cheilitis, involving the lower lip with redness and scale, and blurring the border between the lip and the surrounding skin;
Bowen's disease, sometimes referred to as squamous cell carcinoma in situ. (The Latin words in situ refer to the presence of the cancer only in the superficial epidermis, without deeper involvement.) Bowen's disease appears as scaly patches on sun-exposed parts of the trunk and extremities; and
Bowenoid papulosis: These are genital warts that under the microscope look like Bowen's disease but behave like warts, not like cancers.

What are risk factors for developing squamous cell carcinoma?
The single most important factor in producing squamous cell carcinomas is sun exposure. Many such growths can develop from precancerous spots, called actinic or solar keratoses. These lesions appear after years of sun damage on parts of the body like the forehead and cheeks, as well as the backs of the hands. Sun damage takes many years to promote skin cancer. It is therefore common for people who stopped being "sun worshipers" in their 20s to develop precancerous or cancerous spots decades later.
Several rather uncommon factors may predispose to squamous cell carcinoma. These include exposure to arsenic, hydrocarbons, heat, or X-rays. Some squamous cell carcinomas arise in scar tissue. Suppression of the immune system by infection or drugs may also promote such growths. Some strains of HPV (the human papillomavirus responsible for causing genital warts) can promote development of squamous cell carcinoma in the anogenital region.
Can squamous cell carcinoma of the skin spread (metastasize)?
Yes. Unlike basal cell carcinomas, squamous cell carcinomas can metastasize, or spread to other parts of the body. These tumors usually begin as firm, skin-colored or red nodules. Squamous cell cancers that start out within solar keratoses or on sun-damaged skin are easier to cure and metastasize less often than those that develop in traumatic or radiation scars. One location particularly prone to metastatic spread is the lower lip. A proper diagnosis in this location is, therefore, especially important.
How is squamous cell carcinoma diagnosed?
As with basal cell carcinoma, doctors usually perform a biopsy to make a proper diagnosis. This involves taking a sample by injecting local anesthesia and punching out a small piece of skin using a circular punch blade. Usually the method used referred to as a punch biopsy. The skin that is removed is then examined under a microscope to check for cancer cells.
How is squamous cell carcinoma treated?
Techniques for treating squamous cell carcinoma are similar to those for basal cell carcinoma (for detailed descriptions, see above under treatment of basal cell carcinoma):

Curettage and desiccation: Dermatologists often prefer this method, which consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette. Desiccation is the additional application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in non-crucial areas such as the trunk and extremities.
Surgical excision: The tumor is cut out and stitched up.
Radiation therapy: Doctors often use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery. Obtaining a good cosmetic result generally involves many treatment sessions, perhaps 25 to 30.
Cryosurgery: Some doctors trained in this technique achieve good results by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.
Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is better termed, "microscopically controlled excision." The surgeon meticulously removes a small piece of the tumor and examines it under the microscope during surgery. This sequence of cutting and microscopic examination is repeated in a painstaking fashion so that the basal cell carcinoma can be mapped and taken out without having to estimate or guess the width and depth of the lesion. This method removes as little of the healthy normal tissue as possible. Cure rate is very high, exceeding 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. Such body parts include the scalp, forehead, ears, and the corners of the nose. In cases where large amounts of tissue need to be removed, the Mohs surgeon sometimes works with a plastic (reconstructive) surgeon to achieve the best possible postsurgical appearance.
Medical therapy using creams that attack cancer cells (5-Fluorouracil--5-FU, Efudex, Fluoroplex) or stimulate the immune system (Aldara). These are applied several times a week for several weeks. They produce brisk inflammation and irritation. The advantages of this method is that it avoids surgery, lets the patient perform treatment at home, and may give a better cosmetic result. Disadvantages include discomfort, which may be severe, and a lower cure rate, which makes medical treatment unsuitable for treating most skin cancers on the face.

The possibility of metastasis makes it especially important to diagnose squamous cell carcinomas early and treat them adequately.
How is squamous cell carcinoma prevented?
Even more so than is the case with basal cell carcinoma, the key principles of prevention are minimizing sun exposure and getting regular checkups.
Common-sense preventive techniques are the same as for basal cell carcinoma and include

limiting recreational sun exposure;
avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon);
wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun;
regularly using a waterproof or water-resistant sunscreen with UVA protection and SPF 30 or higher;
undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of a doctor; and
avoiding the use of tanning beds and using a sunscreen with an SPF 30 and protection against UVA (long waves of ultraviolet light). Many people go out of their way to get an artificial tan before they leave for a sunny vacation, because they want to get a "base coat" to prevent sun damage. Even those who are capable of getting a tan, however, only get protection to the level of SPF 6, whereas the desired level is an SPF of 30. Those who only freckle get little or no protection at all from attempting to tan; they just increase sun damage. Sunscreen must be applied liberally and reapplied every two to three hours, especially after swimming or physical activity that promotes perspiration, which can weaken even sunscreens labeled as "waterproof."

What about follow-up care for skin cancer?

Skin cancer has a better prognosis, or outcome, than most other types of cancer. It is generally curable. Even though most skin cancers are cured, people who have been treated for skin cancer have a higher-than-average risk of developing a new cancer of the skin. This is the reason why it is so important for patients to continue to examine themselves regularly, visit their doctor for regular checkups, and follow their doctor's instructions on how to reduce their risk of developing skin cancer again.

How about vitamin D and cancer?

Some recent reports suggest that getting vitamin D from sun exposure may prevent the occurrence and spread of cancers, both of internal organs and of the skin. In spite of the occasional controversy surrounding these studies, their common-sense implications are simple enough. Even those doctors who recommend sun for vitamin D only suggest 15 minutes a few times a week. For most people, especially those who have day jobs or live in cooler climates, following this advice is not likely to result in markedly higher risk of skin cancer. No responsible authority suggests that to help with vitamin D, people ought to sunbathe or visit tanning salons.

What resources are available to patients with skin cancer?

Skin Cancer Foundation
245 Fifth Avenue, Suite 2402
New York, NY 10016
212-725-5176

This nonprofit organization provides publications and audiovisual materials on the prevention, early detection, and treatment of skin cancer. The foundation also publishes Sun and Skin News and The Skin Cancer Foundation Journal, which have nontechnical articles on skin cancer. Send a stamped, self-addressed envelope to the above address to receive free printed information.

American Academy of Dermatology
PO Box 4014
Schaumburg, IL 60168-4014
708-330-0230

The American Academy of Dermatology is an organization of doctors who specialize in diagnosing and treating skin problems. It provides free booklets on skin cancer and can refer people to dermatologists in their local area.
American Society of Plastic and Reconstructive Surgeons
444 East Algonquin Road
Arlington Heights, IL 60005
1-800-635-0635

This society sends free information about various surgical procedures. It can also provide the names of board-certified plastic surgeons in a patient's area.

Skin Cancer At A Glance

There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma (the nonmelanoma skin cancers), and melanoma.
Skin cancer is the most common form of cancer in humans.
Ultraviolet light, which is in sunlight, is the main cause of skin cancer.
The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal. Unexplained changes in the appearance of the skin lasting longer than two weeks should be evaluated by a doctor.
Nonmelanoma skin cancer is generally curable. The cure rate for nonmelanoma skin cancer could be 100% if these lesions were brought to a doctor's attention before they had a chance to spread.
Treatment of nonmelanoma skin cancer depends on the type and location of the skin cancer, the risk of scarring, as well as the age and health of the patient. Methods used include curettage and desiccation, surgical excision, cryosurgery, radiation, and Mohs micrographic surgery.
Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer. Regular surveillance of susceptible individuals, both by self-examination and regular physical examination, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.

DRY SKIN

2012-01-31T03:22:00.000-08:00

What is dry skin?

Dry skin is a very common skin condition characterized by a lack of the appropriate amount of water in the most superficial layer of the skin, the epidermis. While dry skin tends to affect males and females equally, older individuals are typically much more prone to dry skin. The skin in elderly individuals tends to have diminished amounts of natural skin oils and lubricants. Areas such as the arms, hands, and particularly lower legs tend to be more affected by dry skin. Dryness of the skin is affected by the amount of water vapor in the surrounding air, the humidity. Dry skin is also known as xeroderma.
Dry skin may be a mild, temporary condition lasting a few days to weeks. Dry skin may also become a more severe, long-term skin problem for some. Symptoms of dry skin include discomfort from skin tightness and itching. In addition, external factors such as weather can affect the severity of skin dryness. For example, cold or dry air and winter weather can worsen dry skin. Individuals whose occupations require more frequent hand-washing and sanitizing may experience dry skin more often. Dry skin may also be a side effect of some medications or a symptom of an underlying medical disorder.
The epidermis is normally composed of fat (lipid) and protein. The lipid portion of the epidermis helps prevent skin dehydration. When the skin's fatty oils are removed, the skin loses its protection and loses moisture more easily. As skin becomes dry, it also may become more sensitive and prone to rashes and skin breakdown. This condition is sometimes referred to as xerosis. Dry skin may be an entirely invisible skin condition, or may cause a fine dry powder-like appearance of the skin. Untreated, dry skin may become irritated and result in a red rash (xerodermatitis).
Simple prevention and treatment measures are very effective in the treatment of dry skin. Basic dry skin prevention steps include avoidance of harsh soaps and chemical cleansers. Treatment generally requires more frequent and regular applications of bland emollients and moisturizers. Untreated, dry skin may result in complications, including rashes, eczema, secondary bacterial infections, cellulitis, and skin discoloration. Fortunately, dry skin is usually mild and can be easily remedied.

What causes dry skin?

There is no single cause of dry skin. Dry skin causes can be classified as external and internal. External factors are the most common underlying cause and are the easiest to address. External factors include cold temperatures and low humidity, especially during the winter when central heaters are used. Internal factors include overall health, age, genetics, family history, and a personal history of other medical conditions like asthma, allergies, and atopic dermatitis. In particular those with thyroid disease are more prone to developing dry skin.
External factors that cause dry skin include

over-washing with harsh soaps,
overuse of sanitizers and cleaning agents (alcohol),
cold temperature,
low humidity.

Although bathing and showering adds water to skin, it is the evaporation of this water after the completion of the immersion that results in dry skin. Skin that feels overly tight after bathing may indicate excess removal of natural skin oils.
One of the most common factors causing dry skin is frequent application of harsh soaps. The type of soap may have a large impact on dry skin. Soap is an emulsifier that removes oils on the skin. The more often skin is scrubbed with soap, the more oil is removed, ultimately resulting in dryer skin. Excessive use of soaps can worsen dry skin.
Moreover, dry skin may persist or worsen if using moisturizers improperly or choosing an inadequate moisturizer. Sometimes, the material of different clothing can also affect dry skin. Some materials such as wool or synthetic fibers tend to irritate the skin and worsen dry skin.
Dry skin condition may be caused by taking some medicines as well. Some examples are drugs for high blood pressure, cholesterol, allergies, and acne. Occasionally, a dry skin problem can be a sign of an internal medical condition. For instance, aging may inherently make people more prone to developing dry skin. In addition, eczema, psoriasis, diabetes, hypothyroidism, and malnutrition are all associated with dry skin.

What are signs and symptoms of dry skin?

The key symptom of dry skin is itching. People who have dry skin can often find rough, dry, red patches on their skin, and these patches are often itchy. Typical skin areas affected include arms, hands, lower legs, abdomen, and areas of friction such as ankles and soles. As skin dryness becomes more severe, cracks and fissures may evolve.
Symptoms:

Itching
Rough dry skin
Red patches

The itchy feeling may worsen the severity of dry skin. Itching can lead to the development of the "itch-scratch" cycle. That is, as a person feels itchy, he or she scratches in response, which exacerbates the itch, and so on. The itch-scratch cycle is often seen when conscious control of scratching is low or absent, for instance during sleep.
Most common dry skin areas are

the lower legs,
hands,
forearms.

Constantly scratching and rubbing the skin may cause the skin to become thick and leathery. For others, small, red, raised bumps may appear on their skin, and these bumpy spots can be irritated, opened, and infected if scratched.

How is dry skin diagnosed?

Generally, dry skin can be easily diagnosed when the physician physically examines and visually inspects the skin. While dry skin can appear on any type of skin at any age, the elderly and individuals who frequently expose their skin to soaps or detergents are more prone to developing this condition. In addition, a thorough medical history and review of the family history can help support the diagnosis of dry skin. Based on the medical history, other medical conditions may be ruled out or considered. In more difficult cases, a skin biopsy may be helpful to confirm the diagnosis and direct the treatment plan.

Does dry skin cause winter itch?

Winter itch is a common name for the skin symptom of generalized itching in the winter. It is primarily caused by dry skin and is most common in the elderly. Winter itch caused by dry skin may also be seen commonly in those with a history of eczema, allergies, or asthma. External factors, including cold temperatures, low humidity, and the use of central heat, tend to worsen dry skin during the winter season. Therefore, some people refer the condition of dry skin in the winter as "winter itch."

Do genetics play a role in dry skin?

Dry skin may be caused by a genetic condition called ichthyosis. There are many types of ichthyosis. Ichthyosis vulgaris is the most common type and it is a severe dry skin condition, often of the front of the lower legs. Ichthyosis vulgaris causes dry, fishlike scales. Less severe types of dry skin may tend to run in families. Dry skin is also more common in atopic dermatitis, which is thought to have a genetic component.

What medical conditions cause dry skin?

Certain physiological changes and medical conditions may cause dry skin. The onset of dry skin may be due to aging or hormonal changes, as seen in menopausal women. In some cases, individuals who have medical conditions such as hypothyroidism, diabetes, or malnutrition (for example, deficiency of vitamin A) may suffer from xerosis.
The following medical conditions may cause dry skin:

Hypothyroidism
Hyperthyroidism
Diabetes
Malnutrition
Atopic dermatitis

Do any medications cause dry skin?

Medications for medical conditions like high blood pressure (such as diuretics), cholesterol-lowering drugs, and acne (such as retinoids like Retin A) may also dry out the skin.

What is the treatment for dry skin?

The best treatment for dry skin is frequent, daily lubrication with an emollient (a substance that inhibits the evaporation of water). Because most dry skin is due to external causes, external treatments like creams and lotions can be applied and effectively control the skin breakout. Often, dry skin can be improved by applying a bland over-the-counter moisturizer. Once other causes of dry skin have been ruled out, the main goals of treatments are to stop the itching, prevent loss of water, and restore skin hydration.
Light moisturizing lotions for mild dry skin

Cetaphil lotion
Lubriderm lotion
AmLactin 12% lotion

Highly moisturizing products (that characteristically do not flow out of the jar when inverted) for severe dry skin

Vaseline
Aquaphor
Crisco vegetable shortening

Topical steroid creams include

hydrocortisone 1% cream (mild strength),
Pramosone 2.5% cream (mild strength),
triamcinolone 0.1% cream (medium strength),
clobetasol 0.05% cream (strong strength).

As a general rule, only mild corticosteroid creams like hydrocortisone should be used on the face, underarm, and groin areas. Long-term application of strong corticosteroid creams like clobetasol may cause serious adverse effects, including skin thinning, stretch marks, and skin breakdown. Oral corticosteroids may cause temporary or permanent thinned or weakened bones, high blood pressure, high blood sugar, infections, and cataracts. Patients taking corticosteroid should be closely monitored by their health-care professional to adjust the dosage to the minimum dose required for relief of symptoms.
Oral antihistamines such as diphenhydramine (Benadryl), hydroxyzine (Vistaril, Atarax), and cetirizine (Zyrtec) may also alleviate generalized itching in dry skin.
Anti-itch oral medications

hydroxyzine (Atarax)
diphenhydramine (Benadryl)
cetirizine (Zyrtec)
loratidine (Claritin)

What are possible complications of dry skin?

A common complication of dry skin and itching is secondary bacterial infection. Infections may be mild and resolve spontaneously or may be more severe and necessitate antibiotic treatment. Severe itching leads to repeat scratching of lesions, hence the "itch-scratch-rash-itch" cycle. Because of the persistence of this itch-scratch cycle, the skin may become much thickened in these areas from rubbing. Repeat skin rubbing in the same area may lead to two localized chronic skin conditions called lichen simplex chronicus (LSC) and prurigo nodule.

What are some home remedies for dry skin?

Apply Vaseline two or three times daily to wet skin.
Dry skin may be improved by taking lukewarm showers or baths and avoiding excess skin scrubbing. Hot water and harsh scrubbing can take away the natural oils that protect skin and make the skin even drier.
Dry skin may be prevented by use of gentle cleansers. Non-scented, mild cleansers or soap-free products like Aveeno, Cetaphil, Dove, or Neutrogena are recommended for dry and sensitive skin. Many scented, deodorant, and antibacterial soaps can be too harsh and wash off natural skin-protecting oils.
Special moisturizers containing lactic acid (Amlactin, Lac-Hydrin), or urea (Urix or Carmol) are very effective in hydrating the skin.
Mild soaps and cleansers include

Dove soapless cleanser,
Aveeno cleanser,
Cetaphil cleanser.

Mild moisturizers without perfumes are good for dry skin. Thick and greasy emollients work best. Typically, moisturizers should be applied within three to five minutes of bathing when the skin is still damp.
Proper nutrition and essential factors in the diet may help improve dry skin. For instance, essential fatty acids (such as omega-3) can be metabolized in the body to produce natural, moisture-retaining oil barriers of the skin. Omega-3-rich foods include flax, walnuts, safflower oil, and cold-water fish such as tuna, herring, halibut, salmon, sardines, and mackerel.
The moisture on the skin and in the environment is very important to dry skin. Maintaining the skin at optimal hydration and using an indoor humidifier may help improve dry skin.

How can dry skin be prevented?

To prevent skin from drying out, it may be helpful to humidify the indoor environment especially during the drier, winter months. Sometimes decreasing bathing frequency, avoiding strong soaps, and decreasing exposure to detergents also may help improve dry skin. Harsh cleansers can strip away the natural oils and sebum from the skin. Limiting exposure to irritants such as solvents and wool clothing can prevent the dry skin condition from worsening.

Avoid strong soaps and detergents.
Use indoor room humidifiers.
Limit exposure to irritants such as solvents.
Avoid wool clothing.
Use cotton and natural fiber clothing.
Move to a super-humid environment like New Orleans, Houston, Bangkok, Hong Kong, or Manila. Avoid Arizona!

What are the best products for dry skin?

Top products for dry skin include mild cleansers and rich moisturizers. Non-scented, mild cleansers or soap-free products include Dove, Cetaphil, and Purpose soap. Thick, greasy, moisturizers include Aquaphor, Vaseline, Crisco, and SBR Lipocream.

Gonorrhea

2012-01-14T22:19:00.001-08:00

Gonorrhea is a sexually transmitted disease (STD) caused by a bacterium called Neisseria gonorrhoeae. It can also be transmitted from pregnant mothers to their babies at birth.
Gonorrhea most commonly affects teens and young adults. Experts believe that hundreds of thousands of cases go undetected and untreated because the infection does not always have noticeable symptoms. Many people who have gonorrhea also have another common STD, chlamydia. So when doctors diagnose or suspect a case of gonorrhea, they often screen for and treat other STDs too.
Gonorrhea is preventable — and treatable — so anyone having sex (oral, anal, or vaginal) should take precautions against STDs and get screened for them regularly.

Symptoms

Many times gonorrhea does not produce any symptoms. When there are symptoms, the infection can cause painful urination and a cloudy discharge from the penis or vagina. This discharge may be thick and may have a greenish-yellow color. Males may have swelling or pain of their testicles. Females may have lower abdominal pain, painful intercourse, and abnormal bleeding from the vagina.
Gonorrhea can cause rectal pain, especially during a bowel movement. A sore throat can result from a gonorrhea throat infection.
If gonorrhea goes undetected and untreated, it can lead to more serious health problems. In males, it can cause scars inside the urethra, which can make urination difficult. In females, untreated gonorrhea can spread upward from the vaginal area to cause acute pelvic inflammatory disease (PID) — an infection of the uterus, fallopian tubes, or ovaries. It can lead to abscesses in the fallopian tubes and even infertility.
In males and females, gonorrhea that goes undetected can spread through the blood to parts of the body that are far from the reproductive organs, and lead to inflammation in the joints, the skin, the bones, tendons, heart, or even the area around the liver.

Pinkeye

2012-01-13T20:00:00.001-08:00

About Pinkeye

Conjunctivitis, commonly known as pinkeye, is an inflammation of the conjunctiva, the clear membrane that covers the white part of the eye and the inner surface of the eyelids.
While pinkeye can be alarming because it may make the eyes extremely red and can spread rapidly, it's a fairly common condition and usually causes no long-term eye or vision damage. But if your child shows symptoms of pinkeye, it's important to see a doctor. Some kinds of pinkeye go away on their own, but other types require treatment.

Causes

Pinkeye can be caused by many of the bacteria and viruses responsible for colds and other infections, — including ear infections, sinus infections, and sore throats — and by the same types of bacteria that cause the sexually transmitted diseases (STDs) chlamydia and gonorrhea.
Pinkeye also can be caused by allergies. These cases tend to happen more frequently among kids who also have other allergic conditions, such as hay fever. Triggers of allergic conjunctivitis include grass, ragweed pollen, animal dander, and dust mites.
Sometimes a substance in the environment can irritate the eyes and cause pinkeye; for example, chemicals (such as chlorine and soaps) and air pollutants (such as smoke and fumes).

Pinkeye in Newborns

Newborns are particularly susceptible to pinkeye and can be more prone to serious health complications if it goes untreated.
If a baby is born to a mother who has an STD, during delivery the bacteria or virus can pass from the birth canal into the baby's eyes, causing pinkeye. To prevent this, doctors give antibiotic ointment or eye drops to all babies immediately after birth. Occasionally, this preventive treatment causes a mild chemical conjunctivitis, which typically clears up on its own. Doctors also can screen pregnant women for STDs and treat them during pregnancy to prevent transmission of the infection to the baby.
Many babies are born with a narrow or blocked tear duct, a condition which usually clears up on its own. Sometimes, though, it can lead to conjunctivitis.

Symptoms

The different types of pinkeye can have different symptoms. And symptoms can vary from child to child.
One of the most common symptoms is discomfort in the eye. A child may say that it feels like there's sand in the eye. Many kids have redness of the eye and inner eyelid, which is why conjunctivitis is often called pinkeye. It can also cause discharge from the eyes, which may cause the eyelids to stick together when the child awakens in the morning. Some kids have swollen eyelids or sensitivity to bright light.
In cases of allergic conjunctivitis, itchiness and tearing are common symptoms.

Contagiousness

Cases of pinkeye that are caused by bacteria and viruses are contagious; cases caused by allergies or environmental irritants are not.
A child can get pinkeye by touching an infected person or something an infected person has touched, such as a used tissue. In the summertime, pinkeye can spread when kids swim in contaminated water or share contaminated towels. It also can be spread through coughing and sneezing.
Doctors usually recommend keeping kids diagnosed with contagious conjunctivitis out of school, day care, or summer camp for a short time.
Someone who has pinkeye in one eye can also inadvertently spread it to the other eye by touching the infected eye, then touching the other eye.

Preventing Pinkeye

To prevent pinkeye caused by infections, teach kids to wash their hands often with warm water and soap. They also should not share eye drops, tissues, eye makeup, washcloths, towels, or pillowcases with other people.
Be sure to wash your own hands thoroughly after touching an infected child's eyes, and throw away items like gauze or cotton balls after they've been used. Wash towels and other linens that the child has used in hot water separately from the rest of the family's laundry to avoid contamination.
If you know your child is prone to allergic conjunctivitis, keep windows and doors closed on days when the pollen is heavy, and dust and vacuum frequently to limit allergy triggers in the home. Irritant conjunctivitis can only be prevented by avoiding the irritating causes.
Many cases of pinkeye in newborns can be prevented by screening and treating pregnant women for STDs. A pregnant woman may have bacteria in her birth canal even if she shows no symptoms, which is why prenatal screening is important.

Treatment

Pinkeye caused by a virus usually goes away on its own without any treatment. If a doctor suspects that the pinkeye has been caused by a bacterial infection, antibiotic eye drops or ointment will be prescribed.
Sometimes it can be a challenge to get kids to tolerate eye drops several times a day. If you're having trouble, put the drops on the inner corner of your child's closed eye — when the child opens the eye, the medicine will flow into it. If you continue to have trouble with drops, ask the doctor about antibiotic ointment. It can be applied in a thin layer where the eyelids meet, and will melt and enter the eye.
If your child has allergic conjunctivitis, your doctor may prescribe anti-allergy medication, which comes in the form of pills, liquid, or eye drops.
Cool or warm compresses and acetaminophen or ibuprofen may make a child with pinkeye feel more comfortable. You can clean the edges of the infected eye carefully with warm water and gauze or cotton balls. This can also remove the crusts of dried discharge that may cause the eyelids to stick together first thing in the morning.

When to Call the Doctor

If you think your child has pinkeye, it's important to contact your doctor to learn what's causing it and how to treat it. Other serious eye conditions can mimic conjunctivitis, so a child who complains of severe pain, changes in eyesight, or sensitivity to light should be examined. If the pinkeye does not improve after 2 to 3 days of treatment, or after a week when left untreated, call your doctor.
If your child has pinkeye and starts to develop increased swelling, redness, and tenderness in the eyelids and around the eye, along with a fever, call your doctor. Those symptoms may mean the infection has started to spread beyond the conjunctiva and will require additional treatment.

Malaria

2012-01-13T19:55:00.000-08:00

About Malaria

Malaria is a common infection in hot, tropical areas but can also occur (very rarely) in temperate climates.
It is caused by any of four single-celled parasites of the Plasmodium species, which are carried by mosquitoes infected from biting someone who already has the disease. Malaria is then transmitted to other people when infected mosquitoes bite them. Rarely, it is passed from person to person (from mother to child in "congenital malaria," or through blood transfusion, organ donation, or shared needles).
Worldwide, 300-500 million people are infected with malaria each year. Most cases occur in sub-Saharan Africa, with approximately 2 million people dying there each year.
Malaria is rare in the United States, with only about 1,300 cases reported each year over the last 10 years. Most of these cases occurred in travelers, military personnel, and immigrants who had become infected by malaria parasites outside the United States.

Signs and Symptoms

Early symptoms of malaria can include irritability and drowsiness, with poor appetite and trouble sleeping. These symptoms are usually followed by chills, then a fever with rapid breathing. The fever may either gradually increase over 1 to 2 days or may rise very suddenly to 105° F (40.6° C) or above. Then, as fever ends and body temperature quickly returns to normal, there's an intense episode of sweating.
The same pattern of symptoms — chills, fever, sweating — may repeat at intervals of 2 or 3 days, depending on which particular species of malaria parasite is causing the infection.
Because the initial symptoms are not specific and can be mistaken for other diseases, it can be difficult to diagnose. In countries where the disease is seen a lot, it's not uncommon for doctors to treat people for malaria who have fever of no obvious cause without getting laboratory confirmation.

Additional Symptoms

Other symptoms of malaria include headache, nausea, aches and pains all over the body (especially the back and abdomen), and an abnormally large spleen. Convulsions or loss of consciousness may occur if malaria affects the brain. If it affects the kidneys, the amount of urine produced might be abnormally low. In falciparum malaria, caused by the Plasmodium falciparum parasite, the episode of fever and chills is especially intense, and this variety may be fatal in about 20% of cases.
Once malaria parasites enter the bloodstream, they travel to the liver and multiply. Every few days, thousands of parasites are released from the liver into the blood, where they destroy red blood cells.
The incubation period for malaria is the time between the mosquito bite and the release of parasites from the liver. This varies, depending on which malaria parasite is causing the disease. In general, it can range from 10 days to a month.
With treatment, malaria can usually be cured in about 2 weeks. Without treatment, it can be fatal, especially in children who are poorly nourished.

Prevention

Health authorities try to prevent malaria by using mosquito-control programs aimed at killing mosquitoes that carry the disease. If you travel to an area of the world with a high risk for malaria, you can install window screens, use insect repellents, and place mosquito netting over beds. Insecticide-impregnated bed netting has successfully reduced the number of malarial deaths among African children.
Check with your doctor before visiting any tropical or subtropical area at high risk for malaria. Your doctor can give your family anti-malarial drugs to prevent the disease. Several malaria vaccines are currently being developed and tested across the world, but because the malaria parasite has a complicated life cycle, it is a difficult vaccine to develop.

Diagnosis and Treatment

Doctors diagnose malaria by using special blood tests. A blood sample is sent to the laboratory and checked under a microscope for malaria parasites, which may be seen inside infected red blood cells.
Malaria is treated with anti-malarial drugs, such as chloroquine or quinine, given by mouth, by injection, or intravenously (into the veins). Depending on the type of parasite causing the malaria, a person can be treated as an outpatient over a few days or may require hospitalization with IV medication.
Doctors also watch for signs of dehydration, convulsions, anemia, and other complications that can affect the brain, kidneys, or spleen. The patient may require fluids, blood transfusions, and breathing assistance.
Malaria is a leading cause of death worldwide. If diagnosed early and treated, it can be cured. However, many people who live in areas where malaria is common get repeated infections and never really recover between episodes of illness.

Chickenpox

2012-01-13T19:53:00.001-08:00

About Chickenpox

Chickenpox is a common illness among kids, particularly those under age 12. An itchy rash of spots that look like blisters can appear all over the body and be accompanied by flu-like symptoms. Symptoms usually go away without treatment, but because the infection is very contagious, an infected child should stay home and rest until the symptoms are gone.
Chickenpox is caused by the varicella-zoster virus (VZV). Kids can be protected from VZV by getting the chickenpox (varicella) vaccine, usually between the ages of 12 to 15 months. The Centers for Disease Control and Prevention (CDC) also recommends a booster shot at 4 to 6 years old for further protection. The CDC also recommends that people 13 years of age and older who have never had chickenpox or received the chickenpox vaccine get two doses of the vaccine at least 28 days apart.
A person usually has only one episode of chickenpox, but VZV can lie dormant within the body and cause a different type of skin eruption later in life called shingles (or herpes zoster). Getting the chickenpox vaccine significantly lowers kids' chances of getting chickenpox, but they might still develop shingles later in life.

Symptoms

Chickenpox causes a red, itchy skin rash that usually appears first on the abdomen or back and face, and then spreads to almost everywhere else on the body, including the scalp, mouth, nose, ears, and genitals.
The rash begins as multiple small red bumps that look like pimples or insect bites. They develop into thin-walled blisters filled with clear fluid, which becomes cloudy. The blister wall breaks, leaving open sores, which finally crust over to become dry, brown scabs.
Chickenpox blisters are usually less than a quarter of an inch wide, have a reddish base, and appear in crops over 2 to 4 days. The rash may be more extensive or severe in kids who have skin disorders such as eczema.
Some kids have a fever, abdominal pain, sore throat, headache, or a vague sick feeling a day or 2 before the rash appears. These symptoms may last for a few days, and fever stays in the range of 100°-102° F (37.7°-38.8° C), though in rare cases may be higher. Younger kids often have milder symptoms and fewer blisters than older children or adults.
Chickenpox is usually a mild illness, but can affect some infants, teens, adults, and people with weak immune systems more severely. Some people can develop serious bacterial infections involving the skin, lungs, bones, joints, and the brain (encephalitis). Even kids with normal immune systems can occasionally develop complications, most commonly a skin infection near the blisters.
Anyone who has had chickenpox (or the chickenpox vaccine) as a child is at risk for developing shingles later in life, and up to 20% do. After an infection, VZV can remain inactive in nerve cells near the spinal cord and reactivate later as shingles, which can cause tingling, itching, or pain followed by a rash with red bumps and blisters. Shingles is sometimes treated with antiviral drugs, steroids, and pain medications, and there's now a shingles vaccine for people 60 and older.

Contagiousness

Chickenpox is contagious from about 2 days before the rash appears until all the blisters are crusted over. A child with chickenpox should be kept out of school until all blisters have dried, usually about 1 week. If you're unsure about whether your child is ready to return to school, ask your doctor.
Chickenpox is very contagious — most kids with a sibling who's been infected will get it as well (if they haven't already had the disease or the vaccine), showing symptoms about 2 weeks after the first child does. To help keep the virus from spreading, make sure your kids wash their hands frequently, particularly before eating and after using the bathroom. And keep a child with chickenpox away from unvaccinated siblings as much as possible.
People who haven't had chickenpox or the vaccine also can catch it from someone with shingles, but they cannot catch shingles itself. That's because shingles can only develop from a reactivation of VZV in someone who has previously had chickenpox.

Chickenpox and Pregnancy

Pregnant women and anyone with immune system problems should not be near a person with chickenpox. If a pregnant woman who hasn't had chickenpox in the past contracts it (especially in the first 20 weeks of pregnancy), the fetus is at risk for birth defects and she is at risk for more health complications than if she'd been infected when she wasn't pregnant. If she develops chickenpox just before or after the child is born, the newborn is at risk for serious health complications. There is no risk to the developing baby if the woman develops shingles during the pregnancy.
If a pregnant woman has had chickenpox before the pregnancy, the baby will be protected from infection for the first few months of life, since the mother's immunity gets passed on to the baby through the placenta and breast milk.
Those at risk for severe disease or serious complications — such as newborns whose mothers had chickenpox at the time of delivery, patients with leukemia or immune deficiencies, and kids receiving drugs that suppress the immune system — may be given varicella zoster immune globulin after exposure to chickenpox to reduce its severity.

Prevention

Doctors recommend that kids receive the chickenpox vaccine when they're 12 to 15 months old and a booster shot at 4 to 6 years old. The vaccine is about 70% to 85% effective at preventing mild infection, and more than 95% effective in preventing moderate to severe forms of the infection. Therefore, although some kids who are immunized still will get chickenpox, the symptoms are usually much milder than those of kids who haven't had the vaccine and become infected.
Healthy kids who have had chickenpox do not need the vaccine — they usually have lifelong protection against the illness.

Treatment

A virus causes chickenpox, so the doctor won't prescribe antibiotics. However, antibiotics may be required if the sores become infected by bacteria. This is pretty common among kids because they often scratch and pick at the blisters.
The antiviral medicine acyclovir may be prescribed for people with chickenpox who are at risk for complications. The drug, which can make the infection less severe, must be given within the first 24 hours after the rash appears. Acyclovir can have significant side effects, so it is only given when necessary. Your doctor can tell you if the medication is right for your child.

ealing With Discomfort

To help relieve the itchiness, fever, and discomfort of chickenpox:

Use cool wet compresses or give baths in cool or lukewarm water every 3 to 4 hours for the first few days. Oatmeal bath products, available at supermarkets and drugstores, can help to relieve itching. (Baths do not spread the rash.)
Pat (don't rub) the body dry.
Put calamine lotion on itchy areas (but don't use it on the face, especially near the eyes).
Serve foods that are cold, soft, and bland because chickenpox in the mouth may make drinking or eating difficult. Avoid feeding your child anything highly acidic or especially salty, like orange juice or pretzels.
Ask your doctor or pharmacist about pain-relieving creams to apply to sores in the genital area.
Give your child acetaminophen regularly to help relieve pain if your child has mouth blisters.
Ask the doctor about using over-the-counter medication for itching.

Never use aspirin to reduce pain or fever in kids with chickenpox because aspirin has been associated with the serious disease Reye syndrome, which can lead to liver failure and even death.
As much as possible, discourage kids from scratching. This can be difficult for them, so consider putting mittens or socks on your child's hands to prevent scratching during sleep. In addition, trim fingernails and keep them clean to help lessen the effects of scratching, including broken blisters and infection.
Most chickenpox infections require no special medical treatment. But sometimes, there are problems. Call the doctor if your child:

has fever that lasts for more than 4 days or rises above 102° F (38.8° C)
has a severe cough or trouble breathing
has an area of rash that leaks pus (thick, discolored fluid) or becomes red, warm, swollen, or sore
has a severe headache
is unusually drowsy or has trouble waking up
has trouble looking at bright lights
has difficulty walking
seems confused
seems very ill or is vomiting
has a stiff neck

Call your doctor if you think your child has chickenpox and you have a question or are concerned about a possible complication. The doctor can guide you in watching for complications and in choosing medication to relieve itching.
If taking your child to the doctor, let the office know in advance that your child might have chickenpox. It's important to try to avoid exposing other kids in the office — for some of them, a chickenpox infection could cause severe complications.