Health Care References

Recovery for Stroke Survivors With Magnetic Brain Stimulation

2012-03-14T18:42:00.000+07:00

There is new hope for better recovery for patients who survive a debilitating stroke. Italian researchers have discovered that the use of magnets to stimulate the nerve cells of the brain can help to correct the condition known as hemispatial neglect, which prevents stroke patients from seeing or recognizing anything on one side of their body. The details of the research appear in the journal Neurology.

Previous studies have estimated that between 20 and 50 percent of patients suffer hemispatial neglect following a stroke. The condition most often occurs when stroke damaged is suffered in the right half of the brain.

In a news release, study author Giacomo Koch, MD, Ph.D., of the Santa Lucia Foundation in Rome, Italy stated, “The treatment is based on the theory that hemispatial neglect results when a stroke disrupts the balance between the two hemispheres of the brain. He went on to explaind, “A stroke on one side of the brain causes the other side to become overactive, and the circuits become overloaded.”

Currently, treatment for hemispatial neglect combines physical therapy with brain retraining, which involves performance of mental tasks via a computer or pen and paper. However, the treatment is often not effective enough to provide significant improvement.

A new treatment, known as transcranial magnetic stimulation (TMS), uses a sizable magnetic coil placed against the patient’s scalp to create mild electric currents that stimulate nerve cells, which may have the ability to restore balance between both sides of the brain.

For their study, Koch and colleagues provided daily TMS treatment for 10 of 20 stroke patients who suffered from hemispatial neglect for a period of two weeks. The other 10 participants received a faux treatment, while all of the study subjects took part in brain retraining treatment.

The study participants underwent testing at the end of the study, and then again after an additional two weeks, to measure their abilities to perform daily tasks such as dialing numbers on a phone, reading a menu, and sorting coins, as well as their abilities of line crossing and figure-and-shape-copying.

The findings of the analysis showed that overall, those participants who received TMS had improved by 16.3 percent by the end of treatment, and improvement increased to 22.6 percent after another two weeks. In addition, improvement was seen in the overactive brain circuits of patients who received magnetic treatment. No improvements were noted in test scores of those who received the sham treatment.

While it is possible for patients to recover without treatment after a few weeks following a stroke, their progress can be greatly hampered during the initial weeks of suffering a stroke that are vital to their overall recovery. Use of TMS can help to prevent such hindrance to healing, and may help patients to recover better cognitive abilities and movement.

The researchers noted that the positive results of the study may be due to the combination of the use of both TMS and brain retraining treatments. In addition, because the study was small, more research will be necessary to determine whether TMS is a more effective treatment than brain retraining.

Balanced diet

2012-03-13T19:10:00.001+07:00

Eat a healthy, balanced diet and stay active

The key to a healthy balanced diet is not to ban or omit any foods or food groups but to balance what you eat by consuming a variety of foods from each food group in the right proportions for good health.

Fruit and vegetables

These should make up about a third of your daily diet and can be eaten as part of every meal, as well as being the first choice for a snack.

You should eat at least five portions of fruit and vegetables each day. Research suggests this can help to protect against cancer, obesity and various chronic diseases such as heart disease. This is because of the unique package of nutrients and plant compounds they contain.

Bread, rice, potatoes and pasta

This food group should also make up about a third of your diet and contains the starchy carbohydrates that are the body's main source of energy.

When selecting products from this food group, choose unrefined carbohydrates over those that have been refined, as they will contain the whole of the grain. Wholegrain foods are rich in fibre and other nutrients that have many health benefits, and people who consume wholegrains seem to have a reduced risk of certain cancers, diabetes and coronary heart disease.

The final third of the eatwell plate is made up of three groups containing foods that need to be consumed in smaller proportions than the other two principal categories. These food groups also contain nutrients essential to our diet, so it's important not to leave them out altogether.

Milk and dairy foods

These should be eaten in moderation because of their high saturated fat content, but they're an important source of calcium, which is essential for healthy bones and teeth. Choose low-fat or reduced-fat versions.

Meat, fish, eggs and beans

This food group includes both animal and plant sources of protein, which is a major functional and structural component of all cells. Protein provides the body with between 10 and 15 per cent of its dietary energy, and is needed for growth and repair.

Foods and drinks high in fat and/or sugar

This group makes up the smallest section on the eatwell plate and includes foods that should only be eaten sparingly because, although they're an important energy source, they contain very few nutrients and are often known as 'empty calories'.

Foods from this group are high in unhealthy components such as saturated fat, trans fatty acids, sugar and salt - all of which are associated with an increased risk of developing certain diseases.

They should only be eaten as occasional treats, or to increase the palatability of other important foods (such as olive oil on salads, a scraping of spread on bread, or a sprinkling of sugar on some tart fruits).

How to eat a balanced diet

Eat a variety of foods to obtain all of the essential nutrients
Too much as well as too little can be bad for you – balance is required
Everyone's plate will look slightly different as we all have different requirements depending on our body’s shape and size, and our levels of activity.

Maintaining a healthy, balanced diet

The Food Standards Agency's eight tips for eating well are:

Base meals on starchy foods
Eat lots of fruit and vegetables
Eat more fish
Cut down on saturated fat and sugar
Try to eat less salt - no more than 6g a day
Get active and try to be a healthy weight
Drink plenty of water
Don't skip breakfast

Portion size

In recent years, portions have been gradually getting bigger with the introduction of king-size chocolate bars, bigger bags of crisps and super-sized meals.

Larger packets and plates can encourage us to eat greater quantities of food, which increases our energy intake. Studies have found that consuming additional food doesn't increase your sense of fullness, so think of 'down-sizing' rather than 'super-sizing' for most foods, except fruit and vegetables.

Energy density

This is the amount of stored energy in food. Just 1g of fat provides nine calories, which is more than double the calories in 1g of protein or carbohydrate. This means you can feel fuller on fewer calories if you choose the right foods, and in the long term you're less likely to gain weight.

Healthy living

Food is there to enjoy, which is often forgotten amid all the media hype surrounding various food items. Just remember to keep a check on portion size and energy density.

Food habits change slowly, but

try new foods
join a local cookery club to boost your culinary confidence
have a positive attitude about food – it's one of life's pleasures

Exercise helps to maintain your body weight by balancing your energy intake (food eaten) with energy output (exercise).

Take small steps if you're new to exercise - use the stairs instead of the lift at work, get off the bus one stop early and walk the rest of the way, or try to exercise with a friend.

Low fat diet breast cancer hope

2012-03-13T18:48:00.002+07:00

The research found after five years, breast cancer had returned in 12.4 % of those on a standard diet - but in only 9.8% of those on a low-fat diet.

However, most women did not benefit, and experts say the findings may be due to other factors.

The Los Angeles Biomedical Research Institute study was presented to the American Society of Clinical Oncology.

The study focused on 2,437 women who had surgery for early-stage breast cancer, followed by standard chemotherapy, and tamoxifen if their tumours were receptive to the drug.

On average, the women already followed a healthy diet, gaining 29% of their calories from fat.

Doctors told 1,462 of them to continue their normal diets, averaging 51.3 grams of fat a day.

The rest were given help to follow a low-fat diet, averaging just 33.3 grams of fat a day.

Overall, the low-fat group had a 24% lower risk of the disease coming back.

Hormone positive cancer

However, the only women who benefited were those whose tumours were not helped to grow by the female sex hormone oestrogen.

These women had 42% lower risk of recurrence if they ate low-fat diets - but they accounted for just one in five women in the study, similar to breast cancer cases in the general population.

Results for the other 80% of women in the study did not reach statistical significance - meaning they could have occurred by chance alone.

Dr Len Lichtenfeld, of the American Cancer Society, said the results did not mean that all women with breast cancer should be advised to follow a low-fat diet.

Others noted that women in the low-fat group lost on average four pounds (1.8kg), and that many studies have linked excess weight to excess breast cancer risk.

The low-fat dieters also likely ate more fruits and vegetables and less red meat - other things known to lower breast cancer risk.

Even lead researcher Dr Rowan Chlebowski admitted: "We can't separate those components out."

Dr Eric Winer, of the Dana-Farber Cancer Institute in Boston, also urged caution.

He said: "There are more questions than answers.

"What we don't want to happen is for every woman who's had breast cancer to panic if she's had a Big Mac."

Red meat 'ups breast cancer risk'

2012-03-13T18:45:00.001+07:00

Eating red meat significantly increases a post-menopausal woman's chance of breast cancer, research suggests.

A University of Leeds team monitored 35,000 women over seven years.

Older women who ate one 2oz portion a day (57 grams) had a 56% increased risk compared with those who ate none, the British Journal of Cancer reports.

And those who ate the most processed meat, such as bacon, sausages, ham or pies, had a 64% greater risk of breast cancer than those who refrained.

However, experts warned it was extremely difficult to pin down the effect of specific parts of the diet on cancer risk, and said previous research had produced inconclusive results.

Lead researcher Professor Janet Cade said younger, pre-menopausal women who ate large amounts of red and processed meat also had a raised risk of breast cancer - but the effect was not statistically significant.

Saturated fats

Professor Cade said: "Meat is high in saturated fat, and saturated fat influences the amount of cholesterol the body makes. Cholesterol is precursor to oestrogen, which has been linked to an increased risk of breast cancer.

"Cooking meat at high temperatures might also form carcinogenic compounds.

"My advice to women who are consuming relatively high amounts of red and processed meat on a daily basis is to consider reducing their intake."

Earlier findings from the same study showed that pre-menopausal women who have the greatest intake of fibre have cut their risk of breast cancer in half.

Diet a factor

Dr Alexis Willett, of the charity Breakthrough Breast Cancer, said: "This is an interesting study but because we eat a variety of foods it is difficult to separate out the specific effect of red meat on breast cancer risk.

"Differences in other factors such as age, weight and level of exercise were also found between red meat eaters and non-red meat eaters in this study and may also play a part in the risk of developing breast cancer.

"Previous research studying red meat and breast cancer risk have been inconclusive.

"However, experts estimate that approximately 30% of all cancers in Western countries are linked to diet."

Henry Scowcroft, of Cancer Research UK, said women should maintain a healthy body weight, take regular exercise, and avoid regular portions of fatty foods like red and processed meat.

A US study published in November found eating large amounts of red meat might double young women's breast cancer risk.

The Archives of Internal Medicine study looked at over 90,000 pre-menopausal women.

Having one-and-a-half servings of red meat per day almost doubled the risk of hormone receptor-positive breast cancer compared to three or fewer per week.

However, UK cancer experts said animals in the UK were not given growth hormones which are used for US animals.

Eat less red meat to reduce cancer risk

2012-03-13T18:38:00.001+07:00

New advice recommends eating no more than 70g a day - equivalent to three rashers of bacon or two sausages.

Experts say thousands of bowel cancer deaths could be prevented every year if people kept to the new limits.

Advisers to the Department of Health in England say the restrictions would not put people at risk of iron deficiencies.

Bowel Cancer is the third most common cancer in the UK - about 36,000 people are diagnosed every year, and 16,500 die.

Eating 100 to 120g of red and processed meat a day - things like salami, ham and sausages - increases the risk of developing the condition by 20 to 30%, according to studies.

But some commentators have questioned whether reducing red meat consumption would put people at greater risk of iron deficiency; red meat is a very good source of iron.

Iron deficiency causes anaemia, which leads to tiredness and dizzy spells, can affect brain development and result in behavioural problems.

'Occasional steak'

But a report from the Scientific Advisory Committee on Nutrition says if adults cut back to 70g of red meat a day, there would not be much impact on the number of people with low iron intake.

"Red meat can be part of a healthy balanced diet," said the interim Chief Medical Officer for England, Professor Sally Davies, "but people who eat a lot should consider cutting down."

"The occasional steak or extra few slices of lamb is fine, but regularly eating a lot could increase your risk of bowel cancer."

The charity Beating Bowel Cancer welcomed the report.

"A diet high in red and processed meat may increase your risk of developing bowel cancer," said chief executive Mark Flannagan. "But the good news is that red meat can still be enjoyed in moderation."

Some experts, though, say the advice should distinguish between red and processed meat, which is thought to carry a higher bowel cancer risk.

The World Cancer Research Fund advises avoiding processed meat altogether.

"We would suggest that people following this new report's guidelines should try and make sure as little as possible of their 70g per day is processed," said Dr Rachel Thompson, deputy head of science for the fund.

Study Says : Red meat increases death, cancer and heart risk

2012-03-13T18:35:00.000+07:00

The study of more than 120,000 people suggested red meat increased the risk of death from cancer and heart problems.

Substituting red meat with fish, chicken or nuts lowered the risks, the authors said.

The British Heart Foundation said red meat could still be eaten as part of a balanced diet.

The researchers analysed data from 37,698 men between 1986 and 2008 and 83,644 women between 1980 and 2008.

They said adding an extra portion of unprocessed red meat to someone's daily diet would increase the risk of death by 13%, of fatal cardiovascular disease by 18% and of cancer mortality by 10%. The figures for processed meat were higher, 20% for overall mortality, 21% for death from heart problems and 16% for cancer mortality.

The study said: "We found that a higher intake of red meat was associated with a significantly elevated risk of total, cardiovascular disease, and cancer mortality.

"This association was observed for unprocessed and processed red meat with a relatively greater risk for processed red meat."

The researchers suggested that saturated fat from red meat may be behind the increased heart risk and the sodium used in processed meats may "increase cardiovascular disease risk through its effect on blood pressure".

Victoria Taylor, a dietitian at the British Heart Foundation, said: "Red meat can still be eaten as part of a balanced diet, but go for the leaner cuts and use healthier cooking methods such as grilling.

"If you eat processed meats like bacon, ham, sausages or burgers several times a week, add variation to your diet by substituting these for other protein sources such as fish, poultry, beans or lentils."

What is Prostate Cancer?

2012-03-12T17:45:00.001+07:00

Definition

Prostate cancer is cancer that starts in the prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man's reproductive system. It wraps around the urethra, the tube that carries urine out of the body.

Symptoms

Thanks to PSA testing, most prostate cancers are now found before they cause symptoms. Although most of the symptoms listed below can occur with prostate cancer, they are more likely to be associated with noncancerous conditions.

Urinary hesitancy (delayed or slowed start of urinary stream)

Urinary dribbling, especially immediately after urinating

Urinary retention

Pain with urination

Pain with ejaculation

Lower back pain

Pain with bowel movement

Other symptoms that may occur with this disease:

Excessive urination at night

Urinary leakage (incontinence)

Bone pain or tenderness

Blood in the urine (hematuria)

Abdominal pain

Low red blood cell count (anemia)

Unintentional weight loss

Lethargy

Causes & Risk Factors

The cause of prostate cancer is unknown. Some studies have shown a relationship between high dietary fat intake and increased testosterone levels.

There is no known association with an enlarged prostate or benign prostatic hyperplasia (BPH).

Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.

People who are at higher risk include:

African-American men

Men who are older than 60

Farmers

Tire plant workers

Painters

Men who have been exposed to cadmium

The lowest number of cases occurs in Japanese men and those who do not eat meat (vegetarians).

Tests & Diagnostics

A rectal exam will often show an enlarged prostate with a hard, irregular surface.

A number of tests may be done to diagnose prostate cancer:

PSA test (may be high, although noncancerous enlargement of the prostate can also increase PSA levels)

Free PSA (may help tell the difference between BPH and prostate cancer)

AMACR (a newer test that is more sensitive than the PSA test for determining prostate cancer)

Urinalysis (may show blood in the urine)

Urine or prostatic fluid testing (may reveal unusual cells)

Prostate biopsy is the only test that can confirm the diagnosis.

The following tests may be done to determine whether the cancer has spread:

CT scan

Bone scan

Chest x-ray

Health care providers use a system called staging to describe how far the cancer has grown. Tumor size, and how far the cancer has spread outside of the prostate determine the stage. Identifying the correct stage may help the doctor recommend the best treatment.

There are several different ways to stage tumors, including:

The TNM staging system (most common)

The A-B-C-D staging system, also known as the Whitmore-Jewett system

The grade of a tumor describes how aggressive a cancer might be. The more tumor cells differ from normal tissue, the faster these cells are likely to grow. The grading system for prostate cancer is called the Gleason grade or score. Higher scores are usually faster growing cancers.

Treatments

The appropriate treatment for prostate cancer is not clear. Treatment options vary based on the stage of the tumor. In the early stages, talk to your doctor about several options including surgery, radiation therapy, or, in older patients, monitoring the cancer without active treatment.

Prostate cancer that has spread may be treated with drugs to reduce testosterone levels, surgery to remove the testes, or chemotherapy.

Surgery, radiation therapy, and hormonal therapy can interfere with sexual desire or performance on either a temporary or permanent basis. Discuss your concerns with your health care provider.

SURGERY

Surgery is usually only recommended after a thorough evaluation and discussion of all treatment options. A man considering surgery should be aware of the benefits and risks of the procedure.

Surgery to remove the prostate gland is often recommended for treating stages A and B prostate cancers. This is a lengthy procedure and complications are possible. There are many different surgery options. See: Radical prostatectomy and Robotic surgery.

Orchiectomy alters hormone production and may be recommended for cancer that has spread to other areas of the body. There may be some bruising and swelling right after surgery, but this will gradually go away. The loss of testosterone production may lead to problems with sexual function, osteoporosis (thinning of the bones), and loss of muscle mass.

RADIATION THERAPY

Radiation therapy is used primarily to treat stage A, B, or C prostate cancers. Whether radiation is as good as prostate removal is unclear. The decision about which treatment to choose can be difficult. In patients whose health makes surgery too risky, radiation therapy is often the preferred alternative. Radiation therapy to the prostate gland is either external or internal:

External beam radiation therapy is done in a radiation oncology center by specially trained radiation oncologists, usually on an outpatient basis. Before treatment, a therapist will mark the part of the body that is to be treated with a special pen. The radiation is delivered to the prostate gland using a device that looks like a normal x-ray machine. The treatment itself is generally painless. Side effects may include impotence, incontinence, appetite loss, fatigue, skin reactions such as redness and irritation, rectal burning or injury, diarrhea, inflamed bladder (cystitis), and blood in urine. External beam radiation therapy is usually done 5 days a week for 6 - 8 weeks.

Prostate brachytherapy or internal radiation involves placing radioactive seeds inside you, directly into the prostate. A surgeon inserts small needles through the skin behind your scrotum to inject the seeds. The seeds are so small that you don't feel them. They can be temporary or permanent. Because internal radiation therapy is directed to the prostate, it reduces damage to the tissues around the prostate. Prostate brachytherapy may be given for early, slow-growing prostate cancers. It also may be given with external beam radiation therapy for some patients with more advanced cancer. Side effects may include pain, swelling or bruising in your penis or scrotum, red-brown urine or semen, impotence, incontinence, and diarrhea.

Radiation is sometimes used for pain relief when cancer has spread to the bone.

MEDICATIONS

Medicines can be used to adjust the levels of testosterone. This is called hormonal manipulation. Because prostate tumors require testosterone to grow, reducing the testosterone level often works very well at preventing further growth and spread of the cancer. Hormone manipulation is mainly used to relieve symptoms in men whose cancer has spread. It may also be done by surgically removing the testes.

The drugs Lupron and Zoladex are also being used to treat advanced prostate cancer. These medicines block the production of testosterone. The procedure is often called chemical castration, because it has the same result as surgical removal of the testes. However, unlike surgery, it is reversible. The drugs must be given by injection, usually every 3 - 6 months. Possible side effects include nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, reduced sexual desire, and impotence.

Other medications used for hormonal therapy include androgen-blocking drugs (such as flutamide), which prevent testosterone from attaching to prostate cells. Possible side effects include erectile dysfunction, loss of sexual desire, liver problems, diarrhea, and enlarged breasts.

Chemotherapy is often used to treat prostate cancers that are resistant to hormonal treatments. An oncology specialist will usually recommend a single drug or a combination of drugs. Chemotherapy medications that may be used to treat prostate cancer include:

Adriamycin

Docetaxel

Estramustine

Mitoxantrone

Paclitaxel

Prednisone

After the first round of chemotherapy, most men receive further doses on an outpatient basis at a clinic or physician's office. Side effects depend on the drug, how often you take it, and for how long. Some of the side effects for the most commonly used prostate cancer chemotherapy drugs include:

Blood clots

Bruising

Dry skin

Fatigue

Fluid retention

Hair loss

Lowering of your white cells, red cells, or platelets

Mouth sores

Nausea

Tingling or numbness in hands and feet

Upset stomach

Weight gain

MONITORING

You will be closely watched to make sure the cancer does not spread. This involves routine doctor check-ups. Monitoring may include:

Serial PSA blood test (usually every 3 months to 1 year)

Bone scan or CT scan to check whether the cancer has spread

Complete blood count (CBC) to monitor for signs and symptoms of anemia

Monitoring for other signs and symptoms, such as fatigue, weight loss, increased pain, decreased bowel and bladder function, and weakness

Complications

Impotence is a potential complication after prostate removal or radiation therapy. Recent improvements in surgical procedures have made this complication less common. Urinary incontinence is another possible complication. Medications can have side effects, including hot flashes and loss of sexual desire.

Prevention

There is no known way to prevent prostate cancer. Following a vegetarian, low-fat diet or one that is similar to the traditional Japanese diet may lower your risk. Early identification (as opposed to prevention) is now possible by screening men over age 40 each year with a digital rectal examination (DRE) and PSA blood test.

There is a debate, however, as to whether PSA testing should be done in all men. There are several potential downsides to PSA testing. The first is that a high PSA level does not always mean that a patient has prostate cancer. The second is that health care providers are detecting and treating some very early-stage prostate cancers that may never have caused the patient any harm. The decision about whether to use a PSA testing to screen for prostate cancer should be based on a discussion between the patient and his health care provider.

What is Multiple Myeloma ?

2012-03-12T17:31:00.001+07:00

Definition

Multiple myeloma is cancer of the plasma cells in bone marrow.

Symptoms

Bleeding problems
Bone or back pain
Increased susceptibility to infection
Symptoms of anemia (such as tiredness, shortness of breath, and fatigue)
Unexplained fractures

Causes & Risk Factors

Plasma cells help the body's immune system fight disease by producing substances called antibodies. In multiple myeloma, plasma cells grow out of control and form tumors in the bone marrow.

The excess growth of plasma cells interferes with the body's ability to make red blood cells, white blood cells, and platelets. This causes anemia, which makes a person more likely to get infections and have abnormal bleeding.

As the cancer cells grow in the bone marrow, they can cause pain and destruction of the bones. If the bones in the spine are affected, it can put pressure on the nerves, resulting in numbness or paralysis.

Multiple myeloma mainly affects older adults. A history of radiation therapy raises your risk for this type of cancer.

Tests & Diagnostics

Blood tests can help diagnose this disease. They may include:

Blood chemistry (CHEM 20) may show increased levels of calcium, total protein, and abnormal kidney function
Complete blood count (CBC) reveals low numbers of red and white blood cells and platelets
Serum protein electropheresis (SPEP)
Urine protein electrophoresis (UPEP) or Bence-Jones protein analysis
Quantitative immunoglobulins (nephelometry)

Bone x-rays show fractures or hollowed out areas of bone. If your doctor suspects this type of cancer, a bone marrow biopsy will be performed.

Treatments

The goal of treatment is to relieve symptoms.

People who have mild disease or a questionable diagnosis are usually carefully monitored without treatment. Some people have a slow-developing form of multiple myeloma that takes years to cause symptoms.

Treatment begins when the disease becomes worse or causes symptoms.

Chemotherapy and radiation therapy may be performed to relieve bone pain or treat a bone tumor.

Bone marrow transplantation in younger patients has been shown to increase disease-free and overall survival, but it has significant risks.

Medications for multiple myeloma include decadron, melophalan, thalidomide, lenalidomide (Revlimid), and bortezomib (Velcade). Bisphosphonates are used to prevent fractures.

People with multiple myeloma should drink plenty of fluids to prevent dehydration and help maintain proper kidney function. They should also be cautious when having x-ray tests that use contrast dye.

Chemotherapy and transplants rarely lead to a permanent cure.

Complications

Kidney failure is a frequent complication. Other complications may include:

Bone fractures
Increased chances for infection (especially pneumonia)
Paralysis from tumor or spinal cord compression

Prevention

There are no clearly-established risk factors for multiple myeloma and it is possible that a combination of factors interact to cause the disease. Thus, there is no method for preventing multiple myeloma.

What is Osteoarthritis ?

2012-03-12T17:15:00.000+07:00

Definition

Osteoarthritis (OA) is the most common joint disorder.

Symptoms

The symptoms of osteoarthritis include:

Deep aching joint pain that gets worse after exercise or putting weight on it, and is relieved by rest
Pain that is worse when you start activities after a period of no activity
Over time, pain is present even when you are at rest
Grating of the joint with motion
Increase in pain during humid or moist weather
Joint swelling
Limited movement
Muscle weakness around arthritic joints

Some people might not have symptoms.

Causes & Risk Factors

In osteoarthritis, the cushioning (cartilage) between the bones wears away in the joints. As osteoarthritis gets worse, the cartilage disappears and bone rubs on bone. Bony spurs or growths usually form around the joint. The ligaments and muscles around the joint loosen and become weaker.

Often, the cause of OA is unknown. It is mainly related to aging, but other factors can also lead to OA.

Osteoarthritis tends to run in families
Being overweight increases the risk
Fractures or other joint injuries can lead to osteoarthritis later in life
Long-term overuse at work or in sports can lead to osteoarthritis

Medical conditions that can lead to osteoarthritis include:

Bleeding disorders that cause bleeding in the joint, such as hemophilia
Disorders that block the blood supply near a joint, such as avascular necrosis
Other types of arthritis, such as chronic gout, pseudogout, or rheumatoid arthritis

The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in men and women. After age 55, it is more common in women.

Tests & Diagnostics

A physical exam can show:

Joint movement may cause a cracking (grating) sound
Joint swelling (bones around the joints may feel larger than normal)
Limited range of motion
Tenderness when the joint is pressed
Normal movement is often painful

No blood tests are helpful in diagnosing osteoarthritis.

An x-ray of affected joints will show a loss of the joint space. In advanced cases, there will be a wearing down of the ends of the bone and bone spurs.

Treatments

The goals of treatment are to:

Increase the strength of the joints
Maintain or improve joint movement
Reduce the disabling effects of the disease
Relieve pain

The treatment depends on which joints are involved.

MEDICATIONS

Over-the-counter pain relievers can help with symptoms. Most doctors recommend acetaminophen (Tylenol) first, because it has fewer side effects than other drugs.

If your pain continues, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs help relieve pain and swelling. Types of NSAIDs include aspirin, ibuprofen, and naproxen.

However, long-term use of NSAIDs can cause stomach problems, such as ulcers and bleeding. These drugs may also increase the risk for heart attacks and strokes.

The prescription drug, Celebrex (a COX-2 inhibitor) may work as well as other NSAIDs. Because of a risk for heart attacks and stroke, it is given only at the lowest possible dose for the shortest possible period of time.

Corticosteroids injected right into the joint can also be used to reduce swelling and pain. However, relief only lasts for a short time.

Many people use over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage. Some doctors recommend a trial period of 3 months to see whether glucosamine and chondroitin work.

Capsaicin (Zostrix) skin cream may help relieve pain. You may feel a warm, stinging sensation when you first apply the cream. This sensation goes away after a few days of use. Pain relief usually begins within 1 - 2 weeks.

Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee. It may relieve pain for 3 - 6 months.

LIFESTYLE CHANGES

Exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.

Other lifestyle recommendations include:

Applying heat and cold
Eating a healthy, balanced diet
Getting rest
Losing weight if you are overweight
Protecting the joints

People whose work is causing stress in certain joints should find ways to reduce trauma. You may need to adjust the work area or change work tasks.

PHYSICAL THERAPY

Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3 - 6 weeks, then it likely will not work at all.

BRACES

Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.

SURGERY

Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:

Arthroscopic surgery to trim torn and damaged cartilage
Changing the alignment of a bone to relieve stress on the bone or joint (osteotomy)
Surgical fusion of bones, usually in the spine (arthrodesis)
Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty, hip arthroplasty)

Drugs

Patients with mild OA may be treated only with pain relievers such as acetaminophen (i.e., Tylenol). Most patients with OA, however, are given nonsteroidal anti-inflammatory drugs (NSAIDs). These include compounds such as ibuprofen (e.g., Motrin, Advil), ketoprofen (e.g., Orudis), and naproxen (e.g. Naprosyn). NSAIDs have the advantage of relieving slight inflammation as well as pain. Patients taking NSAIDS, however, may experience side effects, including stomach ulcers, sensitivity to sun exposure, kidney disturbances, and nervousness/anxiety or depression. Topical capsaicin cream (e.g., AthriCare) may provide relief when applied to affected areas.

Some OA patients are treated with corticosteroids, which are injected directly into the joints to reduce inflammation. As of 2001, studies were being conducted regarding the use of hyaluronic acid, which is more commonly injected into the knee. Because the joint naturally contains some hyaluronic acid (for joint lubrication), the addition of extra hyaluronic acid can protect the joint, in some cases, for six months to one year.

Alternative Therapies

For more information and support, see arthritis resources.

Complications

Adverse reactions to drugs used for treatment
Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking
Decreased ability to walk
Surgical complications

What is Migraine Headache ?

2012-03-12T16:39:00.001+07:00

Definition

A migraine is a common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head.

Some people who get migraines have warning symptoms, called an aura, before the actual headache begins. An aura is a group of symptoms, usually vision disturbances, that serve as a warning sign that a bad headache is coming. Most people, however, do not have such warning signs.

Symptoms

Vision disturbances, or aura, are considered a "warning sign" that a migraine is coming. The aura occurs in both eyes and may involve any or all of the following:

A temporary blind spot

Blurred vision

Eye pain

Seeing stars or zigzag lines

Tunnel vision

Not every person with migraines has an aura. Those who do usually develop one about 10 - 15 minutes before the headache. However, it may occur just a few minutes to 24 hours beforehand.

Migraine headaches can be dull or severe. The pain may be felt behind the eye or in the back of the head and neck. For many patients, the headaches start on the same side each time. The headaches usually:

Feel throbbing, pounding, or pulsating

Are worse on one side of the head

Start as a dull ache and get worse within minutes to hours

Last 6 to 48 hours

Other symptoms that may occur with the headache include:

Chills

Increased urination

Fatigue

Loss of appetite

Nausea and vomiting

Numbness, tingling, or weakness

Problems concentrating, trouble finding words

Sensitivity to light or sound

Sweating

Symptoms that may linger even after the migraine has gone away include:

Feeling mentally dull, like your thinking is not clear or sharp

Increased need for sleep

Neck pain

Causes & Risk Factors

A lot of people get migraines -- about 11 out of 100. The headaches tend to first appear between the ages of 10 and 46. Occasionally, migraines may occur later in life in a person with no history of such headaches. Migraines occur more often in women than men, and may run in families. Women may have fewer migraines when they are pregnant. Most women with such headaches have fewer attacks during the last two trimesters of pregnancy.

A migraine is caused by abnormal brain activity, which is triggered by stress, certain foods, environmental factors, or something else. However, the exact chain of events remains unclear.

Scientists used to believe that migraines were due to changes in blood vessels within the brain. Today, most medical experts believe the attack actually begins in the brain itself, where it involves various nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues.

Migraine attacks may be triggered by:

Alcohol

Allergic reactions

Bright lights

Certain odors or perfumes

Changes in hormone levels (which can occur during a woman's menstrual cycle or with the use of birth control pills)

Changes in sleep patterns

Exercise

Loud noises

Missed meals

Physical or emotional stress

Smoking or exposure to smoke

Certain foods and preservatives in foods may trigger migraines in some people. Food-related triggers may include:

Any processed, fermented, pickled, or marinated foods

Baked goods

Chocolate

Dairy products

Foods containing monosodium glutamate (MSG)

Foods containing tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans

Fruits (avocado, banana, citrus fruit)

Meats containing nitrates (bacon, hot dogs, salami, cured meats)

Nuts

Onions

Peanut butter

This list may not be all-inclusive.
True migraine headaches are not a result of a brain tumor or other serious medical problem. However, only an experienced health care provider can determine whether your symptoms are due to a migraine or another condition.

Tests & Diagnostics

Your doctor can diagnose this type of headache by asking questions about your symptoms and family history of migraines, and by monitoring how you respond to treatment. A complete physical exam will be done to make sure that your headaches are not due to muscle tension, sinus problems, or a more serious underlying brain disorder.

Tests are usually not needed if you have typical signs and symptoms of migraines. However, your doctor may order a brain MRI or CT scan to rule out other causes.

If you have a migraine with unusual symptoms such as weakness, memory problems, or loss of alertness, an EEG may be needed to rule out seizures. Rarely, a lumbar puncture (spinal tap) might be done.

reatments

There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or changing your triggers.

A good way to identify triggers is to keep a headache diary. Write down:

When your headaches occur

How severe they are

What you've eaten

How much sleep you had

Other symptoms

Other possible factors (women should note where they are in their menstrual cycle)

For example, the diary may reveal that your headaches tend to occur more often on days when you wake up earlier than usual. Changing your sleep schedule may result in fewer migraine attacks.

When you do get migraine symptoms, try to treat them right away. The headache may be less severe. When migraine symptoms begin:

Drink water to avoid dehydration, especially if you have vomited

Rest in a quiet, darkened room

Place a cool cloth on your head

Many different medications are available for people with migraines. Medicines are used to:

Reduce the number of attacks

Stop the migraine once early symptoms occur

Treat the pain and other symptoms

REDUCING ATTACKS
If you have frequent migraines, your doctor may prescribe medicine to reduce the number of attacks. Such medicine needs to be taken every day in order to be effective. Such medications may include:

Antidepressants such as amitriptyline

Blood pressure medicines such as beta blockers (propanolol) or calcium channel blockers (verapamil)

Seizure medication such as valproic acid and topiramate

Serotonin reuptake inhibitors (SSRIs) such as venlafaxine

STOPPING AN ATTACK
Other medicines are taken at the first sign of a migraine attack. Over-the-counter pain medications such as acetaminophen, ibuprofen, or aspirin are often helpful, especially when your migraine is mild. (Be aware, however, that overuse or misuse of such pain medications may result in rebound headaches.) If these don't help, ask your doctor about prescription medications.

Your doctor can select from several different types of medications, including:

Triptans -- the most frequently prescribed medicines for stopping migraine attacks -- such as almotriptan (Axert), frovatriptan (Frova), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig)

Ergots such as dihydroergotamine or ergotamine with caffeine (Cafergot)

Isometheptene (Midrin)

These medications come in different forms. Patients who have nausea and vomiting with their migraines may be prescribed a nasal spray or injection instead of pills.

Some migraine medicines narrow your blood vessels and should not be used if you are at risk for heart attacks or have heart disease, unless otherwise instructed by your health care provider. Ergots should not be taken if you are pregnant or planning to become pregnant, because they can cause serious side effects to an unborn baby.

TREATING SYMPTOMS
Other medications are primarily given to treat the symptoms of migraine. Used alone or in combinations, these drugs can reduce your pain, nausea, or emotional distress. Medications in this group include:

Nausea medicines such as prochlorperazine

Over-the-counter pain relievers such as acetaminophen (Tylenol)

Sedatives such as butalbital

Narcotic pain relievers such as meperidine

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen

If you wish to consider an alternative, feverfew is a popular herb for migraines. Several studies, but not all, support using feverfew for treating migraines. If you are interested in trying feverfew, make sure your doctor approves. Also, know that herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.

Complications

Migraine headaches generally represent no significant threat to your overall health. However, they can be a long-term (chronic) problem and may interfere with your day-to-day life.

Prevention

Understanding your headache triggers can help you avoid foods and situations that cause your migraines. Keep a headache diary to help identify the source or trigger of your symptoms. Then modify your environment or habits to avoid future headaches.
Other tips for preventing migraines include:

Avoid smoking

Avoid alcohol

Avoid artificial sweeteners and other known food-related triggers

Get regular exercise

Get plenty of sleep each night

Learn to relax and reduce stress -- some patients have found that biofeedback and self-hypnosis helps reduce the number of migraine attacks

What is Gastroesophageal Reflux Disease (GERD) ?

2012-03-11T22:17:00.002+07:00

Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.

Symptoms

More common symptoms are:

Feeling that food may be left trapped behind the breastbone
Heartburn or a burning pain in the chest (under the breastbone)
- Increased by bending, stooping, lying down, or eating
- More likely or worse at night
- Relieved by antacids
Nausea after eating

Less common symptoms are:

Cough or wheezing
Difficulty swallowing
Hiccups
Hoarseness or change in voice
Regurgitation of food
Sore throat

Causes & Risk Factors

When you eat, food passes from the throat to the stomach through the esophagus (also called the food pipe or swallowing tube). Once food is in the stomach, a ring of muscle fibers prevents food from moving backward into the esophagus. These muscle fibers are called the lower esophageal sphincter, or LES.

If this sphincter muscle doesn't close well, food, liquid, and stomach acid can leak back into the esophagus. This is called reflux or gastroesophageal reflux. This reflux may cause symptoms, or can even damage the esophagus.

The risk factors for reflux include hiatal hernia (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities), pregnancy, and scleroderma.

Obesity, cigarettes, and possibly alcohol also increase the chance of GERD.

Heartburn and gastroesophageal reflux can be brought on or worsened by pregnancy and many different medications. Such drugs include:

Anticholinergics (e.g., for seasickness)
Beta-blockers for high blood pressure or heart disease
Bronchodilators for asthma
Calcium channel blockers for high blood pressure
Dopamine-active drugs for Parkinson's disease
Progestin for abnormal menstrual bleeding or birth control
Sedatives for insomnia or anxiety
Tricyclic antidepressants

If you suspect that one of your medications may be causing heartburn, talk to your doctor. Never change or stop a medication you take regularly without talking to your doctor.

Tests & Diagnostics

You may not need any tests if your symptoms are not severe.

If your symptoms are severe or they come back after you have been treated, one or more tests may help diagnose reflux or any complications:

Esophagogastroduodenoscopy (EGD) is often used to identify the cause and examine the esophagus (swallowing tube) for damage. The doctor inserts a thin tube with a camera on the end through your mouth. The tube is then passed into your esophagus, stomach, and small intestine.
Barium swallow
Continuous esophageal pH monitoring
Esophageal manometry

A positive stool occult blood test may diagnose bleeding from the irritation in the esophagus.

Treatments

To prevent heartburn, avoid foods and beverages that may trigger your symptoms. For many people, these include:

Alcohol
Caffeine
Carbonated beverages
Chocolate
Citrus fruits and juices
Tomatoes
Tomato sauces
Spicy or fatty foods
Full-fat dairy products
Peppermint
Spearmint

If other foods regularly give you heartburn, avoid those foods, too.

Also, try the following changes to your eating habits and lifestyle:

Avoid bending over or exercising just after eating
Avoid garments or belts that fit tightly around your waist
Do not lie down with a full stomach. For example, avoid eating within 2 -3 hours of bedtime.
Do not smoke.
Eat smaller meals.
Lose weight if you are overweight.
Reduce stress.
Sleep with your head raised about 6 inches. Do this by tilting your entire bed, or by using a wedge under your body, not just with normal pillows.

Over-the-counter antacids may be used after meals and at bedtime, although they do not last very long. Common side effects of antacids include diarrhea or constipation.

Other over-the-counter and prescription drugs can treat GERD. They work more slowly than antacids but give you longer relief. Your doctor or nurse can tell you how to take these drugs.

Proton pump inhibitors (PPIs) are the most potent acid inhibitors: omeprazole (Prilosec), esomeprazole (Nexium), iansoprazole (Prevacid), rabeprazle (AcipHex), and pantoprazole (Protonix)
H2 antagonists: famotidine (Pepsid), cimetidine (Tagamet), ranitidine (Zantac), and nizatidine (Axid)
Promotility agents: metoclopramide (Reglan)

Anti-reflux operations (Nissen fundoplication and others) may be an option for patients whose symptoms do not go away with lifestyle changes and drugs. Heartburn and other symptoms should improve after surgery, but you may still need to take drugs for your heartburn. There are also new therapies for reflux that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach).

Complications

Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)
Bronchospasm (irritation and spasm of the airways due to acid)
Chronic cough or hoarseness
Dental problems
Esophageal ulcer
Inflammation of the esophagus
Stricture (a narrowing of the esophagus due to scarring from the inflammation)

Prevention

Heartburn prevention techniques
Looking at the esophagus with an endoscope and obtaining a sample of esophagus tissue for examination (esophagoscopy with biopsy) may be recommended to diagnose Barrett's esophagus.
Follow-up endoscopy to look for dysplasia or cancer is often advised.

What is Diabetes ?

2012-03-11T21:59:00.001+07:00

Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood.

Causes, incidence, and risk factors

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.

To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:

A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.

People with diabetes have high blood sugar. This is because:

Their pancreas does not make enough insulin
Their muscle, fat, and liver cells do not respond to insulin normally
Both of the above

There are three major types of diabetes:

Type 1 diabetes is usually diagnosed in childhood. Many patients are diagnosed when they are older than age 20. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown. Genetics, viruses, and autoimmune problems may play a role.
Type 2 diabetes is far more common than type 1. It makes up most of diabetes cases. It usually occurs in adulthood, but young people are increasingly being diagnosed with this disease. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to increasing obesity and failure to exercise.
Gestational diabetes is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes. Women who have gestational diabetes are at high risk of type 2 diabetes and cardiovascular disease later in life.

Diabetes affects more than 20 million Americans. Over 40 million Americans have prediabetes (early type 2 diabetes).

There are many risk factors for type 2 diabetes, including:

Age over 45 years
A parent, brother, or sister with diabetes
Gestational diabetes or delivering a baby weighing more than 9 pounds
Heart disease
High blood cholesterol level
Obesity
Not getting enough exercise
Polycystic ovary disease (in women)
Previous impaired glucose tolerance
Some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans)

Symptoms

High blood levels of glucose can cause several problems, including:

Blurry vision
Excessive thirst
Fatigue
Frequent urination
Hunger
Weight loss

However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.

Symptoms of type 1 diabetes:

Fatigue
Increased thirst
Increased urination
Nausea
Vomiting
Weight loss in spite of increased appetite

Patients with type 1 diabetes usually develop symptoms over a short period of time. The condition is often diagnosed in an emergency setting.

Symptoms of type 2 diabetes:

Blurred vision
Fatigue
Increased appetite
Increased thirst
Increased urination

Signs and tests

A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes.

The following blood tests are used to diagnose diabetes:

Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions. Levels between 100 and 126 mg/dL are referred to as impaired fasting glucose or prediabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.
Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours. (This test is used more for type 2 diabetes.)
Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic diabetes symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)

Persons with diabetes need to have their hemoglobin A1c (HbA1c) level checked every 3 - 6 months. The HbA1c is a measure of average blood glucose during the previous 2 - 3 months. It is a very helpful way to determine how well treatment is working.

Treatment

The immediate goals are to treat diabetic ketoacidosis and high blood glucose levels. Because type 1 diabetes can start suddenly and have severe symptoms, people who are newly diagnosed may need to go to the hospital.

The long-term goals of treatment are to:

Prolong life
Reduce symptoms
Prevent diabetes-related complications such as blindness, heart disease, kidney failure, and amputation of limbs

These goals are accomplished through:

Blood pressure and cholesterol control
Careful self testing of blood glucose levels
Education
Exercise
Foot care
Meal planning and weight control
Medication or insulin use

There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms.

LEARN THESE SKILLS

Basic diabetes management skills will help prevent the need for emergency care. These skills include:

How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
What to eat and when
How to take insulin or oral medication
How to test and record blood glucose
How to test urine for ketones (type 1 diabetes only)
How to adjust insulin or food intake when changing exercise and eating habits
How to handle sick days
Where to buy diabetes supplies and how to store them

After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. Review and update your knowledge, because new research and improved ways to treat diabetes are constantly being developed.

SELF-TESTING

If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes. It can help your doctor prevent complications.

The American Diabetes Association recommends keeping blood sugar levels in the range of:

80 - 120 mg/dL before meals
100 - 140 mg/dL at bedtime

Your doctor may adjust this depending on your circumstances.

WHAT TO EAT

You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can help you plan your dietary needs.

People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low.

People with type 2 diabetes should follow a well-balanced and low-fat diet.

HOW TO TAKE MEDICATION

Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.

People with type 1 diabetes cannot make their own insulin. They need daily insulin injections. Insulin does not come in pill form. Injections are generally needed one to four times per day. Some people use an insulin pump. It is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use inhaled insulin. See also: Type 1 diabetes

Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes. See also: Type 2 diabetes

Medications may be switched to insulin during pregnancy and while breastfeeding.

Gestational diabetes may be treated with exercise and changes in diet.

EXERCISE

Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than those who do not exercise regularly.

Here are some exercise considerations:

Always check with your doctor before starting a new exercise program.
Ask your doctor or nurse if you have the right footwear.
Choose an enjoyable physical activity that is appropriate for your current fitness level.
Exercise every day, and at the same time of day, if possible.
Monitor blood glucose levels before and after exercise.
Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
Carry a diabetes identification card and a cell phone in case of emergency.
Drink extra fluids that do not contain sugar before, during, and after exercise.

You may need to change your diet or medication dose if you change your exercise intensity or duration to keep blood sugar levels from going too high or low.

FOOT CARE

People with diabetes are more likely to have foot problems. Diabetes can damage blood vessels and nerves and decrease the body's ability to fight infection. You may not notice a foot injury until an infection develops. Death of skin and other tissue can occur.

If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.

To prevent injury to the feet, check and care for your feet every day.

Expectations (prognosis)

With good blood glucose and blood pressure control, many of the complications of diabetes can be prevented.

Studies have shown that strict control of blood sugar, cholesterol, and blood pressure levels in persons with diabetes helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.

Complications

Emergency complications include:

Diabetic hyperglycemic hyperosmolar coma
Diabetic ketoacidosis

Long-term complications include:

Atherosclerosis
Coronary artery disease
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy
Erection problems
Hyperlipidemia
Hypertension
Infections of the skin, female urinary tract, and urinary tract
Peripheral vascular disease
Stroke

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of ketoacidosis:

Abdominal pain
Deep and rapid breathing
Increased thirst and urination
Loss of consciousness
Nausea
Sweet-smelling breath

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction):

Confusion
Convulsions or unconsciousness
Dizziness
Double vision
Drowsiness
Headache
Lack of coordination
Weakness

Prevention

Maintaining an ideal body weight and an active lifestyle may prevent type 2 diabetes.

Currently there is no way to prevent type 1 diabetes.

There is no effective screening test for type 1 diabetes in people who don't have symptoms.

Screening for type 2 diabetes and people with no symptoms is recommended for:

Overweight children who have other risk factors for diabetes starting at age 10 and repeating every 2 years
Overweight adults (BMI greater than 25) who have other risk factors
Adults over 45, repeated every 3 years

To prevent complications of diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having.

Regularly have the following tests:

Have your blood pressure checked every year (blood pressure goals should be 130/80 mm/Hg or lower).
Have your glycosylated hemoglobin (HbA1c) checked every 6 months if your diabetes is well controlled, otherwise every 3 months.
Have your cholesterol and triglyceride levels checked yearly (aim for LDL levels below 100 mg/dL).
Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine).
Visit your ophthalmologist (preferably one who specializes in diabetic retinopathy) at least once a year, or more often if you have signs of diabetic retinopathy.
See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.
Make sure your health care provider inspects your feet at each visit.

Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.

What is Breast Cancer ?

2012-03-11T21:48:00.002+07:00

Breast cancer is a cancer that starts in the tissues of the breast.

There are two main types of breast cancer:

Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type.
Lobular carcinoma starts in parts of the breast, called lobules, that produce milk.

In rare cases, breast cancer can start in other areas of the breast.

Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancer is called estrogen receptor positive cancer or ER positive cancer.

Some women have what's called HER2-positive breast cancer. HER2 refers to a gene that helps cells grow, divide, and repair themselves. When cells have too many copies of this gene, cells -- including cancer cells -- grow faster. Experts think that women with HER2-positive breast cancer have a more aggressive disease and a higher risk of recurrence than those who do not have this type.

Symptoms

Early breast cancer usually does not cause symptoms. This is why regular breast exams are important. As the cancer grows, symptoms may include:

Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt
Change in the size, shape, or feel of the breast or nipple -- for example, you may have redness, dimpling, or puckering that looks like the skin of an orange
Fluid coming from the nipple -- may be bloody, clear to yellow, green, and look like pus

Men get breast cancer, too. Symptoms include breast lump and breast pain and tenderness.
Symptoms of advanced breast cancer may include:

Bone pain
Breast pain or discomfort
Skin ulcers
Swelling of one arm (next to breast with cancer)
Weight loss

Causes & Risk Factors

Over the course of a lifetime, 1 in 8 women will be diagnosed with breast cancer.
Risk factors you cannot change include:

Age and gender -- Your risk of developing breast cancer increases as you get older. The majority of advanced breast cancer cases are found in women over age 50. Women are 100 times more likely to get breast cancer then men.
Family history of breast cancer -- You may also have a higher risk for breast cancer if you have a close relative who has had breast, uterine, ovarian, or colon cancer. About 20 - 30% of women with breast cancer have a family history of the disease.
Genes -- Some people have genes that make them more prone to developing breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. But if a parent passes you a defective gene, you have an increased risk for breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life.
Menstrual cycle -- Women who get their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer.

Other risk factors include:

Alcohol use -- Drinking more than 1 - 2 glasses of alcohol a day may increase your risk for breast cancer.
Childbirth -- Women who have never had children or who had them only after age 30 have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer.
DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s - 1960s.
Hormone replacement therapy (HRT) -- You have a higher risk for breast cancer if you have received hormone replacement therapy for several years or more. Many women take HRT to reduce the symptoms of menopause.
Obesity -- Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which can fuel the development of breast cancer.
Radiation -- If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a significantly higher risk for developing breast cancer. The younger you started such radiation, the higher your risk -- especially if the radiation was given when a female was developing breasts.

Breast implants, using antiperspirants, and wearing underwire bras do not raise your risk for breast cancer. There is no evidence of a direct link between breast cancer and pesticides.

Tests & Diagnostics

The doctor will ask you about your symptoms and risk factors, and then perform a physical exam, which includes both breasts, armpits, and the neck and chest area. Additional tests may include:

Mammography to help identify the breast lump
Breast MRI to help better identify the breast lump
Breast ultrasound to show whether the lump is solid or fluid-filled
Breast biopsy, needle aspiration, or breast lump removal to remove all or part of the breast lump for closer examination by a laboratory specialist
CT scan
Sentinal lymph node biopsy
PET scan

If your doctor learns that you do have breast cancer, additional tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.

Breast cancer stages range from 0 to IV. Breast cancer that has not spread is called ductal carcinoma in situ (DCIS), or noninvasive breast cancer. If it spreads, the cancer is called invasive breast cancer. The higher the number, the more advanced the cancer.

Treatments

Treatment is based on many factors, including type and stage of the cancer, whether the cancer is sensitive to certain hormones, and whether or not the cancer overproduces (overexpresses) a gene called HER2/neu.
In general, cancer treatments may include:

Chemotherapy medicines to kill cancer cells
Radiation therapy to destroy cancerous tissue
Surgery to remove cancerous tissue -- a lumpectomy removes the breast lump; mastectomy removes all or part of the breast and possible nearby structures

Other treatments:

Hormonal therapy to block certain hormones that fuel cancer growth
Targeted therapy to interfere with cancer cell growth and function

An example of hormonal therapy is the drug tamoxifen. This drug blocks the effects of estrogen, which can help breast cancer cells survive and grow. Most women with estrogen-sensitive breast cancer benefit from this drug. A newer class of medicines called aromatase inhibitors, such as exemestane (Aromasin), have been shown to work just as well or even better than tamoxifen in postmenopausal women with breast cancer.

Targeted therapy, also called biologic therapy, is a newer type of cancer treatment. This therapy uses special anticancer drugs that identify certain changes in a cell that can lead to cancer. One such drug is trastuzumab (Herceptin). For women with stage IV HER2-positive breast cancer, Herceptin plus chemotherapy has been shown to be work better than chemotherapy alone. Studies have also shown that in women with early stage HER2-positive breast cancer, this medicine plus chemotherapy cuts the risk of the cancer coming back by 50%.

Cancer treatment may be local or systemic.

Local treatments involve only the area of disease. Radiation and surgery are forms of local treatment.
Systemic treatments affect the entire body. Chemotherapy is a type of systemic treatment.

Most women receive a combination of treatments. For women with stage I, II, or III breast cancer, the main goal is to treat the cancer and prevent it from returning. For women with stage IV cancer, the goal is to improve symptoms and help them live longer. In most cases, stage IV breast cancer cannot be cured.

Stage 0 and DCIS -- Lumpectomy plus radiation or mastectomy is the standard treatment. There is some controversy on how best to treat DCIS.
Stage I and II -- Lumpectomy plus radiation or mastectomy with some sort of lymph node removal is standard treatment. Hormone therapy, chemotherapy, and biologic therapy may also be recommended following surgery.
Stage III -- Treatment involves surgery possibly followed by chemotherapy, hormone therapy, and biologic therapy.
Stage IV -- Treatment may involve surgery, radiation, chemotherapy, hormonal therapy, or a combination of such treatments.

After treatment, some women will continue to take medications such as tamoxifen for a period of time. All women will continue to have blood tests, mammograms, and other tests following treatment.

Complications

New, improved treatments are helping persons with breast cancer live longer than ever before. However, even with treatment, breast cancer can spread to other parts of the body. Sometimes, cancer returns even after the entire tumor is removed and nearby lymph nodes are found to be cancer-free.

You may experience side effects or complications from cancer treatment. For example, radiation therapy may cause temporary swelling of the breast, and aches and pains around the area. Ask your doctor about the side effects you may have during treatment.

Prevention

Many risk factors -- such as your genes and family history -- cannot be controlled. However, a healthy diet and a few lifestyle changes may reduce your overall chance of cancer in general.

Breast cancer is more easily treated and often curable if it is found early.

Early detection involves:

Breast self-exams (BSE)
Clinical breast exams by a medical professional
Screening mammography

Most experts recommend that women age 20 and older examine their breasts once a month during the week following the menstrual period.

Women between the ages 20 and 39 should have a doctor examine their breasts at least once every 3 years.
After age 40:

Women 40 and older should have a mammogram every 1 - 2 years, depending on their risk factors. Women should call their doctor immediately if they notice in change in their breasts whether or not they do routine breast self-exams.
Women 40 and older should have a complete breast exam by a health care provider every year.

Mammography is the most effective way of detecting breast cancer early.

Certain women at high risk for breast cancer may have a breast MRI along with their yearly mammogram. Ask your doctor if you need an MRI.

Screening for breast cancer is a topic filled with controversy. A woman needs to have an informed and balanced discussion with her doctor, along with doing additional reading and researching on her own, to determine if mammography is right for her.

Tamoxifen is approved for breast cancer prevention in women aged 35 and older who are at high risk.

Women at very high risk for breast cancer may consider preventive (prophylactic) mastectomy, which is the surgical removal of the breasts. Possible candidates for this procedure may include those who have already had one breast removed due to cancer, women with a strong family history of breast cancer, and persons with genes or genetic mutations that raise their risk of breast cancer.

What is Bipolar Disorder (Manic Depression) ?

2012-03-11T21:40:00.003+07:00

Bipolar disorder involves periods of excitability (mania) alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.

Symptoms

The manic phase may last from days to months and can include the following symptoms:

Agitation or irritation
Elevated mood
- Hyperactivity
- Increased energy
- Lack of self-control
- Racing thoughts
Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)
Little need for sleep
Over-involvement in activities
Poor temper control
Reckless behavior
- Binge eating, drinking, and/or drug use
- Impaired judgment
- Sexual promiscuity
- Spending sprees
Tendency to be easily distracted

These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.

The depressed phase of both types of bipolar disorder involves very serious symptoms of major depression:

Difficulty concentrating, remembering, or making decisions
Eating disturbances
- Loss of appetite and weight loss
- Overeating and weight gain
Fatigue or listlessness
Feelings of worthlessness, hopelessness and/or guilt
Loss of self-esteem
Persistent sadness
Persistent thoughts of death
Sleep disturbances
- Excessive sleepiness
- Inability to sleep
Suicidal thoughts
Withdrawal from activities that were once enjoyed
Withdrawal from friends

There is a high risk of suicide with bipolar disorder. While in either phase, patients may abuse alcohol or other substances, which can worsen the symptoms.

Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur simultaneously or in quick succession in what is called a mixed state.

Causes & Risk Factors

Bipolar disorder affects men and women equally. It usually appears between ages 15 - 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.

Bipolar disorder results from disturbances in the areas of the brain that regulate mood.

There are two primary types of bipolar disorder. People with bipolar disorder I have had at least one fully manic episode with periods of major depression. In the past, bipolar disorder I was called manic depression.
People with bipolar disorder II seldom experience full-fledged mania. Instead they experience periods of hypomania (elevated levels of energy and impulsiveness that are not as extreme as the symptoms of mania). These hypomanic periods alternate with episodes of major depression.

A mild form of bipolar disorder called cyclothymia involves periods of hypomania and mild depression, with less severe mood swings. People with bipolar disorder II or cyclothymia may be misdiagnosed as having depression alone.

Tests & Diagnostics

A diagnosis of bipolar disorder involves consideration of many factors. The health care provider may do some or all of the following:

Ask about your family medical history, particularly whether anyone has or had bipolar disorder
Ask about your recent mood swings and for how long you've experienced them
Observe your behavior and mood
Perform a thorough examination to identify or rule out physical causes for the symptoms
Request laboratory tests to check for thyroid problems or drug levels
Speak with your family members to discuss their observations about your behavior
Take a medical history, including any medical problems you have and any medications you take

Note: Use of recreational drugs may be responsible for some symptoms, though this does not rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.

Treatments

For the manic phase of bipolar disorder, antipsychotic medications, lithium, and mood stabilizers are typically used. For the depressive phase, antidepressants are sometimes used, with or without the manic phase treatment.

There is very little long-term evidence suggesting that any medication has great success in the maintenance phase. However, in studies that followed patients for 2 years, lithium and some antipsychotics were found to be moderately successful.

Antipsychotic drugs can help a person who has lost touch with reality. Anti-anxiety drugs, such as benzodiazepines, may also help. The patient may need to stay in a hospital until his or her mood has stabilized and symptoms are under control.

Electroconvulsive therapy (ECT) may be used to treat bipolar disorder. ECT is a psychiatric treatment that uses an electrical current to cause a brief seizure of the central nervous system while the patient is under anesthesia. Studies have repeatedly found that ECT is the most effective treatment for depression that is not relieved with medications.

Getting enough sleep helps keep a stable mood in some patients. Psychotherapy may be a useful option during the depressive phase. Joining a support group may be particularly helpful for bipolar disorder patients and their loved ones.

Alternative Therapies

General recommendations include maintaining a calm environment, avoiding over-stimulation, getting plenty of rest, regular exercise, and proper diet. Some Chinese herbs may soften mood swings, but care must be taken (and good communication with the physician is essential) when combining herbal therapies with medications. Biofeedbackis effective in helping some patients control symptoms such as irritability, poor self-control, racing thoughts, and sleep problems. A diet low in vanadium (a mineral found in meats and other foods) and high in vitamin C may be helpful in reducing depression.

Complications

Stopping or improperly taking medication can cause your symptoms to come back, and lead to the following complications:

Alcohol and/or drug abuse as a strategy to "self-medicate"
Personal relationships, work, and finances suffer
Suicidal thoughts and behaviors

This illness is challenging to treat. Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder.

Prevention

The ongoing medical management of bipolar disorder is critical to preventing relapse (recurrence) of manic episodes. Even in carefully controlled treatment programs, bipolar patients may experience recurring episodes of the disorder. Patient education in the form of psychotherapy or self-help groupsis crucial for training bipolar patients to recognize signs of mania and depression and to take an active part in their treatment program.

What is Attention Deficit Hyperactivity Disorder (ADHD) ?

2012-03-11T21:32:00.002+07:00

ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For these problems to be diagnosed as ADHD, they must be out of the normal range for the child's age and development.

Symptoms

The Diagnostic and Statistical Manual (DSM-IV) divides the symptoms of ADHD into those of inattentiveness and those of hyperactivity and impulsivity. To be diagnosed with ADHD, children should have at least 6 attention symptoms or 6 activity and impulsivity symptoms -- to a degree beyond what would be expected for children their age. The symptoms must be present for at least 6 months, observable in 2 or more settings, and not caused by another problem. The symptoms must be severe enough to cause significant difficulties. Some symptoms must be present before age 7. Older children have ADHD in partial remission when they still have symptoms but no longer meet the full definition of the disorder. Some children with ADHD primarily have the Inattentive Type, some the Hyperactive-Impulsive Type, and some the Combined Type. Those with the Inattentive type are less disruptive and are easier to miss being diagnosed with ADHD.

Inattention symptoms:

Fails to give close attention to details or makes careless mistakes in schoolwork
Difficulty sustaining attention in tasks or play
Does not seem to listen when spoken to directly
Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
Difficulty organizing tasks and activities
Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
Easily distracted
Often forgetful in daily activities

Hyperactivity symptoms:

Fidgets with hands or feet or squirms in seat
Leaves seat when remaining seated is expected
Runs about or climbs in inappropriate situations
Difficulty playing quietly
Often "on the go," acts as if "driven by a motor," talks excessively

Impulsivity symptoms:

Blurts out answers before questions have been completed
Difficulty awaiting turn
Interrupts or intrudes on others (butts into conversations or games)

Causes & Risk Factors

ADHD affects school performance and interpersonal relationships. Parents of children with ADHD are often exhausted and frustrated.

Neuroimaging studies suggest that the brains of children with ADHD are different from those of other children. These children handle neurotransmitters (including dopamine, serotonin, and adrenalin) differently from their peers.

ADHD is often genetic. Whatever the specific cause may be, it seems to be set in motion early in life as the brain is developing.

Depression, sleep deprivation, learning disabilities, tic disorders, and behavior problems may be confused with, or appear along with, ADHD. Every child suspected of having ADHD deserves a careful evaluation to sort out exactly what is contributing to the behaviors causing concern.

Attention Deficit Disorder (ADD) is the most commonly diagnosed behavioral disorder of childhood, affecting an estimated 3 - 5% of school aged children. It is diagnosed much more often in boys than in girls.

Most children with ADHD also have at least one other developmental or behavioral problem.

Tests & Diagnostics

Too often, difficult children are incorrectly labeled with ADHD. On the other hand, many children who do have ADHD remain undiagnosed. In either case, related learning disabilities or mood problems are often missed. The American Academy of Pediatrics (AAP) has issued guidelines to bring more clarity to this issue.
The diagnosis is based on very specific symptoms, which must be present in more than one setting. The child should have a clinical evaluation if ADHD is suspected.
Evaluation may include:

Parent and teacher questionnaires (Connors, Burks)
Psychological evaluation of the child AND family including IQ testing and psychological testing
Complete developmental, mental, nutritional, physical, and psychosocial examination

Treatments

The American Academy of Pediatrics has guidelines for treating ADHD:

Set specific, appropriate target goals to guide therapy.
Medication and behavior therapy should be started.
When treatment has not met the target goals, evaluate the original diagnosis, the possible presence of other conditions, and how well the treatment plan has been implemented.
Systematic follow-up is important to regularly reassess target goals, results, and any side effects of medications. Information should be gathered from parents, teachers, and the child.

ADHD can be a frustrating problem. Alternative remedies have become quite popular, including herbs, supplements, and chiropractic manipulation. However, there is little or no solid evidence for many remedies marketed to parents.

Children who receive both behavioral treatment and medication often do the best. Medications should not be used just to make life easier for the parents or the school. There are now several different classes of ADHD medications that may be used alone or in combination. Psychostimulants are the primary drugs used to treat ADHD. Although these drugs stimulate the central nervous system, they have a calming effect on people with ADHD.
These drugs include:

Methylphenidate (Ritalin, Concerta, Metadate, Daytrana)
Dexmethylphenidate (Focalin)
Amphetamine-dextroamphetamine (Adderall)
Dextroamphetamine (Dexedrine, Dextrostat)
Lisdexamfetamine (Vyvanse)

The FDA has approved the nonstimulant drug atomoxetine (Strattera) for use in ADHD. Effectiveness appears to be similar to that of stimulants. Strattera is not addicting.

Some ADHD medicines have been linked to sudden death in children with heart problems. Talk to your doctor about which drug is best for your child.

The following may also help:

Limit distractions in the child's environment.
Provide one-on-one instruction with the teacher.
Make sure the child gets enough sleep.
Make sure the child gets a healthy, varied diet, with plenty of fiber and basic nutrients.

Complications

Many adults with ADHD are in successful jobs. Possible complications, if ADHD is not adequately treated, could include failure in school or other similar problems.

Ask About Your 2012 Health Benefits

2012-03-11T11:34:00.000+07:00

Many U.S. employers will drop a bunch of health-care options in their workers' laps in the next few weeks, if they haven't already. If you're one of those workers, unless you change jobs or lose your job, the choices you make will stick with you and possibly your family for all of 2012, so it's important to scrutinize and compare health-plan options.

You may be tempted to automatically re-enroll in the same plan you have now, but that could cost you. Many plans are shifting costs and benefits around and some employers have introduced new ways for workers to save money, experts say.

"If an employee blows off open-enrollment communications, the employee could pay more because they're missing incentives to pay less that are tied to participation in wellness activities," said Eric Parmenter, vice president of consulting for High Roads, a benefit consulting firm in Nashville, Tenn.

For next year, employers generally aren't as interested as they've been in recent years in raising workers' premium contributions, but they're finding other ways to pass on higher health-care costs, said Michael Thompson, principle in human-resource services at PricewaterhouseCoopers in New York.

"There's not as much focus on increasing premiums for workers as much as there is on increasing the amount of cost-sharing workers have at the point of service," he said.

People who use their health plan might feel more of a squeeze than those who don't, said John Asencio, senior vice president of Sibson Consulting, a human-resource consulting firm in New York.

"If you had a $15 copay, you'll probably see those go up to $20, $25 for physician office visits," he said.

The good news is underlying benefit-cost increases are expected to be moderate, compared with earlier in the 2000s when double-digit premium spikes whipsawed employers and employees alike.

Though they still far outpace general inflation and workers' wage gains, health-benefit costs are on track to rise 5.4% on average next year, the lowest rate of increase in 15 years, according to preliminary survey data from Mercer, a consulting firm in New York. If employers did nothing to manage the cost increase through plan-design changes, the increase would be 7.1%. The overall trend of the past five years has been about 9%, according to Mercer's findings.

Use of health-care services declined last year as people were left with less disposable income in a struggling economy and more workers faced higher out-of-pocket medical costs, said Beth Umland, director of research for health and benefits for Mercer in New York.

"If money is tight and you've got a $1,000 deductible, you might think twice about going to the doctor if you also think you could put it off," she said, noting the average deductible has doubled in the past five years.

Here are five bottom-line questions to consider as you compare your 2012 options:

1. What's new this year? As part of the health-reform law that kicks in more comprehensively in 2014, most employers already extend coverage to workers' adult children up to age 26 even if they're married or in school. And they have to offer free preventive care for a number of services such as colonoscopies and mammograms. For 2012, many employers are offering what are called consumer-driven health plans, which have high deductibles and often attached savings accounts. They're trying to control costs before 2014, when they have to extend coverage to part-time workers putting in at least 30 hours a week, among other anticipated costs, Umland said.

For 2012, the minimum annual deductible required for high-deductible health plans to be coupled with health savings accounts (HSAs) is unchanged at $1,200 for self-only coverage and $2,400 for family coverage. But the annual maximum for workers' out-of-pocket expenses is going up $100 to $6,050 for single coverage and rising $200 to $12,100 for family coverage next year, according to the Internal Revenue Service. Out-of-pocket expenses include deductibles and copays but exclude premiums.

Workers with HSAs for themselves only can contribute up to $3,100 to their accounts in 2012 compared with up to $6,250 for workers with family coverage in a high-deductible health plan. Those limits are slightly higher than for 2011.

2. What would the plan cost me? If your plan is shifting to coinsurance, where you pay a percentage of the total instead of a flat fee, you may have to think differently. "If you had a $10 or $20 copay, it was easy to understand what it was going to cost you when you went to the doctor," Thompson said. "If the plan now has coinsurance and a deductible, that visit may cost over $100 if you haven't met your deductible."

In making a total estimate of what a plan might cost you, first take stock of the premiums, the amount you contribute each month out of your paycheck, which will likely be higher for more a comprehensive benefit plan than for a bare-bones one. The second part relates to your out of pocket costs. For this, consider your recent history of health services. If you see a doctor or need blood work drawn frequently, for example, your copay or coinsurance amounts could make a big difference in your overall spending projections.

Next, if you're considering a health plan with a savings account such as an HSA, factor in what, if anything, your employer contributes to that account that may offset your costs. Your monthly premiums will likely be lower, but don't forget unpredictable and intangible costs. "How much am I saving for sure vs. how much might I lose if I actually use the plan?," Umland suggested asking. Plus, are you OK with managing another financial account? Try to find out how many extra administrative tasks you may need to do to use the HSA funds. Some offer debit cards you can swipe, but others may force you to submit and track claims for reimbursement.

3. What happens if I get really sick or injured? Try to run a worst-case health scenario under each of the plan options to see how financially exposed you would be among them should you or one of your covered dependents have a grave accident or illness. Know what expenses are counted in the out of pocket maximums. "How much would I be out of pocket in this option vs. this option if I suddenly need $50,000 worth of care?" Asencio said.

4. Are my meds covered? If you're on maintenance medication for a chronic illness, check to see if any plans will waive your copay or coinsurance on certain prescription drugs, making them effectively free to encourage you to keep taking them, Thompson said. You may have to talk to a health coach or participate in a disease-management program to get the free meds, but more employers are trying this option to get a handle on their long-term health costs. Some plans also offer a separate out of pocket maximum for prescription drugs, he said.

5. Am I leaving money on the table by failing to participate in wellness programs aimed at making or keeping me healthy? Whether it's a game-oriented workplace exercise competition, private dietary counseling, talking to a health coach or taking classes to help you quit smoking, you may not be able to afford to ignore your employer's 2012 wellness offerings. "While these programs have been around for a while, employers are really taking them seriously now as a way to manage costs," Umland said.

You may not have to do much work to score a break on your health-care costs. In fact, some employees may end up paying $25 to $50 more in premiums per month or hundreds of dollars more in deductibles if they don't complete a health risk assessment or other activities meant to gauge their general health status, Asencio said. "Companies are getting more aggressive around these issues."

How to Overcoming Depression ?

2012-03-11T11:29:00.000+07:00

I’ve got a question for you: Are you in the mood? Your response is probably something along the lines of, “Uh, not really, doc, I’m sitting in front of my computer with my pajamas on.” Despite the fact that my question typically means one very specific thing to most folks, I’m not asking you that. I’m asking if you’re in the mood to work? The mood to play? The mood to walk down the street and introduce yourself to the new neighbors? The mood to play hide-and-seek with your kids? Are you in the mood to live?

While depression can be a complex issue that needs medical attention, there are several things you can do to help elevate your spirits. Here are three of my suggestions:

Get Your Sweat On

If you haven’t exercised in a while, the thought of slipping into a pair of tight pants and a sports bra might seem depressing in itself. Exercise, however, has been shown to be more effective than many antidepressants in reducing major depression. And it has the same kind of effect on less serious mood issues, too. Part of that may be attributed to the endorphin effect of exercise; we may also feel a sense of purpose and accomplishment that comes with completing an exercise program.

A simple walk will do, but doing something that really elevates your heart rate and gets your sweat flowing will have a major payoff when you’re finished. Sometimes, action has to come before motivation, and depressed folks need to act to prime their motivational engine.

Find a Guide

Guided imagery isn’t the screen of your car’s GPS. It’s actually a way of making you feel better. The technique has been shown to improve the ability to cope with depression, improve mood, and decrease stress. How do you do it? Go to a quiet place (the bathroom often works well, since privacy is usually respected there).

Start by relaxing and breathing deeply, then visualize yourself in different scenarios. Some variations include visualizing yourself in a pleasant place (the beach), fighting disease (seeing your good immune cells fighting off bad germs), or practicing for a big performance (doing well in your job).

Fix Your Diet

It’s one of the most vicious circles there is: You feel sad, you reach for chips. You reach for chips, you feel sad. Food, in many ways, really is medicine. And if you can break that cycle of reaching for sugary carbs, mashed carbs, fried carbs, and all-adjective junk foods, then you’ve got a fighting chance to improve your mood in natural ways. Lots of fruits, vegetables, lean proteins and healthy fats can help. Top it off with a small piece of dark chocolate.

How to Keep Your Brain Young ?

2012-03-11T11:24:00.000+07:00

One of the greatest longevity secrets you’ll ever learn is how to take care of your brain throughout your entire lifetime. What better time to learn how to prevent degeneration and support a sharp, well-balanced mind than Brain Awareness Week! Here are 4 leading-edge tips to power up your brain.

1. Omega-3’s for a Brain Boost

You may have heard that it’s great for your health to take fish oil every day, but did you ever wonder why? Fish oil, along with flax seeds and many nuts and seeds, contains high levels of omega-3 fatty acids. We’ve known for some time that omega-3’s support cardiovascular health, but the link between cardiovascular health and cognitive health is relatively recent. New scientific research indicates that people with higher omega-3 levels are more likely to perform well on cognitive tests of visual memory, attention, and abstract thinking, and to experience less age-related brain shrinking. Omega-3’s are also very helpful for reducing blood pressure, which can worsen your memory by inhibiting brain cell nourishment. Don’t know your omegas from your elbow? Find out more about omega-3 fatty acids in the Natural Health Dictionary!

Get omegas on the go! Try this simple anti-aging trail mix to bring the power of omega-3’s with you wherever you go. Combine walnuts, pine nuts, sesame seeds, pumpkin seeds, dried goji berries, dried apricots, and dried blueberries together and keep in a small sealed container. Eat a handful of trailmix by itself or add to plain, unsweetened yogurt with some ground flaxseed. Snack on this delicious treat between meals and give your brain a healthy boost!

2. Supplement Your Brain Health

Omega-3’s are just the tip of the brain-boosting iceberg! Here are a few other supplements that will enhance your brain’s longevity and mental prowess:

• Ginkgo Biloba Chinese doctors once likened the gingko leaf shape to the shape of the brain, and conjectured that this meant the herb would benefit brain health. As it turns out, this traditional supplement can strengthen learning, thinking, retention, and recall. It gets its reputation by virtue of its ability to increase blood circulation, in addition to nutrient and oxygen flow, to the brain and other organs. You can brew ginkgo in a tea or take it in supplement form. Find out more about gingko biloba in The Natural Health Dictionary.

• Microalgae like blue green algae, chlorella, and spirulina are high-energy, high-protein supplements that support healthy brain function. They are easy to digest and contain an added health boost with over one hundred trace minerals.

• L-glutamine is a helpful amino acid that is especially popular among athletes. Not only does it help minimize the breakdown of muscle tissue, it converts to glutamic acid, a potent brain fuel. You may take L-glutamine as supplement, or find it naturally by consuming beef, poultry, yogurt, cabbage, or raw spinach. Want to know more about this amino acid? Look up L-glutamine in The Natural Health Dictionary.

3. Fit Body, Fit Brain

More good news about exercise: new studies suggest that exercising can help fuel your brain! When we’re working out our bodies, it’s easy to forget that our brain is even involved in the motion, but physical movements demand a lot from the brain. During exercise, we’re rapidly activating and stimulating neurons in our brains, which send and interpret the messages that enable our bodies to move.

Of course, with this increased brain activity during exercise comes an increased need to refuel with nutrients. Until recently, researchers didn’t understand how neurons fueled themselves during exercise, but new studies with animals from Japan have revealed that when starved of blood sugar, neurons are actually able to maintain their energy levels by absorbing glycogen, a stored carbohydrate, from helpful neighbor cells. In these studies, after rats worked out on treadmills, they immediately ate, and the food seemed to go right to their brains—sometimes increasing brain glycogen levels by 60% in the areas of the brain associated with learning and memory. After 24 hours, the glycogen levels had returned to normal—unless exercise was repeated every day. In the rats that ran for four weeks, these special stores of glycogen built up in the parts of the brain that support memory and learning, effectively becoming the brain’s new baseline.

What does this mean? These early studies suggest that you may be able to develop a better, sharper brain by storing and utilizing brain glycogen—which appears to happen through regular exercise that is immediately followed by consumption of carbohydrates. What this looks like: exercise regularly, and after your workout, feed your brain with a healthy carb, like a banana. Then reap the brain benefits!

4. Use It or Lose It

Exercise isn’t just for you body—you have to exercise your brain, too, if you want to keep it in tip-top shape! Set aside a time every day to challenge your brain with new memory and problem-solving tasks, including chess or crossword puzzles, learning the words to a new song, or writing with your non-dominant hand. When you do these activities every day, you are developing and engaging new neural pathways to keep your brain on the cutting edge.

I hope that these tips will help keep your brain young!

Foods That Can Trigger a Stroke

2012-03-11T11:00:00.001+07:00

Few things feel more terrifying and random than a stroke, which can strike without warning. And fear of stroke -- when a blood vessel in or leading to the brain bursts or is blocked by a blood clot, starving brain cells of oxygen and nutrients -- is well founded. After all, stroke is the number-three killer in the U.S., affecting more than 700,000 people each year. Here are five foods that cause the damage that leads to stroke.

1. Crackers, chips, and store-bought pastries and baked goods

Muffins, doughnuts, chips, crackers, and many other baked goods are high in trans fats, which are hydrogenated oils popular with commercial bakeries because they stay solid at room temperature, so the products don't require refrigeration. Also listed on labels as "partially hydrogenated" or hydrogenated oils, trans fats are found in all kinds of snack foods, frozen foods, and baked goods, including salad dressings, microwave popcorn, stuffing mixes, frozen tater tots and French fries, cake mixes, and whipped toppings. They're also what makes margarine stay in a solid cube. The worst offenders are fried fast foods such as onion rings, French fries, and fried chicken.

Why they're bad:

For years scientists have known trans fats are dangerous artery-blockers, upping the concentrations of lipids and bad cholesterol in the blood and lowering good cholesterol. Now we can add stroke to the list of dangers. This year researchers at the University of North Carolina found that women who ate 7 grams of trans fat each day -- about the amount in two doughnuts or half a serving of French fries -- had 30 percent more strokes (the ischemic type, caused by blocked blood flow to the brain) than women who ate just 1 gram a day. Another recent study, also in women, found that trans fats promoted inflammation and higher levels of C-reactive protein, which have been linked to an increased risk of diabetes, heart disease, and stroke.

What to do:

Aim to limit trans fats to no more than 1 or 2 grams a day -- and preferably none. Avoid fast-food French fries and other fried menu items and study packaged food labels closely. Even better, bake your own cookies, cakes, and other snacks. When you can't, search out "health-food" alternative snacks, such as Terra brand potato chips and traditional whole grain crackers such as those made by Finn, Wasa, AkMak, Ryvita, and Lavasch.

2. Smoked and processed meats

Whether your weakness is pastrami, sausage, hot dogs, bacon, or a smoked turkey sandwich, the word from the experts is: Watch out.

Why they're bad:

Smoked and processed meats are nasty contributors to stroke risk in two ways: The preserving processes leave them packed with sodium, but even worse are the preservatives used to keep processed meats from going bad. Sodium nitrate and nitrite have been shown by researchers to directly damage blood vessels, causing arteries to harden and narrow. And of course damaged, overly narrow blood vessels are exactly what you don't want if you fear stroke.

Many studies have linked processed meats to coronary artery disease (CAD); one meta-analysis in the journal Circulation calculated a 42-percent increase in coronary heart disease for those who eat one serving of processed meat a day. Stroke is not the only concern for salami fans; cancer journals have reported numerous studies in the past few years showing that consumption of cured and smoked meats is linked with increased risk of diabetes and higher incidences of numerous types of cancer, including leukemia.

What to do:

If a smoked turkey or ham sandwich is your lunch of choice, try to vary your diet, switching to tuna, peanut butter, or other choices several days a week. Or cook turkey and chicken yourself and slice it thin for sandwiches.

3. Diet soda

Although replacing sugary drinks with diet soda seems like a smart solution for keeping weight down -- a heart-healthy goal -- it turns out diet soda is likely a major bad guy when it comes to stroke.

Why it's bad:

People who drink a diet soda a day may up their stroke risk by 48 percent. A Columbia University study presented at the American Stroke Association's 2011 International Stroke Conference followed 2,500 people ages 40 and older and found that daily diet soda drinkers had 60 percent more strokes, heart attacks, and coronary artery disease than those who didn't drink diet soda. Researchers don't know exactly how diet soda ups stroke risk -- and are following up with further studies -- but nutritionists are cautioning anyone concerned about stroke to cut out diet soda pop.

What to do:

Substitute more water for soda in your daily diet. It's the healthiest thirst-quencher by far, researchers say. If you don't like water, try lemonade, iced tea, or juice.

4. Red meat

This winter, when the respected journal Stroke published a study showing that women who consumed a large portion of red meat each day had a 42-percent higher incidence of stroke, it got nutrition experts talking. The information that red meat, with its high saturated fat content, isn't healthy for those looking to prevent heart disease and stroke wasn't exactly news. But the percentage increase (almost 50 percent!) was both startling and solid; the researchers arrived at their finding after following 35,000 Swedish women for ten years.

Why it's bad:

Researchers have long known that the saturated fat in red meat raises the risk of stroke and heart disease by gradually clogging arteries with a buildup of protein plaques. Now it turns out that hemoglobin, the ingredient that gives red meat its high iron content, may pose a specific danger when it comes to stroke. Researchers are investigating whether blood becomes thicker and more viscous as a result of the consumption of so-called heme iron, specifically upping the chance of strokes.

What to do:

Aim to substitute more poultry -- particularly white meat -- and fish, which are low in heme iron, for red meat. Also, choose the heart-healthiest sources of protein whenever you can, especially beans, legumes, nuts, tofu, and nonfat dairy.

5. Canned soup and prepared foods

Whether it's canned soup, canned spaghetti, or healthy-sounding frozen dinners, prepared foods and mixes rely on sodium to increase flavor and make processed foods taste fresher. Canned soup is cited by nutritionists as the worst offender; one can of canned chicken noodle soup contains more than 1,100 mg of sodium, while many other varieties, from clam chowder to simple tomato, have between 450 and 800 mg per serving. Compare that to the American Heart and Stroke Association's recommendation of less than1,500 mg of sodium daily and you'll see the problem. In fact, a nutritionist-led campaign, the National Salt Reduction Initiative, calls on food companies to reduce the salt content in canned soup and other products by 20 percent in the next two years.

Why they're bad:

Salt, or sodium as it's called on food labels, directly affects stroke risk. In one recent study, people who consumed more than 4,000 mg of sodium daily had more than double the risk of stroke compared to those who ate 2,000 mg or less. Yet the Centers for Disease Control estimate that most Americans eat close to 3,500 mg of sodium per day. Studies show that sodium raises blood pressure, the primary causative factor for stroke. And be warned: Sodium wears many tricky disguises, which allow it to hide in all sorts of foods that we don't necessarily think of as salty. Some common, safe-sounding ingredients that really mean salt:

Baking soda
Baking powder
MSG (monosodium glutamate)
Disodium phosphate
Sodium alginate

What to do:

Make your own homemade soups and entrees, then freeze individual serving-sized portions. Buy low-sodium varieties, but read labels carefully, since not all products marked "low sodium" live up to that promise.

Fight Sickness With Food

2012-03-11T10:46:00.000+07:00

Nobody plans to get sick. On the contrary, your efforts to avoid it sometimes seem borderline OCD: Don't sneeze into your hands, always cook your chicken to exactly 170 degrees, and hose down every germ-carrying preschooler in sight with soap and water. And yet, no matter how many times you gargle with salt before bedtime or coat yourself in antibacterial hand cleanser, now and again the inevitable rumble in your tummy or tickle in your throat hits. Hard. Suddenly, you're down for the count and up to date on the daytime soaps.

What are you doing wrong? Probably nothing. But you can do a few more things right. Certain foods and drinks have a natural immunity boost; to tap their benefits, just open up and say, "Ahh."

Tea Off Against Colds

Not just any hot tea, though. Chamomile, according to researchers from London's Imperial College, is the one that'll help prevent sickness. In a recent study, they found people who drank five cups of the brew a day for 2 weeks had increased blood levels of plant-based compounds called polyphenols, some of which have been associated with increased antibacterial activity. Levels remained high for 2 weeks after subjects stopped drinking the tea, says lead researcher Elaine Holmes, Ph.D. (Bonus: chamomile tea also raised levels of glycine, a mild nerve relaxant and sedative.)

Knock 'em Dead

There's a killer living in all of us. Known as a macrophage and produced deep in your bone marrow, it's a white blood cell that roams the body, picking fights with bacteria, viruses, or any other intruders. But it only works if you help it. These killer cells are activated by beta-glucans, a component of fiber foods. The best source? Oats, says David Grotto, R.D., director of nutrition education at the Block Center for Integrative Cancer Care in Evanston, Illinois. So eat your oatmeal. The steel-cut oats, like McCann's Irish Oatmeal, have double the amount found in the rolled, quick-cooking kind.

Dressing for Success
Eating a salad for lunch is smart. Drowning it in fat-free dressing isn't. A recent study from Iowa State University found that without dietary fat, your body doesn't absorb some of the disease-fighting nutrients in vegetables. Researchers fed seven people salad for 12 weeks and tested their blood after each meal. Those who topped their salads with fat-free dressing consistently failed to absorb carotenoids, antioxidants that have been linked to improved immunity. Fat is necessary for the carotenoids to reach the absorptive intestinal cells, says lead researcher Wendy White, Ph.D. Choose dressings with healthy fats from olive or nut oils, such as Many Seeds of Change (available at Whole Foods or in the crunchy section of your neighborhood market) and many Annie's Naturals dressings. If you're feeling adventuresome, try making your own. For an Italianate, try 2 or 3 parts extra virgin olive oil to 1 part balsamic vinegar; for something with an Asian influence, go 3 parts sesame oil to 1 part rice wine vinegar.

Fight Bugs this Whey

A shot of whiskey might be one way to feel better, but whey protein is a much more effective immune-boosting cocktail. Whey is rich in an amino acid called cysteine, which converts to glutathione in the body. Glutathione is a potent antioxidant that fortifies cells against bacterial or viral infection. For the highest concentration of protein, try something called powdered whey protein isolate, which is more pure—and more expensive—than concentrate. Fortify your morning smoothie with whey protein powder or try another source: yogurt. The clear liquid that forms on top of most cartons of yogurt is pure whey protein—so don't drain it off, just stir it back into the yogurt.

Tomato Trumps Chicken

To beat back a cold, you slurp chicken noodle soup. To avoid getting sick in the first place, ladle out some tomato. In a study published in the American Journal of Clinical Nutrition, 10 subjects ate a tomato-rich diet for 3 weeks, followed by a tomato-free diet for 3 more weeks. While subjects were on the tomato diet, their infection-fighting white blood cells sustained 38 percent less damage from free radicals—atoms in the body that damage and destabilize cells—than when they ate no tomato products. Researchers speculate that the lycopene in tomatoes acts as an antioxidant, helping white blood cells resist the damaging effects of free radicals.

Give Ma Nature a Taste of Her Own Medicine

Butterbur may sound like something that makes you sneeze. But the herbal supplement actually helps you fight allergies. Scottish researchers found that patients with grass and pollen allergies who popped 50 mg of the plant extract twice daily had 13 percent better nasal airflow than those who took a placebo. Another study published in the British Medical Journal reported that butterbur treated seasonal allergies nearly as well as the prescription medication Zyrtec. It's effective against all symptoms of allergic rhinitis, including sneezing, itching, and conjunctivitis, says Andreas Schapowal, M.D., Ph.D., the author of the study. Butterbur is believed to block leukotriene, a chemical that causes allergic reactions, while at the same time controlling eosinophils, the white blood cells that accumulate when allergic reactions take place, says Dr. Schapowal. What's more, there's no drowsy effect with butterbur. You can buy the supplement ($25 for 60 capsules) at most health food stores or at iherb.com.

Down a Sports Drink

Not only will guzzling Gatorade help your body recover from a tough workout, but it may also protect you from the latest strain of the flu. According to a study published in the International Journal of Sport Nutrition, when 10 triathletes drank more than 1 cup of sports drink every 15 minutes during intense exercise, they had significantly better immune response than they did when they drank a placebo.

Wine, then Dine

Drinking wine with your meal, in addition to being good for your heart, may help ward off food poisoning before it happens. Scientists at Oregon State University recently found that wine can put the kibosh on three common food pathogens: E. coli, listeria, and salmonella. In lab studies, the wine's combination of ethanol, organic acids, and low pH appeared to scramble the bugs' genetic material. All wines have some effect, say researchers, but reds are the most potent.

Feel the Burn

Several animal and laboratory studies have shown that capsaicin—the compound that gives chili peppers their fire—can help stop sickness before it starts. Mice in one study were given a daily dose of capsaicin and had nearly three times more antibody-producing cells after 3 weeks than those given no capsaicin. More antibodies mean fewer colds and infections. Results of other studies suggest that eating food containing hot components such as capsaicin may improve immune status, says Rina Yu, Ph.D., of the University of Ulsan in South Korea, the lead researcher. The point is, it can't hurt. At the very least, a dash or two of hot sauce might help flush out some toxins.

Change Your Numbers Game

Losing a little extra baggage will not only reduce your risk of cardiovascular disease and diabetes, but also will help shape up your immune system. Researchers at Tufts University asked a group of slightly overweight people to cut 100 to 200 calories from their daily food intake. The result, in addition to weight loss and a drop in cholesterol counts? Participants boosted their immune system response to disease-causing microorganisms. Researchers aren't exactly sure why, but speculate that the benefit comes from a combination of effects. One thing is certain: Cutting 200 calories out of your daily diet is easy. At your next restaurant meal, ditch the baked potato with sour cream and order steamed vegetables instead.

What is Sneezing ?

2012-03-11T10:42:00.000+07:00

Sneezing, also known as sternutation, is the response of the mucous membrane of the nose to an irritant or foreign body that causes allergy in a hypersensitive person.

Description

A sneeze is an involuntary explosive burst of air from the nose and mouth that removes offending material from the nasal passages.

Causes & symptoms

Sneezing can occur from a number of causes, or may itself be a symptom of an underlying condition, most likely an allergy or common cold. Sneezing may simply be triggered by a small foreign object or substance in the nose, including particles of pepper, smoke, irritating chemical fumes, or gases. It may also be a symptom of a common cold, upper respiratory tract infection, hay fever, or other allergies to pollen, dust, dust mites, mold, dander, grass, or other substances. Additional potential causes of sneezing include withdrawal from opiate drugs, inhaling corticosteroids, whooping cough, or anaphylaxis. Many people sneeze when they step outdoors into bright sunlight. Others report sneezing whenever they tweeze their eyebrows.

In a January 2000 paper in the journal Neurology, Dr. Mark Hersch of Australia's New South Wales University reported that some stroke patients find themselves temporarily unable to sneeze, leading to speculation that a "sneeze center" may exist in the medulla of the brainstem.

Diagnosis

An attempt to determine the cause of sneezing is likely to include an examination of the upper respiratory tract. A doctor might perform skin tests to uncover any allergies, or antibody tests. In some cases, x rays are also useful.

Herbs and supplements

Echinacea, Yin Chiao Chieh Tu Pien (a Chinese over-the-counter formulation), zinc, and vitamin C are all potentially useful against sneezing and other cold symptoms. Stinging nettle (Urtica dioica) and red clover (Trifolium pratense) may be used for allergies.

Avoid Spring Sneezing and Stuffiness

2012-03-11T10:38:00.000+07:00

Letting pollen drift in through open windows and using the wrong air filter can contribute to allergy flare-ups in spring, experts say.

Some 35 million Americans suffer from sneezing, sniffling, stuffiness and itchy eyes due to spring allergies, according to experts from the American College of Allergy, Asthma and Immunology (ACAAI).

"People with spring allergies often don't realize how many things can aggravate their allergy symptoms, so they just muddle along and hope for an early end to the season," said Dr. Myron Zitt, former ACAAI president, in a college news release. "But there's no reason to suffer. A few simple adjustments in habits and treatment can make springtime much more enjoyable."

Allergists recommend allergy-sufferers keep their house and car windows closed so pollen can't drift in from outdoors. They also recommend making sure to use the right air filter. Inexpensive central-furnace or air-conditioning filters and ionic electrostatic room cleaners aren't helpful, the allergists said. Ionic electrostatic air filters release ions that can irritate allergies. And whole-house filtration systems can only be effective if the filters are changed regularly.

The experts also note that some people with seasonal allergies, particularly to grass or birch trees, may also suffer from allergies to closely related fruits, vegetables and nuts. About one in five people with grass allergies and as many as 70 percent of people with birch allergies have these cross-reactions, known as pollen food allergy syndrome.

People with allergies to birch or alder trees may experience tingling, itching and swelling around the mouth when they eat celery, cherries or apples. People with grass allergies sometimes find tomatoes, potatoes or peaches problematic.

Although often not serious, reactions to these foods can be life- threatening in a small percentage of people. A life-threatening allergic reaction is called anaphylactic shock, and high-risk people should carry a portable epinephrine pen.

Allergists also encourage people to take their medicine even before their symptoms flare, and to see an allergist who can suggest the best course of treatment.

Cut Back on Visits to Doctor

2012-03-11T10:29:00.000+07:00

Insured Americans are using fewer medical services, raising questions about whether patients are consuming less health care as they pick up a greater share of the costs.

The drop in usage is showing up as health-care companies report financial results. Insurers, lab-testing companies, hospitals, and doctor-billing concerns say that patient visits, drug prescriptions, and procedures were down in the second quarter from year-ago levels.

"People just aren't using health care like they have," said Wayne DeVeydt, WellPoint Inc.'s chief financial officer, in an interview Wednesday. "Utilization is lower than we expected, and it's unusual."

Others say that consumers are beginning to forgo elective procedures like knee replacements. "We have a very weak economy and it's just a different environment for the elective parts of health care," said Paul Ginsburg, a health economist who runs the Center for Studying Health System Change and has been analyzing health-company earnings. But "this could go beyond the recession. Being a less aggressive consumer of health care is here to stay."

Continued weak demand could eventually put downward pressure on spiralling health-care costs, a long-sought goal of policy makers. It could also force insurers to lower premiums.

The new trend comes amid a broader drop in health-care use as more Americans lose their jobs and their health insurance. Such cutbacks have happened before in recessions, but the drop seems to be more pronounced this time, industry analysts say.

More Americans also are buying high-deductible health plans that force them to bear more of the upfront costs for health services. Some 18 million Americans bought high-deductible plans this year, compared with 13 million last year, according to Paul Mango, a director at consulting firm McKinsey & Co.

At the beginning of the year, Dan and Natalie Johnson, of Gig Harbor, Wash., used the website eHealthInsurance.com to buy a new plan with a high deductible, now set at $5,500 for their family. Their previous coverage had no deductible.

Now, the couple says they are thinking twice before scheduling doctor visits. Recently, when their 16-year-old daughter's allergy prescription ran out, Ms. Johnson called the allergist's office to ask for a renewal, without coming in for an appointment, as she would have done under their previous insurance.

And this spring, their son, 14, got his athletic physical at a local urgent-care clinic that charged just $40, instead of a doctor's office, which would have cost about $90. "We don't want to go through our savings going to the doctor," says Ms. Johnson, a photographer.

All this raises the question of whether, after a year of national attention on out-of-control health costs before the federal health overhaul passed in March, the trend portends a lasting change in the way Americans use the medical system.

Just a year ago, insurers reported surging health-care usage. Back then, more consumers were signing up for Cobra, the federal program that allows people who have lost their jobs to keep their insurance. The government had extended a subsidy to cover 65% of the cost of the coverage, which can be prohibitively expensive.

However, the Cobra subsidies only covered the unemployed for 15 months, and many people have hit the limit and dropped coverage. What's more, people who have lost their jobs since the end of May don't qualify for the Cobra subsidies.

To be sure, the change in behavior could be short-lived. On an earnings call last week in which it reported a decline in hospital usage, UnitedHealth Group Inc. (NYSE: UNH - News) said it thought utilization would rise again in the second part of the year, as Americans exhaust their deductibles and insurers start paying for services. Both Aetna Inc. (NYSE: AET - News) and WellPoint (NYSE: WLP - News) said the utilization fall-off was new as of this year, and they had not seen the trend previously even as the economy has deteriorated. Some insurers also cited an unusually mild flu season this year as a temporary factor.

What's more, the federal health overhaul could cause usage to surge again. The new law will hand insurance cards to many Americans in 2014, which could unleash pent-up demand.

Utilization has ticked down in previous recessions, and tends to take a year or two to change because of how far in advance employers and insurers design their health plans, said Carl McDonald, an analyst at Citigroup Investment Research. He said the last time he saw utilization fall off was in 2003, adding that usage also dipped in the early 1990s. But he added the drop is bigger this time than in previous recessions.

The declines in utilization has boosted profits for insurers, who set their prices to cover anticipated medical costs. Insurance industry prices and profits have been under fire by Democrats and regulators this year. Insurers have justified high premiums by pointing to out-of-control medical costs. But the recent drop in usage could make it difficult for insurers to argue that continued price increases are necessary.

On Wednesday, Aetna said usage of health-care fell in the second quarter, feeding a 42% increase in profits. WellPoint reported a 4% earnings bump, saying that hospital admissions and usage of prescription drugs had dropped compared with a year earlier.

After the earnings releases, Rep. Pete Stark (D., Calif.) called on the companies to reduce their premiums since they are paying out less in medical care. In an interview, Aetna's chief financial officer Joseph Zubretsky said companies might eventually have to do just that. "If utilization stays down, it will have a favorable impact on rates," he said.

One company reporting evidence of lower utilization is CVS Caremark Corp. (NYSE: CVS - News), the drugstore giant. In its earnings announcement Wednesday, it said it is seeing a drop-off in new prescriptions for maintenance drugs tied to a decline in physician visits.

People are "visiting fewer primary care doctors and specialists," said Chief Executive Tom Ryan, in a conference call with analysts.

Last week, Quest Diagnostics Inc. (NYSE: DGX - News), a laboratory-testing company, told investors that its volume fell 2.6% in the first quarter and 1.3% in the second partly because of decreasing physician visits. In addition, AmSurg Corp. (NASDAQ: AMSG - News), an outpatient-surgery company, reported that same-store procedures declined by 2.6% compared to a year earlier.

Another sign that people are forgoing doctor visits or getting less care came from athenahealth Inc. (NASDAQ: ATHN - News), which provides billing services and electronic health records for more than 1,700 medical groups. It said last week that the number of claims filed per physician, as well as the average value of the billing for each visit, had dropped from a year earlier.

Physician visits and hospital admissions are dropping this year, according to Thomson Reuters' healthcare business, which surveys doctors and hospitals. Doctor visits have declined each month this year, including a 7.6% drop in May 2010 from May 2009. Likewise, hospital admissions dropped in three of the first four months of this year compared to those months last year, including being down 2.3% in April 2010 from April 2009.

Urticaria

2012-03-10T16:58:00.000+07:00

Causes of urticaria

There are distinct types of urticaria:

Acute urticaria may be caused by an allergy and can last between several hours and six weeks
Chronic urticaria isn't usually caused by an allergy and persists beyond six weeks
Physical urticaria is triggered by physical factors and lasts only an hour or two

The most likely triggers for acute urticaria are allergies to pets, horses, latex and foods, such as shellfish and nuts in adults and eggs and cow's milk in children.

Other possible causes include bee or wasp stings, and allergies to medicines such as antibiotics, blood pressure pills and aspirin.

Viral infections, such as glandular fever and herpes, dental and sinus infections, fungal infections, blood transfusions and vaccines can also cause acute urticaria.

The cause of chronic urticaria is often more difficult to identify. Most cases are called chronic idiopathic urticaria, which means they're caused by the body's unexplainable development of antibodies to itself (auto-antibodies).

Chronic bacterial and parasitic infections, long-term use of blood pressure drugs, underlying thyroid disease and autoimmune diseases such as lupus can provoke urticaria.

Chronic urticaria is often accompanied by coexistent physical urticaria, triggered by environmental exposure to heat, cold, sunlight, vibration, pressure on the skin or even exercise.

Most people with urticaria have such sensitive skin that any rubbing will cause raised red lines to develop. This is called dermatographism.

Urticaria symptoms

The rash is very itchy and consists of a number of raised pale bumpy weals surrounded by red skin. Ordinary urticaria tends to move about or migrate all over the skin surface. In chronic cases, the itchiness may cause sleepless nights and lead to depression.

The condition tends to settle and then relapse again at times of viral illness, stress and after taking medication that contains aspirin. This chronic pattern may recur for many years.

Tissue swelling, called angioedema, may occur with urticaria. This affects the lax tissues around the eyelids, lips, neck and groin. Occasionally, an inherited deficiency of the C1 esterase inhibitor enzyme leads to marked swelling without urticaria. This rare condition is called hereditary angioedema.

If urticaria doesn't disappear after a few weeks, or doesn't respond to antihistamine medication, and is accompanied by any other health problem, see your GP. Blood tests may be able to identify an allergy or underlying immune disease.

Urticaria treatments

High doses of non-sedating antihistamines may be necessary for prolonged periods of up to six weeks or more. Short courses of oral steroids are occasionally required to settle severe symptoms.

Try to avoid general urticaria triggers such as stress, alcohol, aspirin, hot baths, rapid temperature changes, tight clothing and junk or processed foods containing sulphur dioxide, sodium benzoate, salicylate and tartrazine.

Avoid tomatoes, strawberries, strong cheese, dark fish and fermented foods. Although these 'pseudo-allergens' aren't the primary cause of urticaria, they do tend to aggravate it.

The new leukotriene receptor antagonist medications used in asthma may also help urticaria if used in conjunction with antihistamines.

If there's no response to conventional treatment, a specialist should investigate other possible underlying illnesses, such as lupus, thyroid disease and chronic infections.

Eye allergies

2012-03-10T16:47:00.001+07:00

Hay fever eyes

Seasonal allergic conjunctivitis is the eye equivalent of hay fever and affects up to 25 per cent of the general population. The eyes become itchy, watery and red in the summer pollen season, usually from exposure to grass and tree pollen.

Vernal conjunctivitis is a more severe form of this disease seen in children. The eyes are sticky with a stringy discharge, and it's painful, especially when opening the eyes on waking.

The inner membranes of the eyelid swell and the conjunctiva develops a cobblestone appearance. Corneal damage may occur if the condition is left untreated.

Perennial allergic conjunctivitis tends to occur all year round, with house dust mite and cat allergies. The symptoms are usually milder than those in seasonal allergic conjunctivitis.

Eczema eyes

Although rare, atopic keratoconjunctivitis is the most severe manifestation of allergic eye disease. It occurs predominantly in adult males and is the eye equivalent of severe eczema.

This persistent condition results in constant itching, dry eyes and blurred vision. It's associated with corneal swelling and scarring. Eyelid eczema and infection are common, and lens cataracts may develop over time.

Contact lens allergy

Contact lens wearers may develop giant papillary conjunctivitis, triggered by constant local irritation by the contact lenses on the conjunctival surfaces. The lining of the upper eyelid is usually most affected. Disposable contact lenses may help settle symptoms, but occasionally wearing contact lens has to be suspended.

Never use steroid eye drops unless under the direct supervision of a doctor. Although they're effective for treating eye allergies, they can lead to unwanted side-effects such as glaucoma and cataract formation.

They may also encourage infections of the eye, with resultant corneal scarring.

Eye allergy treatments

Regular use of anti-allergy eye drops such as sodium chromoglycate, nedocromil, olopatidine and lodoxamide can help to treat mild seasonal disease.

Non-sedating oral antihistamines - cetirizine, loratadine, mizolastine and fexofenadine - can also help, especially when there's an associated nasal allergy.

Corticosteroid eye drops occasionally have to be used for more severe eye allergies, but this should be for short periods only.