Occupational Therapy

Blindness

2009-12-25T02:40:00.001-08:00

Blindness?

Blindness is defined as a loss of vision in both eyes that cannot be corrected to better than 10/100 feet or 6/60 meters. The term blindness also applies to loss of peripheral vision so that visual field is restricted to less than a 20 degree angle (tunnel vision). People who had sight but lost it are referred to as adventitiously or newly blinded, whereas people born without sight are said to be congenitally blind.

Cause

There are many possible causes of blindness: a detached retina, diabetic retinopathy, puncture wounds to the eyes, multiple sclerosis, conjunctivitis, retinal hemorage, retinal fibrosis, enucleation,glaucoma, pressure ob the optic nerve, or rubella.

Assessment

Areas

People with visual impairments frequently have multiple handicaps that need to be assessed and managed to improve coping skills.

range of motion
hand function and skills-grasp, pinch,and release
muscle strength
ambulation and mobility
postural reflexes and balance/equilibrium reactions
sensory awareness and discrimination
auditory localization
perceptual skills, including directionality and laterality
self perception
interpersonal skills
self-care skills, including oral motor skills
communication skills
productivity interests and skills
leisure interests and skills

Instruments

Screening for physical and Occupational Therapy Referral
Activities of daily living scale
Occupational histiry
Leisure checklist

Problems

Motor

The person loses ease of mobility.
Hand functions that normally rely on visual input are decreased.

Sensory

The person has a loss of acuity.
The person ha a los of color vision.
The person may have no awareness of the environment.
The person may have light perception only (awareness of light and dark).
The person may have travel vision but cannot move safely about the environment independently.

Cognitive

Learning problems may occur for persons previosly dependent on sight for gaining most

of their information.

Intrapersonal

The person has feelings of insecurity.
The person has feelings of helplessness and hopelessness.
The person may be depressed .
The person may become introverted.

Interpersonal

The person may become dependent to others.
The person may avoid friends and situations previously enjoyed.

Self-Care

The person may have loss of skills that depend on vision, such as grooming, telling time,

or matching socks, skirt, and blouse.

Productivity

the person may be unable to continue a former occupation or need adjustments in the

working environment.

Leisure

The person may be unable to continue some leisure interests previously enjoyed or need

adjustments to continue them, such as stamp or coin collecting and reading.

Treatment/Management

Motor

Help the person regain mobility.
Provide practice in using hands in activities.

Sensory

Increase the person's skills and awareness of other sensory modalities, including hearing, touch, kinesthesia, proprioception, and vestibulum.

Cognitive

Inform the person of learning options available to the blind, including books on tape and music activities.

Intrapersonal

Improve self-perception through use of creative activities, such as crafts, drama, dance, or music activities.

Interpersonal

Encourage the person's family to discuss role changes that may occur because of blindness and what roles the person can perform within the family structure.
Encourage the person to participate in social activities.

Self-Care

Help the person to organize objects needed for activities of daily living, such as marking objects for easy identification and making use of Braille-coded objects, such as watches and timers.

Productivity

Help the person determine whether previous employment or job interests are feasible with limited or no sight.
Suggest changes that could be made in the work environment to facilitate continued employment for a person with limited sight.
help the person explore alternate vocational interests if continuation of present emplotment is not possible.
Help the person organize home living environment to facilitate management of it.

Leisure

Help the person explore new or redevelop old interests adapted for blind persons, including materials that can be purchased, such as Braille-marked cards.

Precautions

Safety is a major concern. Always check equipment and the physical environment for possible hazards.
If blindness is due to diabetic retinopathy, be aware of other problems associated with diabetes, such as poor circulation and loss of tactile sensation.

Prognosis/Outcome

The person can demonstrate the ability to perform basic activities of daily living independently.
The person is able to negotiate home and local community without assistance.
The person is able to engage in productive activities as a worker, student or volunteer.
The person participates in a variety of leisure activities.

Child Abuse and Neglect

2009-11-15T17:37:00.001-08:00

Child Abuse and Neglect

Child abuse and neglect is defined as physical injury, emotional disturbance, sexual abuse, negligence, or maltreatment of a child under the age of 18 by a person who is responsible for the child's welfare.

Cause

Abuse is the breakdown of impulse control in the parent, guardian, or other caregiver.

there are four factors involved:

Personalities features-The caregiver experienced lack of affection and support as a child and thus does not know how to provide the same for his or her child, or the caregiver is out of control due to substance abuse or psychotic illness.
The difficult or different child- Examples include hyperactive, handicapped, premature, or sickly children or stepchildren.
Inadequate support- The caregiver feels isolated or abandoned by relatives or friends who could provide guidance and assistance.
Crisis situation- Stress overcomes the caregiver's ability to function.

Neglect is observed in families with multiple problems and disorganized lifestyles. Depression, desertion, drug or alcohol abuse, and chronic medical conditions may be seen in one or more caregivers.

Assessment

Areas

gross motor development and skills
fine motor skills, manipulation, dexterity, and bilateral coordination
muscle strength
reflex development and maturation
postural control (use of protective and equilibrium reactions)
muscle tone
joint stability and mobility
sensory registration/awareness
sensory sensitivity/processing
perceptual skills ( visual, auditory, tactile, and kinesthetic)
attending behavior and concentration
ability to follow directions/sequencing
motivation or self-initiated activity
mood or affect
self-control
coping skills
social conduct skills
daily living skills
academic readiness or academic skills
play skills

Instruments

No comprehensive or specific scale for occupational therapist to use assessing child abuse was identified. The following assessments may be useful:

Bayley Scales of infant development
Brazelton Neonatal Assessment Scale
A play scale
Child abuse potential inventory

Problems

The problems associated with child abuse can be verified and many. The list of problems should be considered as examples and not as comprehensive list.

Motor

Developmental milestones may be delayed, especially gross and fine motor skills.
Muscle weakness may be present if nerve or brain damage has occurred.
Paralysis may be present if nerve or brain damage has occurred.
Contractures may be present if condition has existed for some time.
Reduction range of motion may be present, depending on the type of injury.
Reflex maturation may be incomplete, with primitive reflexes continuing to be present.

Sensory

Sensory loss may have occurred in vision, hearing, touch proprioception, or kinesthesia and less commonly in taste or smell.
Body image may fail to develop or an impaired body image may develop.
Sensory integrative Dysfunction may be present, including developmental dyspraxia and vestibular- bilateral disorder.
Sensory responses may be hypo- or hyperactive.

Cognitive

Learning disabilities may be present, including dyslexia, short attention span and hyperkinetic behavior.
The child may have poor problem- solving skills.

Intrapersonal

The child may have poor self-image and lack of confidence.
The child may feel guilty for "causing so much trouble." (note: The child is not the cause but may be made to feel so by repeated statements from one or more adults.)
The child may have blunted or flat affect.
The child may lack self-control, such as being sensitive and aggressive or having low tolerance for frustration.
The child may act helpless or be overly complaint or withdrawn.
Role identity within family unit may be ill-defined or fluctuating.

Interpersonal

Parent(s) and child may lack coping skills.
The child may have delayed development of social interaction and conduct skills.
the child may be delayed in acquiring speech or vocabulary.
Bonding between parent and child may be inadequate or lacking.
The child may lack group interaction skills.

Self-Care

The child may be delayed in developing activities of daily living, such as dressing, tying shoes, or eating with a fork.
The child may be unable to perform certain ADLs (activities of daily living) if motor skills are involved.

Productivity

The child may have developmetal delays in acquiring play skills.
the child may use less imagination in play.
The child may be unable to organize play activities.
The child may show little exploratory behavior in play.

Leisure

The child may have few leisure interests beyond watching television or video.

Treatment/Management

Models of treatment include sensory integration (Ayres), and neurodevelopmental therapy (Bobath).

Motor

Promote development of groos and fine motor skills according to developmental level.
Increase muscle strength through progressive resistive exercises.
Maintain or increase joint range of motion through passive exercises and active involvement in activities.
Facilitate integration of primitive reflexes.

Sensory

If sensory loss has occurred, facilitate development of remaining senses.
Increase body awareness and position in space.
Is sensory dysfunction is noted, see section on the specific disorder for treatment suggestions.
Modulate hyper- or hyporesponsiveness to stimuli.

Intrapersonal

Improve self-image and sense of mastery through use of creative activities ,such as crafts, games, music, dance, or drama.
Increase self-control by assisting the child to think of alternative approaches to situations and tasks.

Interpersonal

Provide an opportunity for the child to practice social conduct in a group situation.

Self-Care

promote self-feeding skills.
Decrease oral motor sensitivity.
Increase skills in daily living.

Productivity

Teach parents or caregivers the child's level of play skills and how to participate in play activities with the child.
Promote development of play skills
Assist in promoting academic readiness skills.

Leisure

Encourage exploration of interests and developments of leisure skills.

Precautions

Observe a child for signs of any additional abuse or neglect.

Prognosis and Outcome

Parent or caregiver is able to interact with the child without violent or abusive behavior.
Parent or caregiver demonstrates knowledge of the child's level of development and adjusts expectations to the child's level of performance.
Parent or caregiver is able to manage his or her own life situation and stresses without taking anger or frustration out on the child.
Child demonstrates improved developmental profile in motor, sensory, language, and self-care skills
Child demonstrates improvement in play skills.

Arthrogryposis Multiplex Congenita

2009-11-13T00:07:00.000-08:00

Arthrogryposis Multiplex Congenita
Arthrogryposis multiplex congenita (AMC) is a nonprogressive neuromuscular disorder present birth that is characterized by fibrous ankylosis (contractures) of multiple joints. Muscle development is arrested at some time during the fetal period and fibrous or fatty tissue replaces the muscle, resulting in contractures and abnormal joint surfaces. Types of AMC include neuropathic, myopathic, and mixed.

Cause
The cause of AMC is unknown. The disorder is not genetic; individuals have normal chromosomes. Some cases can be traced to neurogenic causes through histologic and electromyographic evidence, or to myopathic causes through studies of muscle fiber. Other causative agents may include prenatal exposure to adverse environmental agents, maternal infection, abnormal connective tissue, chromosomal or genetic defects, and impaired intrauterine fetal movement.

Assessment

Areas:

Range of motion.

Muscle strength.

Developmental of gross and fine motor skills.

Developmental of hand skills, grasp, and prehension

Balance and postural control

Self-perception

Family and social support

Daily living skills

Play skills

Instruments:
No specific instruments have been developed by occupational therapists to deal with this disorder. The following may be useful:

· Developmental assessment

· Activities of daily living scale

· Play history

Problems

Motor:

The disorder is usually characterized by rigidity and/or contractures of the joints.Typically, in the upper extremities , the shoulders are adducted and internally rotated, the elbows are extended but occasionally flexed, the forearms are pronated, the wrists are flexed and ulnary deviated, the fingers are flexed, and the thumb is in the palm. In the lower extremities, the hips may be dislocated and are usually flexed and externally rotated, the knees are extended but occasionally flexed, and the feet are in equinovarus.

There is usually severely limited range of motion in all major joints.

Muscle weakness usually occurs.

The person may have absence or atrophy of individual muscle or muscle groups.

The person may ave gross abnormalities of the chest and spine (myopathic type).

Other problems include webbing on the ventral aspects of flexed joints, cleft palate, scoliosis, torticollis, facial palsy, limb deformity, and congenital amputation.

Achievement of gross and fine motor skills is usually delayed

Development of hand functions is usually delayed.

Sensory

Sensory system is intact, but perceptual skills, such as stereognosis, could be delayed due to lack of opportunity.

Cognitive
Cognition is normal and intelligence is average to above average, but learning could be delayed due to lack of opportunity and many surgical procedures.

Intrapersonal

Parents, especially the mother, may feel guilt about having a handicapped child.

Child may have tantrums due to frustrations.

Interpersonal
Family members may reject the "funny looking" child and leave the parents or mother without support.

Self-Care
Development of self-care skills is usually delayed because the patient's hand functions and fine motor skills are now develop.

Productivity
Play skills are usually underdeveloped.

Leisure

See productivity.
Treatment/Management

Motor

Increase and maintain range of motion through activities, such as exercise and stretching.

Promote achievement of gross and fine motor skills.

Improve posture and positioning through the use of adapted equipment, such as corner seats, strollers, swivel buckets, or parapodiums.

Provide splints to maintain gains in range of motion or serial casts to increase range of motion.

Sensory
Provide opportunities to experience sensory input.

Cognitive

Provide opportunities for learning and encourage child to explore problem-solving methods.

Provide information to parents about the disorder and encourage parental participation in the therapy program. They should understand the importance of having the child wear splints until bone matures and continuing range of motion activities everyday so the child maintains use his/her body

Provide information about community resources and services.

Provide information about normal growth and development.

Provide information about architectural and environmental barriers.
Intrapersonal

Provide opportunities to develop self-perception through the use of creative activities, such as art, crafts, drama, dance, music, and games.

Encourage parents to express feelings and concerns about the child's condition and welfare.

Provide instructions in stress-management techniques.
Interpersonal

Encourage parent-infant bonding.

Encourage parents to participate in self-help groups.

Self-Care

Provide self-help devices to assist in the performance of daily living skills. A lazy susan may be used as a plate. Food can be placed around the edge of the plate.

Adapted equipment may be necessary for grooming, such as extended handles on combs, brushes and toothbrushes.

Clothing adaptation may be needed to account for various deformities, using Velcro and elastic. Providing large rings on zippers or loops to grasp and large button is also useful.

Productivity

Promote development of play skills, especially exploratory and manipulative play.

Assist teachers in determining what, if any, adapted equipment or devices may be needed to assist a child with academic activities. Computers with adapted keyboards may be helpful. the child should be able to attend regular classroom instruction, except for physical education.

Leisure
Usually no special goals or objectives are necessary. The child or an adult will seek those activities that are within the child's functional abilities.

Precautions
Bone structure is fragile. Range of motion and stretching exercises should be carefully monitored.

Prognosis/Outcome

The person has maximum range of motion possible given structural limitations.

The person achieves gross and fine motor skills, although the development of skills does not progress normally.

The person has functional hand skills, although the use of the hands may be unorthodox.

The person has independently mobility with or without powered mobility.

The person achieves independence in self-care and daily living skills.

The person develops productive skills.

Kidney Disease with Dialysis

2009-11-12T16:43:00.000-08:00

What is Kidney Disease with Dialysis?

Diseased kidneys are unable to maintain homeostatic balance of water, minerals, and excretion. Toxic end-products accumulate in the blood

and tissue. The kidney also is no longer able to function as an endocrine organ.Dialysis is the process of separating elements in a solution by

diffusion across a semipermeable membrane. The purpose is to reestablish homeostatic balance and decrease the toxic end-products.

Cause

Acute or chronic kidney failure may occur as a result of numerous disorders, including uremic encephalopathy, pericarditis, intractable

metabolic acidosis, congestive heart failure, and hyperkalemia. Persons affected may be of any age. Both sexes are affected equally.

Assessment

Areas

developmental profile
muscle strength
range of motion
endurance
fine motor skills, manipulations, dexterity, and bilateral coordination
sensory registration
sensory processing
attention span
learning skills
self-concept
sense of self-mastery or self-control
mood or affect, especially signs of depression
social skills
coping skills
daily living skills
productive history, values skills, and interests, including academic and play skills
leisure skills and interest

Instruments

No specific instruments developed by occupational therapists were identified in the literature. The following types of tests may be useful:

academic testing
manual muscle test by groups of muscle
goniometry
activities of daily living
play history
leisure checklist

Problems

Motor

The person may have decreased muscle strength.
The person may have decreased physical endurance and rapid fatigue.
The may have loss of range of motion.
The person may have decreased muscle control.
The person may have decreased fine motor coordination and dexterity.
The person may have foot drop, trmor, or other signs of peripheral neuropathy.

Sensory

Loss of sensation may occur.
Loss of vision or decreased visual acuity may occur.

Cognitive

The person may have loss of attention span and concentration.
The person may experience drowsiness.

Intrapersonal

The person usually experiences a decrease or loss of self-concept, especially mastery and autonomy.
The person may have lost self-esteem or feelings of self-worth.
The person may express anger and frustration.
The person may experience loss of effective coping skills.
The person may have an increased sense of dependency.
The person may be depressed.
The person may express fear of death.
The person may become irritable and uncooperative.
The person may become confused and anxious.
A preschool child may perceive painful medical procedures, hospitalization, and separation from parents as punishment.
A school-age child may perceive him or herself as different from others.
The parent or parents may have many of the same problems that the child experiences.

Interpersonal

The person may experience difficulty relating to authority figures.
the person may withdraw from social group interaction.
The person may experience conflict with his or her family related to changing roles.

Self-Care

The person may be unable to perform some activities of daily living due to limited energy or decreased range of motion.

Productivity

The person may be unable to perform productive activities, such as academic work, play, and chores, due to reduced energy level or decreased strength.

Leisure

The person may not engage in favorite leisure activities because of decreased functional abilities.

Treatment/Management

Motor

Increase muscle strength through graded activities.
Increase functional range of motion through selected activities within the person's normal activities if possible.
Increase the person's muscle control.
Increase coordination and dexterity through selected activities.
Increase physical endurance through gentle exercises.

Sensory

No specific sensory treatment or management is recommended.

Cognitive

Instruct the person in concepts of energy conservation and work simplification.
Instruct the person in concepts of safety associated with dialysis.
Assist in instructing the person on recommended diet changes and necessary modifications in food preparation.
Instruct the person in development of a time-management schedule that includes cycles of rest and exercise.
Select projects that are quick and require a short attention span, such as games, puzzles, mazes, or crosswords for children.

Intrapersonal

Increase self-concept through successful accomplishment of art, craft, educational, creative writing, or game activities.
Increase the person's sense of mastery through knowledge about and performance of activities.
Encourage the person and family members to verbalize feelings of hopelessness, helplessness, and fear of dying.

Interpersonal

Encourage the person to engage in social activities.
Assist the person and family to reorganize roles within the family unit, if necessary.
Encourage the person and family to articipate in a self-help group, if available, in their hospital or community.
Encourage the person to maintain contact with the outside world if hospitalization is required. Field trips may be useful.

Self-Care

Maintain or increase independence in self-care activities through the use of work-simplification or time management techniques.
Provide adapted equipment to assist the person in the performance of self-care activities when indicated.
Cooking may be useful to increase appetite and reinforce concepts of good nutrition.Check dietary restrictions, such as avoiding salt and chocolate.
Young children may need to develop skills in dressing and grooming.

Productivity

Assist the person to modify his or her home and work environment if needed.
Assist the person to explore alternate interests if current vocation cannot be continued.
Assist the person to perform other productive roles, including home manager, volunteer, or student, as indicated.
Encourage the person to continue studies, if student.
Increase development of play skills. Role playing as a doctor or nurse may relieve a child's fears and anxieties and provide outlet for feelings.

Leisure

Assist the person to modify existing leisure interests to conform to physical capacities.
Assist the person to explore new interests that can be performed within physical capacities.

Precautions

Avoid messy or dirty activities since persons with renal disorders may be in poor general health or have a poor immune system.

Prognosis and Outcome

The person has maintained or increased muscle strength.
The person has maintained or increased range of motion.
The person has maintained or increased fine motor dexterity and bilateral coordination.
The person has maintained or increased physical endurance.
The person has maintained or increased balance and postural control .
The person demonstrates use of energy-conservation and work-simplification techniques.
The person demonstrates Knowledge of safety factors associated with dialysis.
The person is able to express feelings about dying.
The person demonstrates a positive self-concept and internal locus of control.
The person demonstrates stress-management and coping skills.
The person maintains or increase social interaction skills.
The person demonstrates productive skills.
The person demonstrates leisure skills.

Diabetes Mellitus-Type II

2009-11-10T17:55:00.000-08:00

What is Diabetes Mellitus-type II?

Diabetes Mellitus-type II is a disorder with hereditary and environmental factors characterized by abnormal insulin secretion, elevated blood glucose levels, and a variety of potential complications of various organ systems . A person with type II diabetes mellitus is not dependent on insulin (non-insulin-dependent diabetes mellitus, NIDDM) as is someone with type I (insulin-dependent diabetes mellitus, IDDM). Diabetes may be a primary or secondary diagnosis.

Cause?

This disease has no distinct etiology, pathogenesis, specific clinical findings or laboratory tests. The clinical syndrome always involves hypergylcemia, large vessel disease, disease of the retina and kidney, and neuropathy. Onset is usually after age 30.

ASSESSMENT

Areas:

muscle strength by groups of muscles.
fine motor skills, manipulation, dexterity, and bilateral coordination.
grip and pinch strength .
balance and postural control.
sensory registration.
sensory processing ( tactile, pain, proprioceptive, vibration) of the feet, hands, and limbs.
perception skills, especially visual
self concept.
role behavior.
daily living skills.
productivity history, skills, interests, and values.
leisure interests and skills.

Instruments

No specific instruments developed by occupational therapists were identified in the literature. The following types instruments may be useful:

dynamometers and pinch meters.
two-point discrimination tool, such as Disk-Criminator or Boley gauge.
coordination/dexterity tests, such as the Purdue Pegboard Dexterity Test.
balance beam and tilt board.
activities of daily living scale.
occupational history.
leisure checklist.

PROBLEMS

Motor:

The person may have general weakness and loss of weight.
The person usually has decreased endurance and physical tolerance and fatigues easily.
The person may have loss of reflexes or reactions.
The person may have muscle aches and pains.
The person may have specific muscle weaknesses, such as in the intrinsics of the foot (diabetic neuropathy).
The person may have flexion contractures in the hand.
The person may have impaired circulation associated with diabetes, which may cause myocardial or cerebral infarction or result in amputation of a leg.
The person may have renal disease associated with diabetes.

Sensory:

The person may have loss of vision and other eye changes (diabetic retinopathy, diabetic retinitis, diabetic cataract).
The person may have loss of the sense of touch.
The person may experience paresthesia, hyperesthesia, or hypoesthesia.
The person may lose vibration and position sense.
The person may have decreased sensitivity to pain in the extremities but experience chronic pain in other parts.
The person may have decreased temperature sensation.

Cognitive:

Cognitive faculties are not affected directly by the disorder.

Intrapersonal:

The person mat fear being dependent on insulin.
The person may have anxiety about living with diet restrictions.
The person may become depressed or angry. (why me?)
The person may become irritable.
The person may be easily be discouraged.
The person may worry about the future.

Interpersonal:

The person may have decreased social activities due to fatigue or diet restrictions.

Self-Care:

The person may learn to administer insulin, whether orally or by injections.

Productivity:

The person may be unable to perform productive activities due to fatigue.

Leisure:

The person may have stopped participating in his/her favorite leisure activities due to fatigue.

TREATMENT/MANAGEMENT

Models of treatment do not appear to be well established but include aspects of compensation/substitution, biomechanical, and human occupation models.

Motor:

Increase muscle strength through the use of specific activities.
Increase endurance and physical tolerance through the use of functional activities.
Provide a home program to maintain movements of feet and ankles and decrease edema, such as picking up small objects with the toes or rolling a bottle back and forth with the feet.
Biofeedback ma be helpful in increasing circulation, maintaining temperature in the extremities, decreasing heart rate and pressure; and maintaining or increasing muscle contraction.
Serial casting may be used to prevent contractures and increase joint mobility during or after ulcer healing of the foot.

Sensory:

Maintain sensory awareness, especially in the feet,through the use of foot activities and games or biofeedback.
If sensory loss has occurred, provide opportunity to practice compensatory skills using remaining sensory systems as backups or substitutes.

Cognitive:

Instruct the person on concepts of energy conservation and work simplification.
If sensory loss has occurred, instruct the person on safety requirements necessary to avoid injury.
Instruct the person in time management to organize cycles of rest and activity.
Assist in instructing the person to modify diet according to recommended guidelines,including changing recipes and planning meals menus.
Assist in instructing the person secondary complications of diabetes, such as decreased tactile awareness(routine visual inspection especially of the feet needed), circulation impairment ( shoes designed to protect against pressure should be worn), and visual problems (relationship of increased systolic pressure to retinal aneurysms).
Instruct the person on the relationship of exercise to blood sugar level.

Intrapersonal:

Maintaining or increase the person's self-concept and sense of mastery.
Maintaining or increase the person's self-identity and sense of self-responsibility.
Increase the person's coping skills needed to adjust to life with disability but not a handicap.
Provide instruction and practice in relaxation techniques to reduce stress.

Interpersonal:

Encourage the person to maintain dyadic relationship.
Support group interaction, including a support self-help group for persons and families with diabetes.
Assist the family to adjust roles and functions to maintain the person's active participation in the family unit.

Self-Care:

Provide adapted equipment, if neccessary, to facilitate performance of self-care activities.
Encourage the person to maintain independence in activities of daily living.

Productivity:

Explore possible needs for modifications in the work or home environment to conserve energy and simplify work tasks.
If the current jobs situation is dangerous to the person's health, explore alternative vocational interests.
Encourage the person to participate in home-management tasks.

Leisure:

Assist the person to determine which leisure interests must be modified or discontinued.
Assist the person to explore new interests to replacethose that cannot be continued.
Provide information on available community programs and resources.

PRECAUTIONS :

Observe the person for symptoms of insulin shock
Observe safety rules.

PROGNOSIS AND OUTCOME:

The person has sufficient strength and endurance to perform activities of daily living.
The person demonstrates the use of good energy-conservation and work-simplification techniques during functional activities.
The person demonstrates time-management skills in regulating physical activities according to rest and activity cycles based on insulin and diet considerations.
the person demonstrates knowledge regarding skin care to prevent skin breakdown.
The person has learned compensatory skills for any sensory loss and can perform activities safely.
the person has learned coping skills to live within restrictions of the disease without becoming handicapped.

Prostate Cancer

2009-11-09T05:18:00.000-08:00

What Is the Prostate Gland?

The prostate gland, a key part of the male reproductive system, is linked closely with the urinary system. It is a small gland that secretes much of the liquid portion of semen, the milky fluid that transports sperm through the penis during ejaculation.

The prostate is located just beneath the bladder, where urine is stored, and in front of the rectum. It encircles, like a donut, a section of the urethra. The urethra is the tube that carries urine from the bladder out through the penis. During ejaculation, semen is secreted by the prostate through small pores of the urethra's walls.

The prostate is made up of three lobes encased in an outer covering, or capsule. It is flanked on either side by the seminal vesicles, a pair of pouch-like glands that contribute secretions to the semen. Next to the seminal vesicles run the two vas deferens, tubes that carry sperm from the testicles. The testicles, in addition to manufacturing sperm, produce testosterone, a male sex hormone that controls the prostate's growth and function.

What Is Prostate Cancer?

A diagnosis of prostate cancer means that cancer cells have formed in the tissues of the prostate. Prostate cancer tends to grow slowly compared with most other cancers. Cell changes may begin 10, 20, or 30 years before a tumor gets big enough to cause symptoms. Eventually, cancer cells may spread (metastasize) throughout the body. By the time symptoms appear, the cancer may be more advanced.

Most prostate cancer never poses a problem. There are either no signs or symptoms, or the disease never becomes a serious threat to a man's health. A much smaller percentage of men are actually treated for prostate cancer. Most men with the condition, however, do not die from this disease.

No one knows the exact causes of prostate cancer. Doctors often cannot explain why one man develops prostate cancer and another does not. However, we do know that prostate cancer is not contagious. You cannot "catch" it from another person.

Know the Risk Factors

Research has shown that men with certain risk factors are more likely than others to develop prostate cancer. A risk factor is something that may increase the chances of developing a disease.

Studies have found the following risk factors for prostate cancer:

· Age: Age is the main risk factor for prostate cancer. This disease is rare in men younger than 45. The chance of getting it goes up sharply as a man gets older. In the United States, most men with prostate cancer are older than 65.

· Family history: A man's risk is higher if his father or brother has prostate cancer.

· Race: Prostate cancer is more common in African-American men than in white men, including Hispanic white men. It is less common in Asian and American Indian men.

· Certain prostate changes: Men with cells called high-grade prostatic intraepithelial neoplasia (PIN) may be at increased risk for prostate cancer. These prostate cells look abnormal under a microscope.

· Diet: Some studies suggest that men who eat a diet high in animal fat or meat may be at increased risk for prostate cancer. Men who eat a diet rich in fruits and vegetables may have a lower risk.

Scientists have also studied whether other factors might increase the risk for prostate cancer, including:

· BPH

· Obesity

· Smoking

· A virus passed through sex

· Lack of exercise.

At this time, however, these are not clear risk factors.

Also, most studies have not found an increased risk of prostate cancer for men who have had a vasectomy. A vasectomy is surgery to cut or tie off the tubes that carry sperm out of the testicles.

Common Symptoms of Prostate Cancer

For men who have prostate cancer symptoms, common symptoms include:

· Urinary problems

· Not being able to urinate

· Having a hard time starting or stopping the urine flow

· Needing to urinate often, especially at night

· Weak flow of urine

· Urine flow that starts and stops

· Pain or burning during urination

· Difficulty having an erection

· Painful ejaculation

· Blood in the urine or semen.

Other Prostate Cancer Symptoms

Prostate cancer can spread to the lymph nodes of the pelvis. Or it may spread throughout the body. It tends to spread to the bones. So bone pain -- especially in the back, hips, or upper thighs -- can be another symptom of prostate cancer.

Two tests can be used to detect prostate cancer in the absence of any symptoms:

· A digital rectal exam, in which a doctor feels the prostate through the rectum to find hard or lumpy areas

· A prostate-specific antigen (PSA) test, a blood test used to detect a substance made by the prostate.

Together, these tests can detect many "silent" prostate cancers, that is, those that have not caused symptoms.

Other Tests Used to Determine Prostate Cancer Stage

Other tests used for clinical staging of prostate cancer

are:

· Transrectal ultrasound

· Biopsy.

· Bone Scan

· Computed tomography (CT) scan

· Magnetic resonance imaging (MRI) scan

· Lymph node evaluation.

Specific Stages

The stages of prostate cancer are as follows:

· Stage I: The cancer cannot be felt during a digital rectal exam (DRE). It is found by chance when surgery is done for another reason, usually for benign prostatic hyperplasia (BPH). The cancer is only in the prostate.

· Stage II: The cancer is more advanced, but it has not spread outside the prostate.

· Stage III: The cancer has spread outside the prostate. It may be in the seminal vesicles. It has not spread to the lymph nodes.

· Stage IV: The cancer may be in nearby muscles and organs (beyond the seminal vesicles). It may have spread to the lymph nodes. It may have spread to other parts of the body.

· Recurrent: The cancer has come back (recurred) after a time when it could not be detected. It may recur in or near the prostate. Or it may recur in any other part of the body, such as the bones.

Prostate Cancer Treatment

The treatment option that is right for you depends on:

· The stage of the cancer

· The grade of the tumor

· Your symptoms of prostate cancer

· Your general health.

The treatment that is best for one man may not be best for another. Your doctor will describe your treatment choices and the expected results.

Treatment for prostate cancer may involve:

· Watchful waiting

· Surgery

· Radiation therapy

· Hormone therapy

In addition, you may have a combination of treatment methods.

You should consider both the expected benefits and possible side effects of each treatment option. You may want to discuss with your doctor the possible effects on sexual activity. You can work with your healthcare provider to create a prostate cancer treatment plan that reflects your medical needs and personal values.

Prostate Cancer Treatment by Stage: Stage I

Treatment for stage I prostate cancer may include the following:

· Watchful waiting.

· Radical prostatectomy, usually with pelvic lymphadenectomy, with or without radiation therapy after surgery. It may be possible to remove the prostate without damaging nerves that are necessary for an erection.

· External beam radiation therapy.

· Implant radiation therapy.

Prostate Cancer Treatment by Stage: Stage II

Treatment for stage II prostate cancer may include the following:

· Watchful waiting.

· External beam radiation therapy.

· Implant radiation therapy.

Prostate Cancer Treatment by Stage: Stage III

Treatment for stage III prostate cancer may include the following:

· External beam radiation therapy (with or without hormone therapy)

· Hormone therapy

· Radical prostatectomy, usually with pelvic lymphadenectomy (with or without radiation therapy after surgery)

· Watchful waiting

· Radiation therapy, hormone therapy, or transurethral resection of the prostate (TURP) as palliative therapy to relieve symptoms caused by the cancer.

Prostate Cancer Treatment by Stage: Stage IV

Treatment for stage IV prostate cancer may include the following:

· Hormone therapy

· External beam radiation therapy -- with or without hormone therapy

· Radiation therapy or transurethral resection of the prostate (TURP) as palliative therapy to relieve symptoms caused by the cancer

· Watchful waiting.

Prostate Cancer Treatment by Stage: Recurrent

Treatment for recurrent prostate cancer may include the following:

· Radiation therapy

· Prostatectomy for patients initially treated with radiation therapy

· Hormone therapy

· Pain medication, external radiation therapy, internal radiation therapy with radioisotopes such as strontium-89, or other treatments as palliative therapy to lessen bone pain.

Prostate Cancer Follow-up Care

Prostate cancer follow-up care after treatment is important. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment.

Your doctor will monitor your recovery and check for recurrence of the cancer. Checkups help ensure that any changes in your health are noted and treated if needed. Checkups may include:

· Lab tests

· X-rays

· Biopsies

· Other tests.

Between scheduled visits, you should contact your doctor if you have any health problems or unusual changes in your body.

Side Effects of Prostate Cancer Treatment

Because treatment forprostate cancer often damages healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each man, and they may change from one treatment session to the next.

At any stage of disease, supportive care is available to:

· Control pain and other symptoms

· Relieve the side effects of treatment

· Ease emotional concerns.

Research on Prostate Cancer

Much of the research done on prostate cancer involves probing basic causes of the disease and testing drugs to control or reduce risk. Some research studies are exploring numerous links between genes and the development of prostate cancer. Other research studies are testing the effects of a low-fat, high-soy diet among men who have an increased risk of the disease.

Bone Cancer

2009-11-06T23:26:00.000-08:00

Bone Cancer

Bone cancer is a disease in which cancer cells form in the tissues of the bone.

There are several different kinds of bone cancer, including:

· Benign (noncancerous)

· Malignant (cancerous)

· Cancers that start in the bone (primary bone cancer)

· Cancers that start somewhere else in the body and end up in the bone (secondary bone cancer).

Benign Versus Malignant

Bone tumors can be benign (noncancerous) or malignant (cancerous). Benign bone tumors are more common than malignant bone tumors. Although both types of bone cancer may grow and compress healthy bonetissue and absorb or replace it with abnormal tissue, benign tumors do not spread and are rarely life threatening.

Malignant Bone Cancer Types

The three malignant types of bone cancer are:

· Osteosarcoma

· Chondrosarcoma

· Ewing's sarcoma.

Osteosarcoma

The most common form of bone cancer is osteosarcoma, which develops in the new tissue of growing bones. Osteosarcoma is commonly diagnosed in people between the ages of 10 and 25. Common areas where this bone cancer type appears include the:

· Knees

· Upper legs

· Upper arms.

Chondrosarcoma

Chondrosarcoma is another type of bone cancer that develops in the cartilage. Chondrosarcoma is commonly diagnosed in people between the ages of 50 and 60. Common areas where this form of bone cancer appears include the:

· Pelvis

· Upper legs

· Shoulders.

Ewing's Sarcoma

Evidence suggests that Ewing's sarcoma, another form of bone cancer, begins in the immature nerve tissue in the bone marrow. Ewing's sarcoma is usually diagnosed in people between the ages of 10 and 20. Common areas where this bone cancer type appears include the:

· Pelvis

· Upper legs

· Ribs

· Arms.

Metastatic Bone Cancer

When cancer spreads (metastasizes) from its original place to another part of the body, the new tumor will have the same kind of abnormal cells and the same name as the primary tumor. For example, if bone cancer spreads to the lungs, the cancer cells in the lungs are bone cancer cells. The disease is metastatic bone cancer, not lung cancer, and it is treated as bone cancer, not as lung cancer. Doctors may call the new tumor "distant" disease.

Secondary Bone Cancer Types

Bone cancer that appears in the bone (primary bone cancer) is different from cancer that spreads (metastasizes) to the bone from another part of the body (secondary bone cancer). Secondary bone cancer is much more common than primary bone cancer. Common types of secondary bone cancer include:

· Breast cancer

· Lung cancer

· Prostate cancer.

Primary bone cancer is rare. In the United States, approximately 2,500 new cases are diagnosed each year.

What Causes Bone Cancer?

No one knows the exact causes of bone cancer, and doctors can seldom explain why one person will get bone cancer and another person will not. However, it is clear that this disease is not contagious and no one can "catch" bone cancer from another person.Bone cancer research has shown that people with certain risk factors are more likely than others to develop the condition. A risk factor is anything that increases a person's chance of developing a disease. While risk factors do not cause bone cancer, they may act together to increase a person's chances of developing it.

Know the Risk Factors

Specific risk factors for bone cancer include:

· Being a child or young adult

· Previous radiation or chemotherapy

· History of Paget's disease

· Family history of bone cancer

· People with hereditary retinoblastoma.

Bone cancer usually develops over time. As the cancer cells grow, the cells spread more deeply into the bone and to surrounding areas. When bone cancer spreads (metastasizes) outside the bone, cancer cells are often found in nearby lymph nodes, nerves, or blood vessels. If the cancer has reached the lymph nodes, it may spread to other organs. It is helpful to understand the progression of bone cancer in order to understand bone cancer symptoms, staging, and treatment.

Common Bone Cancer Symptoms

Pain is the most common bone cancer symptom. However, symptoms may vary, depending on the location and size of the bone cancer. Tumors that occur in or near joints may cause swelling, tenderness, and/or stiffness in the affected area. Bone cancer can also interfere with normal movements and can weaken the bones, occasionally leading to a fracture.

Other symptoms of bone cancer may include:

· Fatigue

· Fever

· Weight loss

· Anemia.

Diagnosing Bone Cancer

If a person has potential bone cancer symptoms, the doctor will need to perform a physical exam and ask about the patient's personal and family medical history. In order to make a diagnosis, the doctor will also recommend additional tests and procedures that examine the bones.

During the physical exam, the doctor will feel the affected area for any lumps or bumps. The medical history will entail questions about the patient's health habits and a family history of any medical conditions, past illnesses, and treatments.

Exams and Tests Used in Making a Diagnosis

Exams and tests that are used to make a bone cancer diagnosis may include:

· Blood tests

· X-rays

· Computed tomography (CT) scan

· Bone scan

· Magnetic resonance imaging (MRI) scan

· Angiogram

· Biopsy.

Bone Cancer Treatment

There are several treatment options that are available when treating bone cancer. They will vary based on:

· The type of bone cancer

· The stage of bone cancer

· Where the tumor is found and the size of the tumor

· The patient's age and general health.

Patients should work with their healthcare providers to develop a treatment plan that meets their medical needs and personal values. Choosing the most appropriate bone cancer treatment is a decision that ideally involves the patient, the family, and the healthcare team.

Getting a Second Opinion

Sometimes, it is helpful to have a second opinion about the bone cancer diagnosisand the bone cancer treatment plan. While some insurance companies require a second opinion, others may cover a second opinion if the patient or doctor requests it.

The doctor is the best person to describe the bone cancer treatment choices and to discuss the expected results of each treatment option. The doctor and the patient should work together to develop a treatment plan that fits the patient's needs.

Depending on the type and extent of bone cancer, treatment may include:

· Surgery

· Radiation therapy

· Chemotherapy

· A combination of these methods.

Surgery is often the primary treatment for bone cancer. Although amputation of a limb is sometimes necessary, chemotherapy has made limb-sparing surgery possible in many cases. When appropriate, surgeons avoid amputation by removing only the cancerous section of the bone and replacing it with an artificial device called a prosthesis.

Chemotherapy and bone cancer radiation may be used alone or in combination. Ewing's sarcoma tends to metastasize rapidly, which is why multidrug chemotherapy is often used, in addition to radiation therapy or surgery on the primary tumor.

Side Effects of Treatment

Treating bone cancer may damage healthy cells and tissues, which can lead to unwanted side effects. Specific side effects will depend on many factors, including the type and extent of the bone cancer treatment. Side effects may not be the same for each person, and they may even change from one bone cancer treatment session to the next. Healthcare providers should explain the possible side effects and ways to manage them before treatment for bone cancer begins.

Depending on the type of bone cancer, some treatments can cause side effects that continue or that appear years after treatment has ended. These are called late effects. Late effects of bone cancer treatment may include:

· Physical problems

· Changes in mood, feelings, thinking, learning, or memory

· Having second cancers (new types of cancer).

Some late effects may be treated or controlled.

Types of Alternative Treatment for Bone Cancer

Alternative bone cancer treatment methods can include:

· Acupuncture

· Massage therapy

· Herbal products

· Vitamins or special diets

· Visualization

· Meditation

· Spiritual healing.

Many people say that these approaches help them feel better. However, some types of alternative treatment may interfere with standard treatment, and combining alternative treatment for bone cancer with standard treatment may even be harmful. It is important to note that some types of alternative treatments are expensive, and health insurance may not cover the cost of alternative treatments.

Alternative Pain Treatment

Pain is a potential problem for people with bone cancer. It can be caused by a tumor that is pressing against nerves and other organs, or pain can be caused by the treatment for bone cancer itself.

The patient's doctor or a specialist in pain control can relieve or reduce pain in several ways, including:

· Pain medicine

· Radiation

· Nerve block.

The healthcare team may also suggest alternative treatment for pain, such as:

· Massage

· Acupuncture

· Acupressure.

Patients may also learn to relieve pain through relaxation techniques, such as listening to slow music or breathing slowly and comfortably.

Recommendations

Patients should discuss the potential benefits and harmful effects of alternative treatment forbone cancer with their doctor prior to trying them. Questions that patients may want to ask their healthcare provider include:

· What benefits can I expect from this approach?

· What are its risks?

· Do the expected benefits outweigh the risks?

· What side effects should I watch for?

· Will this alternative treatment change the way my bone cancer treatment works?

· Could this alternative treatment be harmful?

· Is this approach under study in a bone cancer clinical trial? If so, who sponsors the trial?

· Will my health insurance pay for this approach?

Factors Influencing the Bone Cancer Survival Rate

In general, the bone cancer survival rate will depend on:

· The size, the location, and the type of bone cancer

· The bone cancer stage (how far the cancer has spread)

· How long the patient has had symptoms

· How much of the cancer is taken out by surgery and/or killed by chemotherapy

· The patient's age, blood, and other test results

· The patient's general health.

Bone Cancer Survival Rate Based on Stage

The bone cancer stage plays a role in the bone cancer prognosis. Based on historical data:

· 41 percent of bone and joint cancer cases are diagnosed while the cancer is still confined to the primary site (localized stage)

· 36 percent of bone and joint cancer cases are diagnosed after the cancer has spread to regional lymph nodes or directly beyond the primary site

· 15 percent of bone and joint cancer cases are diagnosed after the cancer has already metastasized (distant stage)

· 8 percent of bone and joint cancer cases had staging information that was unknown.

The corresponding 5-year relative bone cancer survival rates were:

· 84.5 percent for localized

· 69.4 percent for regional

· 30.6 percent for distant

· 62.2 percent for unstaged.

Overall Bone Cancer Survival Rate

Survival rates can be calculated by different methods for different purposes. The survival rates presented here are based on the relative survival rate. The relative survival rate measures the survival of bone cancer patients in comparison to the general population to estimate the effect of cancer. The overall 5-year relative bone cancer survival rate for 1995-2001 was 69.4 percent.

The 5-year relative bone cancer survival rates by race and sex were:

· 67.5 percent for Caucasian men

· 72.1 percent for Caucasian women

· 70.0 percent for African-American men

· 68.4 percent for African-American women.

Bone Cancer Research

Bone cancer research scientists are currently studying surgery, radiation therapy, chemotherapy, and combinations of these treatments. In order for bone cancer research to be conducted, volunteers are needed. Although bone cancer research trials may pose some risks, scientists take careful steps to protect their patients, who can have the first chance at benefiting from promising, new treatments.

Lung Cancer

2009-11-06T03:51:00.000-08:00

Lung Cancer

Lung cancer is a disease in which uncontrolled growth of abnormal cells begins in the lungs. It is, by far, the leading cause of cancer death in the United States. The five-year survival rate for the disease is only 15 percent.

Researchers have discovered several causes of lung cancer, but the most common are related to the use of tobacco.

Causes include:

Cigarettes
Cigars and pipes
Environmental tobacco smoke ("secondhand smoke")
Radon
Asbestos
Pollution
Lung diseases.

Types of Lung Cancer:

Each type looks different under a microscope, grows and spreads in different ways, and is treated differently.

Non-Small Cell Lung Cancer

Non-small cell lung cancer is more common than small cell lung cancer, and it generally grows and spreads more slowly. There are three main types of non-small cell lung cancer. They are named for the type of cells in which the cancer develops:

Squamous cell carcinoma (also called epidermoid carcinoma)
Adenocarcinoma
Large cell carcinoma.

Squamous Cell Carcinoma

Squamous cell carcinoma is a type of lung cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. This form of lung cancer is also known as epidermoid carcinoma.

Adenocarcinoma

Adenocarcinoma is a form of lung cancer that begins in the cells that line the alveoli and make substances such as mucus.

Large Cell Carcinoma

Large cell carcinoma is a cancer that may begin in several types of large cells.

Other Types of Non-Small Cell Lung Cancer

Less common types of non-small cell lung cancer include:

Pleomorphic
Carcinoid tumor
Salivary gland carcinoma
Unclassified carcinoma.

Small Cell Lung Cancer

Small cell lung cancer (sometimes called oat cell cancer) is less common than non-small cell lung cancer. This lung cancertype grows more quickly and is more likely to spread to other organs in the body.

There are three types of small cell lung cancer. The types of small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look when viewed under a microscope:

Small cell carcinoma (oat cell cancer)
Mixed small cell/large cell carcinoma
Combined small cell carcinoma.

Metastatic Cancer in the Lungs

Metastasis means the spread of cancer. Cancer cells can break away from a primary tumor and enter the bloodstream or lymphatic system (the system that produces, stores, and carries the cells that fight infections). That is how cancer cells spread to other parts of the body.

When cancer cells spread and form a new tumor in a different organ, the new tumor is a metastatic tumor. The cells in the metastatic tumor come from the original tumor. This means, for example, that if breast cancer spreads to the lungs, the metastatic tumor in the lung is made up of cancerous breast cells (not lung cells). In this case, the disease in the lungs is metastatic breast cancer (not lung cancer). Under a microscope, metastatic breast cancer cells generally look the same as the cancer cells in the breast. The lungs are one of the most common places to which cancer from other parts the body spreads.

Is Mesothelioma a Type of Lung Cancer?

Mesothelioma is not a lung cancer type. It is a tumor affecting the lining of the lungs or abdomen. Mesothelioma can either be benign (meaning not cancerous) or malignant (cancer). Exposure to asbestos particles in the air increases the risk of developing malignant mesothelioma.

Common Signs and Symptoms of Lung Cancer

Common signs and symptoms of lung cancer (when present) include:

A cough that doesn't go away and gets worse over time
Constant chest pain
Coughing up blood
Swelling of the neck and face
Loss of appetite
Fatigue
Fever
Weight loss
Shortness of breath, wheezing, or hoarseness
Repeated problems with pneumonia or bronchitis.

Other symptoms that can sometimes occur may include:

Changes in the shape of the fingertips
Swollen or enlarged lymph nodes (glands) in the upper chest and lower neck.

Things to Remember About Lung Cancer Symptoms

Symptoms of lung cancer may vary from person to person, and some patients may experience no symptoms at all. In fact, about 1 in 4 people do not have any symptoms when their disease is initially found.

The possible symptoms described above are not sure signs of lung cancer. Other health problems can also cause these symptoms. Still, a person should see their healthcare provider about any these possible lung cancer symptoms as soon as possible so that the problem can be diagnosed and treated.

Lung Cancer Diagnosis

In order to make a lung cancer diagnosis, the doctor will ask a number of questions, including questions about:

Current symptoms
Smoking history
Exposure to environmental and occupational substances
Family medical history
Current medications.

There are a number of tests or procedures that healthcare providers use to help diagnose lung cancer or other problems in the lungs. Some of these include:

Chest x-ray
Sputum cytology
Lung biopsy.

Tests Used in Staging Lung Cancer

Lung cancer staging helps the doctor plan the appropriate treatment. Some tests used to determine whether the cancer has spread include:

CT scan
MRI
Radionuclide scanning
Bone scan
Mediastinoscopy/mediastinotomy
PET scan.

Non-Small Cell Lung Cancer Stages

Stages for non-small cell lung cancer are divided into the following stages:

Occult Stage

In the occult (hidden) stage, cancer cells are found in sputum (mucus coughed up from the lungs), but no tumor can be found in the lung by imaging or bronchoscopy, or the primary tumor is too small to be assessed.

Stage 0

In stage 0 lung cancer (carcinoma in situ), cancer is limited to the lung and is found only in a few layers of cells. It has not grown through the top lining of the lung.

Stage I

In stage I lung cancer (or stage 1 lung cancer), the cancer is in the lung only, with normal tissue around the tumor. Stage I is divided into stages IA and IB, based on the size of the tumor.

Stage II

In stage II lung cancer (or stage 2 lung cancer), cancer has spread to nearby lymph nodes or to the chest wall (the ribs and muscles that make up the area of the body between the neck and the abdomen), the diaphragm (the thin muscle below the lungs and heart that separates the chest from the abdomen), the mediastinal pleura (the thin membrane that covers the outside of the lungs in the area near the heart), or the parietal pericardium (the outer layer of tissue that surrounds the heart). Stage II is divided into stage IIA and stage IIB, based on the size of the tumor and whether it has spread to the lymph nodes.

Stage III

In stage III lung cancer (or stage 3 lung cancer), cancer has either:

Spread to the lymph nodes in the mediastinum (the middle area between the lungs that contains the heart, major blood vessels, and other structures)
Spread to the lymph nodes on the opposite side of the chest or in the lower neck.

Stage III is divided into stage IIIA (which is sometimes treated with surgery) and stage IIIB (which is rarely treated with surgery).

Stage IV
In stage IV lung cancer (or stage 4 lung cancer), cancer has spread to other parts of the body or to another lobe of the lungs.

Small Cell Lung Cancer Stages

Small cell lung cancer is divided into the following stages:

Limited-Stage

In limited-stage, cancer is found in one lung, the tissues between the lungs, and nearby lymph nodes only.

Extensive-Stage

In extensive-stage, cancer has spread outside of the lung in which it began or to other parts of the body.

Recurrent

Recurrent small cell lung cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the chest, central nervous system, or in other parts of the body.

Treatment for Lung Cancer

There are several different lung cancer treatment options available for someone diagnosed with the disease.

Some factors that may influence recommendations regarding treatment include:

The type of lung cancer.
The stage of the cancer.
The patient's age and general health.

In general, treatment options for lung cancer include:

Surgery
Chemotherapy
Radiation therapy
Photodynamic therapy.

Your doctor can describe your treatment choices and the expected results of each. You and your doctor can work together to develop a treatment plan that meets your medical needs and personal values. Choosing the most appropriate treatment for lung cancer is a decision that ideally involves the patient, family, and healthcare team.

Treatment generally begins within a few weeks after the diagnosis. In most cases, there will be time for patients to talk with the doctor about treatment choices, get a second opinion, and learn more about the disease.

Lung Cancer Treatment Providers

There are usually several healthcare providers involved in a person's treatment. The doctor may refer patients to doctors who specialize in treating lung cancer, or patients may ask for a referral. Some specialists who treat lung cancer include:

Pulmonologists, who are doctors that are experts in diseases of the lungs
Surgeons, who are doctors that perform operations
Medical oncologists, who are doctors that are experts in lung cancer and treat cancers with medicines
Radiation oncologists, who are doctors that treat lung cancers with radiation.

Non-Small Cell Lung Cancer Treatment by Stage:

Non-Small Cell Lung Cancer Treatment at Stage 0

Treatment of stage 0 non-small cell lung cancer (carcinoma in situ) may include the following:

Surgery to remove a small portion of the lung where the cancer cells are found.

Non-Small Cell Lung Cancer Treatment at Stage I

Treatment of stage I non-small cell lung cancer may include the following:

Lung cancer surgery to remove a small portion of the lung or a lobe of the lung
External radiation therapy (for patients who cannot have surgery or choose not to have surgery)
Lung cancer chemotherapy following surgery.

Non-Small Cell Lung Cancer Treatment at Stage II

Treatment of stage II non-small cell lung cancer may include the following:

Surgery to remove the tumor (a small portion of the lung, a lobe of the lung, or an entire lung)
External lung cancer radiation therapy (for patients who cannot have surgery or choose not to have surgery)
Chemotherapy with or without other treatments following surgery.

Non-Small Cell Lung Cancer Treatment at Stage III

Stage III of non-small cell lung cancer is divided into two subgroups: stage IIIA and stage IIIB.

Treatment of stage IIIA non-small cell lung cancer may include the following:

Lung cancer surgery alone
External radiation therapy alone
Chemotherapy combined with other treatments
Surgery and external radiation therapy.

Treatment of stage IIIB non-small cell lung cancer may include the following:

External radiation therapy alone
Chemotherapy combined with external radiation therapy
Chemotherapy combined with external radiation therapy, followed by surgery
Chemotherapy alone.

Non-Small Cell Lung Cancer Treatment at Stage IV

Treatment of stage IV non-small cell lung cancer may include the following:

External radiation therapy as palliative therapy, to relieve pain and other lung cancer symptoms and improve the quality of life
Chemotherapy
Laser therapy and/or internal radiation therapy.

Treatment of Recurrent Non-Small Cell Lung Cancer

Treatment of recurrent non-small cell lung cancer may include the following:

External radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life
Chemotherapy alone
Surgery (for some patients who have a very small amount of cancer that has spread to the brain)
Laser therapy or internal radiation therapy
Radiosurgery (for certain patients who cannot have standard surgery).

Small Cell Lung Cancer Treatment by Stage:

Limited-Stage

Treatment of limited-stage small cell lung cancer may include the following:

Combination small cell lung cancer chemotherapy and radiation therapy to the chest, with or without radiation therapy to the brain
Combination chemotherapy with or without small cell lung cancer radiation therapy to the brain in patients with complete response (patients with no visible signs of cancer after initial chemotherapy)
Combination lung cancer chemotherapy with or without radiation therapy to the chest
Lung cancer surgery followed by chemotherapy, or chemotherapy plus radiation therapy to the chest -- with or without radiation therapy to the brain.

Extensive-Stage

Treatment of extensive-stage small cell lung cancer may include the following:

Chemotherapy
Combination chemotherapy
Combination chemotherapy with or without radiation therapy to the brain for patients with complete response
Radiation therapy to the brain, spine, bone, or other parts of the body where the cancer has spread, as palliative therapy to relieve symptoms and improve quality of life.

Recurrent

Treatment of recurrent small cell lung cancer may include the following:

Radiation therapy as palliative therapy to relieve symptoms of small cell lung cancer and improve quality of life
Chemotherapy as palliative therapy to relieve symptoms and improve quality of life.
Laser therapy, surgical placement of devices to keep the airways open, and/or internal radiation therapy, as palliative therapy to relieve symptoms and improve quality of life.

Preventing Lung Cancer: Know the Risk Factors

The first step in the prevention of lung cancer is knowing the risk factors. Researchers have identified the following lung cancer risk factors:

Smoking
Second-hand smoke
Environmental causes
Beta-carotene in smokers.

Smoking

By far the largest risk factor for lung cancer is smoking. Studies show that smoking tobacco products in any form is the major cause of lung cancer. People who stop smoking and never start again lower their risk of developing lung cancer or of having lung cancer come back.

Many products are available to help people trying to quit smoking, including:

Nicotine gum
Nicotine sprays
Nicotine inhalers
Nicotine patches
Nicotine lozenges
Antidepressant drugs.

Second-Hand Smoke

Second-hand tobacco smoke also causes lung cancer. This is smoke that comes from a burning cigarette or other tobacco product, or smoke that is exhaled by smokers. People who inhale second-hand smoke are exposed to the same cancer-causing agents as smokers, although in weaker amounts. Inhaling second-hand smoke is called involuntary or passive smoking.

Environmental Causes

There are other causes of lung cancer in the environment, but their effect on lung cancer rates is small compared to the effect of cigarette smoking. Cancer-causing agents that may be found indoors, especially in the workplace, include:

Asbestos
Radon
Arsenic
Chromium
Nickel
Tar
Soot.

These substances can cause lung cancer in people who have never smoked, and combine with cigarette smoke to further increase lung cancer risk in smokers. Many countries are working to control these cancer-causing agents in the workplace.

Air pollution may also increase the risk of lung cancer. Studies show that lung cancer rates are higher in cities with higher levels of air pollution.

Beta Carotene

Lung cancer research studies show that beta carotene use in relatively high-intensity smokers increases the risk of lung cancer.

Are There Protective Options to Help Prevent Lung Cancer?

Studies show that a diet rich in fruit, and possibly vegetables, may help lower the risk of lung cancer, while excessive alcohol consumption may increase the risk of lung cancer. In addition, studies show that people who are physically active may have a lower risk of lung cancer than those who are not, even after taking cigarette smoking into account. Taking vitamin E supplements does not reduce the risk of developing lung cancer.

Lung Cancer Research

Some of the current research on lung cancer includes work being done to study the effectiveness of using new drugs, new combinations of chemotherapy, and combinations of chemotherapy and radiation therapy before and after surgery to treat the disease. Research is also being conducted to investigate the effectiveness of using biological therapy to treat lung cancer.

Breast Cancer

2009-11-04T21:01:00.000-08:00

Breast Cancer

Breast cancer is a condition in which abnormal cell growth occurs in the breast. While it can affect men, the disease is more common in women.

Types of Breast Cancer

Breast cancer types can be invasive (moves into the surrounding tissue) or non-invasive (stays in the ducts or lobes). Healthcare providers will often use the term "infiltrating" instead of invasive. Some types can also be named based on where the cancer begins. For example, ductal carcinoma begins in the lining of the milk ducts while another type, lobular carcinoma, begins in the lobules where breast milk is produced.

Invasive Breast Cancer

Invasive breast cancers make up 70 to 80 percent of all breast cancer cases. The most common type of invasive breast cancer is infiltrating ductal carcinoma (also called invasive ductal carcinoma). This type is found in approximately 60 percent of breast cancer cases. The second most common type of breast cancer is infiltrating lobular carcinoma (also called invasive lobular carcinoma), found in approximately 6 percent of breast cancer cases.

Other, less common, invasive types of breast cancer include:

Infiltrating ductal and lobular carcinoma
Inflammatory breast cancer
Medullary carcinoma
Mucinous carcinoma
Paget's disease of the nipple
Papillary carcinoma
Tubular carcinoma.

Non-Invasive Breast Cancer

Non-invasive breast cancer types have not moved into the surrounding breast tissue. Therefore, the prognosis is good for these types of cancer.

Common non-invasive types of breast cancer include:

Intraductal carcinoma, also known as ductal carcinoma in situ (DCIS)
Lobular carcinoma in situ (LCIS).

Breast Cancer Causes

Scientists are not sure of the breast cancer causes in most cases of the disease. In 5 to 10 percent of breast cancer cases, there is a genetic reason for the breast cancer.

Genetic Influences

The genes in cells carry the hereditary information that is received from a person's parents. As mentioned, hereditary breast cancer makes up approximately 5 to 10 percent of all breast cancer patients. Some altered genes related to breast cancer are more common in certain ethnic groups.

Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers. Men who have an altered gene related to breast cancer also have an increased risk of developing this disease.

Tests have been developed that can detect altered genes. These genetic tests are sometimes done for members of families with a high risk of cancer.

Know the Risk Factors

While breast cancer risk factors are not specific breast cancer causes, they can increase the likelihood that a woman will get breast cancer.

Risk factors for breast cancer include the following:

Older age
Menstruating at an early age
Older age at first birth or never having given birth
A personal history of breast cancer or benign (non-cancerous) breast disease
A mother or sister with breast cancer
Treatment with radiation therapy to the breast/chest
Breast tissue that is dense on a mammogram
Taking hormones such as estrogen and progesterone
Excessive drinking of alcoholic beverages
Being white.

What Else Is Known About the Causes of Breast Cancer?

While all the breast cancer causes are not known, there is a lot that is known. Some things that are known about breast cancer causes include the following:

Breast cancer is not caused by stress or by an injury to the breast.
You cannot "catch" breast cancer from other women who have the disease. It is not contagious.
You should not feel guilty. You haven't done anything wrong in your life that caused breast cancer.
Most women who develop breast cancer do not have any known risk factors or a history of the disease in their families.

Is Pain a Warning Sign of Breast Cancer?

In its early stage, breast cancer usually does not cause pain. Still, a woman should see her healthcare provider about breast pain or any possible breast cancer symptoms as early as possible so that problems can be diagnosed and treated. Keep in mind that most often, problems in the breast are not actually due to cancer but to other, less serious, health problems.

Common Symptoms of Breast Cancer

Common signs and symptoms of breast cancer include:

A change in how the breast or nipple feels
A lump or thickening in or near the breast or in the underarm area
Nipple tenderness
A change in how the breast or nipple looks
A change in the size or shape of the breast
A nipple turned inward into the breast
Nipple discharge (fluid).

Symptoms of Inflammatory Breast Cancer

Inflammatory breast cancer is a rare type of breast cancer. In inflammatory breast cancer, the lymph vessels around the breast become blocked. Symptoms of this type of breast cancer include a red, swollen, and warm breast. The skin of the breast may also appear pink, purple, or bruised, and it may have ridges or appear pitted, like the skin of an orange (called peau d'orange). These symptoms often occur quickly over a period of weeks.

Another possible symptom is swollen lymph nodes under the arm, above the collarbone, or in both places. Often, a tumor cannot be felt, and may not be seen on a mammogram.

Diagnosing Breast Cancer

In order to make a breast cancer diagnosis, your doctor may:

Ask about your personal and family medical history.
Perform a physical exam.
Order a mammogram or other imaging procedure. These tests make pictures of tissue inside the breast.

After the tests, your doctor may decide that no other exams are needed, that you have a follow-up exam later on, or that you need to have a biopsy to look for cancer cells. A biopsy is a procedure in which a piece of tissue is removed so that it can be examined further.

Tests Used to Make a Breast Cancer Diagnosis

Certain exams and tests your doctor may use when diagnosing breast cancer include:

Clinical breast exam
Diagnostic mammogram
Ultrasound
MRI
Biopsy
Fine-needle aspiration
Additional tests.

Breast Cancer Stages

To plan your treatment, your healthcare provider needs to know the extent of the disease. This is called the stage of breast cancer stage. This determination is based on such factors as the size of the tumor and whether the cancer has spread.

The different stages of breast cancer include:

Stage 0 (including lobular carcinoma in situ and ductal carcinoma in situ)
Stage I
Stage II (including IIA and IIB)
Stage III (including IIIA, IIIB, and IIIC)
Stage IV
Recurrent.

Stage 0 Breast Cancer

Stage 0 is carcinoma in situ. (In situ means "in place.") There are two types:

Lobular carcinoma in situ (LCIS)
Ductal carcinoma in situ (DCIS).

Lobular Carcinoma in Situ (LCIS)

In this type of breast cancer, abnormal cells are in the lining of a lobule. LCIS seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of cancer in both breasts.

Ductal Carcinoma in Situ (DCIS)

With this cancer, abnormal cells are in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread outside the duct. They have not invaded the nearby breast tissue. DCIS sometimes becomes invasive cancer if not treated.

Stage I Breast Cancer

This stage of breast cancer is an early form of invasive breast cancer. In this case:

The tumor is no more than 2 centimeters (three-quarters of an inch) across
Cancer cells have not spread beyond the breast.

Stage II Breast Cancer

There are two types of stage II breast cancer:

Stage IIA
Stage IIB.

Stage IIA Breast Cancer

In stage IIA breast cancer:

No tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm)
The tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes
The tumor is larger than 2 centimeters but no larger than 5 centimeters and has not spread to the axillary lymph nodes.

Stage IIB Breast Cancer

In stage IIB breast cancer, the tumor is either:

Larger than 2 centimeters but no larger than 5 centimeters and has spread to the axillary lymph nodes
Larger than 5 centimeters but has not spread to the axillary lymph nodes.

Stage III Breast Cancer

This form of breast cancer may be a large tumor, but the cancer has not spread beyond the breast and into nearby lymph nodes. It is locally advanced cancer. There are three types:

Stage IIIA
Stage IIIB
Stage IIIC.

Stage IIIA Breast Cancer

Stage IIIA breast cancer is one of the following:

The tumor in the breast is smaller than 5 centimeters (2 inches) across. The cancer has spread to underarm lymph nodes that are attached to each other or to other structures.
The tumor is more than 5 centimeters across. The cancer has spread to the underarm lymph nodes.

Stage IIIB Breast Cancer

Stage IIIB breast cancer is one of the following:

The tumor has grown into the chest wall or the skin of the breast
The cancer has spread to lymph nodes behind the breastbone.

Stage IIIC Breast Cancer

This breast cancer stage refers to a tumor of any size. It has spread in one of the following ways:

The cancer has spread to the lymph nodes behind the breastbone and under the arm
The cancer has spread to the lymph nodes under or above the collarbone.

Stage IV Breast Cancer

Stage IV breast cancer is distant metastatic cancer. The cancer has spread to other parts of the body.

Breast Cancer Treatment

Different types of treatment are available for people with breast cancer. Treatment options vary based on:

The stage of the cancer
The breast cancer type
Estrogen-receptor and progesterone-receptor levels in the tumor tissue
A person's age, general health, and menopausal status (whether a woman is still having menstrual periods)
Whether the cancer has just been diagnosed or has recurred (come back).

Treatment of breast cancer consists of either local therapy or systemic therapy:

Local Therapy

Surgery or radiation therapy is local breast cancer treatment. These types of treatments remove or destroy cancer in the breast. When breast cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.

Systemic Therapy

Chemotherapy, hormone therapy, and biological therapy are types of systemic breast cancer treatment. They enter the bloodstream and destroy or control cancer throughout the body. Some women with breast cancer have systemic therapy to shrink the tumor before surgery or radiation. Others have systemic therapy after surgery and/or radiation to prevent the cancer from coming back. Systemic breast cancer treatment is also used for cancer that has spread.

Your doctor can describe your treatment choices and the expected results of each. You and your doctor can work together to develop a treatment plan that meets your medical needs and personal values. Choosing the most appropriate treatment is a decision that ideally involves the patient, family, and healthcare team.

Remembering Questions and Answers

Many people with breast cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and breast cancer treatment choices. Knowing more about breast cancer helps many women cope.

Shock and stress after the breast cancer diagnosis can make it hard to think of everything you want to ask your doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor -- to take part in the discussion, to take notes, or just to listen. You do not need to ask all your questions at once. You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat breast cancer include surgeons, medical oncologists, and radiation oncologists. You also may be referred to a plastic surgeon.

Possible Side Effects of Breast Cancer Treatment

Because treatment for breast cancer often damages healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next.

Before treatment starts, your breast cancer healthcare team will explain possible side effects and suggest ways to help you manage them. Also, at any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of the treatment, and to ease emotional concerns.

Getting a Second Opinion

Before starting treatment for breast cancer, you might want a second opinion about your diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. You may have to gather your mammogram films, biopsy slides, pathology reports, and proposed breast cancer treatment plan. Usually, it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some women with breast cancer need treatment right away.

Follow-up Care

Follow-up care after treatment for breast cancer is important. Even when there are no longer any signs of cancer, the disease sometimes returns because undetected cancer cells remain somewhere in the body after breast cancer treatment.

During follow-up for breast cancer treatment, your doctor will monitor recovery and check for recurrence of the cancer. Checkups help ensure that any changes in your health are noted and treated if needed. Between scheduled visits, you should contact the doctor if you have any health problems.

Breast Cancer Research

Scientists conducting research on breast cancer are actively looking for new ways to prevent, diagnose, detect, and treat the disease. This research has led to new advances in surgery, new medications, and possible new early-detection methods. Research is also focused on lessening the side effects from current treatments for breast cancer.

Cervical Cancer

2009-11-03T22:28:00.000-08:00

Cervical Cancer

Cervical cancer is a disease in which cancer cells form in the tissues of the cervix. In the last 50 years, there has been a decrease in the number of new cases and the number of deaths due to cervical cancer.

The cervix is part of a woman's reproductive system. It is located in the lower, narrow part of the uterus (womb). The uterus is a hollow, pear-shaped organ located in the lower abdomen. The cervix connects the uterus to the vagina and the vagina leads to the outside of the body.

The cervical canal is a passageway. Blood flows from the uterus through the canal into the vagina during a woman's menstrual period. The cervix also produces mucus, which helps sperm move from the vagina into the uterus. During pregnancy, the cervix is tightly closed to help keep the baby inside the uterus. During childbirth, the cervix dilates (opens) to allow the baby to pass through the vagina.

Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which cells that are not normal begin to appear in the cervical tissue. Later, cancer cells start to grow and spread more deeply into the cervix and to surrounding areas.

Studies have found a number of factors that may increase the risk of cervical cancer, which include:

Human papillomavirus (HPV) infection
Lack of regular Pap tests
Weakened immune system
Age
Sexual history
Smoking cigarettes
Birth control pills taken for a long period of time
Having many children
Diethylstilbestrol (DES).

Human Papillomavirus (HPV)
HPV is a group of viruses that can infect the cervix and can be passed from person to person through sexual contact. HPV infections are very common and are considered to be the main risk factor for cervical cancer. Most adults have been infected with HPV at some time in their lives.

Lack of Regular Pap Tests
Cervical cancer is more common among women who do not have regular Pap tests. Pap tests help doctors find precancerous cells (cells that are not cancerous but will likely become cancerous if left untreated) and treat precancerous cervical changes, thus helping to prevent cancer.

Weakened Immune System
Women who have a weakened immune system may have a higher-than-average risk of developing cervical cancer. A weakened immune system can develop from:

Human Immunodeficiency Virus (HIV)
Infection
Drugs that suppress the immune system.

For women who have a weakened immune system, doctors suggest regular screening for cervical cancer.

Age
Cancer of the cervix occurs most often in women over the age of 40.

Sexual History
Women who have had many sexual partners and women who have had sexual intercourse with a partner who has had many sexual partners may be at a higher risk of developing cervical cancer. These women are at a greater risk because they have a higher-than-average risk of HPV infection.

Smoking Cigarettes
Women with an HPV infection who smoke cigarettes have a higher risk of cervical cancer than women with an HPV infection who do not smoke.

Using Birth Control Pills for a Long Time
Using birth control pills for a long time (5 or more years) may increase the risk of cervical cancer among women with an HPV infection.

Having Many Children
Studies suggest that giving birth to many children may increase the risk of cervical cancer among women with an HPV infection.

Diethylstilbestrol
Diethylstilbestrol (DES) may increase the risk of a rare form of cervical cancer in daughters exposed to this drug before birth. DES is a drug that was once prescribed during pregnancy to prevent miscarriages or premature deliveries. It was given to some pregnant women in the United States between 1938 and 1971. However, it is no longer given to pregnant women.

Why Early Cervical Cancer Screenings Are So Important
Cervical cancer screenings are extremely important because they can help doctors find abnormal cells before cancer develops. Finding and treating abnormal cells can prevent most cervical cancer, and treatment is more likely to be effective if cancer is found early.

The number of women who are diagnosed each year has been decreasing for the past several decades. Doctors believe that this decrease is directly related to the success of cervical cancer screening.

In order to reduce the risk of developing cervical cancer, healthcare providers recommend that women have regular Pap tests. A Pap test, also known as a Pap smear or cervical smear, is a simple test that is used to look at cervical cells.

Pap tests are important because they can find cervical cancer or abnormal cells that can lead to cervical cancer. Doctors generally recommend that:

Women should begin having Pap tests three years after they begin having sexual intercourse or when they reach age 21 (whichever comes first).

Most women should have a Pap test at least once every three years. Talk to your healthcare provider about what schedule is best for you.

Women age 65 to 70 who have had at least three normal Pap tests and no abnormal Pap tests in the past 10 years may decide, after speaking with their doctor, to stop cervical cancer screening.

Women who have had a hysterectomy to remove the uterus and cervix, also called a total hysterectomy, do not need to have cervical cancer screening. However, if the surgery was used as a treatment for precancerous cells or cancer, the woman should continue with these screenings.

Women should talk with their healthcare provider about when they should begin having Pap tests, how often they should have them, and when they can stop having them. This is especially important for women who have a higher-than-average risk of cervical cancer.

Serious Symptoms
When cervical cancer becomes worse, women may notice one or more of these symptoms:

Abnormal vaginal bleeding
Bleeding that occurs between regular menstrual periods
Bleeding after sexual intercourse, douching, or a pelvic exam
Menstrual periods that last longer and are heavier than before
Bleeding after menopause
Increased vaginal discharge
Pelvic pain
Pain during sexual intercourse.

Cervical Cancer Diagnosis
In order to diagnose a patient with cervical cancer, doctors will:

See if the patient has possible symptoms of cervical cancer
Review Pap test results, which may show precancerous cells (cells that are not cancerous but will likely become cancerous if left untreated) or cervical cancer
Perform a physical exam
Ask about the patient's personal and family medical history
Recommend additional tests and procedures.

The exams and tests that are used to make a cervical cancer diagnosis may include:

Colposcopy
Biopsy
Punch biopsy
Loop electrosurgical excision procedure (LEEP)
Endocervical curettage
Conization.

Staging Tests for Cervical Cancer
In order to identify how far the cancer has spread, doctors use a process called cervical cancer staging. Once the stage is known, doctors will be able to plan the best treatment.The following tests may be used in the staging process of cervical cancer.

Chest X-Ray
An x-ray is a type of energy beam that can go through the body and onto film. It creates a picture of areas inside the body. Doctors will perform a chest x-ray to make sure that the cervical cancer hasn't spread to other areas of the body.

Computed Tomography (CT) Scan
A CT scan is a procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. A computer that is linked to an x-ray machine creates these pictures. Doctors may also use a dye that is injected into a vein or swallowed by the person to help the organs or tissues show up more clearly on these pictures. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography (CAT). This can help determine the extent of the cervical cancer and whether it has spread.

Lymphangiogram
A lymphangiogram is a procedure that is used to x-ray the lymph system. This procedure requires doctors to inject a dye into the lymph vessels in the feet. The dye will travel upward through the lymph nodes and lymph vessels, and an x-ray will be taken to see if there are any blockages. A lymphangiogram will show doctors if the cervical cancer has spread to the lymph nodes.

Ultrasound Exam
An ultrasound is a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, resulting in echoes. These echoes will form a picture (called a sonogram) of body tissues.

MRI (Magnetic Resonance Imaging)
An MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Specific Stages of Cervical Cancer
Stages of cervical cancer include:

Stage 0
Stage I
Stage II
Stage III
Stage IV
Recurrent.

Stage 0 (Carcinoma in Situ)
In stage 0, cancer is only found in the first layer of cells lining the cervix, which means that it has not invaded the deeper tissues of the cervix. Stage 0 is also called carcinoma in situ.

Stage I
In stage I, cancer is only found in the cervix. This stage of cervical cancer is divided into stages IA and IB, based on the amount of cancer that is found.

Stage IA
In stage IA:

A very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix
The cancer is not deeper than 5 millimeters
The cancer is not wider than 7 millimeters.

Stage IB
In stage IB, one of the following conditions is present:

Cancer is still within the cervix
Cancer can be seen with a microscope and is deeper than 5 millimeters or wider than 7 millimeters
Cancer can be seen without a microscope and may be larger than 4 centimeters.

Stage II
In stage II, cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips). This cervical cancer stage is divided into stages IIA and IIB, based on how far the cancer has spread.

Stage IIA
In stage IIA, cancer has spread beyond the cervix to the upper two-thirds of the vagina but not to the tissues around the uterus.

Stage IIB
In stage IIB, cancer has spread beyond the cervix to the upper two-thirds of the vagina and to the tissues around the uterus.

Stage III
In stage III, cancer has spread to the lower third of the vagina and may have spread to the pelvic wall and nearby lymph nodes. This stage of cervical cancer is divided into stages IIIA and IIIB, based on how far the cancer has spread.

Stage IIIA
In stage IIIA, cancer has spread to the lower third of the vagina but not to the pelvic wall.

Stage IIIB
In stage IIIB, cancer has spread to the pelvic wall and/or the tumor has become large enough to block the ureters (the tubes that connect the kidneys to the bladder). This blockage can cause the kidneys to enlarge or stop working. In stage IIIB, cancer cells may also have spread to the lymph nodes in the pelvis.

Stage IV
In stage IV, cancer has spread to the bladder, rectum, or other parts of the body. This cervical cancer stage is divided into stages IVA and IVB, based on where the cancer is found.

Stage IVA
In stage IVA, cancer has spread to the bladder or rectal wall and may have spread to lymph nodes in the pelvis.

Stage IVB
In stage IVB, cancer has spread beyond the pelvis and pelvic lymph nodes to other places in the body, such as the abdomen (stomach), liver, intestinal tract, or lungs.

Recurrent Cervical Cancer
Recurrent cervical cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the cervix or in other parts of the body.

Cervical Cancer Treatment
Factors that may influence treatment options include:

The stage of the cancer
The size of the tumor
The patient's desire to have children
The patient's age.

In general, treatment options include:

Surgery
Chemotherapy
Radiation therapy.

Choosing the most appropriate treatment is a decision that ideally involves the patient, her family, and the healthcare team.

Remembering Questions and Answers
Although many women with cervical cancer want to take an active part in making decisions about their medical care, the shock and stress of a cervical cancer diagnosis can make it hard to think of everything to ask the doctor. Therefore, patients may want to make a list of questions before their appointment with the doctor.

Healthcare Providers Who Treat Cervical Cancer
There are usually several healthcare providers involved in a person's cervical cancer treatment. Doctors may refer patients to a cervical cancer specialist, or patients may ask for a referral. Specialists who treat cervical cancer include:

Gynecologists
Gynecologic oncologists
Medical oncologists
Radiation oncologists.

Cervical cancer treatment can lead to other health problems. In order to control these problems, patients receive supportive care (also called symptom management, supportive care, or palliative care), which will improve their comfort and quality of life during treatment.

Patients with cervical cancer are prone to infections. Therefore, doctors may:

Prescribe antibiotics and other drugs to help protect patients from infections
Advise patients to stay away from crowds
Advise patients to stay away from people with colds and other contagious diseases.

If an infection develops, it can be serious and should be treated promptly.

Treatment for cervical cancer can lead to anemia and bleeding, which often require supportive care such as transfusions of red blood cells or platelet transfusions.

Cervical cancer and chemotherapy can make the mouth sensitive, easily infected, and likely to bleed, which is why dental care is very important. Doctors often advise cervical cancer patients to have a complete dental exam and, if possible, undergo needed dental procedures before chemotherapy begins.

Nutrition During Cervical Cancer Treatment
Patients need to eat well during treatment, which will include a diet that has enough calories to maintain a good weight and enough protein to keep up strength. Good nutrition often helps people with cancer feel better and have more energy.

However, eating well can be difficult because patients may not feel like eating if they are uncomfortable or tired. Side effects of treatment can also cause: poor appetite, nausea, vomiting, and food to taste different. A patient's doctor, dietitian, or other healthcare provider can suggest ways to maintain a healthy diet during treatment.

Clinical Trials
Before starting treatment for cervical cancer, patients may want to consider taking part in a clinical trial. A clinical trial is a cervical cancer research study that is meant to help improve current treatments or obtain information on new treatments. When clinical trials prove that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Follow-up Care After Cervical Cancer Treatment
It is important to have follow-up care after you have been treated for cervical cancer. Cancer can return after treatment even when the cancer appears to have been completely removed or destroyed. If undetected cancer cells remain somewhere in the body after treatment, the cancer can recur.

Throughout your follow-up care, your doctor will monitor your recovery and check for recurrence of the cancer. Checkups help ensure that any changes in your health are noted and treated as needed. Checkups may include a physical exam, Pap tests, and chest x-rays. However, between scheduled visits, you should contact your doctor right away if you experience any health problems.

Cervical Cancer Research
Cervical cancer research allows doctors and patients to learn more about specific aspects of cervical cancer. For example, researchers are currently testing the safety and effectiveness of new anticancer drugs. Researchers are also studying different methods and doses of radiation therapy. Although cervical cancer research trials may pose some risks, researchers take very careful steps to protect their patients.

Osteoporosis

2009-11-02T19:28:00.000-08:00

Osteoporosis

Osteoporosis, which means "porous bone," is a disease characterized by low bone mass (bone thinning) that leads to fragile bones and an increased risk of fractures of the hip, spine, and wrist. Men as well as women are affected by this condition. Osteoporosis is a disease that can be prevented and treated.

Understanding Osteoporosis and Bones

Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft framework, and calcium phosphate, a mineral that adds strength and hardens the framework.

This combination of collagen and calcium phosphate makes bone both flexible and strong, which, in turn, helps it withstand stress. More than 99 percent of the body's calcium is contained in the bones and teeth. The remaining 1 percent is found in the blood.

Throughout your lifetime, old bone is removed (a process called resorption) and new bone is added to the skeleton (a process called formation). During childhood and the teenage years, new bone is added faster than old bone is removed. As a result, bones become larger, heavier, and denser. Bone formation outpaces resorption until peak bone mass (maximum bone density and strength) is reached around age 30. After that time, bone resorption slowly begins to exceed bone formation.

There are two main types of osteoporosis: primary and secondary.

Primary

In cases of primary osteoporosis, either the condition is caused by age-related bone loss (sometimes called senile osteoporosis), or the cause may be unknown (called idiopathic osteoporosis). The term idiopathic osteoporosis is used only for people who are under the age of 70; in older people, age-related bone loss is assumed to be the cause.

Secondary

In cases of secondary osteoporosis, the loss of bone mass is caused by certain lifestyle factors, diseases, or medications. The majority of people with osteoporosis have at least one secondary cause.

Risk Factors You Cannot Change

There are a number of risk factors for osteoporosis that you cannot change, including:

Gender. Your chances of developing osteoporosis are greater if you are a woman. Women have less bone tissue and lose bone faster than men because of the changes that happen with menopause.
Age. The older you are, the greater your risk of osteoporosis. Your bones become thinner and weaker as you age.
Body size. Small, thin-boned women are at greater risk for developing osteoporosis than larger women.
Ethnicity. Caucasian and Asian women are at the highest risk of developing the disease. African-American and Hispanic women have a lower, but still significant, risk.
Family history. Your risk for fractures may be due, in part, to heredity. People whose parents have a history of fractures also seem to have reduced bone mass and may be at risk for fractures themselves.

Risk Factors You Can Change

The good news is that there are a number of risk factors for osteoporosis you can change, including:

Sex hormones. Abnormal absence of menstrual periods (amenorrhea), low estrogen levels (menopause), and low testosterone levels in men can bring on osteoporosis.
Anorexia nervosa. Characterized by an irrational fear of weight gain, this eating disorder increases your risk for osteoporosis.
Calcium and vitamin D intake. A lifetime diet low in calcium and vitamin D makes you more prone to bone loss.
Medication use. Long-term use of glucocorticoids and some anticonvulsants can lead to loss of bone density, which can ultimately result in fractures.
Lifestyle. An inactive lifestyle or extended bed rest tends to weaken bones.
Cigarette smoking. Cigarettes are bad for the bones as well as the heart and lungs.
Alcohol intake. Excessive consumption of alcohol increases the risk of bone loss and fractures.

Signs and Symptoms of Osteoporosis

People with osteoporosis often don't know they have it, simply because there are no osteoporosis symptoms in the early stages of the disease. That is what led specialists to label osteoporosis as the "silent disease."

As osteoporosis progresses, you may develop symptoms related to weakened bones, including:

Back pain
Loss of height and stooped posture
A curved backbone (known as a dowager's hump)
Fractures that may occur with a minor injury, especially of the hip, spine, or wrist.

Making a Diagnosis Before Symptoms Develop

Specialized tests called bone density tests can measure bone density in various sites of the body, thereby predicting those who are at greater risk of developing symptoms of osteoporosis. A bone density test can:

Detect osteoporosis before a fracture occurs
Predict your chances of fracturing in the future
Determine the rate of bone loss
Monitor the effects of treatment if the test is conducted at intervals of a year or more.

The most common bone mineral density test is dual-energy x-ray absorptiometry (DEXA). The results of the DEXA test are scored in comparison to the bone mineral density (BMD) of young, healthy individuals, resulting in a measurement called a T-score. If your T-score is -2.5 or lower, you are considered to have osteoporosis and, therefore, are at high risk for a fracture. T-scores between -1.0 and -2.5 are generally considered to show osteopenia (a reduction in bone mass that is not as severe as with osteoporosis). The risk of fractures is generally lower in people with osteopenia when compared to those with osteoporosis. However, if bone loss continues in a person with osteopenia, the risk for fracture increases, too.

The United States Preventive Services Task Force recommends that all women age 65 or older routinely have a bone mineral density test to screen for osteoporosis. If you have a higher risk for fractures, routine screening should begin at age 60.

Osteoporosis Treatment

A comprehensive treatment program for osteoporosis deals with:

Proper nutrition
Exercise
Safety issues to prevent falls that may result in fractures.

In addition, your physician may prescribe medication as part of your osteoporosis treatment to slow or stop bone loss, increase bone density, and reduce fracture risk.

Nutrition

The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy. All of these nutrients are needed in balanced proportion. In particular,calcium and vitamin D are needed for strong bones and for your heart, muscles, and nerves to function properly.

Exercise

Exercise is an important component of an osteoporosis prevention and treatment program. Exercise not only improves your bone health, but it also increases muscle strength, coordination, and balance, and leads to better overall health. While exercise is good for someone with osteoporosis, it should not put any sudden or excessive strain on your bones. As extra insurance against fractures, your doctor can recommend specific exercises to strengthen and support your back.

Medications

There are a number of medications currently approved for treating osteoporosis, including:

Alendronate (Fosamax^®)
Risedronate (Actonel^®)
Ibandronate (Boniva^®)
Calcitonin (Miacalcin^®, Fortical^®)
Raloxifene (Evista^®)
Estrogen therapy (ET) or hormone therapy (HT)
Parathyroid hormone or teriparatide (Forteo^®).

Alendronate (Fosamax)

This drug belongs to a class of drugs called bisphosphonates and is approved for both osteoporosis prevention and treatment. It is used to treat bone loss from the long-term use of osteoporosis-causing medications and is also used for osteoporosis in men. In postmenopausal women, it has shown to be effective at reducing bone loss, increasing bone density in the spine and hip, and reducing the risk of spine and hip fractures.

Risedronate (Actonel)

Like alendronate, risedronate is also a bisphosphonate. It is approved for:

Osteoporosis prevention and treatment
Bone loss from the long-term use of osteoporosis-causing medications
Osteoporosis in men.

Risedronate has been shown to slow bone loss, increase bone density, and reduce the risk of spine and non-spine fractures.

Ibandronate (Boniva)

Ibandronate is approved for the prevention and treatment of postmenopausal osteoporosis. Taken as a once-a-month pill, ibandronate should be taken on the same day each month. Ibandronate reduces bone loss, increases bone density, and reduces the risk of spine fractures.

Calcitonin (Miacalcin, Fortical)

Calcitonin is a naturally occurring hormone involved in calcium regulation and bone metabolism. Calcitonin can be injected or taken as a nasal spray. In women who are at least five years beyond menopause, it slows bone loss and increases spinal bone density. Women report that it also eases pain associated with bone fractures.

Raloxifene (Evista)

This drug is a selective estrogen receptor modulator (SERM) that has many estrogen-like properties. It is approved for osteoporosis treatment and prevention, and can prevent bone loss at the spine, hip, and other areas of the body. Studies have shown that it can decrease the rate of vertebral fractures by 30 percent to 50 percent.

Estrogen Therapy (ET) or Hormone Therapy (HT)

These drugs, which have been used to treat the symptoms of menopause, also are used to prevent bone loss. However, recent studies suggest that this might not be a good option for many women. The U.S. Food and Drug Administration (FDA) has made the following recommendations for taking ET and HT:

Take the lowest possible doses of ET or HT for the shortest period of time to manage symptoms of menopause
Talk with your doctor about using other osteoporosis medications instead.

Parathyroid Hormone or Teriparatide (Forteo)

Forteo is approved for treating osteoporosis in postmenopausal women and for men who are at high risk for a fracture. It helps new bone to form and increases bone density. In postmenopausal women, it has been shown to reduce fractures in the spine, hip, foot, ribs, and wrist. In men, it can reduce fractures in the spine. It can be taken as a daily injection for up to 24 months.

Osteoporosis Research

The field of research on osteoporosis has grown in recent years. This has resulted in significant advances in determining the causes of osteoporosis, assessing risk factors, and creating new treatment methods. Several initiatives that are focused on skeletal biology should help in developing strategies to maintain and enhance bone density in childhood.

Rheumatoid Arthritis

2009-11-01T19:42:00.000-08:00

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease that causes pain, swelling, stiffness, and loss of function in the joints. It has several special features that make it different from other kinds of arthritis. For example, it generally occurs in a symmetrical pattern, meaning that if one knee or hand is involved, the other one also is. Rheumatoid arthritis often affects the wrist joints and the finger joints closest to the hand.

Scientists estimate that about 2.1 million people, or between 0.5 percent and 1 percent of the U.S. adult population, have rheumatoid arthritis. Interestingly, some recent studies have suggested that the overall number of new cases may actually be going down. Scientists are investigating why this may be happening.

Rheumatoid arthritis occurs in all races and ethnic groups. Although the disease often begins in middle age and occurs with increased frequency in older people, children and young adults also develop it. Like some other forms of arthritis, rheumatoid arthritis occurs much more frequently in women than in men. About two to three times as many women as men have the disease.

Based on recent research, it is believed that the main rheumatoid arthritis causes may be linked to a combination of:

Genetic factors
Environmental factors
Hormones.

Genetic (Inherited) Factors

About 10 percent of people with rheumatoid arthritis have a first-degree relative with the disease. This suggests that genetics plays a role in the cause of the disease. Rheumatoid arthritis research scientists have also discovered that certain genes known to play a role in the immune system are associated with a tendency to develop rheumatoid arthritis. Some people with rheumatoid arthritis do not have these particular genes; and still others have these genes but never develop the disease.

These somewhat contradictory data suggest that a person's genetic makeup plays an important role in determining if he or she will develop rheumatoid arthritis, but that it is not the only factor. What is clear, however, is that more than one gene is involved in determining whether a person develops rheumatoid arthritis and how severe the disease will become.

Environmental Factors

As with other autoimmune diseases, many scientists think that something must occur to trigger the disease process in people whose genetic makeup makes them susceptible to rheumatoid arthritis. A viral or bacterial infection appears likely, but the exact agent is not yet known. Given that rheumatoid arthritis occurs all over the world, it is thought that this organism must be everywhere. Scientists have studied bacteria such as mycoplasmas, as well as viruses such as cytomegalovirus, parvovirus, Epstein-Barr virus, and the rubella virus. However, to date there have been no convincing data to show that these viruses can cause rheumatoid arthritis.

Also, keep in mind that this does not mean that rheumatoid arthritis is contagious; a person cannot catch the disease from someone else.

Hormones

Some scientists also think that a variety of hormonal factors may be a possible rheumatoid arthritis cause. This is based on the fact that women are more likely to develop rheumatoid arthritis than men, pregnancy may improve the disease, and the disease may flare after a pregnancy. Hormones, or possibly deficiencies or changes in certain hormones, may promote the development of rheumatoid arthritis in a genetically susceptible person who has been exposed to a triggering agent from the environment.

Final Thoughts on the Rheumatoid Arthritis Causes

Even though researchers do not have all the answers or know the exact cause or causes of rheumatoid arthritis, one thing is certain: rheumatoid arthritis develops due to a combination of many factors. Researchers are trying to understand these factors and how they work together.

Signs and Symptoms of Rheumatoid Arthritis

In about two out of every three people, early symptoms are pretty vague. These symptoms can include things such as:

Fatigue
Occasional fevers
A general sense of not feeling well
A decreased appetite.

These early symptoms of rheumatoid arthritis may continue for weeks or months before joint symptoms begin, making a diagnosis quite difficult.

About one in every three people will have early symptoms that affect one or two joints. About 10 percent of people diagnosed with rheumatoid arthritis will have a very rapid progression, with early symptoms that involve multiple joints along with fever, enlarged lymph nodes, and an enlarged spleen.

Joint Symptoms

For a person with rheumatoid arthritis, symptoms that affect the joints usually differ from other forms of arthritis. Within the affected joints, common symptoms of rheumatoid arthritis include:

Tender, warm, and swollen joints
Pain that is worse with movement
A decrease in motion
A symmetrical pattern affecting both the right and left sides of the body
Pain and stiffness lasting for more than 30 minutes in the morning or after a long rest.

Other Symptoms

As rheumatoid arthritis progresses, a person may develop other symptoms outside of the joint. Some of these other rheumatoid arthritis symptoms may include:

Rheumatoid nodules, which are small lumps. These can occur under your skin at pressure points. They can occur anywhere, but some common areas for rheumatoid nodules include the elbow, wrist, Achilles tendon, and the back of the head.

Loss of strength in the muscles that surround the affected joints.

Dry eyes and mouth.

Anemia, which is a decrease in the production of red blood cells.

Osteoporosis or osteopenia, which is thinning of bones.

Very rarely, inflammation of the blood vessels, the lining of the lungs, or the sac enclosing the heart.

Progression of Rheumatoid Arthritis Symptoms

Rheumatoid arthritis affects people differently. For some people with rheumatoid arthritis, symptoms last only a few months or a year or two and go away without causing any noticeable damage. Other people have mild or moderate forms of the disease, with periods of worsening symptoms (called flares) and periods in which they feel better (called remissions). Others may have a severe form of rheumatoid arthritis that is active most of the time, lasts for many years or a lifetime, and leads to serious joint damage and disability.

Diagnosing Rheumatoid Arthritis

Rheumatoid arthritis can be difficult to diagnose in its early stages for several reasons. First, there is no single test for the disease. In addition, symptoms differ from person to person and can be more severe in some people than in others. Also, symptoms can be similar to those of other types of arthritis and joint conditions, and it may take some time for other conditions to be ruled out.

Finally, the full range of rheumatoid arthritis symptoms develops over time, and only a few signs may be present in the early stages.

To help in diagnosing rheumatoid arthritis and to rule out other conditions, healthcare providers use a variety of tools. These include:

Medical history
Physical examination
Laboratory tests
X rays

Medical History

The medical history is the patient's description of symptoms and when and how they began. Good communication between the patient and healthcare provider is especially important here. For example, the patient's description of pain, stiffness, and joint function, and how these change over time is critical to the healthcare provider's initial assessment of the disease and how it progresses.

Physical Examination

The physical exam includes the doctor's examination of the joints, skin, reflexes, and muscle strength.

Laboratory Tests

There is no one single test that a healthcare provider can use to make a rheumatoid arthritis diagnosis, so he or she will use a combination of tests. One common test is for rheumatoid factor, an antibody (a special protein made by the immune system that normally helps fight foreign substances in the body) that is present eventually in the blood of most people with rheumatoid arthritis.

However, not all people with this condition test positive for rheumatoid factor. This is especially true early in the disease. Also, some people test positive for rheumatoid factor, yet never develop rheumatoid arthritis.

Other common laboratory tests include a white blood cell count, a blood test for anemia, and a test of the erythrocyte sedimentation rate (often called the sed rate or ESR), which measures inflammation in the body. C-reactive protein is another common test that measures disease activity.

X-rays

X-rays are used to determine the degree of joint destruction. They are not useful in the early stages of rheumatoid arthritis before bone damage is evident, but they can be used later to monitor the progression of the disease.

Final Thoughts

Diagnosing and treating rheumatoid arthritis requires a team effort involving the patient and several types of healthcare professionals. A person can go to his or her family doctor, an internist, or a rheumatologist to seek medical attention. A rheumatologist is a doctor who specializes in arthritis and other diseases of the joints, bones, and muscles.

Rheumatoid Arthritis Treatment

Healthcare providers use a variety of approaches when treating rheumatoid arthritis. These approaches are used in different combinations and at different times during the course of the disease, and are chosen according to the person's individual situation. No matter what types of treatment the healthcare provider and patient choose, however, the goals are the same:

Relieving pain
Decreasing inflammation
Slowing down or stopping joint damage
Improving a person's sense of well-being and ability to function.

Current treatment options for rheumatoid arthritis include:

Lifestyle changes
Medications
Surgery
Routine monitoring and ongoing care.

Keep in mind that good communication between the patient and healthcare providers is necessary for effective rheumatoid arthritis treatment. Talking to the healthcare providers can help ensure that exercise and pain management programs are provided as needed and that drugs are prescribed appropriately. Ultimately, however, successful treatment begins with you. Studies have shown that patients who are well-informed and participate actively in their own care have less pain and make fewer visits to the doctor than do other patients with rheumatoid arthritis.

Lifestyle Changes

As part of treating rheumatoid arthritis, certain activities can help improve a person's ability to function independently and maintain a positive outlook. These activities can include:

Rest and exercise
Joint care
Stress reduction
Helpful diet
Climate.

Rest and Exercise

People with rheumatoid arthritis need a good balance between rest and exercise, with more rest when the disease is active and more exercise when it is not. Rest helps to reduce active joint inflammation and pain and to fight fatigue. While the length of time needed for rest will vary from person to person, shorter rest breaks every now and then are generally more helpful than long times spent in bed.

Exercise is important for maintaining healthy and strong muscles, preserving joint mobility, and maintaining flexibility. Exercise can also help people sleep well, reduce pain, maintain a positive attitude, and lose weight. Exercise programs should be planned and executed based on the person's physical abilities, limitations, and changing needs.

Joint Care

Some people find using a splint for a short time around a painful joint reduces pain and swelling by supporting the joint and letting it rest. Splints are used mostly on wrists and hands, but may also be used on ankles and feet. A doctor or a physical or occupational therapist can help a person choose a splint and make sure it fits properly. Other ways to reduce stress on joints include self-help devices (for example, zipper pullers, long-handled shoe horns, etc.); devices to help with getting on and off chairs, toilet seats, and beds; and changes in the ways that a person carries out daily activities.

Stress Reduction

People with rheumatoid arthritis face emotional challenges as well as physical ones. The emotions they feel because of the disease (including fear, anger, and frustration) combined with any pain and physical limitations can increase their stress level. Although there is no evidence that stress plays a role in causing rheumatoid arthritis, it can make living with the disease difficult at times. Stress may also affect the amount of pain a person feels. There are a number of successful techniques for coping with stress. Regular rest periods can help, as can relaxation, distraction, or visualization exercises. Exercise programs, participation in support groups, and good communication with the healthcare team are other ways to reduce stress.

Healthful Diet

With the exception of several specific types of oils, there is no scientific evidence that any specific food or nutrient helps or harms people with rheumatoid arthritis. However, an overall nutritious diet with enough -- but not excessive quantities of -- calories, protein, and calcium is important.

Some people may need to be careful about drinking alcoholic beverages because of the medications they take for rheumatoid arthritis. Those taking methotrexate may need to avoid alcohol altogether, since one of the most serious long-term side effects of methotrexate is liver damage.

Climate

Some people notice that their arthritis gets worse when there is a sudden change in the weather. However, there is no evidence that a specific climate can prevent or reduce the effects of rheumatoid arthritis. Moving to a new place with a different climate usually does not make a long-term difference in a person's rheumatoid arthritis.

Treating Rheumatoid Arthritis With Medications

For most people who have rheumatoid arthritis, treatment also involves taking medications. Some rheumatoid arthritis medicines are used only for pain relief, while others are used to reduce inflammation. There is also another class of medications, often called disease-modifying antirheumatic drugs (DMARDs), that is used to try to slow down the course of the disease.

Some important factors for deciding which medication is most appropriate as part of a treatment plan for rheumatoid arthritis include the:

Person's general condition
Current and predicted severity of the illness
Length of time he or she will take the drug
Drug's effectiveness and potential side effects.

Biologic response modifiers are new drugs that are used in rheumatoid arthritis treatment. They can help reduce inflammation and structural damage to the joints by blocking the action of cytokines, proteins in the body's immune system that trigger inflammation during normal immune responses. Three of these drugs -- etanercept (Enbrel^®), infliximab(Remicade^®), and adalimumab (Humira^®) -- reduce inflammation by blocking the reaction of TNF-alpha molecules. Another drug, calledanakinra (Kineret^®), works by blocking a protein called interleukin 1 (IL-1) that is seen in excess in people with rheumatoid arthritis.Abatacept (Orencia^®) is a new biologic response modifier that seems to prevent T cells from becoming active. T cells are a type of white blood cell (leukocytes) that play an important role in rheumatoid arthritis.

For many years, healthcare providers initially prescribed aspirin or other pain-relieving drugs for rheumatoid arthritis, as well as rest and physical therapy. Other more powerful drugs were prescribed only if the disease worsened.

Today, however, many healthcare providers have changed their approach, especially for people with severe, rapidly progressing rheumatoid arthritis. Studies show that early treatment for rheumatoid arthritis with more powerful drugs and the use of drug combinations instead of one medication alone may be more effective at reducing or preventing joint damage. Once the disease improves or is in remission, the healthcare provider may gradually reduce the dosage or prescribe a milder medication.

Surgery

Several types of surgery are available for people with severe joint damage. The primary purpose of these procedures is to reduce pain, improve the affected joint's function, and improve the person's ability to perform daily activities.

Surgery is not for everyone, however, and the decision should be made only after careful consideration by the patient and healthcare provider. Together, they should discuss the person's overall health, the condition of the joint or tendon that will be operated on, and the reason for, as well as the risks and benefits of, the surgical procedure. Cost may be another factor.

Some surgical procedures that are commonly performed to treat rheumatoid arthritis include:

Joint replacement
Tendon reconstruction
Synovectomy.

Joint Replacement

This is the most frequently performed surgery for treating rheumatoid arthritis, and it is done primarily to relieve pain and improve or preserve joint function. Artificial joints are not always permanent and may eventually have to be replaced. This may be an important consideration for young people.

Tendon Reconstruction

Rheumatoid arthritis can damage and even rupture tendons, the tissues that attach muscle to bone. Tendon reconstruction is a type of surgery used most frequently on the hands, and it reconstructs the damaged tendon by attaching an intact tendon to it. This procedure can help to restore hand function, especially if the tendon is completely ruptured.

Synovectomy

In this surgery, the healthcare provider actually removes the inflamed synovial tissue. Synovectomy by itself is seldom performed now because not all of the tissue can be removed, and it eventually grows back. Synovectomy is done as part of reconstructive surgery, especially tendon reconstruction.

Routine Monitoring and Ongoing Care

Regular medical care is important to monitor the course of the disease, determine the effectiveness and any negative effects of medications, and change therapies as needed. Monitoring typically includes regular visits to the doctor. It also may include blood, urine, and other laboratory tests and x-rays.

People with rheumatoid arthritis may want to discuss preventing osteoporosis with their healthcare provider as part of their long-term, ongoing care. Osteoporosis is a condition in which bones become weakened and fragile. Having rheumatoid arthritisincreases the risk of developing osteoporosis for both men and women, particularly if a person takes corticosteroids. Such people may want to talk with their healthcare provider about the potential benefits of calcium and vitamin D supplements, hormone therapy, or other treatments for osteoporosis.

Alternative and Complementary Therapies

Special diets, vitamin supplements, and other alternative approaches have been suggested for rheumatoid arthritis treatment. Although many of these approaches may not be harmful in and of themselves, controlled scientific studies either have not been conducted on them or have found no definite benefit to these therapies. Some alternative or complementary approaches may help the person cope or reduce some of the stress associated with living with a chronic illness.

As with any therapy, people should discuss the benefits and drawbacks with their healthcare provider before beginning an alternative or new type of therapy. If he or she feels the approach has value and will not be harmful, it can be incorporated into the treatment plan. However, it is important not to neglect regular healthcare.

As treatment progresses, other professionals often help. These may include:

Nurses
Physical or occupational therapists
Orthopedic surgeons
Psychologists
Social workers.

Rheumatoid Arthritis Treatment Begins With You

Studies have shown that people who are well-informed and participate actively in their own care have less pain and make fewer visits to the doctor than do other people with rheumatoid arthritis. Patient education and arthritis self-management programs, as well as support groups, help people to become better-informed and to participate in their own care.

Self-management programs teach about rheumatoid arthritis and its treatments, exercise and relaxation approaches, communication between patients and healthcare providers, and problem solving. Rheumatoid arthritis research on these programs has shown that they help people:

Understand the disease
Reduce their pain while remaining active
Cope physically, emotionally, and mentally
Feel greater control over the disease and build a sense of confidence in their ability to function and lead full, active, and independent lives.

Osteoarthritis

2009-10-31T19:19:00.000-07:00

Osteoarthritis

Osteoarthritis, the most common type of arthritis, is especially common in older people. The disease is thought to affect over 20 million people in the United States.

Osteoarthritis starts when cartilage begins to become ragged and wears away. Cartilage is the tissue that pads bones in a joint. At its worst, the disease causes all of the cartilage in a joint to wear away, leaving bones that rub against each other.

You are most likely to have osteoarthritis in your hands, neck, lower back, or the large weight-bearing joints of your body, such as knees and hips.

Osteoarthritis is sometimes called degenerative joint disease or osteoarthrosis.

Causes of Osteoarthritis or Just Risk Factors?

While scientists are still searching for causes of osteoarthritis, they do know a number of factors that increase a person's chances of developing it.These are known as risk factors. Risk factors are not the same as osteoarthritis causes. While they do increase the chances of developing osteoarthritis, they do not guarantee that a person will develop it.

Some risk factors for osteoarthritis include:

Getting older
Gender
Being overweight
Genetics
Having weak muscles
Certain medical conditions
Joint injuries
Repetitive stresses on the joints.

Getting Older

As people get older, they are increasingly likely to develop osteoarthritis. By age 65, half of the population has x-ray evidence of osteoarthritis in at least one joint, most often in the hips, knees, or fingers.

Gender

Before the age of 45, men are more likely than women to develop osteoarthritis. After the age of 45, women are more likely then men to develop it. Also, more women than men develop knee arthritis, while more men than women develop hip osteoarthritis.

Being Overweight or Obese

Extra weight may place extra pressure on joints and cartilage, causing them to wear away. In fact, for every pound you gain, you add three pounds of pressure on your knees and six times the pressure on your hips. In addition, people with more body fat may have higher blood levels of substances that cause inflammation. Inflammation at the joints may raise the risk of osteoarthritis.

Weight loss can decrease stress on your knees, hips, and lower back, as well as lessen inflammation in your body. If you have osteoarthritis, losing weight may help improve your symptoms. Overweight or obese people who do not have osteoarthritis may reduce their risk of developing it by losing weight.

Genetics

Genetics play a role in the development of osteoarthritis. For example, if your grandmother or mother had osteoarthritis in the hand, you also are at an increased risk of developing it in the hand. Why this occurs is not known, but scientists continue to search for the specific gene or genes that increase the risk of osteoarthritis.

Gene mutations may be a factor in predisposing individuals to develop osteoarthritis. For example, scientists have identified a mutation (or gene defect) affecting collagen, an important part of cartilage, in people with an inherited kind of osteoarthritis that starts at an early age. The mutation weakens collagen protein, which may break or tear more easily under stress.

Weak Muscles

Research has shown that people with weak quadriceps (thigh muscles) are at an increased risk of developing knee osteoarthritis. This may be due to the fact that the quadriceps act as shock absorbers for the knees. The stronger the thigh muscles, the more shock and stress they are able to keep off the knees. This is why strengthening these muscles decreases the chances of developing osteoarthritis.

Certain Medical Conditions

Certain medical conditions can cause damage to the cartilage or create a deformity, which increases stress on the joints. Some examples of these conditions include:

Joint Injuries

People who suffer knee and hip injuries to the joint are at an increased risk of developing osteoarthritis. The earlier in one's life the injury occurred, the greater this risk appears to be.

Repetitive Stress on Joints

People in certain occupations -- such as landscaping or jobs that involve operating machinery or doing a lot of typing -- appear to be at an increased risk of osteoarthritis. This increased risk is thought to be due to microscopic damage that can occur with repetitive actions. Athletes also appear to be at an increased risk, but not all athletes have the same risk. It appears that runners have no increased risk, while soccer players, football players, and baseball pitchers are at increased risk.

One interesting study illustrates this point particularly well. The study showed that using chopsticks contributes to osteoarthritis in the hand. Chopstick use puts stress on certain joints, specifically, joints of the thumb and second and third fingers. In this study, osteoarthritis was more common in several of the joints in the three fingers of the chopstick hand than in the hand not holding chopsticks.

It is important that people who do repetitive tasks learn how to modify their movements in order to decrease the repetitive stress.

Common Osteoarthritis Symptoms

In the early stages of osteoarthritis, joints may simply ache a little after physical work or exercise. But over time, as more and more of the cartilage wears down, the bare bone ends begin to rub against each other. This may cause other osteoarthritis symptoms, including:

Steady or intermittent pain in a joint.
Stiffness in a joint after getting out of bed or sitting for a long time. The stiffness goes away when you begin to move the joint.
Swelling or tenderness in one or more joints.
Loss of motion in the joint.
Having a joint lock or "give way."
Feeling like the joint is unstable.
A crunching feeling or the sound of bone rubbing on bone.

Hot, red, or tender joints are probably not osteoarthritis. If you have these symptoms, check with your healthcare provider about other possible causes, such as rheumatoid arthritis.

Other Symptoms of Osteoarthritis -- By Location

Osteoarthritis symptoms can occur in any joint. Most often, they occur in the hands (especially at the ends of the fingers and thumbs), knees, hips, or spine (neck or lower back).

Hands

Osteoarthritis in the hands may cause many of the symptoms explained above. People with hand osteoarthritis may also have small, bony knobs that appear on the end joints of the fingers. These are called Heberden nodes. Similar knobs, called Bouchard nodes, can appear on the middle joints of the fingers.

Fingers can also become enlarged and gnarled, and they may ache or be stiff and numb. The base of the thumb joint also is commonly affected by osteoarthritis.

Knees

The knees are the body's primary weight-bearing joints. For this reason, they are among the joints most commonly affected by osteoarthritis. In a person who has osteoarthritis, they may be stiff, swollen, and painful, making it hard to walk, climb, and get in and out of chairs and bathtubs.

Hips

Symptoms of osteoarthritis in the hips may include pain, stiffness, and severe disability. People may feel the osteoarthritis pain in their hips, groin, inner thigh, buttocks, or knees. Walking aids, such as canes or walkers, can reduce stress on the hip.

Osteoarthritis in the hip may also limit moving and bending. This can make daily activities, such as dressing and foot care, a challenge.

Spine

Stiffness and pain in the neck or in the lower back are common osteoarthritis symptoms in the spine.

Weakness or numbness of the arms or legs can also result. Some people feel better when they sleep on a firm mattress or sit using back support pillows.

Final Thoughts on Osteoarthritis Symptoms

As mentioned above, there are many possible symptoms of osteoarthritis. But a number of these symptoms are shared with other medical conditions. Therefore, if you have any possible symptoms of osteoarthritis and they last longer than two weeks, you should see your regular doctor or a rheumatologist. He or she will be able to help diagnose and treat the problem. If you have a fever, feel physically ill, suddenly have a swollen joint, or have problems using your joint, see your healthcare provider sooner.

Finally, remember that most people with osteoarthritis live active, productive lives despite any limitations. They do so by using treatment strategies such as rest and exercise, pain-relief medications, education and support programs, learning self-care, and having a "good attitude."

Diagnosing Osteoarthritis

There is no one specific test that can be used to make an osteoarthritis diagnosis.Therefore, in order to make a diagnosis, the healthcare provider will begin by asking a number of questions. This is known as taking a person's medical history. Some of these questions may be related to:

Current symptoms
Other medical conditions
Current medications
A family history of any medical conditions, including arthritis.

In answering these questions, be sure to give a good description of pain, stiffness, and joint function -- as well as how these symptoms have changed over time. Providing these details will allow the healthcare provider to give you a better assessment. It is also important for your healthcare provider to know how the condition affects your work and daily life.

After asking a number of questions, the healthcare provider will perform a physical exam looking for osteoarthritis symptoms. This physical exam involves examining the joints, skin, reflexes, and muscle strength. The healthcare provider will also observe your ability to walk, bend, and carry out activities of daily living.

After the medical history and physical exam, the healthcare provider may recommend certain tests to help with diagnosing osteoarthritis.

Tests your healthcare provider may recommend to help diagnose osteoarthritis include:

X-rays
Other tests.

X-rays

Doctors take x-rays to see how much joint damage is present. X-rays of the affected joint can show things such as cartilage loss, bone damage, and bone spurs. Often, there is a big difference between the severity of osteoarthritis as shown by the x-ray and the degree of pain and disability the person feels. Also, x-rays may not show early osteoarthritis damage -- that is, damage that occurs before much cartilage loss has taken place.

Other Tests

Your doctor may order blood tests to rule out other causes of symptoms. Another common test is called joint aspiration. This test involves drawing fluid from the joint for examination.

Your doctor will also try to identify conditions that may make osteoarthritis symptoms worse. The severity of your symptoms will be influenced greatly by:

Your attitude
Your anxiety level
Whether you have depression
Your daily activity level.

Final Thoughts on Diagnosing Osteoarthritis

It usually is not difficult to tell if a person has osteoarthritis. What is more difficult is determining whether the disease is causing the person's symptoms. Osteoarthritis is so common -- especially in older people -- that symptoms that seem to be caused by the disease can actually be due to other medical conditions.

Osteoarthritis Treatment

Although there is no cure for osteoarthritis, various therapies can help people manage symptoms and improve their overall quality of life. The choice of treatment depends on the severity of symptoms, the person's general health, and other factors.

Treatment for osteoarthritis is generally focused on treating pain and improving function. There are usually four goals:

Improve joint care through rest and exercise
Control pain with medicine and other measures
Maintain an acceptable body weight
Achieve a healthy lifestyle.

Most successful osteoarthritis treatment programs involve a combination of methods tailored to the person's needs, lifestyle, and health. These treatments can include:

Exercise
Weight control
Rest and joint care
Medicines
Other pain-relief techniques
Surgery
Alternative therapies.

Exercise as a Treatment for Osteoarthritis

Osteoarthritis research has shown that exercise is one of the best osteoarthritis treatments. Exercise can improve mood and outlook, decrease pain, increase flexibility, improve the heart and blood flow, maintain weight, and promote general physical fitness. Exercise is also inexpensive and, if done correctly, it has few negative side effects.

The amount and form of exercise will depend on which joints are involved, how stable the joints are, and whether a joint replacement has already been done.You can use exercises to keep strong and limber, extend your range of movement, and reduce your weight. A few of the different types of exercises used to treat osteoarthritis include:

Strength exercises: These exercises can be performed with exercise bands, which are inexpensive devices that add resistance
Aerobic activities: These exercises keep your lungs and circulation system in shape
Range-of-motion activities: These activities keep your joints limber
Agility exercises: These exercises can help you maintain daily living skills
Neck and back strength exercises: These exercises can help you keep your spine strong and limber.

Ask your healthcare provider or physical therapist what exercises are best for you. You should also ask for guidelines on exercising when a joint is sore or if swelling is present. Also ask if you should do any or all of the following:

Use pain-relieving drugs, such as analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) to make exercising easier
Use ice after exercising.

Rest and Joint Care as Part of Treating Osteoarthritis

Osteoarthritis treatment plans include regularly scheduled rest. People must learn to recognize the body's signals and know when to stop or slow down, which prevents pain caused by overexertion.

Some people find that relaxation techniques, stress reduction, and biofeedback help. Using canes and splints can also help by protecting and taking pressure off of joints. Splints or braces provide extra support for weakened joints. They also keep the joint in proper position during sleep or activity. Splints should be used only for limited periods, however, since joints and muscles need to be exercised to prevent stiffness and weakness. An occupational therapist or a doctor can help you get a properly fitting splint.

Medicines Used in Osteoarthritis Treatment

Doctors prescribe medicines to eliminate or reduce osteoarthritis pain and to improve functioning. Doctors consider a number of factors when choosing medicines for osteoarthritis treatment.

Two important factors are the intensity of the pain and the potential side effects of the medicine. People must use osteoarthritis medication carefully and tell their doctors about any changes that occur.

The following types of medicines are commonly used to treat osteoarthritis:

Acetaminophen, such as Tylenol^®
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as:

Ibuprofen (Motrin^®, Advil^®)
Naproxen (Naprosyn^®) or naproxen sodium (Aleve^®,Anaprox^®, Naprelan^®)
Celecoxib (Celebrex^®)
Meloxicam (Mobic^®)

Other medications.

Pain-Relief Techniques Used to Treat Osteoarthritis

As part of their treatment plan, people with osteoarthritis may find ways to relieve pain without the use of medications. Warm towels, hot packs, or a warm bath or shower can help relieve pain and stiffness in a joint. In some cases, cold packs (a bag of ice or frozen vegetables wrapped in a towel) can relieve pain or numb the sore area. (Check with your healthcare provider or physical therapist to find out if heat or cold is the best treatment.)

Water therapy in a heated pool or whirlpool may also relieve pain and stiffness. For knee osteoarthritis, people may wear insoles or cushioned shoes to redistribute weight and reduce joint stress.

Transcutaneous electrical nerve stimulation (TENS) is a technique that uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in the painful area. TENS may relieve some arthritis pain. It seems to work by blocking pain messages to the brain and by modifying pain perception.

Massage may also be helpful. With this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscles. This may increase blood flow and bring warmth to a stressed area. However,arthritis-stressed joints are sensitive, so the therapist must be familiar with the problems of the disease.

Surgery as an Osteoarthritis Treatment

For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed as part of treating osteoarthritis to:

Remove loose pieces of bone and cartilage from the joint if they are causing mechanical symptoms of buckling or locking
Resurface (smooth out) bones
Reposition bones
Replace joints.

The two most common surgeries to replace joints are hip replacement surgery (total hip replacement) and knee replacement surgery(total knee replacement). For these types of joint replacement surgeries, surgeons may replace affected joints with artificial joints called prostheses. These joints can be made from metal alloys, high-density plastic, and ceramic material. They can be joined to bone surfaces by special cements.

Artificial joints can last 10 to 15 years or longer. About 10 percent of artificial joints may need revision. Surgeons choose the design and components of a prosthesis according to their patient's weight, sex, age, and activity level, as well as other medical conditions he or she may have.

The decision to use surgery depends on several things, such as how much the osteoarthritis symptoms are interfering with the person's lifestyle. Some other factors that both the surgeon and the patient will consider include the affected person's:

Level of disability
Intensity of pain
Age
Occupation.

Currently, more than 80 percent of osteoarthritis surgery cases involve replacing the hip or knee joint. After surgery and rehabilitation, the person usually feels less pain and swelling, and can move more easily.

Alternative Therapies Used as Treatments for Osteoarthritis

Many people with osteoarthritis become discouraged with typical treatments because the disease progresses over time and the symptoms worsen. Consequently, they search for alternative therapies aimed at treating osteoarthritis. But people living with osteoarthritis need to be careful because treatments that are not shown to be safe and effective through controlled scientific studies may be dangerous. Also, since arthritis symptoms may come and go, a person using an unproven remedy may mistakenly think the remedy worked simply because he or she tried it when symptoms were going into a natural remission.

Among the alternative therapies often used to treat osteoarthritis are:

Acupuncture
Folk remedies
Nutritional supplements.

Acupuncture

Some people have found pain relief through acupuncture (the use of fine needles inserted at specific points on the skin). Preliminary research shows that acupuncture may be a useful component in an osteoarthritis treatment plan for some people.

Folk Remedies

Some people seek alternative treatments for their pain and disability. Some of these alternative therapies include wearing copper bracelets, drinking herbal teas, and taking mud baths. While these practices are not harmful, some can be expensive. And any unproven remedy, no matter how harmless, can become harmful if it stops or delays someone from seeking a prescribed treatment program from a knowledgeable physician. To date, no scientific research shows these approaches to be helpful in as an osteoarthritis treatment.

Nutritional Supplements

Nutrients such as glucosamine and chondroitin sulfate have claimed to improve the symptoms of people with osteoarthritis. However, based on a large study funded by the National Institutes of Health (NIH), these two supplements were shown to offer no pain-relief benefits, either alone or combined, compared to a placebo (sugar pill).

Osteoarthritis Research

Scientists continue to try to better understand osteoarthritis and how to effectively deal with it. Some current areas of research on osteoarthritis include tools to detect the condition earlier, genes and their impact on osteoarthritis, and treatment strategies like gene therapy and stem cell transplantation. Talk with your healthcare provider to learn about the potential benefits of participating in research studies.

Anorexia

2009-10-29T23:03:00.000-07:00

Anorexia

Anorexia nervosa is a type of eating disorder in which people can literally starve themselves to death. People with anorexia eat very little even though they are already thin. They have an intense and overpowering fear of body fat and weight gain, with repeated dieting attempts and excessive weight loss.

Those with anorexia are often characterized as perfectionists and overachievers who appear to be in control. In reality, they suffer from low self-esteem and overly criticize themselves. They are also very concerned about pleasing others.

Anorexia affects from 0.5 percent to 1 percent of the female adolescent population, with an average age of onset between 14 and 18 years. An estimated 0.5 percent to 3.7 percent of females suffer from anorexia nervosa in their lifetime.

Warning Signs of Anorexia

Family members and friends might notice some of anorexia's warning signs.

Specific warning signs of this eating disorder in a person can include the following:

Eating only "safe" foods, usually those low in calories and fat
Having odd rituals, such as cutting food into small pieces
Spending more time playing with food than eating it
Cooking meals for others without eating
Engaging in compulsive exercising
Dressing in layers to hide weight loss
Spending less time with family and friends, becoming more isolated, withdrawn, and secretive.

Resistance to maintaining body weight at or above a minimally normal weight for age and height
Intense fear of gaining weight or becoming fat, even though underweight
Undue influence of body weight or shape on self-evaluation
Disturbance in the way in which one's body weight or shape is experienced
Denial of the seriousness of the current low body weight
Infrequent or absent menstrual periods (in females who have reached puberty).

Long-Term Signs of Anorexia

Anorexia signs in someone who has had the condition for a long time can include:

Slow heart rate and low blood pressure
Brittle hair and nails
Dry skin (which may become yellow, and develop a covering of soft hair called lanugo)
Mild anemia
Brain damage
Swollen joints
Reduced muscle mass
Light-headedness
Osteoporosis
Heart failure, especially in those who use drugs to stimulate vomiting, bowel movements, or urination.

Presently, there is no universally accepted, standard treatment for anorexia. Because of its complexity, anorexia requires a comprehensive treatment plan, involving:

Medical care and monitoring
Psychosocial interventions
Nutritional counseling
Medication (when appropriate).

Ideally, this integrated approach to anorexia treatment would include the skills of nutritionists, mental health professionals, endocrinologists, and other physicians.

Families and friends offering support and encouragement can also play an important role in the success of an anorexia treatment program.

Strategies for Treating Anorexia

Treatment is most successful when the condition is diagnosed early. The longer abnormal eating behaviors persist, the more difficult it is to overcome anorexia and its effects on the body.

Anorexia treatment calls for a specific program that involves three main phases:

Restoring weight lost to severe dieting and purging
Treating psychological disturbances, such as poor body image, low self-esteem, and interpersonal conflicts
Achieving long-term remission and rehabilitation or full recovery.

Early Treatment

The first goal for the treatment of anorexia is to ensure the person's physical health, which involves restoring a healthy weight. Reaching this goal may require hospitalization. As part of this early treatment, feeding plans address the person's medical and nutritional needs. In some cases, intravenous feeding is recommended.

Psychotherapy

Once malnutrition has been corrected and weight gain has begun, psychotherapy (often cognitive-behavioral or interpersonal psychotherapy) can help people with anorexia overcome low self-esteem and address distorted thought and behavior patterns. Behavioral therapy also has been effective in helping a person return to healthy eating habits.

Family therapy may be part of treatment for anorexia, during which parents help their child learn to eat again and maintain healthy eating habits on his or her own.

Supportive group therapy may follow, and self-help groups within communities may provide ongoing support as part of treatment.

Medications

Use of psychotropic medication in treating anorexia should be considered only after weight gain has been established. Certain selective serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for weight maintenance and for resolving mood and anxiety symptoms associated with anorexia.

Prognosis With Anorexia Treatment

The course and outcome of anorexia nervosa vary among individuals: some fully recover after a single episode; some have a fluctuating pattern of weight gain and relapse. Others experience a chronically deteriorating course of the illness over many years.

The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15 to 24 in the general population. The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte imbalance, and suicide.

Anorexia Research

Doctors and scientists conducting research on anorexia are focused on understanding and treating this eating disorder. Current areas of research include appetite control biology, hormones, genetics, and the brain. Scientists are also looking for ways to better treat anorexia, as well as preventing it from ever developing.

Epilepsy

2009-10-28T19:56:00.000-07:00

Epilepsy

Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. Neurons normally generate electrochemical impulses that act on other neurons, glands, and muscles to produce human thoughts, feelings, and actions.

In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior, or sometimes convulsions, muscle spasms, and loss of consciousness known as epileptic seizures. The condition is, therefore, sometimes referred to as a seizure disorder. It affects people in all nations and of all races.

During a seizure, neurons may fire as many as 500 times a second, much faster than the normal rate of about 80 times a second. In some people, this happens only occasionally; for others, it may happen up to hundreds of times a day.

Epilepsy Types

Just as there are many different types of seizures, there are many different types of epilepsy. Doctors have identified hundreds of different epilepsy syndromes -- disorders characterized by a specific set of symptoms that include epilepsy. Some of these syndromes appear to be hereditary. For other syndromes, the cause is unknown.

Epilepsy syndromes are frequently described by their symptoms or by where in the brain they originate. People should discuss the implications of their type of epilepsy with their doctors to understand the full range of symptoms, the possible treatments, and the prognosis.

Absence Epilepsy

People with absence epilepsy have repeated absence seizures that cause momentary lapses of consciousness. These seizures almost always begin in childhood or adolescence, and they tend to run in families, suggesting that they may be at least partially due to a defective gene or genes. Some people with absence seizures have purposeless movements during their seizures, such as a jerking arm or rapidly blinking eyes.

Others have no noticeable symptoms except for brief times when they are "out of it." Immediately after a seizure, the person can resume whatever he or she was doing; however, these seizures may occur so frequently that the person cannot concentrate in school or other situations. Childhood absence epilepsy usually stops when the child reaches puberty. Absence seizures usually have no lasting effect on intelligence or other brain functions.

Temporal Lobe Epilepsy

Temporal lobe epilepsy, or TLE, is the most common epilepsy syndrome with focal seizures. These seizures are often associated with auras. TLE often begins in childhood. Research has shown that repeated temporal lobe seizures can cause a brain structure called the hippocampus to shrink over time. The hippocampus is important for memory and learning. While it may take years of temporal lobe seizures for measurable hippocampal damage to occur, this finding underlines the need to treat TLE as early and as effectively as possible.

Neocortical Epilepsy

Neocortical epilepsy is a type of epilepsy characterized by seizures that originate from the brain's cortex, or outer layer.

Lennox-Gastaut Syndrome

Children with Lennox-Gastaut syndrome have severe epilepsy with several different types of seizures, including atonic seizures (also called drop attacks), which cause sudden falls. This severe form of epilepsy can be very difficult to treat effectively and is usually present for life.

Rasmussen's Encephalitis

Rasmussen's encephalitis is a progressive epilepsy type in which half of the brain shows continual inflammation. It sometimes is treated with a radical surgical procedure called hemispherectomy.

Childhood Absence Epilepsy

Some childhood epilepsy syndromes, such as childhood absence epilepsy, tend to go into remission or stop entirely during adolescence, whereas other syndromes (such as juvenile myoclonic epilepsy) usually present for life once they develop. Seizure syndromes do not always appear in childhood, however.

Benign Epilepsy Syndromes

Epilepsy syndromes that are easily treated, do not seem to impair cognitive functions or development, and usually stop spontaneously are often described as benign. Benign epilepsy syndromes include benign infantile encephalopathy and benign neonatal convulsions.

Progressive Epilepsy

Epilepsy syndromes in which the seizures and/or the person's cognitive abilities get worse over time are called progressive epilepsy.

Infantile Spasm

Several epilepsy types begin in infancy. The most common infantile type is infantile spasms, which are clusters of seizures that usually begin before the age of six months. During these seizures the infant may bend and cry out. Anticonvulsant drugs often do not work for infantile spasms, but the seizures can be treated with ACTH (adrenocorticotropic hormone) or prednisone.

Other Syndromes: Types of Epilepsy?

Other syndromes, such as early myoclonic encephalopathy, include neurological and developmental problems. However, these problems may be caused by underlying neurodegenerative processes rather than by the seizures.

Cause of Epilepsy?

Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity -- from illness to brain damage to abnormal brain development -- can lead to seizures.

In about half of all epilepsy cases, the cause is not known.

When the cause of epilepsy is known, it may be one of the following:

Other medical conditions
Trauma
Developmental problems
Poisoning.

Epilepsy is not contagious and is not caused by mental illness or mental retardation.

Epilepsy Causes: Understanding the Brain

Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve-signaling chemicals called neurotransmitters, or some combination of these factors.

Neurotransmitters

Researchers believe that some people with epilepsy have an abnormally high level of excitatory neurotransmitters that increase neuronal activity, while others have an abnormally low level of inhibitory neurotransmitters that decrease neuronal activity in the brain. Either situation can result in too much neuronal activity and cause epilepsy.

One of the most-studied neurotransmitters involved in epilepsy is GABA, or gamma-aminobutyric acid, which is an inhibitory neurotransmitter. Research on GABA has led to drugs that alter the amount of this neurotransmitter in the brain or change how the brain responds to it. Researchers are also studying excitatory neurotransmitters, such as glutamate.

Nerve Connections

In some cases, the brain's attempts to repair itself after a head injury, stroke, or other problem may inadvertently generate abnormal nerve connections that cause epilepsy. Abnormalities in brain wiring that occur during brain development also may disturb neuronal activity and lead to epilepsy.

Cells

Research has shown that the cell membrane that surrounds each neuron plays an important role in epilepsy. Cell membranes are crucial for a neuron to generate electrical impulses. For this reason, researchers are studying details of the membrane structure, how molecules move in and out of membranes, and how the cell nourishes and repairs the membrane. A disruption in any of these processes may lead to epilepsy. Studies in animals have shown that because the brain continually adapts to changes in stimuli, a small change in neuronal activity, if repeated, may eventually lead to full-blown epilepsy. Researchers are investigating whether this phenomenon, called kindling, may also occur in humans.

In some cases, epilepsy may result from changes in non-neuronal brain cells called glia. These cells regulate concentrations of chemicals in the brain that can affect neuronal signaling.

Genetics as a Cause of Epilepsy

Research suggests that genetic abnormalities may be some of the most important factors contributing to epilepsy. Some types of epilepsy have been traced to an abnormality in a specific gene. Many other types of epilepsy tend to run in families, which suggests that genes influence the brain disorder. Some researchers estimate that more than 500 genes could play a role in this disorder; however, it is increasingly clear that for many forms of epilepsy, genetic abnormalities play only a partial role, perhaps by increasing a person's susceptibility to seizures that are triggered by an environmental factor.

Several types of epilepsy have now been linked to defective genes for ion channels, the "gates" that control the flow of ions in to and out of cells and that regulate neuron signaling. Another gene, which is missing in people with progressive myoclonus epilepsy, codes for a protein called cystatin B. This protein regulates enzymes that break down other proteins. Another gene, which is altered in a severe form of epilepsy called Lafora's disease, has been linked to a gene that helps to break down carbohydrates.

While abnormal genes sometimes cause epilepsy, they also may influence the disorder in subtler ways. For example, one study showed that many people with epilepsy have an abnormally active version of a gene that increases resistance to drugs. This may help explain why anticonvulsant drugs do not work for some people. Genes also may control other aspects of the body's response to medications and each person's susceptibility to seizures, or seizure threshold. Abnormalities in the genes that control neuronal migration -- a critical step in brain development -- can lead to areas of misplaced or abnormally formed neurons, or dysplasia, in the brain that can cause epilepsy. In some cases, genes may contribute to the development of epilepsy, even in people with no family history of the disorder. These people may have a newly developed abnormality, or mutation, in an epilepsy-related gene.

Other Conditions That Can Cause Epilepsy

In many cases, epilepsy develops as a result of brain damage from other disorders. Some of these other disorders include:

Brain tumors
Alcoholism
Alzheimer's disease
Strokes
Heart attacks
Cerebrovascular disease
Infections
Celiac disease
Neurocysticercosis
Developmental and metabolic disorders.

About 32 percent of all cases of newly developed epilepsy in elderly people appear to be due to cerebrovascular disease, which reduces the supply of oxygen to brain cells.

Meningitis, AIDS, viral encephalitis, and other infectious diseases are possible causes of epilepsy, as is hydrocephalus -- a condition in which excess fluid builds up in the brain.

Epilepsy also can result from intolerance to wheat gluten (also known as celiac disease) or from a parasitic infection of the brain called neurocysticercosis.

Seizures may stop once these disorders are treated successfully; however, the odds of becoming seizure-free after the primary disorder is treated are uncertain and vary, depending on:

The brain region that is affected
The type of disorder
How much brain damage occurred prior to treatment.

Epilepsy is associated with a variety of developmental and metabolic disorders, including:

Neurofibromatosis (a genetic disorder of the nervous system)
Pyruvate dependency
Cerebral palsy
Tuberous sclerosis (a rare genetic disease that causes benign tumors and affects the central nervous system)
Landau-Kleffner syndrome (a rare childhood neurological disorder that affects the ability to understand or express language)
Autism.

Epilepsy is just one of a set of symptoms commonly found in people with these disorders.

Head Injury as a Cause of Epilepsy

In some cases, head injury can lead to seizures or epilepsy. Safety measures, such as wearing seat belts in cars and using helmets when riding a motorcycle or playing competitive sports, can protect people from epilepsy and other problems that result from head injury.

Prenatal Injury and Developmental Problems as Causes of Epilepsy

The developing brain is susceptible to many kinds of injury. Maternal infections, poor nutrition, and oxygen deficiencies are just some of the conditions that may take a toll on the brain of a developing baby. These conditions may lead to cerebral palsy, which often is associated with epilepsy, or they may cause epilepsy that is unrelated to any other disorders. About 20 percent of seizures in children are due to cerebral palsy or other neurological abnormalities.

Abnormalities in genes that control development also may contribute to epilepsy. Advanced brain imaging has revealed that some cases of epilepsy that occur with no obvious cause may be associated with areas of dysplasia in the brain that probably develop before birth.

Poisoning as a Cause of Epilepsy

Seizures can result from exposure to lead, carbon monoxide, and many other poisons. They also can result from exposure to street drugs and from overdoses of antidepressants and other medications.

Epilepsy Triggers

Epileptic seizures are often triggered by factors such as:

Lack of sleep
Alcohol consumption
Stress
Hormonal changes associated with the menstrual cycle.

These seizure triggers do not cause epilepsy, but can provoke first seizures or cause breakthrough seizures in people who otherwise experience good seizure control with their medication. Sleep deprivation in particular is a universal and powerful trigger of seizures.

For this reason, people with epilepsy should make sure to get enough sleep and should try to stay on a regular sleep schedule as much as possible. For some people, light flashing at a certain speed or the flicker of a computer monitor can trigger a seizure; this problem is called photosensitive epilepsy.

Smoking cigarettes also can trigger seizures. The nicotine in cigarettes acts on receptors for the excitatory neurotransmitter acetylcholine in the brain, which increases neuronal firing. Seizures are not triggered by sexual activity, except in rare instances.

Common Symptoms of Epilepsy

Although the symptoms listed in this section are not necessarily indicators of epilepsy, it is wise to consult a healthcare provider if you or a family member experiences one or more of these possible symptoms of epilepsy:

"Blackouts" or periods of confused memory
Episodes of staring or unexplained periods of unresponsiveness
Involuntary movement of arms and legs
"Fainting spells" with incontinence or followed by excessive fatigue
Odd sounds, distorted perceptions, or episodic feelings of fear that cannot be explained.

Epilepsy Symptoms: Generalized Tonic-Clonic Seizure

Few experiences match the drama of a convulsive seizure. A person experiencing severe symptoms of epilepsy may cry out, fall to the floor unconscious, twitch or move uncontrollably, drool, or even lose bladder control.

Within minutes, the attack is over, and the person regains consciousness, but is exhausted and dazed. This is the image most people have when they hear the word epilepsy. However, this type of seizure -- a generalized tonic-clonic seizure -- is only one kind of epilepsy. There are many other types of the brain disorder, each with a different set of symptoms.

Symptoms of Neocortical Epilepsy

Symptoms of neocortical epilepsy can be either focal or generalized. Some of these symptoms of epilepsy may include:

Strange sensations
Visual hallucinations
Emotional changes
Muscle spasms
Convulsions

Other symptoms, depending on where in the brain the seizures begin.

Epilepsy Diagnosis

One of the best methods for making an epilepsy diagnosis involves compiling a detailed medical history, including symptoms and duration of the seizures. Because people who have experienced a seizure often do not remember what happened, caregivers' accounts of the seizure are vital to doctors making the diagnosis. Tests used to reach an epilepsy diagnosis include electroencephalogram (EEG) monitoring, brain scans, and blood tests.

Epilepsy Treatments

Accurate diagnosis of the type of epilepsy a person has is crucial in finding an effective epilepsy treatment.

There are many different treatment options for epilepsy. Current methods can control seizures at least some of the time in about 80 percent of people with epilepsy. However, another 20 percent -- about 600,000 people with epilepsy in the United States -- have intractable seizures, and another 400,000 feel they get inadequate relief from available treatments. These statistics make it clear that improved treatments for epilepsy are desperately needed.

Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. Research suggests that medication and other options may be less successful once seizures and their consequences become established.

The goal of epilepsy treatment is to decrease the number and severity of seizures and minimize drug side effects.

Medications Used to Treat Epilepsy

For about 80 percent of those diagnosed with epilepsy, seizures can be controlled with medicines and/or surgery. Drugs best treat the symptoms of epilepsy, but they do not cure the disease.

Since 1990, a large number of new antiepileptic drugs have been approved, increasing the treatment options available. All of these medications, even the new ones, have some side effects because antiepileptic drugs act directly on the nervous system.

General Information About Medicines for Epilepsy

Things to keep in mind concerning epilepsy medication include the following:

For about 80 percent of those people diagnosed with epilepsy,seizures can be controlled with medications, surgery, or both.

People with epilepsy may take medicine up to four times a day to prevent seizures.

Drugs for epilepsy treat the related symptoms. They do not cure the disease.

There are many different forms of epilepsy, and certain types of medications seem to work best for different types of epilepsy.

Types of Epilepsy Drugs

Since 1990, a large number of new epilepsy medications have been approved, increasing the treatment options for patients and their doctors.

The oldest drugs used in the treatment of epilepsy include phenobarbital, introduced in 1912, and Dilantin^® (phenytoin), in use since 1938. Altogether, nearly two dozen different medicines have been approved for epilepsy treatment. Some recent drugs that the U.S. Food and Drug Administration (FDA) has approved include:

Tailoring the Dose of Epilepsy Medications

When a person starts a new epilepsy medication, it is important to tailor the dosage to achieve the best results. People's bodies react to medicines in different and sometimes unpredictable ways, so it may take time to find the right drug at the right dose to provide optimal control of seizureswhile minimizing side effects.

Side Effects and Interactions With Medication for Epilepsy

Many times, side effects determine the epilepsy medication that a person eventually will take. The specific side effects vary, depending on the drug; however, all medications -- even the new ones -- have some side effects because they act directly on the brain.

Unfortunately, it is impossible for a healthcare provider to know which, if any, side effects people will experience with a medicine that they have never taken. A drug that has no effect or serious side effects at one dose may work well at another dosage. Doctors will usually prescribe a low dose of the new epilepsy medication initially and monitor blood levels of the drug to determine when the best possible dose has been reached.

The need to try different drugs in order to find the best combination to prevent seizures with the fewest possible side effects sometimes gives families the impression doctors are "experimenting" with their loved one's care. But this is the normal procedure for new patients until their seizures are stabilized.

Also, how well a medicine for epilepsy works may be affected by other medications a person is taking. Known as a drug interaction, this relationship may involve how the drug is absorbed, metabolized, and otherwise distributed in the body. The interaction, for example, may speed up or slow down how quickly a medication is eliminated, either making it less effective at preventing seizures because a lower level is present in the blood, or more likely to build up to toxic levels and cause side effects.

Generic Drugs

Generic versions are available for manyepilepsy medications. The chemicals in generic drugs are exactly the same as in the brand-name drugs, but they may be absorbed or processed differently in the body because of the way they are prepared. Therefore, patients should always check with their doctors before switching to a generic version.

Stopping a Medicine for Epilepsy

Some doctors will advise people with epilepsy to discontinue their medication after two years have passed without a seizure. Others feel it is better to wait for four to five years. Stopping drug therapy should always be done with a doctor's supervision. It is important to continue taking the medicine for as long as the doctor prescribes it.

In addition, people should ask the doctor or pharmacist ahead of time what they should do if they miss a dose.

Stopping epilepsy medication without a doctor's guidance is one of the major reasons people who have been seizure-free start having new seizures. Seizures that result from suddenly stopping treatment can be serious and can lead to status epilepticus. Furthermore, there is some evidence that uncontrolled seizures trigger changes in neurons that can make it more difficult to treat seizures in the future.

The chance that a person will eventually be able to stop taking medicine for epilepsy varies, depending on the person's age and his or her type of epilepsy. More than half of children who go into remission with medication can eventually stop their treatment without having new seizures.

One study showed that 68 percent of adults who had been seizure-free for two years before stopping drugs for epilepsy were able to do so without having more seizures, and 75 percent could successfully discontinue medication if they had been seizure-free for three years.

The odds of successfully stopping epilepsy medication are not as good for:

People with a family history of the condition
Those who need multiple medications
People with focal seizures
Those who continue to have abnormal electroencephalogram (EEG) results while on medication.

Surgery as an Epilepsy Treatment

When a person's seizures cannot be adequately controlled by medications, doctors may recommend that he or she be evaluated for surgery. To decide if a person may benefit from surgery, doctors consider the type or types of seizures he or she has. They also take into account the brain region involved and how important that region is for everyday behavior.

Three broad categories of epilepsy can be treated successfully with surgery. These include:

Focal seizures
Seizures that begin as focal seizures before spreading to the rest of the brain
Unilateral multifocal epilepsy with infantile hemiplegia (such asRasmussen's encephalitis).

Doctors generally recommend surgery for epilepsy treatment only after people have tried two or three different medications without success, or if there is an identifiable brain lesion -- a damaged or dysfunctional area -- believed to cause the seizures.

Expectations for the Procedure

A study published in 2000 compared epilepsy surgery to an additional year of treatment with antiepileptic drugs in people with longstanding temporal lobe epilepsy. The results showed that 64 percent of patients receiving surgery became seizure-free, compared to 8 percent of those who continued with medication only.

Because of this study and other evidence, surgery for temporal lobe epilepsy is now recommended when antiepileptic drugs are not effective. However, there is not guidance on how long seizures should occur, how severe they should be, or how many drugs should be tried before surgery is considered. A nationwide study is now underway to determine how soon surgery for temporal lobe epilepsy should be performed.

If a person is considered a good candidate for epilepsy surgery and has seizures that cannot be controlled with available medication, experts generally agree that surgery should be performed as early as possible.

Life After Epilepsy Surgery

It can be difficult for a person who has had years of seizures to fully re-adapt to a seizure-free life if the epilepsy surgery is successful. The person may never have had an opportunity to develop independence, and he or she may have had school and work difficulties that could have been avoided with earlier treatment. Surgery should always be performed with support from rehabilitation specialists and counselors who can help the person deal with the many psychological, social, and employment issues he or she may face.

Even when surgery completely ends a person's seizures, it is important to continue taking seizure medication for some time to give the brain time to re-adapt. Doctors generally recommend epilepsy medication for two years after a successful operation to avoid new seizures.

What Are the Risks?

While surgery can significantly reduce or even halt seizures for some people, it is important to remember that any kind of surgery carries some amount of risk (usually small).

Surgery for epilepsy does not always successfully reduce seizures, and it can result in cognitive or personality changes, even in people who are excellent candidates for surgery. Patients should ask their surgeon about his or her experience, success rates, and complication rates with the procedure they are considering.

Types of Surgery for Epilepsy

Types of surgery include:

Lobectomy or lesionectomy
Multiple subpial transection
Corpus callosotomy
Hemispherectomy and hemispherotomy
Implanted devices
Surgery to treat other medical conditions causing seizures (such as a brain tumor).

Living With Epilepsy

Most people living with epilepsy lead outwardly normal lives. Approximately 80 percent of people with epilepsy can be significantly helped by modern therapies, and some may go months or years between seizures.

However, the condition can and does affect daily life for people with epilepsy, as well as their family and their friends. People who experience severe seizures that resist treatment have, on average, a shorter life expectancy and an increased risk of cognitive impairment, particularly if the seizures developed in early childhood. These impairments may be related to the underlying conditions that cause epilepsy or to epilepsy treatment rather than the epilepsy itself.

Behavior and Emotions

It is not uncommon for people with epilepsy, especially children, to develop behavioral and emotional problems. Sometimes these problems are caused by embarrassment or frustration associated with epilepsy. Other problems may result from bullying, teasing, or avoidance in school and other social settings.

In children, these problems can be minimized if parents encourage a positive outlook and independence, do not reward negative behavior with unusual amounts of attention, and try to stay attuned to their child's needs and feelings. Families must learn to accept and live with the seizures without blaming or resenting the affected person.

Counseling services can help families cope with epilepsy in a positive manner. Epilepsy support groups also can help by providing a way for people with epilepsy and their family members to share their experiences, frustrations, and tips for coping with the disorder.

People living with epilepsy have an increased risk of poor self-esteem,depression, and suicide. These problems may be a reaction to a lack of understanding or discomfort about epilepsy that may result in cruelty or avoidance by other people. Many people with epilepsy also live with an ever-present fear that they will have another seizure.

Driving and Recreation

For many people living with epilepsy, the risk of seizures restricts their independence, in particular the ability to drive. Most states and the District of Columbia will not issue a driver's license to someone with epilepsy unless the person can document that they have gone a specific amount of time without a seizure(the waiting period varies from a few months to several years).

Some states make exceptions for this policy when seizures don't impair consciousness, occur only during sleep, or have long auras or other warning signs that allow the person to avoid driving when a seizure is likely to occur.

Studies show that the risk of having a seizure-related accident decreases as the length of time since the last seizure increases. One study found that the risk of having a seizure-related motor vehicle accident is 93 percent less in people who wait at least one year after their last seizure before driving, compared to people who wait for shorter intervals.

The risk of seizures also restricts people's recreational choices. For instance, people with epilepsy should not participate in sports such as skydiving or motor racing, where a moment's inattention could lead to injury. Other activities, such as swimming and sailing, should be done only with precautions or supervision.

Jogging, football, and many other sports are reasonably safe for a person with epilepsy. Studies to date have not shown any increase in seizures due to sports, although these studies have not focused on any activity in particular.

There is some evidence that regular exercise may even improve seizure control in some people.

Sports are often such a positive factor in life that it is best for the person to participate, although the person with epilepsy and the coach or other leader should take appropriate safety precautions. It is important to take steps to avoid potential sports-related problems such as dehydration, overexertion, and hypoglycemia, as these problems can increase the risk of seizures.

Education and Employment

By law, people living with epilepsy or other handicaps in the United States cannot be denied employment or access to any educational, recreational, or other activity because of their seizures. However, one survey showed that only about 56 percent of people living with epilepsy finish high school and about 15 percent finish college -- rates much lower than those for the general population. The same survey found that about 25 percent of working-age people with epilepsy are unemployed.

These numbers indicate that significant barriers still exist for people living with epilepsy in school and work. Restrictions on driving limit the employment opportunities for many people with epilepsy, and many find it difficult to face the misunderstandings and social pressures they encounter in public situations. Antiepileptic drugs also may cause side effects that interfere with concentration and memory.

Children living with epilepsy may need extra time to complete schoolwork, and they sometimes may need to have instructions or other information repeated for them. Teachers should be told what to do if a child in their classroom has a seizure, and parents should work with the school system to find reasonable ways to accommodate any special needs their child may have.

Treating Epilepsy Through Diet

Studies have shown that in some cases, children may experience fewer seizures if they maintain a strict diet rich in fats and low in carbohydrates. This unusual diet, called the ketogenic diet, causes the body to break down fats instead of carbohydrates to survive. This condition is called ketosis.

One study of 150 children whose seizures were poorly controlled with medication found that about one fourth of the children had a 90 percent or better decrease in seizures with the ketogenic diet, and another half of the group had a 50 percent or better decrease in their seizures. Moreover, some children can discontinue the diet after several years and remain seizure-free. The ketogenic diet is not easy to maintain, as it requires strict adherence to an unusual and limited range of foods.

Possible side effects include slow growth due to nutritional deficiency and a buildup of uric acid in the blood, which can lead to kidney stones. People who try the ketogenic diet should seek the guidance of a dietician to ensure that it does not lead to serious nutritional deficiency.

Researchers are not sure how ketosis inhibits seizures. One study showed that a by-product of ketosis called beta-hydroxybutyrate (BHB) inhibits seizures in animals. If BHB also works in humans, researchers may eventually be able to develop drugs that mimic the seizure-inhibiting effects of the ketogenic diet.

Using Biofeedback to Treat Epilepsy

Researchers are studying whether biofeedback -- a strategy in which individuals learn to control their own brain waves -- may be useful in controlling seizures. However, this type of treatment for epilepsy is controversial, and most studies have shown discouraging results.

Supplements as Epilepsy Treatments

Taking large doses of vitamins generally does not help a person's seizures and may even be harmful in some cases. But a good diet and some vitamin supplements, particularly folic acid, may help reduce some birth defects and medication-related nutritional deficiencies.

Use of non-vitamin supplements such as melatonin is controversial and can be risky. One study showed that melatonin may reduce seizures in some children, while another found that the risk of seizures increased measurably with melatonin.

Most non-vitamin supplements, such as those found in health food and other types of stores, are not regulated by the U.S. Food and Drug Administration (FDA), so their true effects -- and their interactions with other drugs -- are largely unknown.

Who Treats Epilepsy?

Doctors who treat epilepsy come from many different fields of medicine. They include:

Neurologists
Pediatricians
Pediatric neurologists
Internists
Family physicians
Neurosurgeons.

Doctors who specialize in treating epilepsy are called epileptologists.

People who need specialized or intensive care may get epilepsy treatment at large medical centers and neurology clinics at hospitals or by neurologists in private practice. Many treatment centers are associated with university hospitals that perform research in addition to providing medical care.

Preventing Epilepsy: Prevent Head Trauma

Many cases of epilepsy can be prevented by wearing seat belts and bicycle helmets, putting children in car seats, and practicing other methods of preventing head injury and other trauma.

Preventing Epilepsy With Medications

Prescribing medication after first or second seizures or febrile seizures also may help prevent epilepsy in some cases.

The Role of Prenatal Care in Preventing Epilepsy

Good prenatal care, including treatment of high blood pressure and infections during pregnancy, can prevent brain damage in the developing baby that may lead to epilepsy and other neurological problems later.

Preventing Epilepsy by Getting Treatment for Medical Conditions

Treating cardiovascular disease, high blood pressure, infections, and other disorders that can affect the brain during adulthood and aging also may prevent many cases of epilepsy.

Preventing Epilepsy: Gene Indentification

Finally, identifying the genes for many neurological disorders can provide opportunities for genetic screening and prenatal diagnosis that may ultimately prevent many cases of epilepsy.

Epilepsy Research

Researchers studying epilepsy are examining how and why seizures develop, how they can best be treated or prevented, and how they influence brain development. Researchers are also working to identify genes that may influence epilepsy in some way. Preliminary findings suggest that stem cell transplants may prove beneficial for treating the disease. Other studies are focused on improving the quality of brain scans.

Aphasia

2009-10-27T22:33:00.000-07:00

Aphasia

Aphasia is a neurological disorder caused by damage to the portions of the brain that are responsible for language. Primary signs of the disorder include difficulty in expressing oneself when speaking, trouble understanding speech, and difficulty with reading and writing. Aphasia is not a disease, but a symptom of brain damage. Most commonly seen in adults who have suffered a stroke, aphasia can also result from a brain tumor, infection, head injury, or dementia that damages the brain. It is estimated that about 1 million people in the United States today suffer from aphasia. The type and severity of language dysfunction depends on the precise location and extent of the damaged brain tissue.
Generally, aphasia can be divided into four broad categories: (1) Expressive aphasia involves difficulty in conveying thoughts through speech or writing. The patient knows what he wants to say, but cannot find the words he needs. (2)Receptive aphasia involves difficulty understanding spoken or written language. The patient hears the voice or sees the print but cannot make sense of the words. (3) Patients with anomic or amnesia aphasia, the least severe form of aphasia, have difficulty in using the correct names for particular objects, people, places, or events. (4) Global aphasiaresults from severe and extensive damage to the language areas of the brain. Patients lose almost all language function, both comprehension and expression. They cannot speak or understand speech, nor can they read or write.
treatment
In some instances, an individual will completely recover from aphasia without treatment. In most cases, however, language therapy should begin as soon as possible and be tailored to the individual needs of the patient. Rehabilitation with a speech pathologist involves extensive exercises in which patients read, write, follow directions, and repeat what they hear. Computer-aided therapy may supplement standard language therapy.
Family involvement is often a crucial component of aphasia treatment so that family members can learn the best way to communicate with their loved one.
Family members are encouraged to:
Simplify language by using short, uncomplicated sentences.
Repeat the content words or write down key words to clarify meaning as needed.
Maintain a natural conversational manner appropriate for an adult.
Minimize distractions, such as a loud radio or TV, whenever possible.
Include the person with aphasia in conversations.
Ask for and value the opinion of the person with aphasia, especially regarding family matters.
Encourage any type of communication, whether it is speech, gesture, pointing, or drawing.
Avoid correcting the person’s speech.
Allow the person plenty of time to talk.
Help the person become involved outside the home. Seek out support groups such as stroke clubs.
prognosis
The outcome of aphasia is difficult to predict given the wide range of variability of the condition. Generally, people who are younger or have less extensive brain damage fare better. The location of the injury is also important and is another clue to prognosis. In general, patients tend to recover skills in language comprehension more completely than those skills involving expression.

Research being done
Scientists are attempting to reveal the underlying problems that cause certain symptoms of aphasia. The goal is to understand how injury to a particular part of the brain impairs a person’s ability to convey and understand language. The results could be useful in treating various types of aphasia, since the treatment may change depending upon the cause of the language problem.
Other research is attempting to understand the parts of the language process that contribute to sentence comprehension and production and how these parts may break down in aphasia. In this way, it may be possible to pinpoint where the breakdown occurs and help in the development of more focused treatment programs.
Although different languages have many things in common when specific portions of the brain are injured, there are also differences. Scientists are trying to understand the common (or universal) symptoms of aphasia and the language-specific symptoms of the disorder. Other researchers are examining whether people with aphasia may still know their language but have difficulty accessing that knowledge. These studies may help with the development of tests and rehabilitation strategies that focus on specific characteristics of one language or multiple languages.
Researchers are exploring drug therapy as an experimental approach to treating aphasia. Some studies are testing how drugs can be used in combination with speech therapy to improve recovery of various language functions.
Researchers are also looking at how treatment of other cognitive deficits involving attention and memory can improve communication abilities.
To understand recovery processes in the brain, some researchers are using functional magnetic resonance imaging (fMRI) to better understand the human brain regions involved in speaking and understanding language. This type of research may improve understanding of how these areas reorganize after brain injury. The results could have implications for both the basic understanding of brain function and the diagnosis and treatment of neurological diseases.

Huntington's Disease

2009-10-26T19:26:00.000-07:00

Huntington's Disease

Huntington's disease is a progressive brain condition that causes uncontrolled movements, emotional problems, and cognitive difficulties.

Huntington's disease is also called:

Huntington disease
HD
Huntington chorea.

How Common Is It?

Huntington's disease affects an estimated 3 to 7 per 100,000 people of European ancestry. The condition appears to be less common in other populations, such as African Americans.

In the United States alone, about 30,000 people have Huntington's disease; about 1 in every 10,000 people is thought to have the condition. At least 150,000 other people have a 50 percent risk of developing it, and thousands more of their relatives live with the possibility that they, too, might develop HD.

Huntington's disease typically begins in middle age. This form is called adult-onset Huntington's disease. There is also an early-onset form (juvenile Huntington disease) that begins in childhood or adolescence.

What Is the Cause of Huntington's Disease?

Huntington's disease (also known as Huntington disease or HD) is caused by a defect in a gene on chromosome number 4. This gene is known as the Huntington disease gene or HD gene.

Understanding the HD Gene and Huntington's Disease

The HD gene makes a protein called huntingtin. The function of this protein is unknown, but it most likely plays an important role in nerve cells. When a defect occurs in the HD gene, it leads to the body creating an abnormal huntingtin protein. This abnormal protein disrupts the normal function of certain nerve cells and ultimately leads to their premature death. The signs and symptoms of Huntington disease are caused by this dysfunction and loss of nerve cells.

The area of the brain most affected by an abnormal Huntington disease gene is the basal ganglia, which coordinates movement. This degeneration from the Huntington's disease gene causes uncontrolled movements, loss of intellectual faculties, and emotional disturbance. Also affected is the brain's outer surface, or cortex, which controls thought, perception, and memory.

Chances of Inheriting Huntington's Disease

Each parent has two copies of every chromosome but gives only one copy to each child. Therefore, each child of a person with Huntington's disease has a 50-50 chance of inheriting the Huntington disease gene. A person who inherits the Huntington disease gene, and survives long enough, will sooner or later develop Huntington's disease.

If a child does not inherit the Huntington disease gene, he or she will not develop Huntington's disease and cannot pass it to his or her children.

In some families, all the children may inherit the Huntington disease gene; in others, none do. Whether one child inherits the gene has no bearing on whether others will or will not share the same fate.

Is Huntington's Disease Always Inherited?

A small number of cases of Huntington disease are sporadic; that is, they occur even though there is no family history of Huntington's disease. These cases are thought to be caused by a new genetic mutation -- an alteration in the Huntington disease gene that occurs during sperm development.

Adult-Onset Huntington Disease Symptoms

Symptoms of adult-onset Huntington disease can include:

Irritability
Mood swings
Depression
Small involuntary movements
Poor coordination
Trouble learning new information or making decisions.

As the disease progresses, involuntary jerking movements (chorea) become more pronounced. Affected individuals may have trouble walking, speaking, and swallowing. People with symptoms of Huntington disease also typically experience changes in personality and a decline in thinking and reasoning abilities.

Individuals with this form of Huntington disease generally survive about 15 to 25 years after the symptoms appear.

Symptoms of Early-Onset Huntington's Disease

Early-onset Huntington disease symptoms can include:

Rapid decline in school performance
Slowness
Clumsiness
Rigidity
Loss of developmental milestones, such as those involving motor skills
Slow speech
Drooling.

Seizures occur in 30 to 50 percent of individuals with early-onset Huntington disease.

The course of early-onset Huntington disease may be shorter than the adult-onset form; affected individuals generally survive 10 to 15 years after the disease begins.

Symptoms of Huntington Disease: Final Thoughts

The rate of Huntington disease progression, as well as the age at onset for symptoms, vary from person to person. Adult-onset Huntington disease most often begins in middle age. Individuals with the juvenile form develop symptoms of Huntington disease when they are young -- before age 20.

There are other variations of Huntington disease distinguished not just by the age at onset, but also by the associated symptoms. For example, some people develop the disease as adults, but without chorea. They may appear rigid and move very little, or not at all, a condition called akinesia.

In general, the duration of Huntington disease ranges from 10 to 30 years. The most common causes of death are infection (most often pneumonia), injuries related to a fall, or other complications.

Diagnosing Huntington's Disease

Diagnosing Huntington's disease is generally done by an experienced neurologist. A neurologist making a Huntington's disease diagnosis usually begins by interviewing the patient extensively about his or her symptoms and personal and family medical history. The neurologist then typically performs a series of assessments, testing such things as hearing, eye movements, strength, coordination, reflexes, and mental status. Tests used in diagnosing Huntington's disease may include genetic testing and imaging tests (such as CT scans or MRIs).

Treatment for Huntington's Disease

At this point, there is no cure for Huntington's disease or way of slowing its progression. Therefore, Huntington's disease treatment focuses on controlling the emotional and movement problems associated with the disorder (which is also known as Huntington disease or HD). Treatment for Huntington's disease also focuses on providing care to make living with the disorder easier.

Medications Used in Treatment for Huntington's Disease

There are several medicines that can be prescribed for symptoms of Huntington disease. Most drugs used to treat the symptoms of HD have side effects such as fatigue, restlessness, or hyperexcitability. Sometimes it may be difficult to tell if a particular symptom, such as apathy or incontinence, is a sign of the disease or a reaction to medication.

Antipsychotic drugs, such as haloperidol, or other drugs, such asclonazepam, may help to alleviate choreic movements and may also be used to help control hallucinations, delusions, and violent outbursts.

Antipsychotic drugs, however, are not prescribed for another form of muscle contraction associated with Huntington's disease, called dystonia, and may in fact worsen the condition, causing stiffness and rigidity. These medications may also have severe side effects, including sedation, and for that reason should be used in the lowest possible doses.

For depression, physicians may prescribe fluoxetine, sertraline,nortriptyline, or other compounds. Tranquilizers can help controlanxiety, and lithium may be prescribed to combat pathological excitement and severe mood swings. Medications may also be needed to treat the severe obsessive-compulsive rituals of some individuals with Huntington's disease.

It is important to remember that while medicines may help keep symptoms of Huntington disease under control, there is no treatment to stop or reverse the course of the disease.

Lifestyle and Care Issues Involved in Treatment for Huntington's Disease

An important aspect of treatment for Huntington's disease involves addressing lifestyle and care issues to help people with the disorder cope with the condition. Such treatment may include:

Speech therapy
Regular physical activity
Assistance with feeding-related issues (which may include swallowing therapy)
Proper nutrition
Adequate fluids.

Speech Therapy

Problems may arise when individuals try to express complex thoughts in words they can no longer pronounce intelligibly. It can be helpful to repeat words back to the person with Huntington's disease, so that he or she knows that some thoughts are understood. Sometimes people mistakenly assume that if individuals do not talk, they also do not understand. Never isolate individuals by not talking, and try to keep their environment as normal as possible. Speech therapy may improve the individual's ability to communicate.

Physical Activity

As part of Huntington's disease treatment, it is extremely important for the person with Huntington's disease to maintain physical fitness as much as his or her condition and the course of the disease allows. Individuals who exercise and keep active tend to do better than those who do not. A daily regimen of exercise can help the person feel better physically and mentally.

Although their coordination may be poor, individuals should continue walking, with assistance if necessary. Those who want to walk independently should be allowed to do so as long as possible, and careful attention should be given in keeping their environment free of hard, sharp objects. This will help ensure the most independence possible while minimizing the risk of injury from a fall.

Individuals can also wear special padding during walks to help protect against injury from falls. Some people have found that small weights around the ankles can help stability. Wearing sturdy shoes that fit well can help too, especially shoes without laces that can be slipped on or off easily.

Feeding

Impaired coordination may make it difficult for people with Huntington's disease to feed themselves and to swallow. As the disease progresses, people with Huntington's disease may even choke.

In helping individuals to eat, caregivers should allow plenty of time for meals. Food can be cut into small pieces, softened, or pureed to ease swallowing and prevent choking. While some foods may require the addition of thickeners, other foods may need to be thinned. Dairy products in particular tend to increase the secretion of mucus, which in turn increases the risk of choking.

Some individuals may benefit from swallowing therapy, which is especially helpful if started before serious problems arise. Suction cups for plates, special tableware designed for people with disabilities, and plastic cups with tops can help prevent spilling. The individual's physician can offer additional advice about diet and about how to handle swallowing difficulties or gastrointestinal problems that might arise, such as incontinence or constipation.

Nutrition

Proper nutrition is very important as part of Huntington's disease treatment. Caregivers should pay attention to proper nutrition so that the individual with Huntington's disease takes in enough calories to maintain his or her body weight. Sometimes people with Huntington's disease, who may burn as many as 5,000 calories a day without gaining weight, require five meals a day to take in the necessary number of calories. Physicians may recommend vitamins or other nutritional supplements. In a long-term care institution, staff will need to assist with meals in order to ensure that the individual's special caloric and nutritional requirements are met. Some individuals and their families choose to use a feeding tube; others choose not to.

Fluids

Individuals with Huntington's disease are at special risk for dehydration, and therefore, require large quantities of fluids, especially during hot weather. Bendable straws can make drinking easier for the person. In some cases, water may have to be thickened with commercial additives to give it the consistency of syrup or honey.

Huntington's Disease Support:

Individuals and families affected by Huntington's disease can take steps to ensure that they receive the best advice and care possible. Physicians and state and local health service agencies can provide information on community resources and family support groups that may exist.

Support for people with Huntington's disease may involve:

Legal and social aid
Home care services
Recreation and work centers
Group housing
Institutional care.

Legal and Social Aid

Huntington's disease affects a person's capacity to reason, make judgments, and handle responsibilities. Individuals with Huntington's disease may need help with legal affairs. Wills and other important documents should be drawn up early to avoid legal problems when the person with Huntington's disease may no longer be able to represent his or her own interests. Family members should also seek out assistance if they face discrimination regarding insurance, employment, or other matters.

Home Care Services

Caring for a person with Huntington's disease at home can be exhausting, but part-time assistance with household chores or physical care of the individual can ease this burden. Domestic help, meal programs, nursing assistance, occupational therapy, or other home services may be available from federal, state, or local health service agencies.

Recreation and Work Centers

Many people with Huntington's disease are eager and able to participate in activities outside the home. Therapeutic work and recreation centers give individuals an opportunity to pursue hobbies and interests and to meet new people. Participation in these programs, including occupational, music, and recreational therapy, can reduce the person's dependence on family members and provide home caregivers with a temporary, much needed break.

Group Housing

A few communities have group housing facilities that are supervised by a resident attendant. These facilities provide meals, housekeeping services, social activities, and local transportation services for residents. These living arrangements are particularly suited to the needs of individuals who are alone and who, although still independent and capable, risk injury when they undertake routine chores like cooking and cleaning.

Institutional Care

The physical and emotional demands of caring for a person with Huntington's disease may eventually become overwhelming. While many families may prefer to keep relatives with Huntington's disease at home whenever possible, a long-term care facility may prove to be the best option. To hospitalize or place a family member in a care facility is a difficult decision; professional counseling can help families with this.

Finding the proper facility can be a difficult task. Organizations such as the Huntington's Disease Society of America may be able to refer the family to facilities that have met standards set for the care of individuals with Huntington's disease. Very few of these exist, however, and even fewer have experience with individuals with juvenile (early-onset) Huntington's disease who require special care because of their age and symptoms.

Huntington's Disease Research

In the case of Huntington's disease, research is being conducted across the U.S. to answer important questions about the disease and to find more effective methods of diagnosing and treating it. Some of the research currently under way includes studies of the HD gene, fetal tissue research, and work being done with PET scans and other imaging technology to better understand the effects of Huntington's disease on the brain. Research for Huntington's disease has already led to many advances; however, controlling the disorder remains a challenge.

Bell's Palsy

2009-10-25T19:39:00.001-07:00

Bell's Palsy

Bell's palsy is a form of temporary facial paralysis resulting from damage or trauma to a facial nerve. Generally, the condition affects only one of the two facial nerves and one side of the face; however, in rare cases, it can affect both sides.

Bell's palsy is named for Sir Charles Bell, a nineteenth-century Scottish surgeon who was the first to describe the condition. Bell's palsy, which is not related to stroke, is the most common cause of facial paralysis.

Causes of Bell's Palsy

Bell's palsy occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or paralysis. Exactly what causes this damage, however, is unknown.

Viral Infection as a Possible Cause of Bell's Palsy

Most research scientists believe that a viral infection such as viral meningitis or the common cold sore virus -- herpes simplex -- causes Bell's palsy. They believe that the facial nerve swells and becomes inflamed in reaction to the infection, causing pressure within the fallopian canal and leading to an infarction (the death of nerve cells due to insufficient blood and oxygen supply).

In some mild cases (where recovery is rapid), there is damage only to the myelin sheath of the nerve. The myelin sheath is the fatty covering, which acts as an insulator, on nerve fibers in the brain.

Other Possible Causes

There are several medical conditions associated with Bell's palsy. While scientists do not believe these conditions are specific Bell's palsy causes, people with these conditions may be at increased risk for developing the condition. Medical conditions associated with Bell's palsy include:

Influenza or a flu-like illness
Headaches
Pregnancy
Chronic middle ear infection (otitis media)
High blood pressure (hypertension)
Diabetes
Sarcoidosis
Tumors
Lyme disease
Trauma such as skull fracture or facial injury.

Who Is Affected by Bell's Palsy?

Bell's palsy afflicts approximately 40,000 Americans each year. It affects men and women equally, and can occur at any age, but it is less common before age 15 or after age 60.

Is Bell's Palsy Contagious?

Is Bell's palsy contagious? While doctors can seldom explain why one person gets Bell's palsy and another does not, it is clear that Bell's palsy is not contagious; no one can "catch" it from another person.

Common Bell's Palsy Symptoms

Common symptoms of Bell's palsy may include:

Twitching, weakness, or paralysis on one or both sides of the face
Drooping of the eyelid and corner of the mouth
Drooling
Dryness of the eye or mouth
Impairment of taste
Excessive tearing in one eye.

Most often, these symptoms, which can begin suddenly and reach their peak within 48 hours, lead to significant facial distortion.

Other Symptoms of Bell's Palsy

Other symptoms seen with Bell's palsy may include:

Pain or discomfort around the jaw and behind the ear
Ringing in one or both ears (tinnitus)
Headache
Loss of taste
Hypersensitivity to sound on the affected side
Impaired speech
Dizziness
Difficulty eating or drinking.

Bell's Palsy Symptoms: Final Thoughts

These possible symptoms are not sure signs of Bell's palsy. Other health problems can also cause these symptoms. Anyone with possible symptoms of Bell's palsy should see a healthcare provider. Only a qualified healthcare provider can properly diagnose and treat the problem.

Bell's Palsy Diagnosis

The first step in reaching a Bell's palsy diagnosis often involves the doctor asking the patient a number of questions. A doctor making a Bell's palsy diagnosis will then perform a physical exam and likely recommend certain tests. When diagnosing Bell's palsy using a physical exam, the doctor will examine the individual for upper and lower facial weakness. While there is no specific laboratory test to confirm a Bell's palsy diagnosis, the doctor may employ imaging tests such as electromyography (EMG), magnetic resonance imaging (MRI), and computed tomography (CT) scans.

Bell's Palsy Treatment

The most important factor in treating Bell's palsy is to eliminate the source of the nerve damage.

Bell's palsy affects each individual differently. Some cases are mild and do not require treatment, as the symptoms usually improve on their own within two weeks. For others, options may include medications and other therapeutic options. There is no cure for Bell's palsy.

Medications to Treat Bell's Palsy

Recent Bell's palsy research studies have shown that steroids are an effective treatment. Steroids are used to reduce inflammation and swelling. Studies also have shown that an antiviral drug, such asacyclovir, combined with an anti-inflammatory drug, such as the steroid prednisone, may be effective in improving facial function by limiting or reducing damage to the nerve.

Analgesics, such as aspirin, acetaminophen, or ibuprofen, may relieve pain. Because of possible drug interactions, people taking prescription medicines should always talk to their doctors before taking any over-the-counter drugs.

Eye Protection as a Bell's Palsy Treatment

Another important factor in Bell's palsy treatment is eye protection. The condition can interrupt the eyelid's natural blinking ability, leaving the eye exposed to irritation and drying. Therefore, keeping the eye moist and protecting it from debris and injury, especially at night, is important. Lubricating eyedrops (such as Artificial Tears^®, or eye ointments or gels), and eye patches are also effective treatments for Bell's palsy.

Physical Therapy for Treating Bell's Palsy

Physical therapy to stimulate the facial nerve and help maintain muscle tone may be beneficial to some people with Bell's palsy. Facial massage and exercises may help prevent permanent contractures (shrinkage or shortening) of the paralyzed muscles before recovery takes place. Moist heat applied to the affected side of the face may help reduce pain.

Alternative Bell's Palsy Treatment

Some alternative Bell's palsy treatments may be useful for certain individuals. Alternative treatments that have been used for this condition include:

Relaxation techniques
Acupuncture
Electrical stimulation
Biofeedback training
Vitamin therapy (including vitamin B₁₂, B₆, and zinc), which may help nerve growth.

Before trying any type of alternative treatment, people should discuss its possible benefits and harmful effects with their doctor.

People may want to ask these questions about alternative options to treat Bell's palsy:

What benefits can I expect from this approach?
What are its risks?
Do the expected benefits outweigh the risks?
What side effects should I watch for?
Will this alternative method change the way my current treatment for Bell's palsy works?
Could this be harmful?
Is this approach under study in a clinical trial? If so, who sponsors the trial?
Will my health insurance pay for this approach?

Surgical Treatment for Bell's Palsy

In general, decompression Bell's palsy surgery, designed to relieve pressure on the nerve, is controversial and is seldom recommended. On rare occasions, cosmetic or reconstructive surgery may be needed to reduce deformities and correct damage, such as an eyelid that will not fully close or a crooked smile.

Bell's Palsy Recovery
For people, the complete recovery time from Bell's palsy ranges from three to six months. Typically, improvement is gradual, but recovery will vary from person to person.

Bell's Palsy During Pregnancy

For reasons not completely understood, women may develop Bell's palsy during pregnancy more frequently than the general population. The risk of Bell's palsy during pregnancy is thought to be greatest during the third trimester, or within several weeks of delivery. The prognosis for women with Bell's palsy during pregnancy is generally good. Bell's palsy does not appear to have any effect on the growing fetus.

Bell's Palsy Research

Bell's palsy research now under way is focused on learning more about the circumstances and conditions that cause nerve damage. Other Bell's palsy research is aimed at developing methods to repair damaged nerves and restore full use and strength to injured areas. Bell's palsy research already has led to many advances, and researchers continue to search for more effective treatment methods.

Encephalitis

2009-10-24T19:02:00.000-07:00

Encephalitis

Encephalitis means inflammation of the brain. It can be caused by bacterial infections and, most often, viral infections.Several thousand cases of encephalitis are reported each year, but many more may actually occur, since the symptoms may be mild to non-existent in most patients

Types of Encephalitis

There are two types of the condition:

Primary encephalitis (also called acute viral encephalitis) is caused by a direct viral infection of the spinal cord and brain. The infection may be focal (located in only one area) or diffuse (located in many different areas).
Secondary encephalitis (also known as post-infective encephalitis) can result from complications of a current viral infection. When this type results from an immunization or earlier viral infection, it is known as acute disseminated encephalitis. This illness often occurs two to three weeks following the initial infection.

Causes

Most cases of encephalitis in the United States are caused by:

Enteroviruses
Herpes simplex virus types 1 and 2
A bite from a rabid animal (rabies virus)
Arboviruses, which are transmitted from infected animals to humans through the bite of an infected tick, mosquito, or other blood-sucking insect.

Lyme disease, a bacterial infection spread by tick bite, can also cause it.

Who Is at Risk?

Anyone can get it. People with weakened immune systems, including those with HIV or those taking immunosuppressant drugs, are at the highest risk of contracting encephalitis.

Symptoms

The brain inflammation caused by encephalitis can produce a wide range of symptoms, including:

Sudden fever
Headache
Vomiting
Heightened sensitivity to light
Confusion and impaired judgment
Drowsiness
Weak muscles
Clumsy and unsteady gait
Irritability.

Symptoms that might require emergency treatment include:

Loss of consciousness
Seizures
Muscle weakness
Sudden severe dementia.

Encephalitis Diagnosis

In order to make an encephalitis diagnosis, the doctor will ask a number of questions to review activities of the past several days (such as recent exposure to insects or animals, any contact with ill people, or recent travel), perform a physical exam, and may order various tests.

Early encephalitis diagnosis is vital, as encephalitis symptoms can appear suddenly and escalate to brain damage, hearing and/or speech loss, blindness, or even death.

Using Neurological Exams to Make an Encephalitis Diagnosis

A neurological examination involves a series of tests designed to assess:

Motor and sensory function
Nerve function
Hearing and speech
Vision
Coordination and balance
Mental status
Changes in mood or behavior.

Doctors may test the function of the nervous system through tests of strength and sensation with the aid of items including a tuning fork, small light, reflex hammer, and pins.

Laboratory Screening as a Means of Making an Encephalitis Diagnosis

Laboratory screening of blood, urine, and body secretions can help detect and identify brain and/or spinal cord infection and determine the presence of antibodies and foreign proteins. Such tests can also rule out metabolic conditions that have similar symptoms.

For example, a throat culture may be taken to check for viral or bacterial organisms that cause meningitis or encephalitis. In this procedure, the back of the throat is wiped with a sterile cotton swab, which is then placed on a culture medium. Viruses and bacteria are then allowed to grow on the medium. Samples are usually taken in the physician's office or in a laboratory setting and sent out for analysis to state laboratories or to the U.S. Centers for Disease Control and Prevention. Results are usually available in two to three days.

Encephalitis Diagnosis: Analysis of Cerebrospinal Fluid

Analysis of the cerebrospinal fluid that surrounds and protects the brain and spinal cord can detect infections in the brain and/or spinal cord, acute and chronic inflammation, and other diseases.

In a procedure known as a spinal tap (or lumbar puncture), a small amount of cerebrospinal fluid is removed by a special needle that is inserted into the lower back. The skin is anesthetized with a local anesthetic prior to the sampling. The fluid, which is completely clear in healthy people, is tested to detect the presence of bacteria or blood, as well as to measure glucose levels (a low glucose level is a sign of bacterial or fungal meningitis) and white blood cells (elevated white blood cell counts are also a sign of infection). The procedure is usually done in a hospital and takes about 45 minutes.

Encephalitis Diagnosis: CT Scan and MRI

Computer-assisted imaging can reveal signs of brain inflammation, internal bleeding or hemorrhage, or other brain abnormalities. Two painless, noninvasive imaging procedures routinely used to make an encephalitis diagnosis are CT scans and MRI.

Encephalitis Treatment

People who are suspected of having encephalitis should receive immediate, aggressive encephalitis treatment. Encephalitis can progress quickly and has the potential to cause severe, irreversible neurological damage.

Medications for Encephalitis Treatment

Treatment for very mild cases of encephalitis may include being monitored at home by the physician and a caregiver.

Supportive care as part of encephalitis treatment includes:

Fluids
Bed rest
Over-the-counter analgesics to reduce fever and headache.

Antiviral drugs (including either acyclovir or ganciclovir) may be used for viral encephalitis treatment.

For more severe cases, encephalitis treatment may involve hospitalization. Anticonvulsants may be prescribed to stop or prevent seizures, and sedatives may be used to calm more severely infected people. Certain drugs may be used to counter nausea and vomiting. Corticosteroids and intravenous administration of carbohydrate solutions can reduce brain swelling. Patients with breathing difficulties may require artificial respiration.

Complementary Therapy and Encephalitis Treatment

For patients who experience severe brain inflammation, encephalitis treatment may involve physical, speech, and occupational therapy once the acute illness is under control.

The outcome of encephalitis treatment generally depends on the particular infectious agent involved, the severity of the illness, and how quickly treatment is given. In most cases, people with very mild encephalitis can make a full recovery, although the process may be slow.

Patients receiving treatment for viral encephalitis usually see some relief in 24 to 48 hours and recover in about a month.

In more serious cases, encephalitis can cause:

Hearing and/or speech loss
Blindness
Permanent brain and nerve damage
Behavioral changes
Cognitive disabilities
Lack of muscle control
Seizures
Memory loss.

These patients may need long-term therapy, medication, and supportive care.

Encephalitis Treatment: Prevention

There are ways to reduce the chance of getting encephalitis so that encephalitis treatment is not needed.

Good personal hygiene can reduce the risk of getting encephalitis from an infected person. Avoid sharing food, utensils, glasses, and other objects with a person who may be exposed to or have the infection. Wash hands often with soap and rinse under running water.

To lessen the risk of being bitten by an infected mosquito or other insect, people should:

Limit outdoor activities at night
Wear long-sleeved clothing when outdoors
Use insect repellents that are most effective for that particular region of the country
Rid lawn and outdoor areas of free-standing pools of water, in which mosquitoes breed.

Do not over-apply repellants, particularly on young children and especially infants, as chemicals may be absorbed through the skin.

Encephalitis Research

Current research efforts include gaining a better understanding of how the central nervous system responds to inflammation and the role of T cells (blood cells involved in immune system response) in suppressing infection in the brain.

Scientists hope to better understand the molecular mechanisms involved in the protection and disruption of the blood-brain barrier, which could lead to the development of new treatments for several neuroinflammatory diseases such as meningitis and encephalitis.

Other scientists hope to define, at a molecular level, how certain viruses overcome the body's defense mechanism and interact with target host cells.

A possible treatment under investigation involves testing neuroprotective compounds that block the damage that accumulates after the inflammation of encephalitis. (This damage can lead to potential complications including dementia and loss of cognitive function.)

MS

2009-10-23T20:06:00.000-07:00

Multiple Sclerosis

Multiple sclerosis is a disease of the central nervous system (brain and spinal cord) that usually first appears between the ages of 20 and 40, and affects women twice as often as men. Also known as MS, multiple sclerosis is the leading cause of disability among young adults.

An unpredictable disease of the central nervous system, multiple sclerosis can range from being relatively benign to somewhat disabling to devastating as communication between the brain and other parts of the body is disrupted.

Although multiple sclerosis was first diagnosed in 1849, the earliest known description of a person with possible MS dates back to fourteenth-century Holland.

Types of Multiple Sclerosis

There are a few different types of multiple (MS). Each case of MS follows one of several patterns regarding how it appears and the course it follows. The patterns of multiple sclerosis include:

Relapsing-remitting
Primary-progressive
Secondary-progressive
Progressive-relapsing.

Relapsing-Remitting
Most commonly, multiple sclerosis begins as a series of attacks followed by complete or partial remissions as the symptoms mysteriously lessen, only to return later after a period of stability. This is called relapsing-remitting (RR) multiple sclerosis.

Primary-Progressive
Primary-progressive (PP) MS is characterized by a gradual clinical decline in function, with no distinct remissions. However, there may be temporary plateaus or minor relief from symptoms.

Secondary-Progressive
Secondary-progressive (SP) multiple sclerosis begins with a relapsing-remitting course followed by a later primary-progressive course.

Progressive-Relapsing
In rare cases, patients may have a progressive-relapsing (PR) course in which the disease becomes progressively worse, with acute attacks flaring up along the way. Primary-progressive, secondary-progressive, and progressive-relapsing are sometimes lumped together and called chronic progressive multiple sclerosis.

Benign Types of Multiple Sclerosis
In addition to the four main patterns of MS, 20 percent of the multiple sclerosis population has a benign form of the disease in which symptoms show little or no progression after the initial attack. Patients with benign MS remain fully functional.

Malignant Types of Multiple Sclerosis
A few patients experience malignant multiple sclerosis, defined as a swift and relentless decline resulting in significant disability or even death shortly after the disease begins. Even so, MS is rarely fatal, and most people with MS have a fairly normal life expectancy.

Specific Early Multiple Sclerosis Symptoms
In the early stages of MS, people can often experience the following symptoms:

Muscle weakness
Tingling or numbness
Loss of balance
Blurred or double vision and/or eye pain.

Usually, these early multiple sclerosis symptoms come and go unpredictably. The times when a person is having multiple sclerosis symptoms are called episodes, or MS attacks. The episodes may last a few days or for weeks at a time.

Other Multiple Sclerosis Symptoms
Other possible multiple sclerosis symptoms include:

Double vision
Weakness of the arms and legs
Muscle stiffness
Dizziness
Loss of bladder control
Depression
Memory loss.

The times between episodes (when a person is not having multiple sclerosis symptoms) are called remissions. Many people with multiple sclerosis are able to function quite normally between episodes.

Myelin and Multiple Sclerosis Symptoms
The symptoms that a person experiences -- and the severity of these symptoms -- will vary from person to person.This depends on how much myelin (the covering of the nerves) has been lost and what parts of the central nervous system are affected.

The name "multiple sclerosis" simply refers to the buildup of scar tissue in the brain and spinal cord. With MS, this scarring, or "sclerosis," happens in multiple locations inside the central nervous system.

As the myelin sheath becomes damaged, the electric signals have a harder time getting though -- or become blocked entirely. As the damage progresses, this leads to the various symptoms of multiple sclerosis mentioned previously.

Multiple Sclerosis Causes
The cause of multiple sclerosis is still not known. For reasons not yet understood,

The Autoimmune Process as a Possible Cause of Multiple Sclerosis
Currently, most scientists believe that the loss of myelin is caused by an autoimmune process. This means that the body mistakenly reacts to some part of itself as though it was a foreign invader and attacks it. In the case of multiple sclerosis, the body destroys areas of its own myelin.

The Role of Genetics as a Multiple Sclerosis "Cause"
In addition to a possible autoimmune process, increasing scientific evidence suggests that genetics may play a role in determining a person's susceptibility to multiple sclerosisSome populations, such as Gypsies, Eskimos, and Bantus, never get multiple sclerosis. Native Indians of North and South America, the Japanese, and other Asian populations have low incidence rates. It is unclear whether this is due mostly to genetic or environmental factors.

In the population at large, the chance of developing multiple sclerosis is less than a tenth of 1 percent. However, if one person in a family has multiple sclerosis, that person's first-degree relatives -- parents, children, and siblings -- have a 1 to 3 percent chance of getting the disease.

Multiple Sclerosis Diagnosis

There is no single test used to make a multiple sclerosis diagnosis. When a patient's symptoms, neurological exam results, and medical history suggest multiple sclerosis (MS), doctors use a variety of tools to rule out other possible disorders. They also perform a series of laboratory tests, which, if positive, can confirm the diagnosis.

Today, most patients who undergo an evaluation for multiple sclerosis will be classified as either having the disease or not having it. However, there are still cases where a person may have the clinical symptoms of MS but not meet all the criteria to confirm a diagnosis. In these cases, the classification "possible multiple sclerosis" is used.

Specific Criteria for Diagnosing Multiple Sclerosis
A multiple sclerosis diagnosis is notoriously difficult to make because some people have few MS attacks or such mild symptoms in the early stages that they might not recognize an attack.Doctors use certain criteria to help in diagnosing multiple sclerosis. These criteria include:

The signs and symptoms begin between the ages of 15 and 60.

The signs and symptoms indicate a disease of the brain or spinal cord.

A doctor's exam finds evidence of a diseased brain or spinal cord.

An MRI scan shows at least two separate areas of scar tissue, or "sclerosis."

The disease has followed one of two patterns: First, there have been two or more episodes of symptoms that last at least 24 hours and happen more than a month apart. Or, second, the signs and symptoms have progressively increased over the past six months.

Finally, there can be no other explanation for the person's symptoms.

Conditions That Mimic MS
A number of other diseases may produce symptoms similar to those seen in MS. This fact is one reason why a diagnosis of multiple sclerosis can be difficult to make.

Other conditions with an intermittent course and MS-like lesions of the brain's white matter include:

Polyarteritis
Lupus erythematosus
Syringomyelia
Tropical spastic paraparesis
Some cancers
Certain tumors that compress the brainstem or spinal cord
Lyme disease.

Multiple Sclerosis Treatment

At this time, there is no cure for multiple sclerosis, but research continues to improve the understanding and treatment of this disease.

Current treatments for multiple sclerosis focus on controlling the immune system and managing the symptoms. It is important for people to work with their healthcare providers to find the best approach to address multiple sclerosis symptoms, such as:

Extreme fatigue
Bladder problems
Spasticity (muscle tightness and spasms).
Depression
pain
tremors
Sexual dysfunction

Specific multiple sclerosis treatment can include:

Medications
Physical or occupational therapy
Emotional support.

Medications Used in the Treatment of Multiple Sclerosis
Several medications are available as part of a multiple sclerosis treatment plan.The different categories of medications are discussed in the following paragraphs.

Medications That Manage Exacerbations
MS exacerbations (flare-ups) are usually accompanied by inflammation and breakdown of the myelin in the central nervous system. If your symptoms are severe, high doses of steroids, such as Solu-Medrol^®, may be given through an IV to reduce the swelling and inflammation that contribute to demyelination.

Medications That Modify the Disease
A number of newer drugs have been shown to modify the course of multiple sclerosis. These medications work by altering or suppressing the activity of your immune system. A group of drugs called "beta interferons" mimic a protein that occurs naturally in your body. They appear to block certain white blood cells from attacking the myelin covering of the nerves. They also seem to stop other white blood cells, called T cells, from releasing cytokines -- which are chemicals that encourage inflammation and attract other immune cells to the area.

These medications include:

Betaseron^®
Avonex^®
Rebif^®
Extavia^®.

While they don't cure the disease, beta interferons have been shown to reduce the frequency and severity of MS attacks by about 25 percent or more, depending on the dose. These drugs may also reduce the amount of scar tissue that develops in the brain by 70 to 80 percent. With less damage occurring in the central nervous system, the progression of multiple sclerosis symptoms is slowed, possibly reducing the level of disability you may face in the future.

Other medications used in the treatment of multiple sclerosis include Copaxone^®, a small protein that resembles a protein found in myelin. The U.S. Food and Drug Administration (FDA) has approved Copaxone for the treatment of relapsing-remitting MS. Copaxone has few side effects, and studies indicate that the agent can reduce the relapse rate by almost one-third.

An immunosuppressant medication, Novantrone^® (mitoxantrone), is approved by the FDA for the treatment of advanced or chronic MS.

Medications That Manage MS Symptoms
There are a few types of medications available to help manage the symptoms of MS,options can include things like Botox^® orbaclofen to reduce muscle stiffness (also known as spasticity). Botox is an injection, and baclofen can be given in pill form or through a small, implantable pump.

Multiple sclerosis can also be managed through deep brain stimulation, which uses a small electrode to stimulate a certain part of the brain. This can reduce the tremors sometimes seen in people with MS.

The Role of Emotional Support in Treating Multiple Sclerosis
An important part of multiple sclerosis treatment is emotional support. You may feel anxiety, anger, and fear. You may need help in getting treatment for the depression that often comes with MS.

Caring for someone with active MS requires a team approach. In addition to physicians and nurses, other members of your healthcare team may include:

Physical therapist
Occupational therapist
Social worker
Counselor.

The goal is to enable you to be as independent as possible while helping you deal with the intense emotional feelings that often accompany a disease that can become disabling.

Unproven "Cures"
MS is a disease with no known cause and for which there is no universally effective treatment. However, MS has a natural tendency to improve spontaneously. These factors open the door for a number of unproven claims of cures. At one time or another, many ineffective and even potentially dangerous therapies have been promoted as effective treatments or cures for multiple sclerosis.

A partial list of these "MS cures" includes:

Injections of snake venom
Electrical stimulation of the dorsal column of the spinal cord
Removal of the thymus gland
Breathing pressurized (hyperbaric) oxygen in a special chamber
Injections of beef heart and hog pancreas extracts
Intravenous or oral calcium orotate (calcium EAP)
Hysterectomy
Removal of dental fillings containing silver or mercury amalgams
Surgical implantation of pig brain into the affected person's abdomen (stomach).

None of these are effective forms of multiple sclerosis treatment.

Multiple Sclerosis Research
Multiple sclerosis research continues to make new advances, building on the success of the "Decade of the Brain." New understanding of the disease, and new medications to treat it, have stemmed from the multiple sclerosis research performed in the past several years. Continued research aims to find a cure for the disease or a way to prevent it entirely.

Depression

2009-10-22T17:40:00.000-07:00

Depression

Depression is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way they feel about themselves, and the way they think about things. Depression is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away.

In any given one-year period, almost 10 percent of the population suffers from depression. The economic cost of the disorder is high, but the cost in human suffering cannot be estimated. Depression often interferes with normal functioning and can cause pain and suffering, not only to those who have it, but also to those who care about them. Serious cases can destroy family life, as well as the life of the person with this illness. But much of this suffering is unnecessary.

Depression can strike anyone, regardless of age, ethnic background, socioeconomic status, or gender. Researchers estimate that in the United States at least 6 million men suffer from the illness every year. This is about 7 percent of the population. Nearly twice as many women (more than 12 million women) suffer from depression each year.

Depression is also not just a condition of the young or old. For example, of the 35 million Americans age 65 and older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms.

Types of Depression

Many people may think of depression as a symptom. However, depression is actually a type of illness. Similar to other illnesses, such as heart disease, depression can come in several forms (or types). The three most common depression types are:

Major depression
Bipolar disorder (also known as manic depression)
Dysthymia.

Within these different types are variations in the number of symptoms, their severity, and how long they last.

Major Depression

Major depression is identified by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy activities that were once pleasurable. Such a disabling episode of depression may occur only once, but more commonly occurs several times in a lifetime. This type of depression is also known as:

Clinical depression
Unipolar depression
Major depressive disorder.

A subtype of major depression is atypical depression. Atypical depression signs and symptoms are similar to those of major depression. Yet, unlike a person with major depression, someone who has atypical depression will also have one or more of the following:

Significant anxiety
Oversleeping
Panic attacks
Overeating or significant weight gain
Increased sensitivity to rejection.

Atypical depression is the most common subtype of major depression. This type of depression is common in women.

Bipolar Disorder

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as common as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes -- severe highs (mania) and lows (depression). Sometimes, the mood switches are dramatic and rapid, but most often they are gradual.

When in the depressed cycle, an individual can have any or all of the symptoms of depression. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated and full of grand schemes that might range from unwise business decisions to romantic sprees. If left untreated, mania may worsen to a psychotic state.

Dysthymia

Dysthymia is a less severe type of depression that involves long-term, chronic symptoms that do not disable a person, but do keep him or her from functioning well or feeling good. Many people with dysthymia also experience major depression at some time in their lives.

Other Depression Types

There are several other types of depression, including:

Postpartum depression -- A condition that occurs in some women following childbirth. Postpartum depression is when "baby blues" last longer than two weeks, or are more severe than simple mood swings or mild depression.

Premenstrual dysphoric disorder (PMDD) -- A condition in which depression symptoms occur one week prior to menstruation and disappear after the menstrual period ends.

Seasonal affective disorder (SAD) -- A pattern of depression that occurs during fall and winter and disappears during spring and summer. It is thought that SAD is due to lack of sunlight. It is more common in northern latitudes.

Adjustment disorder with depressed mood -- A type of depression that follows a significant life stress. It usually lasts less than six months and improves when the stress is removed or the person develops coping skills. For this condition, the symptoms of depression are not severe enough to meet the criteria for major depression.

Cyclothymic disorder -- A condition that resembles bipolar disorder, but with mood swings that are less severe than those seen with bipolar disorder. The mood swings are not severe enough to meet the criteria for bipolar disorder, nor are the signs of depression severe enough to meet the criteria for major depression.

Risk Factors

While depression research scientists are still searching for the exact cause or causes of depression, they do know a number of factors that increase a person's chances of developing depression. These are known as depression risk factors. Some risk factors for depression include:

Family history
Medications
Substance abuse
Medical illnesses
Hormonal factors
Stress.

Family History

Some types of depression run in families, which suggests that a biological vulnerability to depression can be inherited. This seems to be the case with bipolar disorder (also known as manic-depression). Studies of families in which members of each generation developed bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true. In other words, not everybody with the genetic makeup that causes a vulnerability to bipolar disorder will have the illness. It seems that additional factors -- possibly stresses at home, work, or school -- are involved in the onset of bipolar disorder.

In some families, major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depression is often associated with changes in brain structures or brain function.

Among the people who are prone to depression are those with low self-esteem, those who consistently view themselves and the world with pessimism, and those who are readily overwhelmed by stress. Whether this represents a psychological predisposition or an early form of the illness is not clear.

Medications

There are a number of medicines whose side effects include depression. Some of these types of medicines include:

High blood pressure medications, including beta blockers
Corticosteroids
Benzodiazepines
Antiarrhythmics
Digoxin (Digitek^®, Lanoxicaps^®, Lanoxin^®)
H2 blockers, including cimetidine(Tagamet^®), famotidine(Pepcid^®), nizatidine (Axid^®), and ranitidine (Zantac^®).

Substance Abuse

Depression is common in people who also have substance abuse. This includes alcohol abuse, cocaine abuse, and stimulant withdrawal.

Medical Conditions

There are a number of medical conditions that increase the risk of developing depression. These conditions can include:

Certain metabolic conditions, like:

Hypothyroidism or hyperthyroidism
Cushing's syndrome
Diabetes

Neurologic conditions, such as:

Nutritional problems, including vitamin B₁₂ deficiency

Certain cancers, such as pancreatic cancer

A recent heart attack or heart surgery.

Hormonal Factors

Hormonal factors can increase a person's chances of developing depression. This includes hormonal changes that occur during menstrual cycle changes, pregnancy, miscarriage, the postpartum period, perimenopause, and menopause.

Stress

In susceptible people, stress seems to play a role in having a depressive episode. This can include stress at work and home, single parenthood, and caring for children or aging parents. Other stresses that may trigger a depressive episode include a serious loss, a difficult relationship, a financial problem, or any stressful change in life patterns (whether unwelcome or desired).

Symptoms of Depression

Depression is identified by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once-pleasurable activities.The two key symptoms of depression that are most often present when diagnosing the condition include:

A depressed mood. This may be present as a persistent sad, anxious, or "empty" mood. In children, it may be expressed as an irritable mood.

Loss of interest or pleasure in hobbies and activities that were once enjoyed. This may include lack of interest in eating, social interactions, exercise, or sex.

Along with these two key symptoms, a person with depression can have a number of other symptoms in a variety of combinations. The specific combination of symptoms will vary depending on the individual.

These other possible depression symptoms are as follows:

Feelings of hopelessness and pessimism
Feelings of guilt, worthlessness, and helplessness
Decreased energy, fatigue, and being "slowed down"
Difficulty concentrating, remembering, and making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight loss or overeating and weight gain
Thoughts of death or suicide; suicide attempts
Restlessness and irritability
Persistent physical symptoms that do not respond to treatment, such as headaches, backaches, chronic pain, and digestive complaints (for example, indigestion, constipation, or diarrhea).

Diagnosing Depression

There is no one specific test that can be used for diagnosing depression. Therefore, in order to make a diagnosis, the healthcare provider will begin by asking a number of questions. This is known as taking the patient's medical history. Some of these questions may be related to:

Current symptoms, including:

Any thoughts of suicide
Feeling of hopelessness
Preoccupation with issues related to death

Other medical conditions, including a recent history of stroke or heart attack
Current medications
Recent events in one's life
A history of drug or alcohol abuse
A family history of any medical conditions.

After asking these and other questions, the healthcare provider will perform a physical exam, looking for signs of conditions known to cause depression. There are no specific lab tests that can help in making a depression diagnosis.

Is the Diagnosis Depression or Another Medical Condition?

Before diagnosing depression, the healthcare provider will also consider other conditions that share a number of symptoms with depression. Some of these conditions include:

Lyme disease
Chronic fatigue syndrome(CFS)
Fibromyalgia
Rheumatoid arthritis
Uncomplicated bereavement (mourning a loss or death).

Depression Treatment

With advances in medicine, clinical depressions (also known as major depression or just depression) is now quite treatable. More than 80 percent of those who seek help show improvement. As with many illnesses, early treatment for depression is more effective and helps prevent the likelihood of serious recurrences. Depression must be treated by a physician or qualified mental health professional.

The most commonly used treatments for depression are:

Depression medications (antidepressants)
Psychotherapy
A combination of the two.

There are a variety of antidepressant medications and psychotherapies for depression treatment. Some people with milder forms of depression may do well with psychotherapy alone. People with moderate to severe depression most often benefit from medication. Most people do best with a combination treatment plan, including:

Medication to gain relatively quick relief of symptoms
Psychotherapy to learn more effective ways of dealing with life's problems, including depression.

Antidepressants as a Depression Treatment

Several types of antidepressant medications are used as treatment for depression. Some specific classes of medications used to treat the condition include:

Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Norepinephrine and dopamine reuptake inhibitors (NDRIs)
Tricyclic antidepressants
Monoamine oxidase inhibitors (MAOIs).

There are also several different medications available within each of the classes of drugs mentioned. SSRIs and other newer medications that affect neurotransmitters (SNRIs and NDRIs) generally have fewer side effects than tricyclics or MAOIs.

Sometimes, the healthcare provider must try a variety of antidepressants before finding the most effective medication or combination of medications to treat a person's depression. In some cases, the dosage must be increased for the antidepressant to be effective. Although some improvements may be seen in the first few weeks, antidepressant medications must be taken regularly for three to four weeks (or, in some cases, for as long as eight weeks) before the full therapeutic effect occurs.

Psychotherapy as a Depression Treatment

Many forms of psychotherapy, including some short-term therapies (10 to 20 weeks), can help people with depression. "Talk" therapies help people gain insight into, and resolve, their problems through verbal exchange with the therapist. This talk therapy is sometimes combined with "homework" assignments between sessions. Behavioral therapists help people learn how to obtain more satisfaction through their own actions and how to unlearn the behavioral patterns that contribute to, or result from, their depression.

Other Treatments for Depression

In addition to medications and therapy, a few other depressiontreatments are available. These include:

Electroconvulsive therapy (ECT)
Alternative treatments.

ECT

When medication, psychosocial treatment, and the combination of these treatments prove ineffective (or work too slowly to relieve severe symptoms), electroconvulsive therapy (ECT) may be considered.

Electroconvulsive therapy is particularly useful for individuals whose depression is severe or life-threatening, or who cannot take antidepressant medication. ECT is often effective when antidepressant drugs do not provide sufficient relief of depression symptoms.

In recent years, this type of depression treatment has improved greatly. The person receives a muscle relaxant prior to ECT, and the treatment is performed while the person is under brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief seizure within the brain, lasting about 30 seconds. The person receiving ECT does not consciously experience the electrical stimulus.

For the full therapeutic benefit to be seen, the person must receive at least several sessions of ECT -- typically given at the rate of three per week.

Alternative Treatments

Over the past few years, there has been quite a bit of interest in using herbs to treat both depression and anxiety. St. John's wort (Hypericum perforatum), an herb used extensively in the treatment of mild to moderate depression in Europe, has recently aroused interest in the United States.

In two large studies of people with major depression, St. John's wort was not shown to be effective at treating major depression of moderate severity. It is currently being studied in people with mild depression to see if it has any effects.

Some other possible alternative treatments for depression include:

Acupuncture

How Long Does Depression Treatment Last?

Your healthcare provider generally separates depression treatment into two stages. The first stage treats the symptoms until a person feels well. The second stage is used to prevent symptoms from returning. The first stage of depression treatment most often involves medication. This stage may last up to 12 weeks. Once symptoms have improved, the medications may be continued for up to nine months. In depression research studies, continuing medicines has been shown to decrease the chances that the depression will return.

For some people, treatment for depression may be needed only once during their lifetime. However, for a lot of people, depression is a lifelong disease requiring ongoing treatment. It is impossible for your healthcare provider to know whether treatment will be short-term or long-term in your situation. Fortunately, in either situation, effective depression treatment is now available.

Depression Research

Doctors and scientists worldwide are conducting depression research studies. These studies are designed to answer important questions and to find out whether new approaches to depression treatment are safe and effective. Such research has already led to many advances, and researchers continue to search for more effective methods of dealing with depression.

Recent Research Findings

The following are some findings from recently completed research studies on depression:

Brain imaging studies are revealing that in people with depression, the neural circuits responsible for moods, thinking, sleep, appetite, and behavior fail to function properly and that the regulation of critical neurotransmitters is impaired.

Genetics research, including studies of twins, indicates that genes play a role in depression. Vulnerability to depression appears to result from the influence of multiple genes acting along with environmental factors.

Other depression research has shown that stressful life events, particularly in the form of loss such as the death of a close family member, may trigger major depression in susceptible individuals.

Studies of brain chemistry, how antidepressant work, and the distorted thinking and relationship problems linked to depression continue to help researchers develop new and better treatments.
Studies of abused women have shown that abuse may lead to depression by fostering low self-esteem, a sense of helplessness, self-blame, and social isolation. There may be biological and environmental risk factors of depression resulting from growing up in a dysfunctional family.

Parkinson's Disease

2009-10-21T18:29:00.000-07:00

Parkinson's Disease

Parkinson's disease is a common condition of the brain that typically begins in the middle to later part of life. It is a progressive condition, meaning that it continues to get worse with time. Parkinson's disease has probably existed for thousands of years. Its symptoms and potential therapies were mentioned in the Ayurveda (the system of medicine practiced in India as early as 5000 B.C.) and in the first Chinese medical text (Nei Jing), which appeared 2,500 years ago.

Parkinson's disease occurs when certain nerve cells (called neurons) in an area of the brain known as the substantia nigra die or become impaired. Normally, these neurons produce an important brain chemical known as dopamine. Dopamine is a chemical messenger responsible for transmitting signals between the substantia nigra and the next "relay station" of the brain, the corpus striatum, to produce smooth, purposeful muscle movement.

A loss of dopamine causes the nerve cells of the corpus striatum to fire out of control, leaving people unable to direct or control their movements in a normal manner. Parkinson's research studies have shown that people with the condition have lost 80 percent or more of the dopamine-producing cells in the substantia nigra.

But why this nerve death or impairment happens is still unknown, although significant findings by research scientists continue to yield fascinating new clues and several theories about Parkinson's disease causes.

Current Theories for the Cause of Parkinson's Disease

Current theories regarding the cause or causes of Parkinson's disease include:

Environmental factors
Genetic factors
Free radicals
Normal age-related wearing down
A combination of some or all of these theories.

Common Parkinson's Disease Symptoms

Common Parkinson's disease symptoms include:

Tremors
Rigid limbs
Slow movement (bradykinesia)
A shuffling gait
An inability to move (akinesia)
A stooped posture
Reduced facial expressions
A soft speaking voice.

Tremors

Tremors are one of the most common symptoms of the disease. The tremor associated with the condition has a characteristic appearance. Typically, it takes the form of a rhythmic back-and-forth motion of the thumb and forefinger at three beats per second. This is sometimes called "pill rolling." Tremors usually begin in a hand, although sometimes, a foot or the jaw is affected first. It is most obvious when the hand is at rest or when a person is under stress. In three out of four people, the tremor may affect only one part or side of the body -- especially during the early stages of the disease. Later it may become more general. Tremors are rarely disabling, and they usually disappear during sleep or improve with intentional movement.

Rigidity

Rigidity, or a resistance to movement, is aParkinson's disease symptom seen in most people with this condition. A major principle of body movement is that all muscles have an opposing muscle. Movement is possible, not just because one muscle becomes more active, but also because the opposing muscle relaxes. In Parkinson's disease, rigidity comes about when, in response to signals from the brain, the delicate balance of opposing muscles is disturbed. The muscles remain constantly tensed and contracted so that the person aches or feels stiff or weak. The rigidity becomes obvious when another person tries to move the affected person's arm, which will move only in ratchet-like or short, jerky movements known as "cogwheel" rigidity.

Bradykinesia

Bradykinesia, or the slowing down and loss of spontaneous and automatic movement, is a particularly frustrating symptom of Parkinson's disease because it is unpredictable. One moment the person can move easily. The next moment, he or she may need help. This may well be the most disabling and distressing symptom of the disease because the person cannot rapidly perform routine movements. Activities once performed quickly and easily -- such as washing or dressing -- may take several hours.

Postural Instability

Postural instability, or impaired balance and coordination, causes a person to develop a forward or backward lean and to fall easily. When bumped from the front or when starting to walk, a person with a backward lean has a tendency to step backwards, which is known as retropulsion.

Postural instability can cause a person to have a stooped posture, in which the head is bowed and the shoulders are drooped. As the disease progresses, walking may be affected. A person may halt in mid-stride and "freeze" in place, possibly even toppling over. Or, he or she may walk with a series of quick, small steps as if hurrying forward to keep balance. This is known as festination.

Other symptoms of Parkinson's disease can include:

Depression
Emotional changes
Dementia
Difficulty swallowing and chewing
Speech impairments
Urinary problems
Constipation
Skin problems
Sleep disturbances
Sexual difficulties.

Depression

Depression is a common problem and may appear early in the course of the disease, even before other symptoms are noticed. Depression may not be severe, but it may be intensified by the drugs used to treat other Parkinson's disease symptoms. Fortunately, depression can be successfully treated with antidepressant medications.

Emotional Changes

Some people with Parkinson's disease become fearful and insecure. Perhaps they fear they cannot cope with new situations. They may not want to travel, go to parties, or socialize with friends. Some lose their motivation and become dependent on family members. Others may become irritable or uncharacteristically pessimistic. Memory loss and slow thinking may occur, although the ability to reason remains intact. Whether people actually suffer intellectual loss (also known as dementia) from Parkinson's disease is a controversial area still being studied.

Difficulty With Swallowing and Chewing

The muscles used in swallowing may work less efficiently in later stages of Parkinson's disease. In these cases, food and saliva may collect in the mouth and back of the throat, which can result in choking or drooling. Medications can often alleviate these problems.

Speech Changes

About half of all people with Parkinson's disease have problems with speech. They may speak too softly or in a monotone voice, hesitate before speaking, slur or repeat their words, or speak too fast. A speech therapist may be able to help these people reduce some of these problems.

Urinary Problems or Constipation

In some people with Parkinson's disease, symptoms affecting the bladder and bowel can occur due to the improper functioning of the autonomic nervous system. The autonomic nervous system is responsible for regulating smooth muscle activity. Some people may become incontinent, while others have trouble urinating.

Others may experience constipation because the intestinal tract operates more slowly. Constipation can also be caused by inactivity, eating a poor diet, or drinking too little fluid. It can be a persistent problem and, in rare cases, can be serious enough to require hospitalization. People should not let constipation last for more than several days before taking steps to alleviate it.

Skin Problems

In Parkinson's disease, it is common for the skin on the face to become oily, particularly on the forehead and at the sides of the nose. The scalp may become oily, too, resulting in dandruff. In other cases, the skin can become quite dry. These problems are also the result of an improperly functioning autonomic nervous system. Standard treatments for skin problems can be help helpful. Excessive sweating, another common symptom, is usually controllable with the medications used forParkinson's disease treatment.

Sleep Problems

Parkinson's disease symptoms can also include sleep problems. These include difficulty staying asleep at night, restless sleep, nightmares and emotional dreams, and drowsiness during the day. It is unclear if these symptoms are related to the disease or to the medications used to treat Parkinson's disease. People with Parkinson's should never take over-the-counter sleep aids without consulting their healthcare providers.

Stages of Parkinson's Disease

Stage I (Beginning Stage of Parkinson's)

Stage I is considered the beginning stage of the disease. A person is categorized with stage I if the following are present:

Signs and symptoms are only on one side of the body
Symptoms are mild
Symptoms are inconvenient but not disabling
Usually has tremors in one limb
Friends have noticed changes in posture, locomotion, and facial expression.

Stage I is also known as early-stage Parkinson's disease.

Parkinson's Disease Stage II

A person is categorized as stage II if the following are present:

Symptoms occur on both sides of the body
Minimal disability
Posture and gait are affected.

Parkinson's Disease Stage III (Moderate Parkinson's Disease)

Stages III, IV, and V are when a person develops significant disability from Parkinson's disease. A person in stage III is considered to have moderate Parkinson's disease.

A person is categorized with stage III if the following are present:

Significant slowing of body movements
Early impairment of equilibrium when walking or standing
Generalized dysfunction that is moderately severe.

Stage IV (Advanced Parkinson's Disease)

A person is categorized with stage IV of the disease if the following are present:

Severe symptoms
The person can still walk to a limited extent
Rigidity and bradykinesia are present
Person is no longer able to live alone
Tremor may be less than earlier stages.

This stage is considered advanced Parkinson's disease.

Stage V Parkinson's Disease

A person is said to be in stage V if the following are present:

Cachectic stage (general reduction in vitality and strength of body and mind)
Invalidism complete
Person cannot stand or walk
Requires constant nursing care.

Diagnosing Parkinson's Disease

Parkinson's disease may be difficult for healthcare providers to diagnose because early symptoms may be vague, and they can mimic other conditions or even be dismissed as normal aging.

In order to make a Parkinson's disease diagnosis, a healthcare provider will begin by asking a number of questions (known as a medical history). Some of these may include questions about:

Your current symptoms
Other medical conditions you have
Medications you may be taking.

He or she will also perform a physical exam to look for signs and symptoms of Parkinson's disease.

Tests and Procedures for Diagnosing Parkinson's Disease

Parkinson's disease can also be hard to diagnose early on because there are no tests or procedures that can definitely diagnose the condition. Your healthcare provider may recommend several tests and/or procedures to help rule out other conditions that can cause similar symptoms. This may involve blood tests or a brain scan. However, brain scans (such as a CT scan or an MRI) generally appear normal in a person with Parkinson's disease.

Is the Diagnosis Parkinson's Disease or Another Condition?

Several medical conditions can share similar symptoms with Parkinson's disease, especially during the early stages. Your healthcare provider will consider these before making a Parkinson's disease diagnosis.

Some of these conditions fall under a group of disorders with similar features called Parkinson syndromes, or parkinsonism. These disorders share several symptoms, and all are the result of the loss of dopamine-producing brain cells. Parkinson's is also called primary parkinsonism or idiopathic Parkinson's disease. Idiopathic is a term describing a disorder for which no cause has yet been found. In the other forms of parkinsonism, either the cause is known or suspected, or the disorder occurs as a secondary effect of another, primary neurological disorder.

Besides Parkinson's disease, other forms of parkinsonism include:

Postencephalitic parkinsonism
Drug-induced parkinsonism
Striatonigral degeneration
Ateriosclerotic parkinsonism
Toxin-induced parkinsonism (such as carbon monoxide or cyanide)
Lewy body dementia
Accompanying other conditions, such as:

Shy-Drager syndrome (sometimes called multiple system atrophy)
Progressive supranuclear palsy
Wilson's disease
Huntington's disease
Hallervorden-Spatz syndrome
Alzheimer's disease
Creutzfeldt-Jakob disease
Olivopontocerebellar atrophy
Post-traumatic encephalopathy.

Parkinson's Disease Treatment

Currently, there is no cure for Parkinson's disease. Also, there is no treatment that has been shown to slow down or stop the progression of the disease. However, there is treatment for Parkinson's disease that provides dramatic relief from the symptoms.

Before recommending a specific treatment, your healthcare provider will consider several factors, including your:

Current Parkinson's disease symptoms, along with how much the symptoms disrupt your life
Mental and emotional state
Current medications.

Based on these factors, your healthcare provider will recommend one or several different treatment options. Some of these treatment options can include:

Medications
Lifestyle changes and support
Surgery.

Medications for Treating Parkinson's Disease

Not everyone who is diagnosed with Parkinson's disease will immediately require medicine. Many people are only mildly affected and do not require medications for several years after the initial diagnosis.

When Parkinson's treatment does become necessary, healthcare providers often begin with one or more of the less powerful Parkinson's disease medications. This includes such drugs as:

Selegiline (Eldepryl^®, Zelapar^®, Emsam^®)
An anticholinergic
A dopamine agonist, such as pramipexole (Mirapex^®) orropinirole (Requip^®).

This allows healthcare providers to save the most powerful treatment (specifically, levodopa) for the time when people need it most.

When Parkinson's disease symptoms become severe, healthcare providers usually prescribe levodopa combined with carbidopa. Carbidopa-levodopa products are available as the brand-name medicinesSinemet^®, Sinemet^® CR, Parcopa^®, or as a generic. Carbidopa is used with levodopa because it delays the conversion of levodopa into dopamine (a chemical messenger) until it reaches the brain. Nerve cells can use levodopa to make dopamine and replenish the brain's dwindling supply of this neurotransmitter.

Lifestyle Changes and Support Groups

Lifestyle changes are an important part of any treatment for Parkinson's disease. This includes exercise and diet. Support groups also can be helpful.

Exercise

Because movements are affected in Parkinson's disease, exercising may help people improve their mobility. Some healthcare providers prescribe physical therapy or muscle-strengthening exercises as a part of Parkinson's disease treatment. This is intended to tone muscles and to put underused and rigid muscles through a full range of motion. Exercises will not stop Parkinson's disease from progressing, but they may improve body strength so that the person is less disabled.

Exercises also improve balance, helping people overcome gait problems, and can strengthen certain muscles so that people can speak and swallow better. Physical activity can also improve the emotional well-being of people with Parkinson's by giving them a feeling of accomplishment.

Although structured exercise programs help many people, more general physical activity is also beneficial. Some examples include:

Walking
Gardening
Swimming
Calisthenics
Using exercise machines.

Diet

Eating a well-balanced, nutritious diet can be beneficial for anybody. However, to prevent or cure Parkinson's disease, there does not seem to be any specific vitamin, mineral, or other nutrient that has any therapeutic value for Parkinson's disease treatment. In fact, a high-protein diet may limit the effectiveness of levodopa.

Despite some early optimism, recent studies have shown that tocopherol (a form of vitamin E) does not delay Parkinson's disease. This conclusion came after a carefully conducted, five-year study that examined the effects of both selegiline and vitamin E on early symptoms of Parkinson's disease. While selegiline was found to slow down the early progression of the disease and delay the need for levodopa, there was no evidence of any therapeutic benefit from vitamin E.

Support Groups

One of the most demoralizing aspects ofParkinson's disease is how completely a person's world changes. The most basic daily routines may be affected -- from socializing with friends and enjoying normal and congenial relationships with family members, to earning a living and taking care of a home. Faced with a very different life, people need encouragement to remain as active and involved as possible. That's when support groups can be a valuable part of Parkinson's disease treatment, not only to the person affected, but to their families and caregivers as well.

Surgery as a Part of Treatment

Surgery for Parkinson's disease was once a common practice. However, after the discovery of levodopa, surgery was restricted to only a few cases. Currently, surgery is reserved for people who have failed to respond satisfactorily to drugs.

One of the procedures used as part of Parkinson's disease treatment, called cryothalamotomy, requires a supercooled metal probe tip to be surgically inserted into the thalamus (a "relay station" deep in the brain). This destroys the area of the brain that produces tremors. This and related procedures, such as thalamic stimulation, are coming back into favor for people who have severe tremors or have Parkinson's only on one side of the body.

A therapy called deep brain stimulation (DBS) has now been approved by the U.S. Food and Drug Administration (FDA) for treating Parkinson's disease. In DBS, electrodes are implanted into the brain and connected to a small electrical device, called a pulse generator, that can be externally programmed. DBS can reduce the need for levodopa and related drugs, which, in turn, decreases the involuntary movements (dyskinesias) that are a common side effect of levodopa. It also helps to:

Alleviate fluctuations of symptoms
Reduce tremors, slowness of movements, and gait problems.

DBS requires careful programming of the stimulator device in order to work correctly.

Parkinson's Disease Research

There has been considerable progress made within Parkinson's research in recent years. Ongoing studies aim to discover better ways of relieving the symptoms of Parkinson's disease and ultimately preventing or halting the disease. New Parkinson's disease research is focusing on many areas, including brain anatomy, dopamine, environmental factors, genetics, mitochondria, and cell transplantation.

ALS

2009-10-20T18:16:00.000-07:00

Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is a rapidly progressive, invariably fatal neurological disease. This disease attacks the nerve cells (neurons) responsible for controlling voluntary muscles. ALS belongs to a group of disorders known as motor neuron diseases, which are characterized by the gradual degeneration and death of motor neurons.

If a person has amyotrophic lateral sclerosis (ALS) and one or more immediate family members also has the disease (for example, a parent, sibling, or grandparent), then the condition is considered familial amyotrophic lateral sclerosis.

Motor neurons are nerve cells located in the brain, brainstem, and spinal cord. These nerve cells serve as controlling units and provide vital communication links between the nervous system and the voluntary muscles of the body. Messages from motor neurons in the brain (called upper motor neurons) are transmitted to motor neurons in the spinal cord (called lower motor neurons). From here, they are transmitted to particular muscles.

Because amyotrophic lateral sclerosis affects only motor neurons, the disease does not impair a person's:

Mind
Personality
Intelligence
Memory.

Nor does it affect a person's ability to:

See
Smell
Taste
Hear
Recognize touch.

People with this condition usually maintain control of eye muscles and bladder and bowel functions.

ALS Symptoms

The early symptoms of ALS (amyotrophic lateral sclerosis) are frequently overlooked because the disease is so subtle in its early stages. When present, the earliest ALS symptoms may include:

Muscle stiffness, twitching, or cramping
Weakness affecting an arm or leg
Slurred and nasal-sounding speech
Difficulty chewing or swallowing.

These general symptoms then develop into more obvious weakness or atrophy (loss of muscle tissue) that may cause a doctor to suspect ALS.

The body parts that early ALS affects will depend on which muscles are damaged first. In some cases, one of the legs is affected and the person experiences awkwardness when walking or running -- or he or she begins to trip or stumble more often. In other cases, the person experiences problems with a hand or arm and has difficulty with simple tasks requiring manual dexterity, such as buttoning a shirt, writing, or turning a key in a lock. Other people may experience speech problems as their first symptom of ALS.

Regardless of where the ALS symptoms first appear, muscle weakness and atrophy will spread to other parts of the body as the disease progresses.

Eventually, people who have ALS will experience increased problems with:

Moving
Swallowing (dysphagia)
Speaking or forming words (dysarthria).

Those with ALS symptoms are aware of their progressive loss of function because this disease generally does not affect a person's thinking or mental capacities. Therefore, people with this condition may experienceanxiety and/or depression. Also, a small percentage of people may experience problems with their memory or decision-making abilities, and there is growing evidence that some people may develop a form ofdementia.

In the later stages of ALS, the person will experience the following symptoms:

Difficulty breathing as the muscles of the respiratory system weaken
Loss of the ability to breathe on his or her own (must depend on ventilator support for survival)
An increased risk of pneumonia.

It's important for people with ALS (and their loved ones) to talk to their healthcare provider about the course of the disease and the options fortreatment of ALS. This can help the patient make informed decisions in advance.

Causes of ALS

The cause or causes of ALS (amyotrophic lateral sclerosis) are not known, and scientists do not yet know why ALS strikes some people and not others.

ALS research scientists are looking at a number of possible ALS causes, including:

Genetics
Glutamate
Autoimmune responses
Environment.

Gene Mutations

An important step toward finding the causes of ALS came in 1993, when research scientists discovered that mutations in the gene that produces the superoxide dismutase 1 (SOD1) enzyme were associated with some cases of familial ALS.

The SOD1 enzyme is a powerful antioxidant that protects the body from damage caused by free radicals. Free radicals are highly reactive molecules that are produced by cells during normal metabolism. If these free radicals are not neutralized, they can accumulate and cause random damage to the DNA and proteins within cells.

Although it is not yet clear how the SOD1 gene mutation leads to motor neuron degeneration, researchers have theorized that an accumulation of free radicals may result from the faulty functioning of this gene. In support of this theory, animal studies have shown that motor neuron degeneration and deficits in motor function accompany the presence of the SOD1 mutation.

Glutamate

Studies have also focused on the role of glutamate in motor neuron degeneration. Glutamate is one of the chemical messengers or neurotransmitters in the brain.

Scientists have found that, compared to healthy people, ALS patients have higher levels of glutamate in the serum and spinal fluid. Laboratory studies have demonstrated that neurons begin to die off when they are exposed over long periods to excessive amounts of glutamate.

Autoimmune Responses

Autoimmune responses -- which occur when the body's immune system attacks normal cells -- have been suggested as one possible cause for ALS. Some scientists theorize that antibodies may directly or indirectly impair the function of motor neurons, interfering with the transmission of signals between the brain and muscles.

Environmental Factors

In searching for possible ALS causes, researchers have also studied environmental factors, such as exposure to toxic or infectious agents, and examined the possible role of dietary deficiency or trauma. However, as of yet, there is insufficient evidence to implicate these factors as possible ALS causes.

ALS Diagnosis

There is no single test used to make an ALS diagnosis. An ALS diagnosis is typically based on a person's symptoms, such as spasticity and muscle weakness. Tests used to rule out other diseases before making an accurate ALS diagnosis include magnetic resonance imaging and electromyography. In order for your doctor to make a definitive ALS diagnosis, he or she will also need your full medical history and will conduct a neurological exam.

Treatment of ALS

Scientists have not found a cure for ALS (amyotrophic lateral sclerosis). However, the U. S. Food and Drug Administration (FDA) has approved the first drug treatment for ALS, which is called riluzole.

Riluzole is believed to:

Reduce damage to motor neurons by decreasing the release of glutamate
Prolong survival by several months (mainly in those with difficulty swallowing)
Extend the time before a patient needs ventilation support.

Riluzole does not reverse the damage that has already occurred to the motor neurons, and patients taking riluzole must be monitored for liver damage and other possible side effects.

Team Effort for Treatment of ALS

Other treatments of ALS are designed to relieve ALS symptoms and improve the quality of life for patients. Multidisciplinary teams of healthcare professionals are available to provide supportive care, including:

Physicians
Pharmacists
Physical, occupational, and speech therapists
Nutritionists
Social workers
Home care and hospice nurses.

These teams can design an individualized ALS treatment plan of medical and physical therapy, and provide special equipment aimed at keeping patients as mobile and comfortable as possible.

ALS Research

Scientists studying ALS are hoping to discover what causes it and to develop more effective treatment methods, among other things. To that end, ALS research scientists are trying to better understand apoptosis (programmed cell death) and examining the disease in families. Investigators are optimistic that research studies will eventually lead to better treatments for ALS.

Dysphagia

2009-10-19T19:01:00.000-07:00

Dysphagia

Dysphagia, or trouble swallowing is a symptom that accompanies a number of neurological disorders. The problem can occur at any stage of the normal swallowing process as food and liquid move from the mouth, down the back of the throat, through the esophagus and into the stomach. Difficulties can range from a total inability to swallow, to coughing or choking because the food or liquid is entering the windpipe, which is referred to as aspiration. When aspiration is frequent a person can be at risk of developing pneumonia. Food may get "stuck" in the throat or individuals may drool because they cannot swallow their saliva. Neurological conditions that can cause swallowing difficulties are: stroke (the most common cause of dysphagia); traumatic brain injury; cerebral palsy; Parkinson disease and other degenerative neurological disorders such as amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease), multiple sclerosis, progressive supranuclear palsy, Huntington disease, and myasthenia gravis. Muscular dystrophy and myotonic dystrophy are accompanied by dysphagia, which is also the cardinal symptom of oculopharyngeal muscular dystrophy, a rare, progressive genetic disorder.

Signs and symptoms of dysphagia:

Pain when swallowing

Inability to start the swallowing process
Persistent coughing or choking while swallowing
Low-grade fevers
Sensation of food stuck in the throat or chest
Frequent heartburn
Lack of interest in eating or taking much longer than normal to finish a meal
Coughing overnight

Children show similar signs and symptoms but have unique indicators also:

Being distracted during meals
Tensing their bodies
Taking more than 30 minutes to finish their meal
Leaking or spitting foods or liquids
Coughing or gagging during meals
Losing weight

Prognosis

The prognosis depends upon the type of swallowing problem and the course of the neurological disorder that produces it. In some cases, dysphagia can be partially or completely corrected using diet manipulation or non-invasive methods. In others, especially when the dysphagia is causing aspiration and preventing adequate nutrition and causing weight loss, it may require aggressive intervention such as a feeding tube. For those with progressive degenerative neurological disorders, dysphagia will be only one in a cluster of symptoms and disabilities that have to be treated.

Diagnosing swallowing problems

Physical exam. Todd Levine, MD, asks his patients to drink water and then say their names. If their voice sounds wet, there is a problem as the water is trapped at the top of the esophagus near the vocal chords. Doctors might also examine your head, neck and tongue; test your gag reflex; and x-ray your lungs.
Modified barium swallow or videofluoroscopy. Patients swallow a barium solution that coats the inside of the esophagus and allows a doctor or speech-language pathologist to see the entire swallowing process and find where the problem occurs.
Flexible endoscopic evaluation. A small flexible scope is passed through the nose to the back of the throat, base of the tongue and larynx to look directly at these areas for potential problems.

Treatments for dysphagia

Changing a person's diet by adding thickeners helps many people, as does learning different ways to eat and chew that reduce the risk for aspiration. Occasionally drug therapy that helps the neurological disorder can also help dysphagia. In a few persons, botulinum toxin injections can help when food or liquid cannot enter the esophagus to get to the stomach. More severely disabled individuals may require surgery or the insertion of feeding tubes.

What research is being done?

National Institutes of Health conduct research related to dysphagia in their clinics and laboratories and support additional research through grants to major medical institutions across the country. Much of this research focuses on finding better ways to treat dysphagia.

Down Syndrome

2009-10-18T19:36:00.000-07:00

What Is Down Syndrome?

Down syndrome is a chromosomal disorder caused by an additional (third) chromosome 21 or "trisomy 21." t is not usually hereditary in the conventional sense. That is, it is not inherited; it does not "run in families." The condition is usually the result of a random event that occurs during the formation of reproductive cells (eggs and sperm). One exception is Down syndrome caused by a balanced translocation. is associated with mental retardation, a characteristic facial appearance, and poor muscle tone (hypotonia)This syndrome occurs in one out of 800 live births, in all races and economic groups. It is the most frequent genetic cause of mild to moderate mental retardation and associated medical problems. As far as we know, it is not caused by any behavioral activity of the parents or environmental factors.

Risk Factors for a Down Syndrome Baby

There are several established risk factors for this condition, including:

Having a Down syndrome baby previously
Increasing maternal age
Carriers of a balanced translocation.

Characteristics of Down Syndrome Symptoms

There are estimated to be over 100 characteristics of Down syndrome. Common characteristics of Down syndrome can include:

A flat facial profile
An upward slant to the eye
A short neck
Abnormally shaped ears
White spots on the iris of the eye (called Brushfield spots)
A single, deep transverse crease on the palm of the hand
Smaller than average size
Exaggerated space between the first and second toe
Poor muscle tone (called hypotonia)
Joint looseness
Broad feet with short toes
Learning disabilities.

Besides the physical characteristics, people with Down syndrome are also at increased risk of developing certain medical conditions that come with their own set of symptoms. Some of these conditions can include:

Thyroid problems
Hearing problems
Congenital heart disease
Eye problems
Seizure disorders
Bone, muscle, nerve, or joint problems
Leukemia and other cancers
Immune system problems
Developmental delay
Mental retardation
Premature aging
Alzheimer's disease.

Because of these medical conditions and their complications, a person with Down syndrome is at increased risk of premature death. Regular checkups are very important. Checkups help ensure that any changes in health are noted and treated if necessary.

Down Syndrome Diagnosis

Tests used to make a Down syndrome diagnosis include amniocentesis, chorionic villus sampling (CVS), and percutaneous umbilical blood sampling (PUBS). To confirm the diagnosis, the doctor may request a blood test called a chromosomal karyotype. The doctor may also make a Down syndrome diagnosis shortly after birth, based on the presence of possible characteristics of the disorder. This blood test goes by several names, including:

Multiple marker screening test
Maternal blood screening test
Triple screen
Quad screen.

Treatment for Down Syndrome

Because it is a problem with the chromosomes, there are no cure , the goals of Down syndrome treatment are to control symptoms and manage any resulting medical conditions. This includes regular checkups and screenings, medications, and surgery. Counseling and support groups are also aspects of treatment for those who need help in coping with emotional and practical aspects of Down syndrome.

Down Syndrome Research
Scientists conducting research on Down syndrome are investigating new prenatal diagnostic techniques and methods to improve understanding of the developmental consequences of the disorder. This research has led to many advances, such as preimplantation diagnosis. Couples who join research studies have the first chance to benefit from treatments that have shown promise in earlier research.