Songwriter, singer and actor Ashley Hamilton, son of George Hamilton and Alana Steward, admitted in a People magazine article that he has suffered from an eating disorder for many years. The 38-year-old, who most recently played former military officer “Jack Taggert” in Iron Man 3 told People that the condition began when he was a teenager at Beverly Hills High School, where his nickname was Fatley:

I suffered from bulimia and anorexia. I believe it was my problem before I got into drugs and alcohol. I used the drugs and alcohol to control the food addiction.

The 6-foot-3-inch actor says that his weight has varied between 180 and 250 pounds.  He has been clean and sober for six years, but found that he still had the eating disorder to deal with:

I don’t have it perfect now. I’ve been free from bulimia for years but I still struggle with food, restricting or overeating. That’s been the hardest for me in sobriety.

When I speak at meetings I have people come up to me and say I suffer from it, too, but I’m too afraid to talk about it because it’s so painful. It’s almost like drug addiction is totally acceptable to talk about in Hollywood. But food addiction? Nobody wants to talk about that. It’s really shameful as a man to have that.

How often do men have eating disorders?

• Approximately 10% of eating disordered individuals coming to the attention of mental health professionals are male.
• There is a broad consensus, however, that eating disorders in males are clinically similar to, if not indistinguishable from, eating disorders in females.

How are males affected?

Like females who have eating disorders, males also have a distorted sense of body image.

For some, their symptoms are similar to those seen in females. Others may have muscle dysmorphia, a type of disorder that is characterized by an extreme concern with becoming more muscular. Unlike girls with eating disorders, who mostly want to lose weight, some boys with muscle dysmorphia see themselves as smaller than they really are and want to gain weight or bulk up.

Men and boys are more likely to use steroids or other dangerous drugs to increase muscle mass.

Although males with eating disorders exhibit the same signs and symptoms as females, they are less likely to be diagnosed with what is often considered a female disorder. More research is needed to understand the unique features of these disorders among males.

Are Eating Disorders in Males a Silent Epidemic?

The National Eating Disorders Association (NEDA) is a leading non-profit organization in the United States advocating on behalf of and supporting individuals and families affected by eating disorders. They contend that eating disorders in males may well be a silent epidemic and produced this infographic to illustrate some of the factors involved:

Key: AN= Anorexia Nervosa, BN= Bulimia Nervosa, BED= Binge Eating Disorder, EDNOS= Eating Disorder Not Otherwise Specified

For more information about eating disorders, click here to go the Resounding Health Casebook on the topic.

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Today’s New York Times op-ed section contained a piece by actress Angelina Jolie in which she makes a startling announcement:

I made a decision to have a preventive double mastectomy.

Jolie’s mother, actress Marcheline Bertrand, died at the age of 56 from ovarian cancer. Jolie underwent genetic testing and found that she carried the BRCA1 gene. Doctors estimated that this increased her risk of getting breast cancer to 87%, and her risk of ovarian cancer to 50%. As the mother of 6 children, she wanted to be proactive and to minimize the risk as much she could.

On February 2, she underwent a medical procedure called a “nipple delay.” Its purpose is to ensure that there are no cancer cells in the nipple and to increase the chance to save the nipples for reconstruction. Two weeks later, she had the bilateral mastectomy to remove the breast tissue. Temporary fillers (typically filled with saline) are placed. Nine weeks later, she underwent breast reconstruction with the use of implants.

Jolie maintains that she was able to keep up her work during this period.

She is coming forward in such a public way to help other women:

For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.

I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.

Jolie is one of several women who have been open about having the BRCA gene and undergoing bilateral mastectomies because of it: Christina Applegate, Sharon Osbourne, and Kathy Bates.

If you want more information about the BRCA gene, take a look at our story about Sharon Osbourne which outlines the most important information you need to know about this topic.

For more information about breast reconstruction, go to the Resounding Health Casebook on the topic.

The post Angelina Jolie Undergoes Double Mastectomy to Prevent Breast Cancer appeared first on Celebrity Diagnosis.

DWTS pro Karina Smirnoff was injured today during rehearsal with partner NFL pro Jacoby Jones. The two were practicing a flip when Smirnoff landed on Jones, twisting her neck and hitting her face on the floor. People magazine is reporting that Smirnoff was taken to Cedar Sinai Medical Center for “possible whiplash and a dislocated jaw.”

At the current time, it is unknown whether the professional dancer will be able to compete tonight. It is possible that Jacoby may be given a substitute dancer partner, but it will definitely put him at a disadvantage.

This is one of several injuries already suffered during this season of Dancing with the Stars. Olympic skater Dorothy Hamill had to leave the competition during the second week due to injury to a lumbar spine cyst. And professional dancer Mark Ballas almost didn’t dance in week 7 when “while trying a lift, I compressed two discs in my lower back and could hardly move for two days.”

What is Whiplash?

Whiplash is a soft tissue injury to the neck an is also called neck sprain or neck strain. When a vehicle stops suddenly in a crash or is struck from behind, a seat belt will keep a person’s body from being thrown forward. The head initially continues to move  forward, then snaps backward causing the injury. Besides automobile accidents, whiplash can occur in any situation where there can be rapid accelerations and decelerations such as amusement park rides.

Whiplash is characterized by a collection of symptoms that occur following damage to the neck and may include injury to inter-vertebral joints, discs, and ligaments, cervical muscles, and nerve roots.

Symptoms such as neck pain may be present directly after the injury or may be delayed for several days. In addition to neck pain, other symptoms may include:

• neck stiffness
• injuries to the muscles and ligaments (myofascial injuries)
• headache
• dizziness
• abnormal sensations such as burning or prickling (paresthesias)
• shoulder or back pain.

Jaw Dislocations

A dislocated jaw means the lower part of the jaw has moved out of its normal position at one or both joints where the jaw bone connects to the skull (temporomandibular joints).

The most common cause of a broken or dislocated jaw is injury to the face. This may be due to an assault, an industrial or motor vehicle accident, or recreational or sports injury.

Symptoms of a dislocated jaw include:

• Bite that feels “off” or crooked
• Difficulty speaking
• Drooling because of inability to close the mouth
• Inability to close the mouth
• Jaw that may protrude forward
• Pain in the face or jaw, located in front of the ear on the affected side, and gets worse with movement
• Teeth that do not line up properly

Complications may include:

• Airway blockage
• Bleeding
• Breathing blood or food into the lungs
• Difficulty eating (temporary)
• Difficulty talking (temporary)
• Infection of the jaw or face
• Jaw joint (TMJ) pain and other problems
• Problems aligning the teeth

We’ll update this story as more information becomes available.

The post Breaking News: DWTS’s Karina Smirnoff Injured During Rehearsal appeared first on Celebrity Diagnosis.

The Lindsay Lohan saga continues…

As you may recall, Lindsay pleaded no contest in March to reckless driving and lying to police. As part of the plea agreement, she was ordered to 90 days in a locked hospital rehab facility.

She then decided not to show up at the Morningside Recovery in Newport Beach, just as her attorney was telling the judge that she was already admitted there.

Lindsay finally checked into the Betty Ford Center last Thursday, but is now threatening to leave because they have taken away her beloved Adderall pills. Lindsay claims that she takes the pills for her attention deficit hyperactivity disorder (ADHD). As she told Piers Morgan last month:

I have ADD. I can’t stand still. So I take Adderall for that, it calms me. I know people who take it to stay up, or girls who take it to supposedly stay slim because it kills your appetite. But I eat all the time. I just take it to stay calm. It works well for me.

Doctors at the Betty Ford Center have evaluated Lindsay, and determined that there are other medications that can be used. Their policy is not to used Adderall on patients older than 15 years old because of its potential for addiction.

There is little chance that Judge Jim Dabney will dismiss the opinions of the experts at the facility and let her leave.

What is Adderall?

Adderall is a psychostimulant medication that contains four forms of amphetamine. It is used for the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy.   ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development.  For many individuals, ADHD symptoms improve during adolescence or as age increases, but the disorder can persist into adulthood. In the United States, ADHD is diagnosed in an estimated 8 percent of children ages 4–17 and in 2.9–4.4 percent of adults.

How Do Prescription Stimulants Affect the Brain?

All stimulants work by increasing dopamine levels in the brain—dopamine is a brain chemical (or neurotransmitter) associated with pleasure, movement, and attention. The therapeutic effect of stimulants is achieved by slow and steady increases of dopamine, which are similar to the natural production of the chemical by the brain. The doses prescribed by physicians start low and increase gradually until a therapeutic effect is reached.

However, when taken in doses and routes other than those prescribed, stimulants can increase brain dopamine in a rapid and highly amplified manner—as do most other drugs of abuse—disrupting normal communication between brain cells, producing euphoria, and increasing the risk of addiction.

Why and How Are Prescription Stimulants Abused?

Stimulants have been abused for both “performance enhancement” and recreational purposes (i.e., to get high).

They suppress appetite (to facilitate weight loss), increase wakefulness, and increase focus and attention. The euphoric effects of stimulants usually occur when they are crushed and then snorted or injected.

The dramatic increases in stimulant prescriptions over the last 2 decades have led to their greater availability and increased risk for abuse.  Because they are perceived by many to be generally safe and effective, prescription stimulants, such as Concerta or Adderall, are increasingly being abused for nonmedical conditions or situations. The practice is occurring among some academic professionals, athletes, performers, older people, and both high school and college students. Such nonmedical use poses potential health risks, including addiction, cardiovascular events, and psychosis.

What Adverse Effects Does Prescription Stimulant Abuse Have on Health?

• Stimulants can increase blood pressure, heart rate, body temperature, and decrease sleep and appetite, which can lead to malnutrition and its consequences.
• Repeated use of stimulants can lead to feelings of hostility and paranoia.
• At high doses, they can lead to serious cardiovascular complications, including stroke.
• Addiction to stimulants is also a very real consideration for anyone taking them without medical supervision. This most likely occurs because stimulants, when taken in doses and routes other than those prescribed by a doctor, can induce a rapid rise in dopamine in the brain. Furthermore, if stimulants are used chronically, withdrawal symptoms—including fatigue, depression, and disturbed sleep patterns—can emerge when the drugs are discontinued.

For more information, you can go to the Resounding Health Casebook on the topic.

The post Lindsay Lohan Wants Out From Betty Ford Center: “I Need My Adderall” appeared first on Celebrity Diagnosis.

New Jersey Governor Chris Christie told the New York Post that he secretly underwent lap band surgery in February of this year.

The Governor, who has been no stranger to barbs about his weight, felt the time was finally right to do something about it:

I’ve struggled with this issue for 20 years. For me, this is about turning 50 and looking at my children and wanting to be there for them.

Christie had investigated the different surgical options, and felt that gastric bypass surgery was “too risky”. He also had several conversation with NY Jets Coach Rex Ryan, who underwent the lap band procedure in 2010.  Ryan is said to have lost 100 pounds after the procedure.

Christie used the same surgeon as Ryan, Dr. George Fielding, head of NYU Medical Center’s Weight Management Program. In order to keep the procedure a secret, Christie had Dr. Fielding visit him at his home, instead of at the medical center.

Despite the speculation, Christie says that his procedure was not motivated by thoughts of a presidential bid in 2016, saying “It’s so much more important than that.”

Sources close to the Governor report that he has already lost about 40 pounds.

How does Lap-Band Surgery Work?

Adjustable Gastric Band (AGB) (sometimes called lap-band surgery)works primarily by decreasing food intake. Food intake is limited by placing a small bracelet-like band around the top of the stomach to produce a small pouch about the size of a thumb.  This is only about one ounce, whereas a normal stomach can hold about 3 pints of food.

The band is made of a special rubber (silastic rubber). The inside of the band has an inflatable balloon. This allows the band to be adjusted. The band is connected to an access port that is under the skin on your belly. The band can be tightened by placing a needle into the port and filling the balloon (band) with water.

The procedure is usually done under general anesthesia, so the patient is asleep and unable to feel pain.

The surgery is done laparoscopically- meaning using a small camera and instruments inserted into several small incisions in the abdomen (belly). It typically takes between 30-60 minutes and patients are often able to return home later the same day.

After the surgery, the diet will consist of liquids or mashed-up foods for 2-3 weeks. Soft foods are slowly added to the diet, followed by regular foods. Most patients are on a regular diet by 6 weeks post-op. Because of the small amount of food injested, patients often must take prescribed vitamins and minerals.

What are the Possible Complications of the Surgery?

Some side effects may occur around the time of the surgery. These include bleeding, infection, leaks from the site where the intestines are sewn together, diarrhea, and blood clots in the legs that can move to the lungs and heart.

Other possible complications include:

•     Gastric band erodes through the stomach (if this happens, it must be removed)
•     Gastric band may slip partly out of place
•     Gastritis (inflamed stomach lining), heartburn, or stomach ulcers
•     Infection in the port, which may need antibiotics or surgery
•     Injury to your stomach, intestines, or other organs during surgery
•     Scarring inside your belly, which could lead to a blockage in your bowel
•     Inability to reach the access port to tighten or loosen the band  (would need minor surgery to fix this problem)
•     Vomiting from eating more than your stomach pouch can hold

Later side effects include nutrients being poorly absorbed, especially in patients who do not take their prescribed vitamins and minerals. If patients do not address this problem promptly, diseases may occur along with permanent damage to the nervous system. These diseases include pellagra (caused by lack of vitamin B3—niacin), beri beri (caused by lack of vitamin B1—thiamine) and kwashiorkor (caused by lack of protein).

Weight-loss surgery may increase your risk for gallstones.

Other late problems include strictures (narrowing of the sites where the intestine is joined) and hernias (part of an organ bulging through a weak area of muscle).

Incisional Hernia

Two kinds of hernias may occur after a patient has bariatric surgery. An incisional hernia is a weakness that sticks out from the abdominal wall’s connective tissue and may cause a blockage in the bowel.

Internal Hernia

An internal hernia occurs when the small bowel is displaced into pockets in the lining of the abdomen. These pockets occur when the intestines are sewn together. Internal hernias are thought to be more dangerous than incisional ones and need prompt attention to avoid serious problems.

Some patients may also require emotional support to help them through the changes in body image and personal relationships that occur after the surgery.

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Meet Hannah Warren. She’s a brave 2-1/2 year old girl who is now the youngest patient to receive a new trachea coated with her own stem cells.

Hannah was born in South Korea in 2010 with the rare congenital condition called tracheal agenesis where the trachea (windpipe) is not formed. This is a fatal condition unless their is another way for air to get into the lungs, usually by an abnormal connection between the windpipe and esophagus called a tracheo-esophageal fistula .

Fortunately, Hannah did have such a fistula, and has survived by means of an plastic tube inserted through her mouth into her lungs. Because of this, Hannah has been unable to eat or drink normally or to speak. She had lived her entire life in a hospital in South Korea.

That is until recently, when she was transferred to the Children’s Hospital of Illinois. There, a surgical team lead by Dr. Paolo Macchiarini, from the Karolinska Institute in Sweden, performed a nine-hour operation which implanted an artificial trachea which had been coated with stem cells obtained from Hannah’s bone marrow.

Hannah appears to be doing well postoperatively. Although she is still on a ventilator, physicians believe she will eventually be able to be discharged home and to live an normal life.

Her parents, Darryl and Young-Mi Warren, are ecstatic, telling People magazine:

“We feel like she’s reborn. They hope that she can do everything that a normal child can do but it’s going to take time.This is her only chance but she’s got a fantastic one and an unbelievable one.”

Dr. Macchiarini cautions that Hannah may need a new trachea as she grows, possibly in four years. The team tried to delay this replacement by using an oversized  implant and by using some biodegradable plastic in the scaffolding which may allow it to stretch over time.

Tracheal Agenesis and Tracheo-esophageal Fistulas

Tracheal agenesis (TA) is a rare condition diagnosed shortly after birth in which the breathing tube (trachea) between the voicebox (larynx) and the bronchial tree in the lungs is missing. The windpipe may be completely missing (agenesis), or present but malformed (atresia).

TA occurs in about 1 in 50,000 births. It is more common in boys than girls. It can be associated  with a premature birth  and with a condition called polyhydramnios , where there is too much amniotic fluid. Other birth defects can be seen in 90% of cases, especially those affecting the cardiovascular or gastro-intestinal systems and the genito-urinary tract.

Since there is no direct connection between the lungs and the air, infants with this problem have the following symptoms:

• Trouble breathing
• Blue coloration to the skin, mouth or extremities
• No cry is heard
• A history of polyhydramnios
• If a physician tries to put a breathing tube in the baby (intubation) the attempt is unsuccessful

The diagnosis is confirmed by CT scan.

The condition is considered fatal unless there is also another birth defect called a  tracheo-esophageal fistula (TEF). A TEF is an abnormal connection between the feeding tube (esophagus) and the windpipe.  This can happen in a number of configurations (see figure, right). It is more commonly associated with esophageal atresia (where it is the esophagus that is interrupted).

The Tracheal Implant

The tracheal implant inserted into little Hannah consists of a scaffold manufactured from small fibers of a special polymer.

In older patients on which the procedure has been performed (11 to date) this material does not degrade. As mentioned above, because of Hannah’s age, some biodegradable polymers were added to her implant in the hope that it would be more flexible and allow for growth. The polymer is also biocompatible, meaning that it does not provoke an reaction from the immune system.

The stems cells are then collected. Stem cells are special cells that are can differentiate into all the different kinds of specialized cells in the body. They are also important in maintaining  the normal turnover of dead cells in organs that regenerate, such as the blood, skin, or the  intestinal tissues. Stem cells can be obtained retrieving bone marrow by putting a special needle in the in the hip bone. The bone marrow is centrifuged and the stem cells separated from the other bone marrow components.

The scaffold is then place in a “bioreactor” (which Dr. Macchiarini likens to a “shoe box”)  with stem cells obtained from the patient. This scaffold attracts the stem cells and allows them to attach to it.  When the implant is placed into the body, the cells are still pluripotent  (meaning they are undifferentiated- just like stem cells ). The human body then takes over as the bioreactor, instructing it to differentiate into trachea cells.

Endoscopy, a procedure where a tube with a camera is put into the trachea,  has been done on patients after the surgery and researchers have found cells that have become tracheal cells in one week’s time. A full transformation has been found in 2 to 3 weeks!

Hannah’s physician, Dr. Paolo Macchiarini (right) says he was drawn to regenerative medicine because he “was frustrated that the windpipe was one of the very few organs that we are unable to transplant, because it does not have a distinct blood vessel supplying it. ”

He told Future Medicine that this process has been in international collaboration: Scientists at the Karolinska Institute in Sweden worked with scientists in London, who designed the scaffold, and groups in the USA and Germany, who produced the specific bioreactor to seed the scaffold.

Asked about the future of this procedure for transplantation of other organs, Dr. Macchiarini said we could most likely produce heart valve or blood vessels, but that we are not yet ready for more complex organs such as hearts or lungs.

Dr. Macchiarini would like to begin clinical trials in the United States if they could gain FDA approval.

There is an interesting interview of Dr. Macchiarini for NPR’s Science Friday. You can listen to it by clicking here.

Do you think this the wave of the future for transplant medicine?

The post Hannah Warren, Age 2-1/2, Gets a New Trachea appeared first on Celebrity Diagnosis.

Academy-Award winning actress Catherine Zeta- Jones has voluntarily checked herself into a hospital for treatment of her bipolar disorder.

This is Zeta-Jones’s second hospitalization for the disease. The first was 2 years ago, when she revealed that she was diagnosed with bipolar disorder type 2. At that time, she had been dealing with a lot of stress, not the least of which was her husband, Michael Douglas’s fight with Stage 4 throat cancer.

Publicist Cece Yorke announced that:

Catherine has proactively checked into a healthcare facility. Previously Catherine has said that she is committed to periodic care in order to manage her health in an optimum manner.

How do you treat bipolar disorder?

We’ve previously covered other aspects of bipolar disorder:

• Symptoms
• Mania
• ECT (electroconvulsant therapy)
• Stigma associated with bipolar disorders
• Dissociative Psychotic Reaction
• Psychomotor Retardation

So a little bit about treatment seems in order.

To date, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms.This is even true for people with the most severe forms of the illness.

Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.

Medications

Bipolar disorder can be diagnosed and medications prescribed by people with an M.D. (doctor of medicine), usually a psychiatrist. Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found.

Mood stabilizing medications are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years.

Except for lithium, many of these medications are anticonvulsants. Anticonvulsant medications are usually used to treat seizures, but they also help control moods. These medications are commonly used as mood stabilizers in bipolar disorder:

• Lithium was the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) in the 1970s for treatment of mania. It is often very effective in controlling symptoms of mania and preventing the recurrence of manic and depressive episodes.
• Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995 for treating mania, is a popular alternative to lithium for bipolar disorder. It is generally as effective as lithium for treating bipolar disorder.
• More recently, the anticonvulsant lamotrigine (Lamictal) received FDA approval for maintenance treatment of bipolar disorder.

Antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken with other medications.

• Olanzapine (Zyprexa), when given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis. Olanzapine can be used for maintenance treatment of bipolar disorder as well, even when a person does not have psychotic symptoms.
• Aripiprazole (Abilify), like olanzapine, is approved for treatment of a manic or mixed episode. Aripiprazole is also used for maintenance treatment after a severe or sudden episode. As with olanzapine, aripiprazole also can be injected for urgent treatment of symptoms of manic or mixed episodes of bipolar disorder.
• Quetiapine (Seroquel) relieves the symptoms of severe and sudden manic episodes. In that way, quetiapine is like almost all antipsychotics. In 2006, it became the first atypical antipsychotic to also receive FDA approval for the treatment of bipolar depressive episodes.
• Risperidone (Risperdal) and ziprasidone (Geodon) are other atypical antipsychotics that may also be prescribed for controlling manic or mixed episodes.

Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. People with bipolar disorder who take antidepressants often take a mood stabilizer too. Doctors usually require this because taking only an antidepressant can increase a person’s risk of switching to mania or hypomania, or of developing rapid cycling symptoms. To prevent this switch, doctors who prescribe antidepressants for treating bipolar disorder also usually require the person to take a mood-stabilizing medication at the same time.

Psychotherapy

In addition to medication, psychotherapy, or “talk” therapy, can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:

• Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
• Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication and problem-solving.
• Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
• Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers.

Lifestyle changes

Successful management of bipolar disorder also  includes living a healthier lifestyle:

• getting more sleep
• eating healthier
• getting more physical activity
• yoga and/or meditation

Hospital Based Treatment

Hospital based treatments can be done an an inpatient or outpatient basis. As Bipolar Disorder I tends to be more severe, hospitalization is more common than for Bipolar Disorder II.

It is especially important for patients after suicide attempts, or for those with suicidal thoughts. Never ignore comments about a friend or relative harming himself or herself.

Hospital based treatments can also be used for periods of medication adjustments.

For more information, go to the Resounding Health Casebook.

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You’d think becoming a major box office draw with 7 movies (including GI Joe and Pain and Gain) coming out this year alone would be enough for Dwayne Johnson.

But no, in January Johnson’s alter ego, WWE’s “The Rock” made a comeback in his first in-ring appearance since April 2012. He defeated superstar CM Punk at the annual “Royal Rumble”  winning his 8th WWE Championship, the first since he left wrestling in 2003.

He successfully defended that title in February against Punk in February, but lost it on April 7th, at WrestleMania 29 to John Cena.

It was learned the next day that Johnson had been injured in that fight, when he Tweeted:

Although it was originally reported that Johnson would not need surgery, he later tweeted:

Saw my Dr. who had to push my intestines back through the tear in my abdomen. Kinda romantic. #Bringiton

Johnson underwent successful surgery Monday and he sent the picture above with the caption: “Surgery a success! Dr. repaired 3 hernial tears (fun pain). Superman is on the mend.”

What are the adductor muscles of the groin (hip)?

The adductor muscles of the hip are a group of five muscles of the thigh.

• Adductor brevis
• Adductor longus
• Adductor magnus
• Pectineus
• Gracilis

These muscles all begin on the bones of the pelvis. They end on the thigh bone (femur).

The primary function of the adductor muscles are adduction (the movement of the leg in towards the centerline of the body). They also serve to stabilize the hip joint. During normal walking they are used in pulling the swinging lower limb towards the middle to maintain balance. They are used extensively in sprinting, playing football, and any sport which requires fast changes in direction.

Adductor muscle tears (also known as a groin strain) rank among the most common sport injuries.

What is a hernia?

A hernia happens when part of an internal organ or tissue bulges through a weak area of muscle. Most hernias are in the abdomen.

There are several types of hernias, including:

• Inguinal, in the groin. This is the the most common type.
• Umbilical, around the belly button
• Incisional, through a scar
• Hiatal, a small opening in the diaphragm that allows the upper part of the stomach to move up into the chest.

Hernias are common. They can affect men, women, and children.

A combination of muscle weakness and straining, such as with heavy lifting, might contribute. Some people are born with weak abdominal muscles and may be more likely to get a hernia.

Treatment is usually surgery to repair the opening in the muscle wall. Untreated hernias can cause pain and health problems.

A little more about inguinal hernias…

An inguinal hernia is a condition in which intra-abdominal fat or part of the small intestine, also called the small bowel, bulges through a weak area in the lower abdominal muscles.

An inguinal hernia occurs in the groin—the area between the abdomen and thigh. This type of hernia is called inguinal because fat or part of the intestine slides through a weak area at the inguinal ring, the opening to the inguinal canal. An inguinal hernia appears as a bulge on one or both sides of the groin.

An inguinal hernia can occur any time from infancy to adulthood and is much more common in males than females.

The two types of inguinal hernia have different causes.

Indirect inguinal hernia

Indirect inguinal hernias are congenital hernias and are much more common in males than females because of the way males develop in the womb.

In a male fetus, the spermatic cord and both testicles—which form inside the abdomen—normally descend through the inguinal canal into the scrotum, the sac that holds the testicles. Sometimes the entrance of the inguinal canal at the inguinal ring does not close as it should just after birth, leaving a weakness in the abdominal wall.

Fat or part of the small intestine slides through the weakness into the inguinal canal, causing a hernia. In females, an indirect inguinal hernia is caused by the female organs or the small intestine sliding into the groin through a weakness in the abdominal wall.

Indirect hernias are the most common type of inguinal hernia. Premature infants are especially at risk for indirect inguinal hernias because there is less time for the inguinal canal to close.

Direct inguinal hernia

Direct inguinal hernias are caused by connective tissue degeneration of the abdominal muscles.  This  causes weakening of the muscles during the adult years. Direct inguinal hernias occur only in males.

A direct hernia develops gradually because of continuous stress on the muscles. One or more of the following factors can cause pressure on the abdominal muscles and may worsen the hernia:

• sudden twists, pulls, or muscle strains
• lifting heavy objects
• straining on the toilet because of constipation
• weight gain
• chronic coughing

Indirect and direct inguinal hernias usually slide back and forth spontaneously through the inguinal canal and can often be moved back into the abdomen with gentle massage.

Symptoms of inguinal hernia include:

• a small bulge in one or both sides of the groin that may increase in size and disappear when lying down; in males, it can present as a swollen or enlarged scrotum
• discomfort or sharp pain—especially when straining, lifting, or exercising—that improves when resting
• a feeling of weakness or pressure in the groin
• a burning, gurgling, or aching feeling at the bulge

What are “incarcerated” and “strangulated” inguinal hernias?

An incarcerated inguinal hernia is a hernia that becomes stuck in the groin or scrotum and cannot be massaged back into the abdomen.

An incarcerated hernia is caused by swelling and can lead to a strangulated hernia, in which the blood supply to the incarcerated small intestine is jeopardized.

A strangulated hernia is a serious condition and requires immediate medical attention. Symptoms of a strangulated hernia include:

• extreme tenderness and redness in the area of the bulge
• sudden pain that worsens in a short period of time
• fever
• rapid heart rate

Left untreated, nausea, vomiting, and severe infection can occur. If surgery is not performed right away, the condition can become life threatening, and the affected intestine may die. Then that portion of the intestine must be removed.

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It’s been a week since the horrific bomb blasts at the Boston Marathon.

Things are beginning to settle into what will become the “new normal” for those of us who live in the Boston metropolitan area.

Many of the victims remain in the hospital, recuperating from their injuries. Among them, however, is a 19-year-old,  Dzhokhar Tsarnaev, who, along with his older brother, 26-year-old Tamerlan, are said to be the persons who placed those bombs and are responsible for such carnage. Tamerlan was killed in nearby Watertown, MA last Friday morning in a standoff with police.

Dzhokhar lies in a hospital bed at Beth Israel Deaconess Hospital in “serious but stable condition” and under tight security. He was captured Friday night, hiding in a boat in the backyard in Watertown. The owner’s noticed some blood on his boat, peeked inside, and seeing a man called the police. After a brief standoff, Dzhokhar surrendered and was taken to the hospital by ambulance.

Although the specifics of his injury have not been revealed, it is said that he has an injury to his neck. It has not been reported whether this injury occurred in the early morning standoff with police, or whether as some have stated, that it was self-inflicted in an attempt to avoid capture.

Although originally heavily sedated, he now appears to be more alert. He is still unable to speak, although it is not clear whether this is due to the injury, or because he has a breathing tube in his trachea. He has been answering some questions by nodding and writing answers.

The Neck

The neck is a very busy place in terms of the anatomy of the area. Many vital structures pass through it. A brief review of the anatomy may be helpful as more specifics come out about Tsarnaev’s injuries.

This is a video from anatomyzone.com that shows a 3-D version of the neck. It’s a little technical, but I’ll define some of the terms the instructor is using below:

First a few words about anatomical positions:

The most obvious extremes of an organism are the “top” and the “bottom”. In human standard anatomical position, these correspond to the head and feet, respectively . The head end is referred to as the superior end  while the feet are referred to as the inferior end.

Anterior refers to the “front” of the individual,  Similarly, posterior, refers to the “back” of the subject.

Definitions:

Platysma: The platysma is a superficial muscle that lays over the sternocleidomastoid. Its anterior portion, the thickest part of the muscle, depresses the lower jaw; it also serves to draw down the lower lip and angle of the mouth in the expression of melancholy, i.e. grimacing. Here’s an example of the platysma in action (look at the expression on Robert De Niro).

Sternocleidomastoid muscle: The sternocleidomastoid muscles (SCM) are a pair muscles in the superficial layers of the front of the neck. When acting together it flexes the neck and extends the head. When acting alone it rotates to the opposite side (contralaterally) and slightly (laterally) flexes to the same side.

Clavicle: The clavicle is the collarbone and is considered part of the shoulder, connecting the arm to the body.

Anterior, and posterior triangles of the neck: Classically the neck is arbitrarily organized into anterior and posterior triangles – they are separated by the sternocleidomastoid (SCM) muscle.

Mastoid process: The mastoid process is a protruding bony area in the lower part of the skull that is located behind the ear in humans and serves as a site of muscle attachment. The mastoid process contains small air-filled cavities called mastoid cells that communicate with the middle ear.

Mandible: The mandible is the jaw bone.

Hyoid bone: The hyoid bone is a horseshoe-shaped bone. It is anchored by muscles from the anterior, posterior and inferior directions, and aids in tongue movement and swallowing. The hyoid bone provides attachment to the muscles of the floor of the mouth and the tongue above, the larynx below, and the epiglottis and pharynx behind.

Infrahyoid muscles: The infrhyoid muscles are also called the strap muscles, based on their shape.  They are a group of four pairs of muscles in the front of the neck. The infrahyoid muscles function to depress the hyoid bone and larynx during swallowing and speech.

Thyroid gland: The thyroid is a small, butterfly-shaped gland in the front of the neck below the larynx, or voice box. The thyroid gland makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.

Parathyroid glands: The parathyroid glands are small endocrine glands in the neck that produce parathyroid hormone. Humans usually have four parathyroid glands, which are usually located on the rear surface of the thyroid gland. Parathyroid glands control the amount of calcium in the blood and within the bones.

Trachea: The trachea is known by most people as the windpipe.

Larynx: The larynx, also called the voicebox, is a short passageway formed by cartilage just below the pharynx in the neck. The larynx contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the larynx to prevent food from entering the air passages. It is a tube lined with cartilage that connects the pharynx and larynx to the lungs

Carotid arteries: are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries.

Jugular veins: The jugular veins are veins that bring deoxygenated blood from the head back to the heart via the superior vena cava.

Vagus nerve: A nerve that supplies nerve fibers to the pharynx (throat), larynx (voice box), trachea (windpipe), lungs, heart, esophagus, and intestinal tract, as far as the transverse portion of the colon. The vagus nerve also brings sensory information back to the brain from the ear, tongue, pharynx, and larynx.

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Should the creators of ABC’s reality show Splash have named it Splat instead?

Maybe…  given that out of the 10 original contestants five have had injuries.

Here’s the premise:  10 celebrities will train and compete in regulation platform and springboard diving. Coached by Olympic champion Greg Louganis, the celebrity divers are critiqued by the judges, London Olympic U.S. Gold medalist David Boudia and Australian Olympic athlete and USA Dive Team director Steve Foley.

The diving celebrities include: Basketball legend, 7 foot 2 inch Kareem Abdul-Jabbar, comedian Louie Anderson (who weighed in at over 400 lbs.), Chelsea Handler’s sidekick Chuy Bravo, Nickelodeon’s Drake & Josh star Drake Bell, extreme skier Rory Bushfield, former Baywatch star Nicole Eggert, former Cosby kid “Rudy”- Keshia Knight Pulliam, defensive tackle for the Detroit Lions, Ndamukong Suh, Miss Alabama and Sports Illustrated model Katherine Webb, and former playboy model and reality show star Kendra Wilkinson.

Challenges have included doing back flips, synchronized dives and diving off the 10-meter (32.8 feet) high diving platform.

Chuy Bravo, who entered the competition not knowing how to swim, was eliminated just before Week 2, after suffering from a broken heel. He was replaced by soccer player Brandi Chastain.

Louie Anderson sustained bruised ribs during practice when attempting a back flip:

Although he continued on the show, he withdrew on Week 4 saying:

I know I have very little chance of winning this competition and I am going home, and I am going to defer to Brandi because she has a chance to win this competition.

During Week 3 extreme skier Rory Bushfield ruptured his eardrum during a practice dive. Video shows him screaming in pain as he gets out the water. Despite being told not to dive anymore by doctors, Bushfield comments:

Doctors say don’t dive, I say, “I’m going to dive,” It’s as easy as that.

Fortunately for Rory, he didn’t have to- his partner for the synchronized dive,  Kendra Wilkinson, withdrew from the competition. She was unable to get past the severe phobia of heights (acrophobia) she’d been struggling with throughout the competition. Tearfully, Kendra told the crowd:

I’m so sorry, everybody. This is the first time in my life I’ve quit something. This will haunt me for the rest of my life.

Next injured was Katherine Webb. In a video, she is seen struggling through her dives in practice. She later told viewers that doctors told her she would have to withdraw from the show due to a back injury:

I’ve had the worst time training this week because even the most simplest dives shot pain all the way from the middle of my back down my leg. I went to the doctor and unfortunately he told me I’m out for the competition.

Sounds like sciatica- the specific cause of which was not disclosed.

Former Baywatch star Nicole Eggert has also had a rough time. During Week 2 she scared viewers when her arms gave out while doing a handstand off the 5-meter platform. As she told People magazine:

I teetered on the top of it and then fell, scraped my legs and bounced off. It looks more dramatic than I can say in words. You have to see it – it scared the crap out of me. It really threw me for a loop. I was just a nervous wreck. But I did recover. I had to.

During Wednesday’s taping of the show , Nicole attempted a dive with multiple backflips but crashed into the water, back first. According to TMZ, the ‘impact looked so painful, on-site EMTs rushed in to pull the 41-year-old out of the pool .”

She was taken to a local hospital for evaluation. She was released several hours later, and Tweeted:  “Just have swelling and bruising on my back and kidney’s [sic].”

No announcement has been made yet about whether Eggert will be able to return to the show.

So, is Splash the most dangerous reality TV show competition?

Hard to say. Obviously it’s inherently dangerous to do anything off a 33 foot platform.

Check out our story about the dangers of reality TV : WARNING: Reality Shows can be Hazardous to Your Health! and let us know what YOU think.

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