On last Thursday’s episode of Grey’s Anatomy (titled “Poker Face”), new mom Mary has a brain tumor called “butterfly tumor” (or Astrocytoma) and only 6 months left to live. Meredith thinks differently and tries to change the course of Mary’s disease.

Danger Level: High

What is it?

Astrocytoma is a type of brain tumor which tends to spread inside the brain ignoring anatomical borders. That causes it to be present on both sides of the brain (and sometimes look life a butterfly – hence the name).

Who gets it?

Astrocytomas are rare – in the United States, every year there are 5.4 new cases per 100,000 people. They are a little more common in men, and most cases appear around ages 20-45.

What causes it?

Astrocytes are star-shaped brain cells located between nerve cells (astro=star, cyte=cell). They are actually part of a larger group of cells in the brain called glia cells – which support the nerve cells and glue them together.

Photo by Neurorocker

When astrocytes start dividing without control, they create a tumor called astrocytoma. These tumors come in different grades (1 to 4) – low grade tumors are slow-growing while high-grade tumors can be very aggressive (on the Grey’s Anatomy episode, Mary had a grade-4 tumor which is the most aggressive type).

The reason for astrocytoma is unknown, but scientists have found that it can be related to radiation to the head at young age, and there are several genes that are also related to this tumor.

How does it feel?

The symptoms of astrocytoma are related to its location – almost any neurological symptom is possible, including changes in mental status, seizures, and movement or sensory problems. These symptoms appear because the tumor puts pressure on brain tissue or ruins it while growing. Symptoms like these are called focal neurological symptoms.

Besides that, astrocytoma (and any other brain tumor) can increase the pressure inside the skull (called intra-cranial pressure) – this causes symptoms like headaches, nausea and vomiting as well as decreased alertness.

How is it discovered?

When someone comes to the doctor with the symptoms described above, the doctor will order a scan – a CT or an MRI (MRI is the best option). Sometimes doctors can guess the type of the tumor according to the way it looks on MRI – but final diagnosis can be made only when checking the tumor under a microscope after it’s removed in surgery.

This is a part of a brain with a grade 4 astrocytoma which spread to both sides of the brain.

How is it treated?

Aggressive astyrocytomas are treated with surgery to remove the tumor, radiation and chemotherapy. Steroids sometimes help with the symptoms, and so do anti-epileptic drugs (for patients with seizures).

What happens after treatment?

Even with treatment, astrocytoma can be deadly. Patients with low-grade tumors can survive for an average of 6-8 years, but with high-grade aggressive disease, average survival is less that 1 year.

The story of Jodi Fenton who recovered from grade-3 astrocytoma

The bottom line – how do I avoid it

Unfortunately, there is no known way to avoid astrocytoma.

Related posts:

1. As Seen on Grey’s Anatomy – Tay-Sachs Disease – Fat Accumulating in The Brain
2. Nesidioblastoma – A Tumor of the Pancreas That Can Secrete Hormones (As Seen on House MD)
3. As Seen on Grey’s Anatomy – Normal Pressure Hydrocephalus (NPH)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!) On episode 3 of season 8 (named “Charity Case”), altruist millionaire Benjamin Byrd collapses in the street right after he donated a large sum of money to another foundation. The team argues wether his altruism is a symptom or not, and meanwhile he develops tachycardia (fast heartbeat) and his hands are shaking. When he offers to donate both his kidneys the presence of mental symptoms is obvious, and when understanding that his symptoms got worse after he received contrast media containing iodine, he is diagnosed with Plummer’s Disease. .

Danger level: Low

What is it?

In Plummer’s Disease (also known as Toxic Nodular Goiter), an area in the thyroid gland works with no control, and causes a state called hyperthyroidism – too much thyroid hormone in the blood.

Who gets it?

The disease is responsible for 15-30% of the hyperthyroidism cases. It usually develops in adults older than 50, and is more common in women. The disease is also more common in areas of the world where iodine deficiency is common.

What causes it?

As explained before about another disease which causes hyperthyroidism (Graves Disease), the thyroid gland normally produces thyroid hormone in response to a molecule called TSH that comes from the brain. In Plummer’s disease, an area in the thyroid gland (a nodule) starts producing thyroid hormone independently – without TSH. Such nodules are called toxic nodules – there is also such thing as non-toxic nodules, which don’t produce thyroid hormone or any other substance.

The disease is related to exposure to iodine (which is an important factor in the function of the thyroid gland).

How does it feel?

Plummer’s disease can cause symptoms that are related to hyperthyroidism and symptoms that are related to the presence of the nodules themselves.

• Hyperthyroidism can cause weight loss with increased appetite, frequent bowel movements, tremor, intolerance to heat, heart palpitations and a fast heart beat (tachycardia), hyperactivity and irritability and muscle weakness.
• If the nodule is large enough, you can see an enlargement of the gland called goiter, that looks like this:

This is a very large goiter (very rare today).

• Also, when the nodule is very large, it may compress other organs in the neck and cause problems with breathing and swallowing, and sometimes also hoarseness or voice changes.

How is it discovered?

First, the doctor will want to check if the level of thyroid hormone in the blood is high. This can be done by testing the levels of the hormone itself and also by checking the levels of TSH (which will be low).

Ultrasound of the thyroid gland can help recognize nodules in the thyroid (which look like balls in different sizes), and another test called thyroid scan can differentiate between toxic and non-toxic nodules. Sometimes the doctor will want to take a biopsy from the nodule to make sure that it’s not cancer.

How is it treated?

There are two ways to treat Plummer’s disease – the first one is to remove the toxic nodule in surgery (like on the House episode), and the second is to use radioactive iodine that is injected to the bloodstream, concentrates in the nodule and destroys it.

What happens after treatment?

Treatment usually cures the disease, but even when untreated the disease is usually not life threatening (though it’s not very pleasant to live with).

The bottom line – how do I avoid it?

Most of the time there is no specific way to prevent the disease. People with low levels of iodine in their blood are at risk for the disease, so it’s important to consume enough iodine in the diet. In the United States iodine is added to table salt and other foods so iodine deficiency in the diet is very rare.

Related posts:

1. Graves Disease – Why Some People Are Hyperactive For A Reason
2. Appendicitis – A Small Part of The Intestine That Can Cause Big Trouble
3. Hashimoto’s Thyroiditis – Do You Suffer From Weight Gain, Fatigue or Hair Loss? This Might Just Be The Cause

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!) On episode 2 of season 8 (named “Transplant”), House treats the lungs of an 18-years old man who died in a motorcycle accident. The lungs were donated and planned to be transplanted in one of Wilson’s patients, but went bad just before the transplant, and House’s job was to find out what’s wrong with them. After ruling out cocaine abuse, a tumor in another organ (which affected the lungs) and even peanut allergy and heavy metal poisoning, House and his new and only team member find white blood cells in the lungs, and then diagnose the lungs with eosinophylic pneumonia

Photo by fox

Photo by FOX

Danger level: Medium

What is it?

Eosinophilic pneumonia is a group of diseases in which eosinophils (a type of white blood cells that are responsible for the body’s response in allergies and infections by parasites) accumulate in the lungs and interfere with their function.

Who gets it?

The disease isn’t common, but exactly how rare it is isn’t known. Different diseases in this group can be more common in men or women, and most of them develop in adults (usually not in elderly people).

What causes it?
Eosinophils are cells in our immune system that are active during allergic reactions and parasitic infections. When activated, eosinophils secrete chemicals that can cause inflammation. In people with eosinophilic pneumonia, eosinophils accumulate in the lung, are activated and secrete the chemicals – this causes the symptoms of the disease.
There are many causes for eosinophilic pneumonia. Some cases develop after the person is exposed to something outside the body – certain foods, drugs or even smoke (like in the House episode). Infections by parasites can also cause eosinophilic pneumonia. In other cases, the disease is related to changes inside the body – for example, it can be associated with another disease process. In some cases the reason for the disease is unknown.

An eosinophil, as seen under a microscope. Photo by Akay Miller

How does it feel?

The symptoms can be mild or severe, and include cough, wheezing and shortness of breath. When the disease is severe, it can cause the rate of oxygen in the blood to decrease and sometimes respiratory failure develops.

How is it discovered?

The doctor will suspect eosinophilic pneumonia if symptoms appeared shortly after exposure to foods or drugs that can cause the disease. Tests are performed to approve the diagnosis: blood tests to search for an elevated number of eosinophils in the blood; chest x-ray to see signs of pneumonia, and microscopic examination of lung secretions to search for eosinophils there as well.

How is it treated?

Usually, eosinophilic pneumonia is treated with steroids. If the disease appeared after exposure to foods or drugs – avoiding them will help with recovery, and if the disease is due to a parasitic infection – antibiotics are required.

What happens after treatment?

Most cases respond to medications (or even get better without treatment at all), but sometimes there’s severe lung failure which can be life threatening.

The bottom line – how do I avoid it?

If the disease appeared after exposure to a certain food or drug, avoiding them may prevent the disease from recurring. Also, people who had an attack of the disease should seek medical help right away if symptoms come back.

Related posts:

1. Your Questions Answered – Asbestosis – What Work Exposure Can Do To Your Lungs
2. Pleural Mesothelioma – Cancer of The Lungs Caused by Exposure to Asbestos
3. Deep Vein Thrombosis – Clots in Your Veins Which Can Travel To Your Heart and Lungs

In September 2009 actor Patrick Swayze passed away due to pancreatic cancer. This week Steve Jobs has lost the battle to the disease.

You can read about this horrible cancer in our original post.

Here are some updated statistics you should know about -

• Each year, more than 43,000 people are diagnosed with this cancer in the United States alone.
• 37,660 people have died of pancreatic cancer since the beginning of the year.
• Smoking is the most important risk factor for pancreatic cancer. Smokers are more likely to develop this cancer, while heavy smokers are at an even higher risk.
• Jaundice (yellowing of the skin, dark urine and pale stools) may be a sign of pancreatic cancer. Also abdominal pain may be one of the first signs.
• It’s usually discovered too late, which is one of the reasons so many people die of it
• If the cancer can’t be removed by surgery, survival may last for only 4-6 months.

Haiku by Andrew Forgrave

The Lustgarten foundation was established to advance the scientific and medical research related to the diagnosis, treatment, cure and prevention of pancreatic cancer. You can make a donation to help prevent further deaths from this disease.

Related posts:

1. In The News – Pancreatic Cancer – The 4th Leading Cause of Death
2. Swine Flu – 7 New Facts
3. The Most Popular Posts in September

After this fall’s allergy season (which is expected to be longer and stronger than usual), the winter will start and most of us will probably start spending more time at home. We expect the winter to be allergy-free, but those of us who are prone to allergies might continue sneezing and itching during the winter.

AllergyBeGone.com have created an infographic about the things indoors that can cause annoying allergy symptoms to continue during the winter, and how we can avoid them. For example:

It also explains in general about allergies:

You can see the entire infographic here:

Allergy Be Gone – 7 Allergens In Your Home That You Didn’t Know About

Related posts:

1. 8 Home Remedies for Summer’s Problems
2. Which Supplements Are Good for You? An Infographic
3. How Much Caffeine Are You Drinking? (Infographic)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)

On the first episode of season 8 (named “Twenty Vicodin”, and featuring an interesting guest in the cast!), House is in prison after crashing his car into Cuddy’s living room. One of the prisoners has a fever, joint pain and a rash on his thigh, and House convinces the prison’s doctor that he has lupus. Later, after the prisoner breaks his arm from a minor hit and doesn’t stop bleeding from a small cut, House listens to his chest and discovers an “acoustic shadow”, meaning there is a mass in his lungs. After drinking some coffee the prisoner develops a severe allergic reaction (anaphylaxis) which causes his airway to swell up and almost kills him. House then realizes that the reason for the reaction was the high temperature of the coffee and diagnoses him with mastocytosis

Photo by fox

Danger level: Medium

What is it?

Our immune system is composed of many types of cells and partןcles. Mast cells belong to the immune system and are involved mostly in allergic reactions. These cells produce substances that cause some of the allergy symptoms, the most famous of them is histamine. In systemic mastocytosis  the amount of these mast cells increases significantly, causing the disease.

This is how a mast cell looks. Photo by Ed Uthman

Who gets it?

Systemic mastocytosis is an extremely rare disease – so rare that it’s frequency in the population is not known. It’s a bit more common in men than women, and appears mostly in children, though it may happen to adults (and then the most common age is 55).

What causes it?

The disease develops when a mast cell starts dividing uncontrollably (like in cancer). Since the mast cells keep dividing, there are too many of them – and they can form a tumor, circulate in the blood or accumulate in organs. Also, substances that mast cells produce like histamine are released in larger amounts than usually. All these processes can cause symptoms.

How does it feel?

Symptoms can appear in any organ where mast cells accumulate. This can cause skin rashes, bone pain and problems with the liver, spleen or bone marrow.

Substances that are produced in mast cells and released in large amounts (like histamine) can cause itching, flushing and symptoms in the digestive system (for example: abdominal pain, diarrhea, peptic ulcers and problems with the absorption of food).

Another important symptom is severe allergic reactions (also called anaphylaxis) which can be dangerous and cause difficulty breathing or a very low blood pressure. The most severe allergic reaction in mastocytosis is to bee stings.

In some cases flushing and low blood pressure can develop in response to certain drugs against inflammation (like in the “aspirin test” at the end of the episode), and any symptom can be worsened by these drugs, alcohol or narcotics.

Mastocytosis in toddlers

How is it discovered?

The doctor can suspect mastocytosis based on the symptoms and blood work, but the only definitive test is a bone marrow biopsy, in which a bone sample is taken from the lower back. An important test which can support the diagnosis before performing the biopsy is measuring the levels of histamine in the blood or urine.

How is it treated?

There is no cure for mastocytosis. Treatment is aimed at reducing symptoms, and this is done mostly by different types of pills (for example, anti-histamines which are usually used for allergies).

What happens after treatment?

There are different types of mastocytosis which are dangerous in different levels. In some cases patients have the same life expectancy as the normal population, but in the more violent types (which are, luckily, more rare) patients survive for several months only.

The bottom line – how do I avoid it?

Unfortunately, there is no known way to avoid mastocytosis.

Related posts:

1. Sickle Cell Disease – When the Shape of Your Blood Cells Can Kill You (As Seen On House MD)
2. Astrocytoma (Butterfly Tumor)–A Brain Tumor That Spreads To Both Sides (As Seen On Grey’s Anatomy)
3. Pheochromocytoma – A Rare Tumor That Can Cause Hypertension (As Seen on House MD)

A Disease A Day is mostly about diseases. Each disease can be discovered in different ways. Some only require the doctor to check you up, while others also entail taking images of your body through various machines. One of those is the MRI machine.

Almost anyone has at least heard the name of the machine. Some of you may have even been scanned by it. But knowing how it works? That’s a completely different story.

A new infographic was published that explains just that. For example, it explains what MRI can be used for:

For the more technical-minded, it also explains the inner workings of the machine:

You can see the entire infographic here:

Visualization in Medicine – How MRI Scans Work

Related posts:

1. Your Questions Answered – Asbestosis – What Work Exposure Can Do To Your Lungs
2. 7 Allergens In Your Home That You Didn’t Know About [Infographic]
3. Which Supplements Are Good for You? An Infographic

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)

Photo by Fox

Photo by Fox

Danger level: Medium

What is it

Syringomyelia is damage to the spinal cord caused by a fluid-filled area (a cyst, which is called a syrinx). The syrinx usually appears first in the neck, and later extends upwards or downwards – putting pressure on other areas of the spinal cord.

Who gets it

Syringomyelia is not common – the frequency in the US is 8.4 cases per 100,000 people. The disease usually appears around the ages of 20-40, and men get it more than women.

What causes it

The fluid inside the syrinx is called Cerebro-Spinal Fluid (CSF) – this fluid can be found normally around and inside the brain and spinal cord. A syrinx is formed when there is a problem with the circulation of this fluid so there’s too much of it in a specific area inside the spinal cord. This might happen for several reasons, including birth defects (which are the most common reason), trauma to the spinal cord (like in the House episode), a tumor in the spine or inflammation of the spine.

How does it feel

The symptoms usually develop slowly and appear gradually:

• Muscle problems, including muscle weakness in the arms and legs, loss of muscle mass and contractions or  muscle-spasm in the legs.
• Sensory problems – decreased sensations (of pain, temperature and touch), numbness or pain. These problems are more common in the neck, shoulders, arms and trunk (a “cape-like” pattern).
• Headaches.
• Problems with bowel and bladder function.

How is it discovered

If you have symptoms of syringomyelia, the doctors will start with a neurological exam (checking muscle strength and sensation) which will help them to estimate where the problem which causes the symptoms is located. In order to prove that there is a syrinx and show it, the doctor will perform an MRI of the spinal cord.

An MRI of syringomyelia. The syrinx is the white area inside the gray spinal cord. Photo by Cyborg Ninja

How is it treated

When there are symptoms, the treatment is surgery to drain the fluid from the syrinx. Sometimes a tube is inserted for continuous draining. After surgery, physiotherapy can help restoring function in the damaged muscles. If there are no symptoms, treatment is not necessary.

What happens after treatment

The surgery stops the progression of the syrinx so new symptoms will not appear. Also, about half of the patients report significant improvement in the symptoms they had.

Without treatment the disease gets worse and worse and eventually causes severe disabilities.

The bottom line – how do I avoid it

There is no way to prevent syringomyelia – the most important thing is to catch it on time before the symptoms cause disabilities.

Related posts:

1. As Seen on Grey’s Anatomy – Tethered Spinal Cord Syndrome
2. As Seen on Grey’s Anatomy – Normal Pressure Hydrocephalus (NPH)
3. Teratoma–When You Can Find Teeth and Hair Inside Your Body (As Seen on House MD)

We usually go to the doctor when we don’t feel well or have a symptom that bothers us – and that’s how diseases are discovered most of the time. But – some diseases can be detected before having any symptoms, when they’re on their early stage. Screening tests are meant just for that and  are one of the best ways to protect your health – they are generally simple, performed routinely and can detect serious illnesses. Here ‘s a list of 10 important screening tests that you should know and consider taking.

Photo by Chandra Marsono

1. Colon Cancer Screening: Every person over 50 years old (or younger if a close relative had colon cancer, if they have IBD, or if they have certain genetic syndromes) should have colorectal cancer screening. The screening tests are aimed to find growths inside your colon, called polyps. Polyps have the potential to become cancer – but if detected early, they can be removed, preventing cancer. There are several ways to find polyps:

• Fecal occult blood (recommended once a year) is a simple stool test in which the feces is searched for small amounts of blood (that comes from polyps) which you can’t see on your own.
• During flexible sigmoidoscopy (recommended every 5 years) a short lighted tube is inserted to your rectum and looks for polyps on the lower third of your colon. During this procedure, polyps can also be removed.
• Colonoscopy (recommended every 10 years) is a similar test using a longer tube which can reach the whole length of your colon.

2. Mammography: A mammogram is a used for early detection of breast cancer – which is the most common cancer in women. This is an x-ray of the breasts, which can discover cancer when it’s still too small to feel it on your own. The test is recommended for all women between the ages of 50 to 74, and should be performed every 2 years. Besides that, it’s recommended for all women to have self-exams and clinical exams (by a doctor) of the breasts regularly.

On the left – a normal breast in mammography. On the right – a breast with breast cancer (white). Photo by National Cancer Institute.

3. Mole Exam: In this exam a dermatologist looks at your moles to see if any of them is suspicious to be skin cancer or melanoma. it’s recommended to have this check-up once a year. Besides that, you should try a self check-up every month – look for moles which are asymmetric, don’t have sharp borders, don’t have a constant color or are larger than 6mm (about a quarter of an inch).

4. Pap smear: This is a screening test for cervical cancer – the cervix is lower part of the uterus in women, and can be reached in a vaginal exam. It’s a simple test which is performed in your gynecologist’s office. During the usual gynecologic exam, the doctor will collect some cells from your uterine cervix and the area around it. Later these cells are check under a microscope and pre-cancer cells will be looked for. These cells can be also checked for a virus called HPV which causes cervical cancer. This test is performed once a year after the age of 21 or 3 years after the first time you have sex (whichever comes earlier).

5. Prostate cancer screening: The prostate is an organ that exists only in men. It’s small (about the size of a walnut), located under the bladder and in front of the rectum, and produces part of the semen fluids. Prostate cancer is the most common cancer in men. There are two screening tests for this cancer: a PSA test is a simple blood test to measure the levels of a substance called Prostate specific antigen (PSA) – which will be high in prostate cancer. Another important test is a digital rectal exam – this is done in your doctor’s office – the doctor inserts a finger to your rectum and feels the size and shape of the prostate. Currently there isn’t enough evidence supporting routine testing for prostate cancer, but you can ask your doctor if you should do one of the tests yourself.

6. Bone Density: The purpose of this test is to diagnose osteoporosis – a condition common in older people (mostly women) in which bones become thin and weakened, which makes them susceptible to fractures. This is a special x-ray picture which measures the density of bones in your hips, spine and wrists. Routine screening is recommended for women older than 65 years old.

7. HIV Test: HIV is the virus causing AIDS (Acquired Immunodeficiency Syndrome), which makes your body susceptible to life-threatening infections. It can be transmitted by having unprotected sex or sharing needles with someone who has the disease. The United States Center for Disease Control and Prevention (CDC) recommends that everyone get tested at least once in their life, and afterwards at least once a year if they had new sex partners since the last test (or their partner had sex with someone else), or if they are injecting drugs or steroids with used injection equipment.

8. Abdominal Ultrasound: This test’s purpose is to look for an aortic aneurysm. This is a dilatation of an artery so it looks like a balloon, causing the wall of the artery to become thinner so it might rupture. A common place for such an aneurysm is the abdominal aorta, which is a part of the largest artery in the body – you don’t want this one to rupture. A simple ultrasound test can discover an aneurysm. In the United States, this screening test is recommended for men between ages 65-75 who smoked in the past (or still are) or men above 60 years old with a family history of an aortic aneurysm. This test should be performed only once.

Photo by National Heart, Lung and Blood Institute

8. Abdominal Ultrasound: This test’s purpose is to look for an aortic aneurism. An aneurism is a dilatation of an artery so it looks like a balloon. This causes the wall of the artery to become thinner so it might rupture. A common place for such an aneurism is the abdominal aorta, which is a part of the largest artery in the body – you don’t want this one to rupture. With a simple ultrasound test (which can produce images of your abdomen without any radiation), the doctor can see if there is an aneurism. Sometimes the treatment for that will be surgery. In the United States, this screening test is recommended for men between ages 65-75 who smoked in the past (or still are) or men above 60 years old with a family history of an aortic aneurism. This test should be performed only once.

9. Routine blood tests: You should have a routine blood test once a year. This includes complete blood count (CBC) to check for anemia, fasting glucose levels – which is a screening test for diabetes, and cholesterol levels – high cholesterol raises the risk for heart diseases (and treating it can prevent them).

10. Routine Check-Up with your family doctor: It’s important to visit your family doctor at least once a year when you’re healthy. They will perform a physical exam, measure your blood pressure (high blood pressure doesn’t cause any symptoms but can be dangerous in the long run) and do an EKG (which is a test that checks the activity of your heart) – to look for various heart diseases. This is also a good opportunity to tell the doctor about symptoms or problems that bother you.

Here’s a summary of screening tests mentioned in the article. Find the ones that apply to you and make your appointment today.

Related posts:

1. Common Variable Immunodeficiency (CVID)–When a Cold Can Threaten Your Life (As Seen on House MD)
2. Crohn’s Disease – Inflammation in The Intestines Which Can Influence Your Whole Life

Even though most Americans (and most of the modern world) are vaccinated, there is an ongoing debate on whether vaccinations can do harm as well. Mind you, you won’t hear this debate in hospital corridors – most, if not all, doctors believe in the necessity of vaccines. Still, there are children who don’t get vaccinated – either because their parents believe it can lead to problems such as autism, or because they don’t have access to vaccines.

The folks at Medical Coding Career Guide have created an infographic summing up the debate, and basically all you ever wanted to know about vaccinations.

For example – Did you know that before vaccinations for pertussis started, 9000 people died of it each year?

Or that the original study that claimed that autism is linked to the MMR vaccine was actually retracted later by the very same journal that published it?

You can follow the link below for the rest of the infographic.

The Great Vaccination Debate [Medical Coding Career Guide]

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2. How Much Caffeine Are You Drinking? (Infographic)
3. All You Wanted To Know About Sleep [Infographic]