Introduction
Acne, commonly referred to as pimples, blemishes, and zits, is a common skin condition that most people experience at some point in life, most often as teenagers. Acne results when tiny openings in the skin become plugged. Acne is treated with self-care measures, over-the-counter products, or professional medications from a doctor.

Anatomy
The skin has numerous small openings that contain hair follicles and sebaceous glands. An oily substance (sebum) is produced by the sebaceous glands. The sebum rises to the skin’s surface to moisturize the outer skin layer.

Causes
Acne is a common condition that the majority of people experience. Acne develops when sebum and dead skin cells collect and plug a hair follicle. Trapped bacteria multiply, leading to redness, swelling, and pus-filled bumps on the skin.

Symptoms
Adolescents and adults can develop acne on the face, shoulders, back, buttocks, and chest– places where oil glands are most active. Acne appears as inflamed bumps on the skin.

There are a few types of acne:

Blackhead
A blackhead is a clogged follicle that remains open with a darkened surface.

Whitehead
A whitehead is a clogged follicle that remains closed, producing a white bump on the skin.

Pimple
A pimple results from inflammation that has moved under the skin. A pimple can appear as a raised red bump or a raised red bump with a pus-filled top.

Cyst
Cysts are infections that occur deep within the hair follicle. A cyst feels like a lump beneath the skin. Cysts can be large and painful.

Diagnosis
A diagnoses of acne is made by a doctor based on the appearance of the skin. Additional tests are usually not necessary. In some cases, a cyst sample is examined to rule out a more serious staph infection.

Treatment
There are many self-care measures to take to manage acne. You should never try to squeeze or “pop” a pimple because it can lead to skin infection and scars. Clean your face by gently washing it with a mild soap once or twice a day. Avoid excessive cleansing or touching your face with your hands. Avoid greasy or oily creams or make-up. There are numerous over-the-counter blemish products to apply directly to the skin. Such products contain medications, such as benzoyl peroxide, sulfur, resorcinol or salicylic acid that fight bacteria and dry the skin.

Am I at Risk
Acne develops most frequently in teenagers because of hormonal changes, although acne can occur at any age. Females may develop acne in association with their menstrual period or birth control related hormonal changes. Other risk factors for acne include:
Pregnancy
Heredity. If your parents had acne, you have a higher risk of developing the skin condition.
Skin Friction
Oily products (cosmetics) applied to the skin
Certain medications, such as steroids, birth control pills, or testosterone
Significant sweating and humidity
Complications
Significant acne can lead to scarring. For some people, acne can contribute to poor self-esteem.

Introduction
Acute stress disorder is a type of anxiety disorder that develops in some people that witness or experience a horrifying life-threatening event. Acute stress disorder causes an assortment of symptoms including re-living the event through memories and nightmares and feeling emotionally numb or dazed. The symptoms are similar to posttraumatic stress disorder, but last less than a month and develop during or soon after a traumatic event. Acute stress disorder can be treated with therapy, medications, or both. Untreated acute stress disorder can lead to posttraumatic stress disorder.

Causes
The exact cause of acute stress disorder is unknown. The condition tends to develop in some people who are exposed to a traumatic event. Research indicates that people may or may not have predisposing factors that make them more likely to develop acute stress disorder. Acute stress disorder results in some people that experience, are threatened with, witness, or learn of an extremely horrific event. The event may threaten their life or the life of others. Such events include abuse, sexual assault, torture, crime, war, terrorism, disasters, and accidents. The severity, proximity, and duration of the event and a history of prior trauma can influence the likelihood of an individual developing acute stress disorder.

Symptoms
The symptoms of acute stress disorder may develop during or within a month of an extremely traumatic event. The symptoms may last from two days to up to four weeks. If the symptoms last longer than four weeks, the diagnosis of post traumatic stress disorder may be considered.

A symptom of acute stress disorder is a symptom called dissociation. This term refers to feeling a lack of emotions or emotionally numb, detached from reality, dazed, or “tuned out.” Acute stress disorder can cause you to re-live the event in repeated memories, nightmares, or “flashbacks” that seem very real. A flashback is a term for the sudden unexpected replaying of very vivid memories. You may avoid places, smells, people, sounds, or situations that remind you of the event. You may feel anxious and distressed at times when there is no actual threat. You may experience other symptoms that are similar to those of post traumatic stress disorder. Your symptoms may disrupt your ability to complete every day tasks and interfere with your job, school, or social life.

Some people with acute stress disorder feel severe feelings of hopelessness and despair and may develop a major depressive episode. It is also common for people with untreated acute stress disorder to have continued symptoms that lead to the diagnosis of post traumatic stress disorder. Therefore, it is very important to seek diagnosis and treatment if you develop symptoms.

Diagnosis
A psychiatrist can begin to diagnose acute stress disorder after reviewing your medical history and symptoms. You should tell your doctor about the traumatic event and the symptoms that you have experienced. Your doctor will listen to your concerns and gather more information from you by asking you questions or using a structured assessment. Your doctor will determine if your symptoms meet the diagnostic criteria for acute stress disorder and any other co-existing conditions.

Treatment
Treatment for acute stress disorder can include therapy, medication, or both. Cognitive-behavioral therapy can be a very successful treatment for acute stress disorder. Cognitive-behavioral therapy can help identify thoughts that cause worry or anxiety and strategies to deal with them. It is also helpful for preventing post traumatic stress disorder.

Introduction
Anal cancer is an uncommon type of cancer. It results when cells in the anus grow abnormally and out of control. The anus is the opening at the end of the rectum through which waste products pass when you have a bowel movement. Treatment for anal cancer may include radiation, chemotherapy, surgery or a combination of treatments. Anal cancer that is diagnosed and treated early is associated with the best outcomes.

Anatomy
The first part of the colon absorbs water and nutrients from the waste products that come from the small intestine. As the colon absorbs water from the waste product, the product becomes more solid and forms a stool or feces. The large intestine moves the stool through the large intestine into the sigmoid colon, where it may be stored before traveling to the rectum. The rectum is the final 6-inch section of your large intestine which stores stool. No significant nutrient absorption occurs in the rectum or anal canal. From the rectum, the stool moves through the anal canal. It passes out of your body through your anus when you have a bowel movement.

Causes
Anal cancer occurs when the cells in the anus grow abnormally and out of control instead of dividing and replicating in an orderly manner. There are several different types of anal cancer cells. People that have the human papillomavirus (HPV), the sexually transmitted disease that causes genital warts, may have a higher risk if they have a version of the virus called HPV-16. People that have many sex partners, participate in anal sex, smoke, and have HIV, AIDS, or are immune compromised have a higher risk of developing anal cancer.

Anal cancer is fairly rare in the United States. It most frequently affects people at an average age of about 60 years old. Anal cancer is more common in women than men. Most people that are diagnosed and treated with anal cancer early may be cured. However, anal cancer is a serious condition and can cause death.

Symptoms
In some cases, anal cancer does not cause symptoms at all. In the majority of cases with symptoms, bleeding is one of the first signs. Anal cancer may also cause pain and lumps in the anal area. Your anal area may itch. You may have abnormal anal discharge. The diameter of your stools may change size. The lymph nodes in your anal and groin areas may be swollen.

Diagnosis
You should contact your doctor if you experience the symptoms of anal cancer. There are several other conditions with similar symptoms, and it is important to see your doctor to receive a diagnosis. Anal cancer that is detected and treated early is associated with the best outcomes. The American Cancer Society suggests that women receive a rectal examination as part of their annual exams, and that men receive an annual rectal exam after the age of 50. People at high risk for anal cancer may be tested at a younger age or more frequently.

Your doctor will review your medical history. It is important to tell your doctor about your risk factors and symptoms. Your doctor will conduct a rectal examination to detect abnormal masses or growths. Your doctor may use other evaluations to help diagnose your condition.

An endoscopy may be used to view the tissues inside of your anus. An anoscopy or a rigid proctosigmoidoscopy are types of endoscopies that may be used. An anoscopy involves placing an anoscope, a short thin tube with a light and viewing instrument, into the anus to allow your doctor to look for abnormalities. A rigid proctosigmoidoscopy is similar to an anoscope, but it is longer and allows your doctor to view more of the colon.

A biopsy may be obtained to test suspicious growths for cancer cells. There are several types of biopsy methods. Your doctor may use a fine needle aspiration to obtain cells or fluid through a fine needle. Your doctor may perform a sentinel lymph node biopsy if he or she suspects that your cancer has spread. A new method of sentinel lymph node biopsy uses an injection of a radioactive blue dye that highlights cancerous areas. A doctor will remove the blue stained areas and have biopsies performed on the cells.

Imaging tests may be used to show how far cancer has spread. Imaging tests may include ultrasound, computed tomography (CT) scans, chest X-rays, positron emission tomography (PET) scans, and magnetic resonance imaging (MRI) scans. These tests simply require that you remain motionless while the images are taken.

If you have anal cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests. Staging describes the cancer and how it has metastasized. Staging is helpful for treatment planning and recovery prediction.

There is more than one type of staging system for cancer, and you should make sure that you and your doctor are referring to the same one. Generally, lower numbers in a classification system indicate a less serious cancer, and higher numbers indicate a more serious cancer. The stages may be subdivided into grades or classifications that use letters and numbers.

Treatment
The type of treatment that you receive for anal cancer may depend on several factors including the stage and type of the cancer that you have. The goals of treatment may be to cure the cancer, prevent the cancer from spreading, prevent the cancer from returning, and to relieve symptoms. Anal cancer may be treated with radiation therapy, chemotherapy, and surgery, or a combination of therapy types. It is common to receive at least two types of treatment.

Radiation therapy uses high-energy rays to destroy cancer cells and shrink tumors. It may be used before a surgery to shrink a tumor to make it easier to be removed. External radiation or internal radiation therapy may be used to treat anal cancer. External radiation delivers radiation from an external source, a machine. External radiation typically uses treatments 5 days per week for about 6 weeks. Internal radiation therapy, brachytherapy, involves implanting radioactive seed pellets in or near the cancer. The seeds deliver a slow dose of radiation. You may receive external radiation, internal radiation, or both.

Chemotherapy uses cancer fighting drugs or combinations of drugs to kill cancer cells. You may receive chemotherapy in the form of pills or they may be injected through a needle. Chemotherapy may be used in combination with radiation therapy or after surgery to destroy any remaining cancer cells.

There are several types of surgery for anal cancer. The type of surgery that you have may depend on several factors, including your general health, the size of your tumor, and the location of the tumor. A local resection is a procedure that is used to remove the cancer and the tissue around it. A local resection usually leaves the anus sphincter intact, and following surgery you will be able to have bowel movements.

An abdominoperineal resection (APR) may be used for cancer that has spread. This surgery involves removing the anus and part of the rectum. You will need a colostomy. A colostomy, a bag worn on the outside of the body to collect waste products, is necessary because you will not be able to have bowel movements following an APR. This surgery is not very common today because most people can be treated with a combination of radiation and chemotherapy.

Even with treatment, some cases of anal cancer may return. This is termed “recurrent anal cancer.” Your doctor can explain your risk for anal cancer and possible treatments if it does recur.

The experience of anal cancer and cancer treatments can be an emotional process for people with cancer and their loved ones. It is important that you receive support from a positive source. Some people find comfort in their family, friends, counselors, co-workers, and faith. Cancer support groups are another good option. They can be a source of information and support from people who understand what you are experiencing. Ask your doctor for cancer support group locations in your area.

Prevention
The American Cancer Society recommends anal cancer screening as part of a woman’s annual examination. Men should be screened for anal cancer every year when they reach the age of 50.

Lifestyle changes may help to prevent anal cancer. It can be helpful to quit smoking. If you have difficulty doing this yourself, ask your doctor for recommendations and resources that may help you.

If you do not have HPV, abstinence, not having sexual contact with another person, is the leading way to prevent HPV. Couples considering sexual relations should be tested for sexually transmitted diseases before beginning sexual contact. It is helpful to stay in a monogamous relationship with a person that you know has been tested and is HPV negative. A monogamous relationship means that you and your partner only have sexual contact with each other. If your partner has HPV, you may reduce the risk of transmission with condoms, but this is not a guarantee. You may prevent the spread of HPV and reduce your risk of anal cancer by not participating in anal sex.

Am I at Risk
Risk factors may increase your likelihood of developing anal cancer, although some people that develop anal cancer do not have any risk factors. People with all of the risk factors may never develop the disease; however, the chance of developing anal cancer increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for anal cancer:

_____ People that have the HPV-16 subtype of the human papilloma virus (HPV), the sexually transmitted disease that causes genital warts, have an increased risk of developing anal cancer.
_____ Smoking increases the risk of anal cancer.
_____ People with multiple sex partners and those that participate in anal sex have an increased risk for anal cancer.
_____ People with HIV, AIDS, or a compromised immune system are at increased risk for anal cancer.

Complications
Anal cancer may spread to the lymph nodes or recur after treatment. Although most cases of anal cancer that are detected and treated early are curable, anal cancer is a serious condition that can result in death.

Introduction
Anaphylaxis is a potentially life-threatening allergic reaction with rapid onset of symptoms. Anaphylaxis usually occurs in people after they are exposed to a substance they are severely allergic to such as foods, medications, and insect stings. It has been estimated that up to 15% of the population is at risk for anaphylaxis. If you or someone near you experiences anaphylaxis, call 911 or seek emergency medical care. Check to see if the person carries an epinephrine (adrenalin) shot (EpiPen, Twinject) and inject it into the thigh immediately. To save time, the shot can be injected through clothing. The person should still receive medical care immediately even if he or she received a shot.

Anatomy
Your immune system usually fights germs to keep you healthy. If you have allergies, your immune system overreacts to fight ordinary substances that normally are not harmful, such as pollen or certain foods. The substances that trigger an allergic reaction are called allergens.

When you are exposed to an allergen, your white blood cells produce antibodies. The antibodies trigger the release of histamine and other chemicals in your blood called mediators. The mediators cause the symptoms of an allergic reaction. The majority of allergic reactions are not life threatening.

Causes
Certain medications, food and insect stings most frequently cause anaphylaxis, especially penicillin, non-steroid anti-inflammatory drugs (NSAIDS), peanuts, tree nuts, milk, eggs, and shellfish. Insect stings from bees, yellow jackets, wasps, hornets, and fire ants are a common cause of anaphylaxis. Intravenous contrast dye used in radiology imaging, muscle relaxants used in anesthesia, and latex are also common causes of anaphylaxis and anaphylactic shock.

Exercise can cause anaphylaxis. The type of exercise that causes a reaction differs among people. Aerobic exercise; exercising in cold, hot, or humid temperatures; eating before exercising; or just general activity can cause anaphylaxis. In some cases, the cause is unknown (idiopathic anaphylaxis).

Symptoms
Symptoms of anaphylaxis usually develop within seconds or minutes of contact with an allergen; although on rare occasion, delayed symptoms have occurred after 30 minutes. Hives, itching, and pale or flushed (reddened) skin are common skin reactions. It can be difficult to breathe if the airways narrow and the throat and tongue swell. A wheezing noise may be heard while breathing. The pulse may feel weak and fast. Nausea, vomiting, diarrhea, dizziness, and fainting can also occur.

Anaphylaxis is potentially life threatening. A severe anaphylaxis reaction can cause a person to develop anaphylactic shock and stop breathing or stop the heart. Symptoms of anaphylactic shock include a sudden drop in blood pressure, difficulty breathing, and a loss of consciousness. Again, 911 should be called and emergency medical treatment received if a person is experiencing anaphylaxis. Although it is rare, death can result.

Diagnosis
Emergency medical personnel will assess a person’s vital signs. Tell the doctor if the patient was exposed to a known allergen. Inform the doctor if an epinephrine auto-injector was used.

Treatment
Emergency personnel will deliver medication as necessary to treat an anaphylaxis event. Epinephrine, oxygen, antihistamines, cortisone, and beta agonists are types of emergency medications that may be delivered. Steroids may be used to treat prolonged symptoms. People with non-life-threatening symptoms are usually released to go home after a period of observation.

Cardiopulmonary resuscitation (CPR), artificial respiratory methods, and other emergency medical care may be necessary for people with life-threatening symptoms. These people are admitted to the hospital. Following an anaphylaxis event, follow-up evaluation and care by an allergist is recommended.

As a precaution, people who have previously had anaphylaxis and those who are aware of severe allergic reactions to certain allergens will often carry an EpiPen or Twin Injector. These devices deliver a dose of epinephrine to help quickly counteract the symptoms of anaphylaxis. This medication can reverse the allergic reaction, at least temporarily, to provide the life-saving time needed to get further treatment.

Prevention
If you know you have a serious allergy, wear an emergency alert bracelet or necklace. Carry your auto-injection medication with you at all times. Inform people that are regularly around you what to do if you have an anaphylactic reaction. Follow your allergist’s advice, and attend all of your medical appointments. It is possible for future reactions to be more severe than past reactions, so talk to your doctor about an emergency preparedness plan. Follow your doctor’s advice for preventing allergic reactions.

Am I at Risk
You may have an increased risk of anaphylaxis if:

• You have had an anaphylactic reaction before.
• You have had a severe allergic reaction in the past.
• You have allergies or asthma.

Complications
If not treated immediately, death from anaphylaxis can occur. If a severe anaphylactic attack occurs you can stop breathing or your heart can stop. In this case, you’ll need cardiopulmonary resuscitation (CPR) and other emergency treatment right away.

Introduction
Anemia is a blood disorder characterized by a lack of red blood cells or hemoglobin, a substance in red blood cells. Anemia results if not enough normal hemoglobin or red blood cells are produced, too many red blood cells are destroyed, or if too much blood is lost. There are many types and several causes of anemia.

Symptoms of anemia include shortness of breath, fatigue, and a pale complexion. Treatment depends on the type and cause of anemia. Untreated anemia can lead to serious medical complications, such as a heart attack.

Anatomy
Your body needs oxygen to live. When you breathe in, your lungs absorb oxygen from the air. The oxygen attaches to hemoglobin, a component of your red blood cells. Your red blood cells travel throughout your body and deliver oxygen to all of your cells.
Red blood cells produced inside of your bones in the bone marrow live for about 120 days. Your bone marrow continually makes new red blood cells to replenish your supply.

Causes
Anemia is a medical condition that occurs when a person does not have enough red blood cells or enough hemoglobin. There are many causes and types of anemia. Anemia results if not enough normal red blood cells are produced or if too many red blood cells are destroyed. Anemia also occurs if too many red blood cells are lost due to excessive bleeding.

A lack of hemoglobin may result if there is not enough iron, folate, or vitamin B12 in a person’s diet. These nutrients are necessary for hemoglobin and red blood cell production. Some people may not produce enough red blood cells because of medical conditions that affect the bone marrow, such as certain infections, chronic illness, kidney disease, and arthritis. Certain medications may suppress the bone marrow’s production of red blood cells or trigger destruction of red blood cells in the bloodstream. In rare cases, people are born with the inability to produce enough red blood cells.

Normally, red blood cells are round and flat. Genetic conditions, such as sickle cell anemia, can change the shape of a red blood cell and cause its destruction. Certain medications, infections, and chronic diseases can also change the shape of red blood cells.

The bone marrow may not be able to produce and replace red blood cells fast enough if a large amount of blood is lost due to bleeding. Substantial blood loss can result from serious traumatic accidents or from complications from surgery or childbirth. Anemia can result if a small amount of blood is lost over a long period of time. This may occur in females with heavy menstrual periods and people with inflammatory bowel disease or colon cancer.

Symptoms
Anemia can make you feel very tired. Your skin may look pale. You may experience shortness of breath or angina (heart-related) chest pain.

Diagnosis
Your doctor can diagnose anemia by reviewing your medical history, conducting a physical examination, and testing your blood. Your blood will be analyzed to determine the number of red blood cells, the amount of hemoglobin, and the size and shape of the red blood cells. Your doctor may order other tests depending on the type of anemia that you have.

Treatment
Treatment will depend on the cause and type of your anemia. Your doctor will treat the underlying cause of your condition, if possible. Your doctor may prescribe medication to help your bone marrow produce red blood cells. Your doctor may recommend vitamin and mineral supplements and a diet rich in such substances. A blood transfusion may be necessary for people with severe anemia.

Prevention
You may be able to prevent anemia by receiving prompt medical attention for prolonged or heavy bleeding from colon conditions or heavy menstrual bleeding in females. It may help to eat a diet that includes foods containing iron, folate, and vitamin B12. Iron is found in meat, dried beans, and leafy green vegetables. Folate is contained in citrus fruits, green vegetables, and fortified cereals. Meat, eggs, and dairy products are sources of vitamin B12. Your doctor may refer you to a nutritionist that can help you select products and plan meals based on your nutrition needs.

Am I at Risk
Risk factors may increase your likelihood of developing anemia, although some people that develop the condition do not have any risk factors. People with all of the risk factors may never develop the disease; however, the chance of developing anemia increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for anemia:

_____ You may be at risk for anemia if you have an iron, folate, or vitamin B12 deficiency.
_____ Some anemia related blood diseases may be inherited. If your parents experienced or genetically carry a blood condition, you should talk to your doctor about your risk.
_____ Your risk for anemia is higher if you have medical conditions that affect your bone marrow, such as chronic illness, kidney disease, or arthritis.
_____ Significant blood loss from an injury or surgery can increase your risk for anemia.
_____ Females with heavy menstrual periods are at risk for anemia.
_____ Bleeding associated with inflammatory bowel disease or colon cancer increases the risk of anemia.
_____ Older adults and pregnant females have an increased risk for anemia.
_____ Certain medications may increase your risk for developing anemia, especially chemotherapies.

Complications
Severe anemia can lower the oxygen levels in blood. Low oxygen levels can lead to fatigue, shortness of breath, or even a heart attack. If you have low oxygen levels in your blood, your doctor should carefully monitor you. You may need to use supplemental oxygen.

Introduction
Ankle Sprains are a very common injury that can happen to anyone. Our ankles support our entire body weight and are vulnerable to instability. Walking on an uneven surface or wearing the wrong shoes can cause a sudden loss of balance that makes the ankle twist. If the ankle turns far enough, the ligaments that hold the bones together can overstretch or tear, resulting in a sprain. A major sprain or several minor sprains can lead to permanent ankle instability.

Anatomy
The bones in our leg and foot meet to form our ankle joint. The leg contains a large bone, called the Tibia and a small bone called the Fibula. These bones rest on the Talus bone in the foot. The Talus bone is supported by the Calcaneus bone, our heel. Our heels bear 85% to 100% of our total body weight.

Strong tissues, called ligaments, connect our leg and foot bones together. One ligament, called the Lateral Collateral Ligament (LCL), is very susceptible to ankle sprains. The LCL is located on the outer side of our ankle. It contributes to balance and stability when we are standing or walking and moving. The LCL also protects the ankle joint from abnormal movements, such as extreme ranges of motion, twisting, and rolling.

The LCL is composed of three separate bands commonly referred to as separate ligaments. The Anterior Talofibular Ligament is the weakest and most commonly torn, followed by the Calcaneofibular Ligament. The Posterior Talofibular Ligament is the strongest and is rarely injured.

Causes
Our ankles are susceptible to instability, especially when walking on uneven surfaces, stepping down at an angle, playing sports, or when wearing certain shoes, such as high heels. Everyone, even the fittest athlete, is vulnerable to a sudden loss of balance under these conditions. Our ankles support our entire body weight. When the foot is placed at an abnormal angle, the weight of our body places an abnormal amount of force on the ligaments causing them to stretch. When a ligament is forced to stretch beyond its limit, it may overstretch, tear, or disconnect from the bone.

Symptoms
You may lose your balance and fall if your foot is placed at a poor angle on the ground. Some individuals may hear a “pop” noise when the injury takes place. You will probably have difficulty putting weight on your foot or walking. Pain is usually the first symptom of a Sprained Ankle. Swelling, stiffness, and skin discoloration from bruising may occur right away or take a few hours to develop.

Diagnosis
Your doctor can diagnose a Sprained Ankle by conducting a physical examination and asking you what happened to cause the injury. Your doctor will move your ankle in various positions to determine which ligament was injured. Your ankle may be X-rayed to make sure that you do not have a broken bone in your ankle or foot. In severe cases, a Magnetic Resonance Imaging (MRI) scan may be ordered to view the ankle structures in more detail. The X-ray and the MRI scan are painless and require that you remain very still while the images are taken.

Ankle Sprains are categorized by the amount of injury to the ligaments. A Grade One sprain has minimal impairment. The ligament has sustained slight stretching and some damage to the fibers. A Grade Two sprain is characterized by partial tearing of the ligament. The ankle joint is lax or looser than normal. A Grade Three Spain describes a complete tear of the ligament. The ankle joint is completely unstable.

Treatment
The majority of Ankle Sprains heal with non-surgical treatment methods. It is imperative that you seek evaluation and treatment for any ankle injury, as sometimes fractures are mistaken for sprains.

The treatment of an Ankle Sprain depends on its Grade. Grade One sprains are treated with the RICE method – Rest, Ice, Compression, and Elevation. You should rest your ankle by not placing weight on it. You may use crutches to help you walk. Applying ice packs to your ankle can help keep the swelling down and reduce pain. You should apply ice immediately after spraining your ankle. Your doctor will provide you with a continued icing schedule. Your doctor may recommend over-the-counter or prescription pain medication. Compression bandages, such as elastic wraps, are helpful to immobilize and support the ankle. You should also elevate your ankle at a level above your heart for 48 hours to help reduce swelling.

Care for Grade Two sprains includes applying the RICE method of treatment and in most cases your doctor will prescribe an ankle air cast or soft splint for positioning and stability. As healing takes place, your doctor will gradually increase your activities. Your doctor may recommend that you wear an ankle brace for stability as your healing continues.

In addition to the primary care, your doctor may recommend a short leg cast or a cast-brace system for a Grade Three sprain. The cast is typically worn for two or three weeks and followed by rehabilitation. Rehabilitation is helpful to decrease pain and swelling and to increase movement, coordination, and strength. Your doctor may recommend customized inserts called orthotics for your shoe or special shoes to help you maintain proper ankle positioning.

The recovery time is shorter for ankle sprains that do not require surgery. Grade One sprains may heal in about six weeks. Grade Two and Three Sprains may take several months to heal. Grade Three Sprains usually involve a period of physical therapy to promote healing.

Surgery
Ankle Sprains rarely require surgery; however, it is an option when non-surgical treatments and rehabilitation fail. Your physician will evaluate each case of Ankle Sprain on an individual basis. Your physician will discuss surgical options and help you determine the most appropriate choice for you.

One type of surgery, termed Ligament Tightening, is performed to tighten the overstretched ligaments. This usually involves the Anterior Talofibular Ligament (ATFL) and the Calcaneofibular Ligament (CFL). The surgeon will make an opening over the ligaments and separate the ATFL and the CFL in half. The ends of these two ligaments are surgically attached to the Fibula. The surgeon will further reinforce the ligaments by also attaching the top edge of the Ankle Retinaculum. The Ankle Retinaculum is a large band of connective tissue located at the front of the ankle.

If the ligaments are severely damaged or not appropriate for a Ligament Tightening procedure, the surgeon may perform a Tendon Graft. For this procedure, the surgeon will use a portion of a nearby tendon for a tendon graft. The tendon from the Peroneus Brevis muscle in the foot is most commonly used. The tendon graft is surgically attached to the Fibula and the Talus, near the attachment sites of the original tendon.

In some cases of chronic pain, an Arthroscopic Surgery may be performed to remove bone fragments, scar tissue, and damaged cartilage. Arthroscopic surgery uses a small camera, called an arthroscope, to guide the surgery. Only small incisions need to be made and the joint does not have to be opened up fully. This can shorten the recovery time.

Recovery
Depending on the grade of the injury and what surgical or non-surgical methods are applied to repair the ankle, will determine the rate of recovery.

Grade 1 sprains should only experience slight limits to range of motion, and the recovery process is approximately six weeks.

Grade 2 sprains experience moderate impairment and recovery may take a few months.

Grade 3 sprains have severe impairment and may take several months to fully recover. Even after a full recovery, some patients find that swelling still might occur. In most cases, rehabilitation will help restore strength, mobility and range of motion.

Recovery from surgery differs and depends on the extent of your injury and the type of surgery that was performed. Your physician will let you know what to expect. Individuals usually wear a cast for up to 2 months following surgery. Your doctor will instruct you to carefully increase the amount of weight that you put on your foot. Rehabilitation following surgery is a slow process. Individuals typically participate in physical therapy for two to three months. Physical therapy helps to strengthen the ankle muscles and increase movement. Success rates are high for both surgical procedures. The majority of individuals achieve an excellent recovery in about six months.

Prevention
Individuals that experience one ankle sprain are at an increased risk to experience another. It may be helpful to wear shoes that provide extra ankle support and stability. Shoes with low heels and flared heels may feel steadier. In some cases, doctors recommend a heel wedge or prescribe an orthosis, a plastic brace, to help position the foot inside of the shoe.

Introduction
Anorexia nervosa is a type of eating disorder. People with eating disorders have problems with their eating behavior, thoughts, and emotions. They have a distorted body image and attempt to control their weight by controlling their food intake. People with anorexia nervosa barely eat and are underweight. They think they are too fat, when in fact, they are too thin. Untreated anorexia nervosa can result in serious medical complications, starvation, and death. Treatments include therapy, medication, hospitalization, or a combination of treatments.

Causes
The exact cause of anorexia nervosa is unknown, but eating disorders are a real illness, not a choice, and can be treated. Researchers believe that it is caused by a combination of many factors. People with anorexia nervosa commonly have low self-esteem, goal oriented personalities, and are high academic achievers and perfectionists. They may also have a history of sexual abuse. People with anorexia nervosa tend to have rigid thinking patterns, meaning that they perceive things to be “black or white” or “all good or all bad.” They may perceive pressure from society, family, or friends to be thin or equate a thin body with ideal attractiveness. However, even extreme weight loss fails to relieve the fear of being fat.

The family environment may play a role as well. Family conflict, over-controlling parents, and parents that do not allow emotional expression may contribute to anorexia nervosa in a child. A possible theory is that anorexia nervosa is a way for a child to gain control and pull away from his or her parents. Controlling food intake may be used as a coping mechanism for negative emotions.

Researchers believe that brain abnormalities may contribute to anorexia nervosa. It may be that too much or too little of certain brain chemicals affect the way that the brain processes thoughts and emotions. Researchers think that some people may be genetically predisposed to eating disorders, meaning that they inherit a risk of developing the condition under certain circumstances. Further, obsessive compulsive disorder (OCD), anxiety, and alcohol or drug addiction may contribute to the development of anorexia nervosa.

Anorexia nervosa is more common in females than males. It most frequently occurs in teenagers and young adults, but may develop in children. Some people recover after a single episode. For others, anorexia nervosa is a lifelong battle.

Symptoms
It is frequently difficult for people with anorexia nervosa to recognize or indicate that they have a problem. It is common for people with anorexia nervosa to deny that they have an eating disorder. Frequently, the loved ones of a person with anorexia nervosa recognize the symptoms and help an individual access treatment. The majority of people enter treatment when their symptoms are fairly advanced.

The symptoms of anorexia nervosa can vary from person to person. People with anorexia nervosa do not eat enough food and experience a weight loss of 15% or more below their appropriate weight. The lack of nutrition and weight loss may be extreme. Essentially, they are starving themselves. Additionally, depression, anxiety, panic disorder, obsessive compulsive disorder, or substance abuse may accompany anorexia nervosa.

A person may play with their food, hide food instead of eating it, or not eat in front of others. Eating may involve structured rituals, for example eating only 5 peanuts at intervals throughout the day. People with anorexia nervosa may abuse laxatives, diet pills, enemas, or make themselves vomit after eating. They may also exercise excessively to burn off calories and frequently check their weight.

People with anorexia nervosa lose body fat and muscle bulk. Females may have infrequent periods or stop menstruating. Males may become impotent. The skin may appear blotchy, dry, and yellow. Fine hair may cover the body. Self-induced vomiting can cause tooth decay and gum disease.

If left untreated, anorexia nervosa can lead to severe and life-threatening medical conditions including malnutrition, dehydration, ulcers, diabetes, anemia, kidney failure, heart disease, electrolyte imbalances, liver failure, pancreas failure, low blood pressure, and osteoporosis. The complications caused by anorexia nervosa can lead to death. Further, people with anorexia nervosa have an increased incidence of suicide.

Diagnosis
A psychiatrist can begin to determine if a person meets the diagnostic criteria for anorexia nervosa. A complete medical examination is usually necessary to rule out other disorders that may cause significant weight loss and to evaluate the general health of an individual. A psychiatrist can specify the subtype of anorexia nervosa that a person has, which is helpful for treatment planning.

People with the restricting subtype of anorexia nervosa attain weight loss through dieting, fasting, and excessive exercise. These individuals do not usually binge or purge. People with the binge-eating and purging subtype of anorexia nervosa regularly binge eat, purge, or do both to lose weight. Binge-eating entails eating abnormally large amounts of food. Purging involves eliminating the food from the body after eating it by self-induced vomiting, laxatives, diuretics, or enemas. Some individuals with this subtype may not binge-eat, but may purge after eating only small amounts of food. Overtime, some people with the binge-eating/purging subtype may progress to a change in diagnosis to bulimia nervosa.

Treatment
Treatment can include participation in inpatient or outpatient individual therapy. Group therapy settings or day programs for people with eating disorders can address self-image, self-esteem, positive coping skills, structured meal plans, and healthy eating and exercise. Family counseling is helpful to identify and resolve conflicts. Medications may be used to treat depression, anxiety, and obsessive compulsive disorder. People that are in danger from starvation may require immediate hospitalization to restore weight and fluids.
Recovery from anorexia nervosa is different for everyone. Some people recover after just one episode. For others, it can be a life long battle that requires ongoing counseling, support, and nutritional management. Positive support from loved ones can be essential for an individual’s success. It is important to remember that anorexia nervosa is a real illness that can be treated.

Introduction
An aortic aneurysm is a condition that results from the swelling of a weakened wall in the aorta. The aorta is the largest artery in your body. It branches off your heart and distributes blood throughout your body and organs. An aortic aneurysm may enlarge and burst. Emergency medical treatment and surgery is necessary for a ruptured aneurysm. If left untreated, an aortic aneurysm can cause massive internal bleeding and death.

Anatomy
The aorta is the largest blood vessel in your body. It carries oxygenated blood from the left ventricle of your heart. The aortic valve prevents the backflow of blood between heartbeats.

The aorta extends upwards from the heart, arches, and travels downward through the chest and into the abdomen. These sections of the aorta are called the ascending aorta, aortic arch, descending thoracic aorta, and the abdominal aorta.

Causes
The exact cause of aortic aneurysm is unknown. There appear to be several risk factors that may contribute to the development of aortic aneurysm. Aortic aneurysms occur most frequently in the abdomen below the kidneys in the abdominal aorta or in the chest area in the thoracic aorta.

Symptoms
Aortic aneurysms may develop over several years and may initially have no symptoms. The chance of an aortic aneurysm rupturing depends on its size. Larger aneurysms are more likely to rupture. You should call emergency services or go to a hospital emergency department immediately if you suspect that you have a ruptured aneurysm. Symptoms may develop suddenly when the aneurysm expands, ruptures, or leaks blood. A thoracic aortic aneurysm can cause severe, “tearing,” and sudden chest or back pain.

Symptoms of an abdominal aortic aneurysm include severe sudden pain in the abdomen or back. Your pain may be constant and spread to your buttocks, groin area, and legs. Your legs may feel numb and sense a pulsating in your abdomen. You may feel an abdominal mass or experience abdominal rigidity. Your heart may beat rapidly when you move from a sitting to a standing position. The skin may feel clammy and you may have nausea, vomiting, and shock.

Diagnosis
Your doctor can begin to diagnose an aortic aneurysm through a series of examinations and tests. A series of tests may be ordered to evaluate your heart structure and functioning. Common tests include echocardiogram and coronary angiography. An echocardiogram uses sound waves to produce an image of the heart. A dye and X-ray are used to show an image of the heart with a coronary angiography. A coronary angiography may be done with a heart catheterization. Heart catheterization involves inserting a long narrow tube through a blood vessel and into the heart to see how the heart and coronary arteries are working. The heart structures may also be viewed with imaging scans, including computed tomography (CT), ultrasound, and magnetic resonance imaging (MRI) .

Treatment
Aortic aneurysms that are small and do not cause symptoms are monitored regularly. Aortic aneurysms that are large or that cause symptoms are treated surgically. The type of surgery depends on your aneurysm’s location and size.

A traditional open repair involves surgically removing the damaged portion of the aorta and replacing it with a synthetic graft. Another type called endovascular stent grafting involves placing a graft through a catheter that is placed through your groin area. This type of surgery is less invasive and associated with quicker recovery times.

Prevention
You may be able to prevent an aortic aneurysm by reducing the risk factors under your control. Keep your heart and blood vessels healthy. Do not smoke, eat a healthy well-balanced diet, exercise, and maintain a healthy weight, blood pressure, and cholesterol. If you are at risk for an aortic aneurysm, ask your doctor about a screening ultrasound.

Am I at Risk
Risk factors may increase your likelihood of developing aortic aneurysm, although some people that develop the condition do not have any risk factors.

Risk factors for aortic aneurysm:

_____ Males experience more aortic aneurysms than females.
_____ Age over 60
_____ High blood pressure
_____ Smoking
_____ High cholesterol
_____ Obesity
_____ Emphysema
_____ Genetic factors appear to play a role in the development of aortic aneurysm.
_____ Atherosclerosis, hardening of the arteries
_____ Syphilis
_____ Marfan syndrome
_____ Trauma

Complications
Aortic aneurysms can be fatal. A ruptured aneurysm can cause vast internal bleeding that without treatment, can lead to a quick death. Aneurysms can also cause blood clots that can lead to a heart attack or stroke.

Introduction
Your appendix is a small tube-like structure that extends off your large intestine. While the appendix does not have a known function, if it becomes inflamed or infected the result is appendicitis. Appendicitis can be quite dangerous as there is no way to medically treat it. If it occurs, it is considered an emergency and requires surgery to remove. Severe sharp pain in the right lower abdomen is the main symptom of appendicitis. Prompt surgery is necessary to remove the appendix to avoid complications. If there is a delay in treatment, the appendix can burst and cause life threatening complications. Anyone can get appendicitis, but it most often occurs between 10 and 30.

Anatomy
Your large intestine, also called the large bowel, is a tube that is about 5 feet long and 3 or 4 inches around. The large intestine is divided into sections. The appendix is located near the beginning of the large intestine in a section called the cecum. The appendix is a finger-shaped pouch. It does not serve any known purpose.

Causes
Appendicitis results when the appendix becomes infected, inflamed, or blocked. A piece of stool or ingested material can block the appendix. In some cases of appendicitis, the cause is not known. Appendicitis is an emergency medical condition and needs immediate treatment. An inflamed appendix may rupture. A ruptured appendix can lead to a fatal infection or abscess if it is not treated immediately.

Symptoms
Pain that gradually gets worse is a main symptom of appendicitis. The pain usually starts at the belly button and then shifts to the lower right. Appendicitis related pain typically intensifies over 6 to 12 hours and can become very severe and sharp. The pain may increase when you gently press and release on the area. You may experience a fever, chills, nausea, diarrhea, constipation, and vomiting. You may not feel like eating.

If your appendix ruptures, you may actually feel better for a short time. However, a ruptured appendix may lead to an infection called peritonitis. The infection will make you feel very sick and your pain will feel worse. Your abdomen may swell and feel hard. You may not be able to pass gas. You may feel thirsty and may only pass small amounts of urine. Peritonitis is a medical emergency, and you should go to the emergency department of a hospital immediately if you experience symptoms.

Diagnosis
You should be evaluated and treated by a doctor immediately if you suspect that you have appendicitis. Appendicitis is an emergency medical condition. Your doctor will conduct a physical examination and may order some tests. Your doctor will examine your lower abdomen. Your doctor may check a sample of your blood or urine for signs of infection to rule out other conditions with similar symptoms, such as kidney stones.

Imaging tests may be used to help confirm the diagnosis of appendicitis and rule out other conditions. An abdominal X-ray, ultrasound, or computed tomography (CT) scan are commonly used. A CT scan is used to check for an abscess from a ruptured appendix.

Treatment
Some mild forms of appendicitis may be treated with antibiotics, but for most people, appendicitis is treated with surgery to remove the appendix. You may receive traditional open surgery or laparoscopic surgery. Open surgery uses a larger incision and usually requires a longer recovery time than laparoscopic surgery.

Laparoscopic appendectomy is performed with a laparoscope. A laparoscope is a thin viewing instrument with a miniature camera at the end. The laparoscope is inserted through small incisions. The camera transmits images to a video screen, which a surgeon uses to guide the surgery. Thin surgical instruments are passed through the incisions to perform the procedure. Because only small incisions are necessary for laparoscopic appendectomy, this procedure is associated with less pain, less bleeding, fewer complications, and a quicker recovery than traditional surgical methods.

Recovery time is faster for people that have their appendix removed before it ruptured. A longer recovery time is associated with infections, abscesses, and ruptured appendices. In some cases, doctors may treat an infection before removing the appendix.

Prevention
You may prevent complications by contacting your doctor immediately if you experience the symptoms of appendicitis.

Am I at Risk
Appendicitis can happen to anyone. It occurs most frequently between the ages of 10 and 30. A ruptured appendix is more common in children.

Complications
In rare cases, a ruptured appendix can cause death. A ruptured appendix can lead to infection and needs to be treated immediately in the emergency department of a hospital.

Introduction
Arthritis is a common disease that causes joint pain, stiffness, immobility, and swelling. Arthritis is actually a term for a group of over 100 diseases that affect the muscle and skeletal system, particularly the joints. Arthritis alters the cartilage in joints. Cartilage is a very tough, shock absorbing material that covers the ends of many of our bones. The cartilage forms a smooth surface and allows the bones in our joints to glide easily during motion. Arthritis can cause the cartilage to wear away. Loss of the protective lining can cause painful bone on bone rubbing. Arthritis can be quite painful and disabling. While this may be tolerated with medications, therapy, other modalities, and lifestyle adjustments, there may come a time when surgical treatment is necessary.

Anatomy
Bones are the hardest tissues in our body. They support our body structure and meet to form joints. Cartilage covers the ends of many of our bones and forms a smooth surface for our bones to glide on during motion. A membrane called synovium lines the joint. The synovium secretes a thick liquid called synovial fluid. The synovial fluid acts as a cushion and lubricant between the joints. It reduces friction between the bones and prevents “wear and tear.”

Ligaments are strong tissues that connect our bones together and provide stability. Our ligaments are also lined with synovium. The synovial fluid allows the ligaments to glide easily during movement. Tendons are strong fibers that attach our muscles to our bones. The tendons and muscles power the joint and enable us to move.

Causes
There are over 100 different types of arthritis. Arthritis can occur for many reasons, including aging, “wear and tear,” autoimmune disease, trauma, and inflammatory disease. Arthritis usually affects the bones and the joints; however, it can affect other parts of the body, such as muscles, ligaments, tendons, and some internal organs. Two of the more common types of arthritis, Osteoarthritis and Rheumatoid Arthritis are discussed below.

Osteoarthritis is the most common type of arthritis, affecting some 21 million Americans alone. It causes the cartilage covering the end of the bones to gradually wear away, resulting in painful bone on bone rubbing. Abnormal bone growths, called spurs or osteophytes can grow in the joint. The bone spurs add to the pain and swelling, while disrupting movement. All of the joints may be affected by Osteoarthritis.
Osteoarthritis is often more painful in the weight bearing joints, including the spine, hip, and knee. It tends to develop as people grow older. Osteoarthritis can occur in young people as the result of an injury or from overuse of a joint during sports or work.

Rheumatoid Arthritis is one of the most serious and disabling types of arthritis. It is a long-lasting autoimmune disease that causes the synovium to become inflamed and painful. It also causes joint swelling and deterioration. Pain, stiffness, and swelling are usually ongoing symptoms, even during rest.

Rheumatoid Arthritis most commonly occurs in the hand and foot joints. It can also develop in the larger joints, including the hip, knees, and elbows. Many joints may be involved at the same time. Further, tissues surrounding the joint may also be affected. Rheumatoid Arthritis can affect people of all ages, but most frequently occurs in women and those over the age of 30.

Symptoms
Inflammation is the main finding of arthritis. Inflammation can cause your joints to feel painful, swollen, and stiff. These symptoms are most likely continuous, even when you are resting. Your joints may feel weak or unstable. You may have difficulty moving and performing common activities, such as walking or climbing stairs.

Diagnosis
Your health care provider can diagnose arthritis by conducting a physical examination. You will be asked about your symptoms and level of pain. Your provider will assess your muscle strength, joint motion, and joint stability. Blood tests and other laboratory tests may identify what type of arthritis you have. Imaging tests provide more information about the condition of your joint.

X-rays are used to see the condition of your bones and joints, and to identify areas of arthritis or bone spurs. The tissues that surround the joint do not show up on an X-ray. In this case, a Magnetic Resonance Imaging (MRI) scan may be requested to get a better view of the soft tissue structures, such as ligaments, tendons, and cartilage.

A bone scan may be ordered to identify the location of abnormal growths in a bone, such as bone spurs, cysts, or arthritis. It is a sensitive test that can indicate joint degeneration in early stages that may not yet be visible on plain x-rays. A bone scan requires that you receive a small harmless injection of a radioactive substance several hours before your test. The substance collects in your bones in areas where the bone is breaking down or repairing itself. These imaging tests are painless.

Treatment
Most cases of arthritis can be treated with non-surgical methods. Temporary joint rest and pain relievers are sometimes all that are needed. Over-the-counter medication or prescription medication may be used to reduce pain and swelling. If your symptoms do not improve significantly with these medications a cortisone injection may be successful in reducing inflammation and pain.

Viscosupplementation is another injection option for arthritis, but currently is FDA approved for use only in the knee. Studies are underway to test its usefulness in other joints. Several products are on the market that when injected in a series into the knee can reduce pain by temporarily improving the health of the joint.

Occupational or physical therapists can help you strengthen the muscles surrounding your joint. The resulting added joint stability can help relieve pain. Aquatic therapy in a heated pool can be especially soothing. In addition, the buoyancy of the water takes stress off the joints while exercising, and the resistance of the water can help strengthening efforts. Your therapists may also apply heat to treat stiffness, and ice to decrease pain. They may recommend splints, walkers, or canes to help relieve stress on your joints. The therapists will instruct you on how to do your daily activities, such as housework and meal preparation, in a manner that puts less stress on your joints.

Acupuncture is a time-tested treatment for pain. Very fine needles are strategically placed around the body to block or interrupt pain pathways. Acupuncture should be administered by a trained professional, and can often be extremely helpful.
A variety of herbs and nutritional supplements have been shown to be helpful in treating arthritis. Two of the more commonly known supplements are glucosamine and chondroitin. They have been studied most in arthritis of the knee, and have shown some good results for treating arthritis in other joints. Some research has also shown that a proper diet consisting of fruits and vegetables, with a minimum of fat, can benefit arthritis.

Exercise regimes, such as yoga, Pilates, and tai chi can improve arthritis pain in many ways. Physically, the stretching and strengthening provided by these programs has a direct positive effect for many with arthritis. Additionally, the stress-reducing relaxation that usually occurs from these types of exercise can have a significantly positive effect on arthritis pain.

Surgery
Because arthritis is a degenerative and progressive disease, it may get worse over time. When non-surgical treatments no longer provide relief, surgery may be recommended. The type of surgery that you receive will depend on your type of arthritis, its severity, and your general health. Your doctor will discuss appropriate surgical options to help you decide what is best for you.

There are several types of surgical procedures for arthritis. The surgeon may remove the diseased or damaged joint lining (synovium) in an operation called a synovectomy. The bones in a joint may be realigned with a procedure called an osteotomy. The bones in a joint may also be fused together to prevent joint motion and relieve pain.

In advanced arthritis, the damaged joint can be replaced with an artificial one. Artificial joints are made of metal, plastic, ceramics, or a combination of the materials. The material selected depends on the reason for the surgery, as well as which joint is being replaced. Joint replacement can provide significant pain relief and improved mobility.

Recovery
Recovery from arthritis surgery is very individualized. Your recovery time will depend on the extent of your condition, the joint that was involved, and the type of surgery that you had. Your doctor will let you know what you may expect.

Generally, traditional open joint surgeries take several months to heal, depending on the joint. Minimally invasive surgery and arthroscopic surgery use smaller incisions and typically heal in a shorter amount of time, from several weeks to a few months. Your doctor may restrict your activity for a short time following your surgery. In most cases, rehabilitation is recommended to mobilize and strengthen the joint.

Prevention
Some types of arthritis and arthritis symptoms may be prevented. It is important to know what type of arthritis you have and to ask your health care provider what you can do to prevent symptoms. For example, for some types of arthritis it is helpful to reduce your weight or stop performing repetitive joint movements. It may be helpful to consult an occupational or physical therapist to learn how to use proper body mechanics to protect your joints during your daily activities.

Assistive devices, such as a walker, shower chair, or raised toilet seat may enable you to perform tasks while minimizing the stress on your joints. It may also be helpful to participate in aquatic therapy in a heated pool or exercise to keep your joints strong.

Introduction
Arthroscopic Surgery is a procedure that allows surgeons to see, diagnose, and treat problems inside a joint. The procedure, also called an Arthroscopy, requires only small incisions and is guided by a miniature viewing instrument or scope. Before arthroscopy existed, surgeons made large incisions that affected the surrounding joint structures and tissues. They had to open the joint to view it and perform surgery. The traditional surgery method carries a higher risk of infection and requires a longer time for recovery. In contrast, arthroscopy is less invasive. It has a decreased risk of infection and shorter recovery period. Today, arthroscopic surgery is one of the most common orthopedic procedures.

Treatment
Arthroscopic Surgery uses an arthroscope, which is a very small surgical instrument; about the size of a pencil. An arthroscope contains a lens and lighting system that allows a surgeon to view inside a joint. The surgeon only needs to make small incisions and the joint does not have to be opened up fully. The arthroscope can be attached to a miniature camera. The camera allows the surgeon to view the magnified images on a video screen or take photographs and record videotape.

Initially, the arthroscope was designed as a diagnostic tool for planning traditional open joint surgeries. A surgeon uses an arthroscope to diagnose joint conditions when physical examinations or imaging scans are not conclusive. The diagnostic accuracy of arthroscopy is highly precise. As the technology developed, special surgical instruments were created to use with the arthroscope. Now, it can be used to treat conditions as well. Like the arthroscope, the thin surgical instruments are inserted into the joint through small incisions. Some injuries or problems are treated with a combination of arthroscopic and open surgery.

Conditions Treated with Arthroscopy
Although nearly all joints can be viewed with an arthroscope, it is used most frequently to treat six joints. These include the knee, shoulder, elbow, ankle, hip and wrist. Arthroscopy most commonly treats diseases and injuries that damage the bones, cartilage, ligaments, tendons, and muscles that make up a joint.

Bones are the hardest tissues in our body. They support our body structure and meet to form joints. Cartilage covers the ends of many of our bones. The cartilage forms a smooth surface and allows the bones to glide easily during motion. Disease and injury can compromise the cartilage and joint structure and disrupt their functions.

A condition called Chondromalacia can cause the cartilage to soften and deteriorate because of injury, disease, or “wear and tear.” The curved cartilage in the knee joint, called a meniscus, is especially vulnerable to tears during injury. An arthroscopic surgery can treat these conditions by shaving and smoothing out the cartilage. It can also remove abnormal growths from bones, such as calcium deposits and bone spurs.

Tendons are strong fibers that attach our muscles to our bones. They are tissues that do not stretch easily and are susceptible to tears under repeated or traumatic stress. Ligaments are strong tissues that connect our bones together and provide structural support. The ligaments are lined with Synovial Membrane called Synovium. The Synovium secretes a thick liquid called Synovial Fluid. The Synovial Fluid acts as a cushion and lubricant between the joints, allowing us to perform smooth and painless motions. Trauma and “wear and tear” from overuse can cause injury and inflammation to our tendons, ligaments, and Synovium.

Tendons in the shoulder and ligaments in the knee are frequently torn or impinged from trauma and overuse. An arthroscopy can repair tendons. Many ligaments and tendons can be repaired arthroscopically. Synovitis, a condition caused by an inflamed lining of a joint, can develop in the knee, shoulder, elbow, wrist, or ankle. Arthroscopy can treat synovitis by removing scar tissue or the inflamed synovium. A synovial biopsy, a tissue sample for examination, can be done via arthroscopy.

What to Expect
Arthroscopic surgery is usually performed as an outpatient procedure. In some cases, an overnight stay in the hospital may be needed. You may be sedated for the surgery or receive a local or regional anesthetic to numb the area, depending on the joint or suspected problem. Before the surgery, your surgeon will elevate your limb and apply a tourniquet, an inflatable band. This will reduce the blood flow to your joint during the procedure.

Your surgeon will make one or more small incisions, about ¼” to ½” in length, near your joint. Your surgeon will fill the joint space with a sterile saline (salt-water) solution. Expansion of the space allows your surgeon to have a better view of your joint structures. Your surgeon will insert the arthroscope and manipulate it to see your joint from different angles. If you are having another surgical procedure, your surgeon may make additional small incisions and use other slender surgical instruments. When your procedures are completed, your surgeon may inject your joint with medication to reduce pain and inflammation. Because the incisions are so small, they will require just a few stitches

Your recovery time will depend on the extent of your condition and the amount of surgery that you had. Your surgeon will let you know what to expect. Your surgeon may restrict your activity for a short period of time following your surgery. It is common for people to return to work or school within a few days. In some cases, rehabilitation is recommended to mobilize and strengthen the joint. It usually takes a joint several weeks to fully recover.

Benefits of Arthroscopy
An arthroscopy can be a short procedure. In some cases, it may only take minutes for the actual surgery. Because it is often a shorter procedure, a smaller amount of anesthesia is required and individuals need to be sedated for shorter amounts of time than with open joint surgery. Most people have the procedure as an outpatient and return to their homes in just a few hours.

Overall, an arthroscopy requires a shorter length of time for recovery than open joint surgery. It also has a reduced risk of infection and causes less pain because only small incisions are used and less surrounding tissue is affected or exposed.

Introduction
Asthma is a lung disease. Asthma causes the breathing tubes in the lungs to temporarily narrow. People with asthma have difficulty breathing air in and out of their lungs. An allergen or irritant in the environment usually triggers an asthma flare-up.

There is no cure for asthma. Some asthma flare-ups can be prevented. Asthma can be treated with lifestyle changes and medication. Untreated asthma can become severe and life threatening. People can control their asthma with self-management and medical treatment.

Most people with asthma can lead normal lives.

Anatomy
Your lungs are located inside of the ribcage in your chest. Your diaphragm is beneath your lungs. The diaphragm is a dome-shaped muscle that works with your lungs when you breathe.

From your nose and mouth, air travels towards your lungs through a series of tubes. The trachea or windpipe is located in your throat. The bottom of the trachea separates into two large tubes called the main stem bronchi. The left main stem bronchus goes into the left lung, and the right main stem bronchus goes into the right lung.

Once in the lung, the bronchi branch off throughout the lung and become smaller. These smaller air tubes are called bronchioles. There are approximately 30,000 bronchioles in each lung. The end of each bronchiole has tiny air sacs called alveoli. There are about 600 million alveoli in your lungs. Each alveolus is covered in small blood vessels called capillaries. The capillaries move oxygen and carbon dioxide in and out of your blood.

When you breathe air in or inhale, your diaphragm flattens and your ribs move outward to allow your lungs to expand. The air that you inhale through your nose or mouth travels down the trachea. Tiny hair-like structures in the trachea, called cilia, filter the air to help keep mucus and dirt out of your lungs. The air travels through the bronchi and the bronchioles and into the alveoli. Oxygen in the air passes through the alveoli into the capillaries. The oxygen attaches to red blood cells and travels to the heart. The heart sends the oxygenated blood to the cells in your body.

When you breathe air out or exhale, the process is the opposite of when you inhale. Once your body has used the oxygen in the blood, the deoxygenated blood returns to the capillaries. The blood now contains carbon dioxide and waste products that must be removed from your body. The capillaries transfer the carbon dioxide and wastes from the blood and into the alveoli. The air travels through the bronchioles, the bronchi, and the trachea. As you exhale, your diaphragm rises and your ribs move inward. As your lungs compress, the air is released out of your mouth or nose.

Causes
Asthma causes the bronchial tubes in the lungs to swell and become narrower. The muscles in the airways contract causing even further narrowing. The bronchioles may also produce extra sticky secretions or mucus. Asthma makes it harder for a person to inhale or exhale.

Doctors do not know exactly what causes asthma. They do know that the airways in some people are sensitive to triggers that cause an asthma flare-up or “asthma attack.” Allergens are a type of trigger that causes allergic reactions in the airways. Common allergens include pollen, pet dander, dust mites, mold, cigarette smoke, polluted air, perfume, and cleaning products. Triggers may also include cold dry air, physical exercise, stress, nonsteroidal anti-inflammatory drugs, and sulfites, a type of additive found in food or wine. Some people experience asthma when they have a cold, the flu, or bronchitis. Laughing or crying can even trigger asthma.

There are different types of asthma. Adult-onset asthma begins after the age of 20. Exercise induced asthma occurs during exercise that requires breathing through the mouth, continuous activity, or cold weather. Occupational asthma involves exposure to irritants at the workplace. Such irritants may include chemicals, plastics, rubber, paint, and metal products. Nocturnal asthma occurs between midnight and 8 AM. It is triggered by allergens in the home or sinus conditions.

Symptoms
Most people with asthma have periodic flare-ups and symptom free periods. Some people have difficulty breathing all of the time and periods of very difficult breathing. Asthma flare-ups can last from minutes to days. They can be very dangerous if the airway is severely restricted.

Asthma makes it difficult to breathe. You may have to work extra hard to breathe under normal conditions. You may experience shortness of breath that is made worse by exercise.

You may hear a wheezing sound when you breathe. Wheezing sounds like a whistle or high pitched musical noise. It is caused by air being forced through the narrow airways. Wheezing usually begins suddenly. It may come and go. It may occur more often in the night or early morning hours. Cold air or exercise may cause wheezing to increase. Wheezing may be accompanied by a cough. It is important to note that not all people with asthma wheeze, and not all people who wheeze have asthma.

You may also experience nasal flaring, chest pain, or chest tightness. It may take you longer to breathe out than it does to breathe in. You may have an uneven breathing pattern with temporary stops. It may be difficult for you to speak.

Symptoms of severe asthma are signs of a medical emergency and may lead to death without treatment. You should call emergency medical services, or have someone drive you to a hospital emergency room if you experience an extreme difficulty with breathing. Other emergency symptoms include sweating, a rapid pulse, and anxiety associated with shortness of breath. Additionally, your lips and face may appear blue.

Diagnosis
Your doctor can diagnose asthma by reviewing your medical history and conducting a physical examination and tests. You should tell your doctor about your symptoms, risk factors, and what appears to trigger your asthma flare-ups. Your doctor will listen to your chest while you breathe. If you are experiencing an asthma episode, your doctor may hear wheezing. However, wheezing is not present between asthma flare-ups. There are several tests that your doctor may conduct to find out the cause of your symptoms and the degree of your airway obstruction. Your doctor may also order a chest X-ray to rule out other conditions that have similar symptoms.

Your doctor will have you breathe into a hand-held device called a spirometer. A spirometer measures how much air you breathe out and how forcefully you breathe the air out. Your doctor will also have you breathe into a peak flow meter. A peak flow meter is a hand-held device used to manage asthma by monitoring the airflow through your bronchi. The peak flow meter measures your ability to expel air from your lungs under the best or peak conditions. Your rates will be higher when you are feeling well and lower when you have an asthma flare-up. By monitoring the changes in your breathing patterns your doctor can identify how well your lungs are functioning, the severity of your symptoms, and appropriate treatment.

Your doctor may use a pulse oximeter to determine the amount of oxygen in your blood. For this test, a probe will simply be placed on your fingertip. A medical device attached to the probe displays the percentage of oxygen in your blood.

Your doctor may take a sample of your blood to determine the amount of carbon dioxide and oxygen in your blood. A blood test may also be used to identify infections or other causes of your symptoms. Additionally, a blood test or skin test may be used to determine the type of allergies that you may have.

Asthma is classified as Mild, Moderate, or Severe according to its severity. People with Mild Asthma have symptoms that occur twice per week or less. The symptoms are quickly relieved with medication and there are no symptoms in between episodes. People with Moderate Asthma experience symptoms everyday. They require inhaler medication almost every time for symptom relief. Severe Asthma causes symptoms for the majority of every day. People with Severe Asthma may need to restrict their activities. They may need a hospital stay for treatment.

Treatment
The goals of asthma treatment are to establish normal lung function, relieve symptoms, and prevent asthma flare-ups. There is no cure for asthma, although symptoms may decrease over time. It is important to identify and avoid the allergens that trigger your asthma. Your doctor may prescribe medications based on your condition.

The type of medication that you receive depends on the severity of your asthma, the cause of your symptoms, and your lung functioning. You may receive long-term medications or quick relief “rescue” medications. Long-term medications are used on a regular basis to prevent asthma. People with persistent asthma flare-ups use long-term medications to prevent symptoms. Quick relief medications are used during an asthma flare-up to relieve symptoms. People with Mild Asthma or infrequent flare-ups may use quick relief medications as needed.

Your doctor will instruct you how to use a peak flow meter at home. By measuring your lung volume, you may be able to detect an upcoming asthma flare-up and take action according to your doctor’s instructions. Using a peak flow monitor can prevent an asthma flare-up from taking you by surprise.

Prevention
You should wear a MedicAlert bracelet and carry a MedicAlert card in your wallet. In the case of an emergency, the MedicAlert information will be helpful to the healthcare professionals treating you. Because the medical complications associated with asthma can be very serious, people with asthma need to diligently manage their condition to remain healthy.

You should formulate a plan with your doctor as to what you should do in the case of an emergency or serious situation. You should know how to use your medication properly and when to use it. You should also know what to do if your medication does not work right away and when to go to the emergency room.
You may be able to prevent or reduce your asthma flare-ups by avoiding the triggers that cause it. Talk to your doctor to find out if allergy treatments are an option for you. You may also make lifestyle changes to protect yourself from allergens. This may include staying indoors when pollen levels are high or removing carpets from your home. Ask your doctor for recommendations that are appropriate for you.

Learn how to use a peak flow meter at home. Check your peak flow regularly. Keep a record of your results and bring them to your doctor appointments. The record will help your doctor to monitor your medications. Additionally, make sure that you attend all of your doctor appointments.

Am I at Risk
About half of all asthma cases occur in children under the age of ten. Boys are more likely than girls to develop asthma. Conversely, women are more likely than men to develop adult-onset asthma. Asthma affects people of all races. It is more common in people who are Afro-American or Hispanic.

Risk factors for asthma:

_____ Smoking or living with a smoker can increase your risk because smoke is unhealthy for the lungs and can be an asthma trigger.
_____ A family history of asthma. If your parents, brothers, or sisters had asthma, you have an increased risk of developing it as well.
_____ If you have allergies or eczema, a skin condition, you have an increased risk of developing asthma.
_____ If you had allergies or a severe viral infection before you were three years old, you are at risk for developing asthma.
_____ Living in the inner city or being exposed to mice and cockroach waste products increases your chance of developing asthma.
_____ If you are frequently exposed to triggers, you are at risk for asthma.

Complications
Complications from asthma can lead to hospitalization and even death. You may be hospitalized if your asthma is very severe or does not respond to treatment. You may be hospitalized if you develop a serious lung illness or a pneumothorax, a collapsed lung. Other conditions that warrant hospitalization include poor lung function and elevated carbon dioxide or low oxygen levels in the blood. The hospital staff will monitor and treat your condition. Some people may have to be placed on a ventilator, which is a machine that can breathe for them.

Introduction
Athletes are not the only people who can get athlete’s foot. A fungus that thrives in warm environments, such as poolside surfaces and locker rooms, causes the skin infection to develop between the toes or on the soles of the feet. Many cases of athlete’s foot can be treated with over-the-counter products. You should contact your podiatrist or dermatologist if you have a severe or prolonged athlete’s foot infection.

Anatomy
Your skin is the largest organ of your body and covers your body to protect it from the environment. The skin has three layers. The epidermis is the skin’s outermost layer. It protects the inner skin layers. Basal cells at the bottom of the epidermis move upward to replace the outermost cells that wear off.

When athlete’s foot fungus (dermatophytes) infects the skin, the basal cells respond by overproducing cells. As the excess cells reach the skin’s surface, they cause the symptoms and appearance of athlete’s foot.

Causes
Athlete’s foot is a fungus infection of the skin. It results from contact with the fungus and an environment favorable for fungal growth. Simply being exposed to the fungus alone does not cause athlete’s foot. A warm moist environment, such as between the toes, is an ideal place for the fungus to grow.

Symptoms
Athlete’s foot can cause mild to severe symptoms, primarily an itchy stinging rash between the toes or on the feet. The rash may appear as bumps, blisters, scales, peeling skin, or cracked skin. Athlete’s foot may have an unpleasant odor. It can recur.

Diagnosis
A doctor can diagnose athlete’s foot by reviewing your medical history and examining the affected skin. The doctor may brush your skin with a swab to obtain cell samples to examine to confirm the diagnosis.

Treatment
Many cases of athlete’s foot can be treated with over-the-counter medicated powders, creams, sprays, or lotions that are specifically formulated to fight the athlete’s foot fungus. If your condition is severe or unresponsive to treatment, your doctor may prescribe stronger medication to kill the fungus.

You should keep your feet clean and dry. Wear shoes or sandals that allow good airflow. Do not cover your feet during sleep. Wear cotton socks, and change them every day or if they get damp.

Prevention
There are many steps that you can take to help prevent athlete’s foot including:

• Do not share shoes or socks with others.
• Wear shoes or shower shoes in public areas, such as locker rooms, gyms, and showers.
• Keep your feet clean and dry.
• Wear roomy shoes with good air circulation, or sandals.
• Wear cotton socks and change them daily or sooner if the socks are damp.
• Keep your floors and showers very clean at home.
• Use antifungal spray or powder daily.

Am I at Risk
The fungus that causes athlete’s foot thrives in warm damp areas, including public areas such as locker rooms, showers, gyms, and pool surrounds. Walking barefoot increases the likelihood that the fungus can contact your skin. The fungus can also grow on damp objects, such as towels, socks, or shoes. Athlete’s foot is contagious; meaning you can get it from another person or even a pet.

Complications
Open skin from scratching the athlete’s foot rash is at risk for a bacterial skin infection (cellulitis). Contact your doctor if your skin develops signs of a bacterial infection such as swelling, red streaks, and pain. The athlete’s foot fungus can spread to other parts of the body, such as the toenails, heels, and hands. People with diabetes should contact their doctors if they have athlete’s foot.

Introduction
Atrial Fibrillation, also known as A Fib or AF, is a common heart condition that causes an abnormal rhythm (arrhythmia). It is sometimes described as a quivering heart or fluttering heartbeat. A change in the electrical charge that travels through the heart’s upper chambers can cause the rhythm of the heart to get out of sync. During an episode, typical symptoms include heart palpitations, shortness of breath, and weakness that may come and go or last for extended periods of time. A Fib is a treatable condition that should be managed by a cardiologist to prevent serious complications, such as blood clots, heart failure, or stroke. AF is not life-threatening, but emergency treatment may be required at times to restore regular rhythm.

Anatomy
The heart is an organ whose primary function is to pump blood throughout the body. It is divided into four sections called chambers, with two on top and two on bottom. Blood comes in through the upper chambers (atria) and exists through the lower chambers (ventricles). There are four valves that regulate the flow of blood through the heart. The lub-dub sound your heart makes with each beat is the sound of heart values opening and closing. The pumping action of the heart is controlled by electrical impulses from the sinus node, which starts each heartbeat in a steady rhythm.

When the heart receives irregular electrical impulses, the rhythm becomes irregular. It will start beating irregularly in an attempt to correct and restore the natural rhythm. In the case of A Fib, the AV node, which connects the upper chambers to the lower chambers, is flooded with electrical impulses. This causes the bottom of the heart to beat more rapidly than the top, and the rhythm falls out of sync.

Causes
The cause of atrial fibrillation is an abnormality in the heart. In some cases a heart defect you are born with or cardiovascular disease of some kind can be the cause. A history of heart attack, high blood pressure, hyperthyroidism, and alcohol abuse can increase your risk. Lung disease, pneumonia, and previous heart surgery are other possible causes.

People with an otherwise healthy heart and no other risk factors can also have atrial fibrillation. The arrhythmia is caused by “hot spots” on the heart that act like abnormal pacemaker cells. They fire rapid electrical impulses, causing the upper chambers of the heart to flutter or quiver instead of beating normally.

Symptoms
Someone with atrial fibrillation may have no symptoms at all, making it difficult to detect and diagnose. During an episode, the classic symptom is a fast, irregular heartbeat, often described as a fluttering or quivering feeling in your chest. This is usually accompanied by shortness of breath, weakness, and fatigue (extreme tiredness). You may also experience dizziness, sweating, lightheadedness, anxiety, and chest pain.

Diagnosis
Some people may never know they have A Fib until their doctor examines their heart. Normally, your heart beats steadily without you noticing it at all. If you suddenly notice your heartbeat, it may be due to a change in the electrical impulses that regulate the rhythm. Be sure to consult your doctor right away. Take note of how long and how often you notice your own heart beat and what it feels like.

Lab tests and cardiac imaging are used to confirm the diagnosis. Common tests used to diagnose AF include a blood work (to eliminate other possible causes), chest x-ray, electrocardiogram (ECG), and echocardiogram. You may need to wear a Holter or Event monitor to detect an arrhythmic event during a 24 to 48-hour period.

Treatment
The type of treatment you need will depend on the frequency and severity of your symptoms. Most commonly, symptoms will last for less than a week, which can be managed relatively easily. But for some, the symptoms will last indefinitely, which requires a different treatment approach. The overall goal of treatment is the same – restore your natural rhythm and prevent complications, like blood clots.

There are two ways to reset the rhythm using a cardioversion. An electrical shock can be delivered to your chest to shock the heart back into sync, or special medication can be administered while your condition is monitored to see if your heart will reset on its own.

After getting the heart beat back on track, your doctor may prescribe certain medications to address the cause of A Fib. Normal treatment includes an anticoagulant (blood thinner) to prevent blood clots and reduce the risk of stroke. Anti-arrhythmia medication may also be prescribed to help regulate your heart beat and prevent future episodes. A combination of drugs may be needed to control heart rate, as well.

For some cases of A Fib, surgical intervention may be needed to repair diseased or damaged areas in the heart that restrict blood flow. A stent or pacemaker may be inserted during the repair. Or, a special technique can be used to create scar tissue on the heart to redirect electrical impulses because electricity cannot travel across scar tissue. This can be accomplished with a catheter ablation or surgical maze procedure. The scars are made using radiofrequency, cryotherapy, or heat. A catheter ablation can correct arrhythmias without the need for medication or an implantable device. Ablation of the AV node may be an option if a catheter ablation doesn’t work. A surgical maze procedure requires open heart surgery, which is not recommended unless all other options have failed.

Prevention
Preventing atrial fibrillation is usually handled with anti-arrhythmia medication and simple changes in lifestyle, like swapping coffee for caffeine-free tea. Even with medication, you are still at risk for stroke, heart failure, and other serious complications if you have had atrial fibrillation. If there is an underlying condition, such as hyperthyroidism causing your symptoms, treating the thyroid can prevent or reduce A Fib.

If you know that you are at risk for A Fib because of heart disease or certain risk factors, the best thing to do is avoid substances that can be stimulating, like alcohol, tobacco, caffeine, and some medications. You should also eat heart-healthy foods, get appropriate exercise, maintain a healthy weight, avoid stress, and of course, see your doctor regularly for check-ups to keep symptoms at bay.

Am I at Risk
Because atrial fibrillation is usually associated with cardiac abnormalities, having heart disease can increase your risk. Other risk factors include a family history of A Fib, obesity, alcohol abuse, high blood pressure, and some chronic conditions like sleep apnea, diabetes, hyperthyroid, and lung disease.

Introduction

Attention Deficit Disorder (ADD) is a neurologically based condition. People with ADD have difficulty paying attention, maintaining their focus on a task, and are easily distracted. They may move from one task to the next without completing any of them. Adults and children may have ADD. This condition can become problematic when it causes children to fall behind on their schoolwork or causes adults to miss deadlines at work or to not complete tasks at home. There is no way to prevent ADD; however, the condition is usually very treatable with medications and therapy.

Causes

It appears that ADD results from an abnormal balance of certain brain chemicals, including neurotransmitters such as dopamine, serotonin, and adrenaline. Neurotransmitters are brain chemicals that help nerve signals travel in the brain. Researchers suspect that ADD may be an inherited condition that forms in early brain development. It can affect both boys and girls. Children with ADD begin to have symptoms before the age of seven.

Symptoms

People with ADD have difficulty maintaining their attention, completing tasks they have started, and are easily distracted. They may go from one uncompleted task to another. They may have poor time-management skills and be very disorganized. Other symptoms of ADD include forgetfulness, procrastination, chronic tardiness, chronic boredom, anxiety, depression, low self-esteem, and mood swings. Children with ADD may be mislabeled as “daydreamers,” “slow-learners,” or “spacey.” Adults may be mislabeled as “lazy” or “incompetent.” ADD can be problematic if it interferes with a person’s schoolwork, job performance, home management, or social relationships.

ADD is technically considered Attention Deficit Hyperactivity Disorder, Predominantly Inattentive Type. This means that people with ADD may or may not have the hyperactivity or impulsivity that is associated with Attention Deficit Hyperactive Disorder (ADHD). People with ADD may experience purely inattention or inattention with a lesser degree of hyperactivity and impulsivity than people with ADHD

Diagnosis

A child or an adult should be evaluated for ADD if it is suspected. A psychiatrist can begin to diagnose ADD using questionnaires, psychological testing, developmental examinations, behavioral observation, and physical examinations. Questionnaires completed by the parents, teachers, or the individual are helpful. The psychiatrist uses the results of the assessments to determine if an individual meets the diagnostic criteria for ADD. A psychiatrist can also diagnose conditions that may accompany ADD, such as depression, substance abuse, anxiety disorder, bipolar disorder, and oppositional defiant disorder.

Treatment

Prescription medications can help relieve the symptoms of ADD in children and adults. In some cases, more than one medication trial may be necessary before the most appropriate medication or combination of medication is determined. Psychological and behavioral therapy can be helpful to learn coping strategies and social skills. For most people, treatment is effective for ADD, and people that are treated can lead full productive lives.
Prescription medications can help relieve the symptoms of ADD in children and adults. In some cases, more than one medication trial may be necessary before the most appropriate medication or combination of medication is determined. Psychological and behavioral therapy can be helpful to learn coping strategies and social skills. For most people, treatment is effective for ADD, and people that are treated can lead full productive lives.

Introduction

Attention Deficit Hyperactive Disorder (ADHD) is a neurologically based disorder. People with ADHD have difficulty maintaining attention, act before thinking, and are hyperactive or restless. Untreated ADHD can be problematic and disrupt school or work performance, as well as social relationships. ADHD is a long term condition and can continue into adulthood. More and more frequently this disease is recognized as occurring in adults. There is no way to prevent ADHD; however, early identification and treatment are associated with the best outcomes.

Causes

It appears that ADHD results from a shortage of certain brain chemicals, including neurotransmitters such as dopamine, serotonin, and adrenaline. Neurotransmitters are brain chemicals that help nerve signals travel in the brain. Researchers suspect that ADHD may be an inherited condition that forms in early brain development. It can affect both boys and girls. Children with ADHD often begin to have symptoms before the age of seven.

Symptoms

People with ADHD have difficulty maintaining attention, demonstrate impulsive behavior (acting before thinking), and exhibit hyperactivity or restlessness. Because the brain does not produce enough of certain neurotransmitters, people with ADHD try to stimulate themselves to produce the chemical with excess physical activity or by changing their focus frequently. They may be restless and unable to “sit still.” In a classroom, children may have difficulty staying in their seat or may respond to questions before the teacher has finished a sentence. People with ADHD have difficulty paying attention, maintaining their focus on a task, and are easily distractible. They may move from one task to the next without completing any of them. Children with ADHD may be labeled as defiant or unruly, when actually they are not. It can become problematic when it causes children to fall behind on their schoolwork.

ADHD is a long-term chronic condition that can continue into adulthood. Untreated ADHD may interfere with an adult’s work performance. They may miss deadlines, forget things, have difficulty following directions, and have difficulty staying engaged during meetings. Adults with ADHD may not complete tasks at home and be very disorganized. They may have a low frustration tolerance, poor social skills, and impulsive behaviors, such as an unpredictable temper, that cause conflict in relationships and with the law.

Diagnosis

A child or an adult should be evaluated for ADHD if it is suspected. A psychiatrist can begin to diagnose ADHD using questionnaires, psychological testing, developmental examinations, behavioral observation, and physical examinations. Questionnaires completed by the parents, teachers, or the individual are helpful. The psychiatrist uses the results of the assessments to determine if an individual meets the specific diagnostic criteria for ADHD. A psychiatrist can also diagnose conditions that may accompany ADHD, such as depression, substance abuse, anxiety disorder, bipolar disorder, and opposition defiant disorder.

Treatment

Prescription medications can help relieve the symptoms of ADHD in children and adults. In some cases, more than one medication trial may be necessary before the most appropriate medication or combination of medication is found. Psychological and behavioral therapy can be helpful to learn coping strategies and social skills. For most people, treatment is effective for ADHD, and people that are treated can lead full productive lives.

Introduction
Bacterial vaginosis is a common type of vaginal infection. It results when there is an imbalance and overgrowth of the natural organisms within the vagina. Bacterial vaginosis may produce a foul smelling vaginal discharge. It is usually treated with over-the-counter or prescription medication.

Anatomy
The healthy vagina contains a normal balance of microorganisms, including the bacteria that causes bacterial vaginosis.

Causes
Bacterial vaginosis is a common type of vaginal infection. It is caused by an imbalance and overgrowth of the natural organisms in the vagina. It is not considered a sexually transmitted disease, but it may be spread between sexual partners.

Symptoms
Bacterial vaginosis may cause grayish-white vaginal discharge. The discharge may have a foul smell, similar to fish. You may experience vaginal irritation or itching. Many women with bacterial vaginosis do not notice symptoms.

Diagnosis
Your doctor can diagnose bacterial vaginosis by reviewing your medical history and conducting a pelvic examination. You doctor will test your vaginal discharge to confirm the diagnosis.

Treatment
Bacterial vaginosis is treated with medication. Your doctor may recommend over-the-counter medication. Your doctor may prescribe medication in the form of pills, vaginal gel, or vaginal cream.

Prevention
You may prevent bacterial vaginosis by not douching. If you use an IUD and experience recurrent bacterial vaginosis, you may have your IUD removed.

Am I at Risk
Bacterial vaginosis is common in pregnant women. Women with multiple sex partners have a higher risk for bacterial vaginosis. Douching or using an intrauterine device (IUD) increases the risk as well.

Complications
In pregnant women, bacterial vaginosis has been linked to premature delivery and low birth weight babies. Pregnant women should contact their doctor if they suspect they have a vaginal infection.

The food that you eat can directly affect your health. As Americans are facing higher rates of obesity, diabetes, cancer, and cardiovascular disease, it is more important than ever to make sure that you and your family are eating a well balanced diet. There are plenty of fad diet products on the market, and it can be difficult to determine what exactly a well balanced diet is. A well balanced diet consists of the nutritional elements that your body needs to function properly and maintain a healthy weight. The specific elements for a well balanced diet may be different for everyone, but are composed of the same basic food elements.

My Pyramid (www.mypyramid.gov) is a helpful food guide that you can use to develop your nutrition plan. The U.S. Department of Agriculture created My Pyramid after researching the rising obesity rates in America. The My Pyramid food guide ensures that you eat the proper nutrients and calories each day to maintain a healthy weight. My Pyramid also contains exercise guidelines.

My Pyramid contains six food groups- grains, vegetables, fruits, oils, milk products, and meat and beans. You should eat foods from each group daily. My Pyramid provides portion size guidelines. For example, My Pyramid suggests that average adults eat 6 oz. of grains, 2 ½ cups of vegetables, 2 cups of fruit, 3 cups of milk products, and 5 ½ oz. of meat and bean products each day, based on a 2,000 calorie diet. The exact portion size that you use depends on the amount of calories your body needs in one day. Your doctor or a nutritionist can recommend how many calories you need to meet or maintain your weight goal. The handy tools at the My Pyramid website can help you customize your eating plan.

In addition to eating guidelines, My Pyramid provides recommendations for exercise. My Pyramid suggests that adults participate in physical activity for at least 30 minutes each day on most days of the week. My Pyramid suggests 60 minutes of physical activity per day to prevent weight gain. To sustain a weight loss, 60 to 90 minutes of physical activity each day may be necessary. Your doctor can make specific recommendations depending on your health status.

My Pyramid is a great place to start for developing your well balanced nutrition plan. You should always use your doctor as a resource for guidelines specific to you. Your doctor can make recommendations that are specific to controlling certain medical conditions. For example, there are food guidelines for diabetes, heart disease, high blood pressure, and high cholesterol. Women’s nutritional needs may change when they are pregnant or aging. Ask your doctor for a referral to a nutritionist for specific help with daily meal planning and recipe recommendations.

It is important to teach your children and family members about healthy eating. Make sure that everyone in your family is getting enough daily exercise. By doing so, you may reduce the risk of obesity and serious health concerns.

Introduction

Bile duct cancer, also called cholangiocarcinoma, is a rare form of cancer that occurs in the duct that carries bile from the liver to the small intestine. Bile duct cancer is relatively slow growing. Its main symptom is jaundice (yellowing of skin and eyes). Surgery is the treatment of choice for bile duct cancer. Radiation and chemotherapy is commonly used before surgery to reduce the size of a tumor or as a follow-up treatment after surgery.IntroductionBile duct cancer, also called cholangiocarcinoma, is a rare form of cancer that occurs in the duct that carries bile from the liver to the small intestine. Bile duct cancer is relatively slow growing. Its main symptom is jaundice (yellowing of skin and eyes). Surgery is the treatment of choice for bile duct cancer. Radiation and chemotherapy is commonly used before surgery to reduce the size of a tumor or as a follow-up treatment after surgery.

Anatomy

The bile duct begins as many small channels in your liver that meet to form the hepatic duct. The hepatic duct is joined by the cystic duct from the gallbladder, and their union forms the common bile duct. The common bile duct continues to the duodenum, the first part of your small intestine.
Your gallbladder works with your liver and pancreas to produce bile and digestive enzymes. Bile is a fluid that breaks down fat in food for digestion. Bile is produced in the liver and stored in the gallbladder until it is needed. When you eat high-fat or high-cholesterol foods, your gallbladder sends bile to your duodenum via the common bile duct.

Causes

Bile duct cancer is a rare form of cancer. Most bile duct cancers are adenocarcinomas. The majority of cases are slow growing and late to metastasize. Cancer that has spread to other parts of the body is termed metastasized. However, by the time most bile duct cancers are diagnosed, they are too advanced for surgical removal.

Researchers do not know the cause of most bile duct cancers. Cancer occurs when cells grow abnormally and out of control, instead of dividing in an orderly manner. Most bile duct cancer arises from the mucus glands that line the duct. It appears that chronic irritation of the bile duct, by inflammation or parasitic infection, is the top risk factor associated with bile duct cancer formation.

Cancer can develop in any part of the bile duct. The cancer is classified based on its location. The majority of bile duct cancer develops in the hepatic duct at the site where the small channels in the liver join together. Cancers in this area are called perihilar cancers or Klatskin tumors. Distal bile duct cancers form in the common bile duct near the small intestine. A small percentage of bile duct cancers form in the channels within the liver and are called intrahepatic bile duct cancers.

Symptoms

Symptoms occur when the bile ducts become blocked. Jaundice is the most common symptom of bile duct cancer. Jaundice is a condition caused by an excess of bilirubin. Symptoms of jaundice include yellowing of the eyes and skin, dark urine and pale-colored stools. You may also experience fever, nausea, vomiting, chills, and itching. You may lose your appetite and lose weight. You may feel pain in your right upper abdomen that may spread to your back.

Diagnosis

Your doctor can begin to diagnose bile duct cancer through a series of tests, examinations, and by reviewing your medical history. Your doctor will feel your abdomen for masses or enlarged organs. Blood tests will evaluate your liver function and bilirubin. Your blood may be tested for tumor markers, which some people produce in the presence of bile duct cancer.

Imaging tests are used to identify the location and size of tumors and blockages. Common imaging tests include ultrasound, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, endoscopic retrograde cholangiopancreatography (ERCP), positron emission tomography (PET) scans, cholangiography, and angiography. Ultrasound uses sound waves to produce images of internal organs and detect abnormal tissues. An ultrasound device may be placed over the abdomen area, inserted through the mouth and into the stomach (endoscopic ultrasound), or through an incision in the side of the body (laparoscopic ultrasound).

CT scans take cross-sectional images of the body. They may be used with a contrast agent or dye to take pictures of your bile duct and nearby organs. CT scans are useful for determining if cancer has metastasized. MRI scans produce even more detailed images and can outline the exact site of bile duct blockage.

An ERCP uses an endoscope to view the biliary system. An endoscope is a thin tube with a light and viewing instrument at the end of it. After you are sedated, the thin tube is passed through your mouth and into your small intestine. An endoscope is used to take tissue samples with biliary brushing. It can administer dye to enhance views.

A cholangiography can determine the exact location of bile duct cancer. It is helpful for determining if the cancer can be treated with surgery. For this procedure, contrast dye is injected into the bile duct before X-rays are taken.

Angiography is used to show surgeons the location of blood vessels that are near the bile duct cancer for surgical planning. Angiography involves inserting a small tube into a blood vessel to inject contrast dye near the suspected site before X-rays are taken.

A PET scan is an imaging test that uses a radioactive sugar substance. A PET scan determines how quickly the cells metabolize the sugar. Cancer cells and normal cells metabolize sugar at different rates.

A laparoscopy is a procedure used to view the bile duct, gallbladder, liver, and other internal organs. It uses a thin-lighted instrument, a laparoscope, which is inserted through an incision in the abdomen. A laparoscope can take a biopsy. A biopsy is a tissue sample that is taken for evaluation of cancer cells. A CT scan is used to guide needle biopsies.

If you have bile duct cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests. Staging describes the cancer and how it has metastasized. Staging is helpful for treatment planning and recovery prediction.

There is more than one type of staging system for cancer, and you should make sure that you and your doctor are referring to the same one. Generally, lower numbers in a classification system indicate a less serious cancer, and higher numbers indicate a more serious cancer. The stages may be subdivided into grades or classifications that use letters and numbers.

Treatment

Surgery is the treatment of choice to remove bile duct cancer. Chemotherapy or radiation may be used if all of the cancer cannot be removed with surgery. The type of treatment that you receive depends on many factors, including the location and stage of your cancer.

Intrahepatic surgery is used for bile duct cancer that originates in the liver. This procedure removes the part of the liver that contains cancer. Surgery for perihilar cancer usually includes removing the bile duct, gallbladder, and part of the pancreas, small intestine, and liver. The remaining bile ducts are connected to the small intestine. Part of the pancreas and small intestine is usually removed during surgical treatment of distal bile duct cancer. A Whipple procedure removes the bile ducts, part of the stomach, duodenum, pancreas, gallbladder, and lymph nodes. In select cases, a complete liver transplantation may be necessary to treat bile duct cancer. If all of the cancer cannot be removed, a bypass surgery is used to relieve symptoms of bile duct obstruction. Bypass surgery creates a new route from the bile duct to the small intestine.

Chemotherapy, radiation therapy, or both may be used to reduce the size of a tumor before surgery or as a follow-up treatment after surgery. Radiation therapy uses high-energy rays to eliminate cancer cells. Chemotherapy uses cancer-fighting drugs to destroy cancer cells. There are different types of chemotherapy and radiation therapy.

Even with treatment, some cases of bile duct cancer may return. This is termed “recurrent bile duct cancer.” The cancer may come back near the site of the original cancer or in other parts of the body. Your doctor can explain your risk for recurrent bile duct cancer and possible treatments if it does recur.

The experience of bile duct cancer and cancer treatments can be an emotional process for people with cancer and their loved ones. It is important that you receive support from a positive source. Some people find comfort in their family, friends, counselors, co-workers, and faith. Cancer support groups are another good option. They can be a source of information and support from people who understand what you are experiencing. Ask your doctor for cancer support group locations in your area.

Prevention

You may prevent bile duct cancer by reducing the risk factors that you can control. It may be helpful to avoid the hazardous chemicals associated with bile duct cancer. You can prevent hepatitis B with a vaccine and hepatitis C by avoiding blood-borne or sexually transmitted infections. Stopping alcohol abuse may prevent liver cirrhosis. When travelling in Asia, it is important to avoid contact with liver flukes.

Am I at Risk

Risk factors may increase your likelihood of developing bile duct cancer, although some people that experience this cancer may not have any risk factors. People with all of the risk factors may never develop bile duct cancer; however, the likelihood increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for bile duct cancer:

_____ Long-term inflammation of the bile duct is associated with an increased risk of developing bile cancer.
_____ Sclerosing cholangitis is a type of bile duct inflammation that leads to scar tissue formation and is associated with an increased risk of bile duct cancer.
_____ Ulcerative colitis is an inflammation of the large intestine that can lead to sclerosing cholangitis.
_____ Smoking increases the risk of bile duct cancer for people with sclerosing cholangitis.
_____ Stones in the bile duct increase the risk for developing bile duct cancer.
_____ Diseases of the liver and bile duct increase the risk for bile duct cancer. Such conditions include polycystic liver disease, choledochal cysts, congenital dilation of the intrahepatic bile ducts, and cirrhosis.
_____ In Asian countries, parasites called liver flukes are a major cause of bile duct cancer.
_____ Aging increases the risk for bile duct cancer. Bile duct cancer occurs most frequently in people over the age of 65.
_____ Radioactive chemicals, including Thorotrast (thorium dioxide) which was used years ago during X-rays, are associated with an increased risk for bile duct cancer development.
_____ Certain chemicals may be associated with bile duct cancer formation. These chemicals include dioxin, nitrosamines, and polychlorinated biphenyls (PCBs).
_____ Viral hepatitis B or C is linked to intrahepatic bile duct cancer. The link is greater for hepatitis C.
_____ An association with both diabetes and HIV have been suggested but not proven.

Advancements

Scientists are studying the genetic changes associated with bile duct cancer. They hope to use such information to better prevent, diagnose, and treat the disease. Researchers are studying immunotherapy to boost the immune system’s response to fight cancer. Photodynamic therapy is being investigated as a treatment method that uses medication and special light rays to cause cancer cells to die.

Introduction

Binge-eating is a disorder of eating. It involves episodes of eating an enormous amount of food in a very short period of time. People may feel out of control during binge-eating and guilty or depressed afterwards. People with binge-eating disorder are commonly overweight or obese. Treatment involves therapy that focuses on the emotional components of overeating, overall health and nutrition, and establishing healthy eating patterns. Some people may be helped by medications prescribed by their doctor as well.

Causes

The exact cause of binge-eating disorder is unknown. It appears that binge-eating may be an unhealthy coping mechanism for dealing with stress, depression, poor self-worth, or painful emotions. Many people with binge-eating disorder have clinical depression or have been depressed in the past. Some people find that their mood appears to trigger a binge-eating episode, while others state that they binge-eat regardless of their mood.
New findings from research suggest that brain signal abnormalities may be a contributing factor. It may be that too much or too little of certain brain chemicals affect the way that the brain processes thoughts and emotions. Researchers think that some people may be genetically predisposed to eating disorders, meaning that they inherit an increased risk of developing the condition under certain circumstances.

Symptoms

People that binge-eat may feel out of control during an episode. They may feel unable to stop eating or control the amount of food that they eat. They may eat very fast and eat past the point of feeling full. They may consume enormous amounts of calories, fats, and sugars. People that binge-eat may eat alone to hide their behaviors or because they feel ashamed afterwards.

Binge-eating can have an element of bulimia; however, most people with binge-eating disorder do not purge. Binge-eating is similar to compulsive overeating, however, people who binge-eat do not have a compulsion to overeat and do not fantasize about food.

Overtime, untreated binge-eating can lead to serious medical complications. Binge-eating can cause people to be overweight or obese. It can lead to high blood pressure, diabetes, high cholesterol, heart disease, gallbladder disease, and certain types of cancer.

Diagnosis

A psychiatrist can diagnose binge-eating disorder. Frequently, the loved ones of an individual who binge-eats recognizes the symptoms and helps the person access treatment. The psychiatric evaluation may consist of structured evaluations or interviews with the individual and their parents, spouse, or significant others. A psychiatrist could also identify co-existing conditions, such as depression, which commonly accompanies binge-eating disorder. In some cases, a complete medical examination may be necessary to evaluate the general health of an individual.

Binge-eating disorder is classified as an “eating disorder- not otherwise specified.” Binge-eating falls into this category because it does not meet the diagnostic criteria for any specific eating disorder. In the future, researchers may formulate the exact diagnostic criteria for it.

Treatment

Treatment of binge-eating disorder includes addressing both the physical and emotional health of an individual. A foremost goal is to stop the binge-eating and establish healthy eating patterns. Cognitive-behavioral therapy can help people develop new healthy behaviors, problem solving skills, and coping mechanisms. Interpersonal therapy is helpful for analyzing your relationships with others and resolving issues. Psychotherapy may include individual therapy, family counseling, and group therapy. Nutritional education, structured meal planning, and healthy exercise instruction may be beneficial as well. In some cases, mediations such as antidepressants can be helpful. Overall, binge-eating disorder treatments are associated with good outcomes.

Introduction

Bipolar disorder is a type of mood disorder characterized by alternating moods of depression and mania, often with normal moods in between. Depression may cause feelings of sadness, worthlessness, hopelessness, and suicidal thoughts. Mania may cause excitability, rage, and racing thoughts. The mood changes may be dramatic and abrupt. Untreated bipolar disorder can interfere with relationships, work, school, and lead to suicide. Bipolar disorder is treatable and people with bipolar disorder can lead happy and full lives.

Causes

The exact cause of bipolar disorder is unknown. It appears that several factors may contribute to bipolar disorder. Bipolar disorder can run in families, and researchers suspect that there is an inherited genetic component to it. It also appears that certain environmental factors may trigger bipolar disorder, such as intense stress, substance abuse, and lack of sleep.

Bipolar disorder typically develops in the late teens and early twenties. It can affect both men and women. People with a family history of bipolar disorder or depression appear to have a higher risk for developing the condition.

Symptoms

Bipolar disorder is noted for its dramatic mood swings, from extreme highs to extreme lows. The moods may last from days to months before changing again. You may experience “normal” moods in between the mood swings. Sometimes the moods may change quickly, occur at the same time, or overlap in what is termed a “mixed state.” Alcohol or drug use can make the moods even worse.

Symptoms of the depressive phase include feeling sad, hopeless, helpless, and worthless. You may feel self-hate, anger, restlessness, irritability, and inappropriate guilt. You may experience a lack of interest or diminished pleasure in activities that you used to enjoy. You may withdraw from others and become less active. You may feel tired all of the time. It may be difficult to sleep. You may have problems falling asleep, staying asleep, sleeping too much, or not sleeping at all. It may be difficult to concentrate, make decisions, or remember things. Your appetite may change significantly, and you may gain or lose weight.

Bipolar disorder is associated with a high risk of suicide. While experiencing depression, people may think about death a lot, feel suicidal, or feel like harming others. If you experience such symptoms, you should contact emergency medical services, usually, 911, or go to the nearest emergency department of a hospital.

The manic phase of bipolar disorder provokes intense feelings that may range from sudden rage and poor temper control to feelings of euphoria and extreme happiness. You may feel hyperactive, energetic, and have little need for sleep. Your thoughts may race and you may feel an invincible or like you can accomplish anything. You may have grandiose delusions that you have special abilities or connections with famous people or God. Your behavior may become very risky, for example, you may go on shopping sprees, drive recklessly, or engage in risky sexual behavior.

Because the dramatic mood swings with bipolar disorder can be so abrupt and unpredictable, you may have conflicts with your spouse, family members, and friends. It can cause problems at school, work, or with the law. Bipolar disorder may disrupt your entire life.

Diagnosis

Because the consequences can be so severe, it is important that you receive a psychiatric evaluation if you suspect that you have bipolar disorder. A psychiatrist can begin to diagnose bipolar disorder by listening to your symptoms and conducting an interview or evaluations. It can be helpful for your spouse or loved ones to provide information.

Treatment

Bipolar disorder is very treatable in most cases. Medication and psychotherapy are helpful treatments for this condition. Mood stabilizing medications are frequently prescribed to help manage bipolar disorder. Bipolar disorder is a recurrent condition and you may need to take medication for your entire life. It is important not to discontinue taking your medication, even if you feel better.

Psychotherapy can help you resolve issues and rebuild relationships. It can be helpful for family members and loved ones to attend therapy as well. Therapy can help them heal and learn how to be a part of the treatment process as well.

Introduction

Animal bite injuries can cause skin wounds and structural damage to the hand. Infection and, less commonly, rabies are always a main concern. Pets are the most common source of bite injures, although they may result from wild animals as well. Animal bite injuries need prompt careful cleaning. Hand surgery may be necessary to drain infections or repair injured bones, blood vessels, muscles, tendons, ligaments, and nerves.

Anatomy

Your hand is composed of many bones that provide structure for your wrist and fingers. The bones are connected with strong ligament tissues. Tendons are strong fibers that attach your muscles to your bones and allow movement. Your hand also contains nerves, blood vessels, and fat. The skin that covers your hand protects it from the environment.

Causes

The hand is the most common place for animal bites. Animal bites can result in skin lacerations, puncture wounds, crushed bones, torn ligaments, tendons, and muscles. They can injure or damage blood vessels and nerves. Compounding the physical injuries, several types of infections, including rabies, are transmittable from the animal’s mouth into the hand.

Dogs have rounded teeth and strong jaws that can cause crushing injuries. Animal bites can break the skin and cause a puncture wound. Cats have sharp pointed teeth and cause more puncture wounds than dogs.

Infection is a major concern for all bite injuries. Most infections from animal bites are mixed infections, meaning that a combination of sources including bacteria, virus, fungal, and other germs cause them. Rabies is a concern, because without timely treatment rabies is fatal. Most pets in the United States are vaccinated against rabies. The majority of rabies cases occur from wild animals such as skunks, bats, or raccoons.

Pets are a common cause of animal bites. Dog bites occur most frequently, followed by cat bites. Stray animals and wild animals also cause bite injuries. Skunks, raccoons, foxes, bats, rodents, reptiles, and farm animals may bite people if they are sick, provoked, or feel threatened.

If an animal bites you or your child, you should try to keep the animal in view and contact your local animal control experts to capture it. They may quarantine the animal and check it for rabies. They can also verify the rabies vaccination status of stray pets.

Symptoms

An animal bite can cause pain and swelling. It may be difficult for you to move your fingers or wrist if the bones, muscles, tendons, ligaments, or nerves are injured. You may experience a loss of sensation or tingling in your fingers.

You should inspect your hand for puncture wounds and bleeding. Signs of infection include warmth, redness, pain, and tenderness. Drainage of pus can occur with abscess formation. Infections can also cause a fever, chills and or sweats.

You should contact your doctor if you or your child suffers an animal bite. You should carefully wash the wound with soap and water, unless the area is actively bleeding. If you experience bleeding apply direct pressure with a clean dry cloth and elevate your hand above the level of your heart. You should go to your doctor or an emergency department for immediate treatment of bleeding.

Diagnosis

You should tell your doctor what kind of animal bit you and how you received the bite. Your doctor will examine your hand and arm. An X-ray may be ordered if structural damage is suspected.

Your doctor will carefully wash and remove any foreign material from your wound. Your doctor may order a blood test to check for infections. You may need to get a tetanus shot and antibiotics to help prevent infection.

If rabies is identified or suspected, you will receive a series of vaccinations. The medication is highly effective if it is received in the first stage of rabies. As the consequences of rabies are so severe, you should always promptly contact your doctor if you or your child suffers an animal bite.

Treatment

Animal bites that puncture the skin require careful cleaning. To avoid infection, wounds are usually kept open, instead of stitched shut. If you have an infection, you may receive antibiotic medication, antibiotic ointment, or IV antibiotics. Your wound will be loosely bandaged. Your doctor will provide you with home care instructions. It is very important that you attend your follow-up appointments so that your condition can be monitored.

Surgery

Surgery may be necessary if bones, blood vessels, muscles, tendons, ligaments, or nerves are injured, or if an abscess develops. The type of surgery that you receive depends on the type and extent of your injury. You will most likely participate in hand therapy rehabilitation following surgery. The goal of surgery is to return your hand structure and function to its pre-injured condition.

Recovery

Recovery from animal bites is an individualized process. Your recovery will depend on the extent of your injury or infection and the type of treatment you receive. Your doctor will let you know what to expect. Attend all of your doctor and hand therapy appointments to ensure the best recovery possible.

Prevention

There are several ways that you may be able to prevent animal bites. Do not approach, pick up, or play with any type of wild animal. You should not try to separate animals that are fighting. Avoid animals that appear sick or that are acting odd—call your local animal control service to have the animal picked up. Do not provoke or tease animals. Do not approach pets when they are eating. Keep your pet on a leash in public and make sure your pet is vaccinated. Do not touch other’s pets without asking permission of the owner first. Teach your children about animal bite prevention.

Introduction

Bladder cancer occurs when the cells in the bladder grow abnormally or out of control. The exact cause of bladder cancer is unknown; however cigarette smoking and exposure to certain industrial chemicals appear to be risk factors. The most common symptoms of bladder cancer are blood in the urine and changes in urinary habits.

Some forms of bladder cancer are curable if detected and treated very early. Follow up care is important for bladder cancer because it has a high risk of returning following treatment. Most bladder cancers that return respond well to treatment.

Anatomy

Your urinary tract system consists of your kidneys, ureters, bladder, and urethra. Your kidneys are a pair of bean shaped organs located in your lower back. They filter waste products and extra fluids from your blood and turn them into urine. Urine is composed mainly of water and metabolic waste products. The urine travels through two tubes, called ureters, to your bladder.

Your bladder holds and collects urine from your kidneys. When a certain level of urine has accumulated in your bladder, your body signals you to urinate. The bladder has a muscular wall that allows it to change size as the volume of urine changes. Your urethra is the tube that carries the urine from your bladder to outside of your body. The female urethra is shorter than the male urethra.

Causes

The exact cause of bladder cancer is unknown. Cancer occurs when cells grow abnormally and out of control, instead of dividing in an orderly manner. Bladder cancer usually originates in the transitional cells that line the inside of the bladder. Smoking and exposure to certain industrial chemicals appear to contribute to bladder cancer. There are different types and subtypes of bladder cancer. They may respond to treatments in different ways. The most common types of bladder cancer include:

Urothelial carcinoma, also called transitional cell carcinoma: This is the most frequent type of bladder cancer. There are several subtypes of urothelial carcinoma. Some types of urothelial carcinoma tend to spread to other sites.

Squamous cell carcinoma: This type of bladder cancer is not common. Squamous cell carcinoma tends to spread to other parts of the body.

Adenocarcinoma: This type of bladder cancer is not common. Adenocarcinoma tends to spread to other parts of the body.

Symptoms

The most common symptoms of bladder cancer are blood in the urine and changes in bladder habits. Blood can cause your urine to appear red, bright-red, or rust colored. You may feel an urgent need to urinate and may urinate frequently. You may feel the urge to urinate but not be able to do so. You may feel pain when you urinate. However, many people with bladder cancer just experience blood in the urine.

Other symptoms of bladder cancer are abdominal pain, weight loss, anemia, feeling tired, and bone pain or tenderness. You may experience incontinence, urinating when you do not intend to. The symptoms of bladder cancer are very similar to common noncancerous conditions, such as urinary tract infections or kidney stones. If you experience any changes related to the urinary tract, a doctor should evaluate you.

Diagnosis

Any changes in your urine or voiding habits should be reported to your doctor. Your doctor can diagnose bladder cancer by reviewing your medical history, conducting a physical examination, and with diagnostic tests. You should tell your doctor about your risk factors and symptoms. Your doctor will perform a rectal and pelvic exam. You will provide a urine sample to be tested. A urinalysis is a test that checks the color and content of the urine. A urine cytology test determines if urine or cells from the bladder are cancerous or precancerous.

A cystoscopy is a procedure that is commonly used to diagnose bladder cancer. A cystoscope is a thin lighted viewing instrument that is gently inserted through the urethra to allow a doctor to view the inside of the bladder. A biopsy can be performed with a cystoscope. A biopsy entails removing a suspicious area of tissue from the bladder for examination by a pathologist.

Imaging tests may be ordered so your doctor can see your bladder and other organs. Some tests include an intravenous pyelogram (IVP), X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, ultrasound, and bone scan which can provide your doctor with more information about your bladder cancer and if it has metastasized. Cancer that has spread from its site of origin is termed metastasized.

An IVP uses X-rays and contrast dye to check for cancer or blockages in the urinary tract. CT scans take pictures of the organs from different angles, and MRI scans take pictures with even more detail. An ultrasound uses sound waves to create images of structures. A bone scan creates images that indicate if cancer is in the bones.

If you have bladder cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests. Staging describes the cancer and how it has metastasized. Staging is helpful for treatment planning and recovery prediction. There is more than one type of staging system for cancer, and you should make sure that you and your doctor are referring to the same one.

In general, your doctor will classify your bladder cancer in a stage labeled from 0-4. Lower numbers indicate a less serious cancer, and higher numbers indicate a more serious cancer. Letters and numbers are also used to classify bladder cancer: T for degree of tumor spread in the bladder wall and nearby tissues, N for degree of lymph node spread, and M for degree of spread to distance organs.

Treatment

If you are diagnosed your doctor will refer you to an oncologist for treatment. An oncologist is a doctor with special training in cancer and cancer treatments. Treatment for bladder cancer depends on many factors, including the stage of the cancer and the cancer cell type. You may opt to receive a second opinion about the best kind of cancer treatment for you. Cancer treatments include surgery, radiation therapy, chemotherapy, intravesical immunotherapy, or a combination of therapy types. Most people with bladder cancer receive surgery and another type of treatment.

There are several types of surgery for bladder cancer. The type that you receive depends on the stage of your cancer. Transurethral surgery and cystectomy (bladder removal) surgery are the most common surgeries for bladder cancer.

Transurethral surgery uses a cystoscope to remove the cancer cells. This treatment is most frequently used for early stage bladder cancer. A cystectomy is used to treat higher stages of bladder cancer. A partial cystectomy removes only part of the bladder. A radical cystectomy removes the entire bladder.

If your entire bladder is removed, reconstructive surgery will create another way for your body to store and remove urine. A urostomy involves attaching tissue from your small intestines to the ureters and using a bag worn on the outside of the body to collect the urine. Continent diversion is another option. Continent diversion entails creating a sac from the small intestines and attaching it to the ureters. With this option, urine can be removed by placing a tube in the diversion or by surgically creating a route for the urine to travel to the urethra to be removed by urination.

Radiation therapy uses high-energy beams to destroy cancer cells. Chemotherapy uses cancer-fighting drugs to destroy cancer cells. Intravesical immunotherapy involves placing a treatment inside of the bladder to trigger your immune system to fight the cancer cells. There are several different types of radiation therapies, chemotherapies, and intravesical immunotherapies.

Even with treatment, it is common for bladder cancer to return. This is termed “recurrent bladder cancer”. The cancer may come back in your bladder or in other parts of the body. Your doctor can explain your risk for recurrent bladder cancer and possible additional treatments if it does recur.

The experience of cancer and cancer treatments can be an emotional process for people with cancer and their loved ones. It is important that you receive support from a positive source. Some people find comfort in their family, friends, counselors, co-workers, and faith. Cancer support groups are another good option. They can be a good source of information and support from people who understand what you are experiencing. Ask your doctor for cancer support group locations in your area.

Prevention

You may reduce your risk of developing bladder cancer by quitting smoking and use of tobacco products, including chew. You should avoid exposure to the chemicals that are known to increase the risk of bladder cancer. Follow safe work place practices for working with hazardous chemicals. Contact your doctor if you experience blood in your urine or changes in your urinary habits.

Am I at Risk

Risk factors may increase your likelihood of developing bladder cancer, although some people that experience this cancer may not have any risk factors. People with all of the risk factors may never develop bladder cancer; however, the likelihood increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for bladder cancer:

_____ Smoking cigarettes or using tobacco products, such as chew, is the greatest risk factor for bladder cancer. Chemicals from tobacco collect in the lining of the bladder and increase the risk of cancer. According to the American Cancer Society, people that smoke develop bladder cancer twice as often as those who do not smoke.
_____ Exposure to certain chemicals used at work or industrial manufacturing is linked to bladder cancer. Chemicals used in making dye, arylamines, or aromatic amines used in making rubber, leather, printing materials, textiles, pesticides, and paint products are associated with bladder cancer. Painters, hairdressers, machinists, rubber workers, aluminum workers, leather workers, pesticide applicators, printers, and truck drivers are at risk if they do not follow good safety practices. People that smoke and are exposed to the chemicals have even a greater risk of developing bladder cancer.
_____ Arsenic in drinking water increases the risk for bladder cancer.
_____ The risk for bladder cancer is higher with increasing age.
_____ Men get bladder cancer more often than women.
_____ Caucasians develop bladder cancer more often than people of other races. Asians have the lowest incidence of bladder cancer.
_____ People that have had bladder cancer are at risk for experiencing it again.
_____ A family history of bladder cancer puts you at a higher risk for developing it.
_____ Urinary infections, kidney stones, and bladder stones do not cause bladder cancer, but they have been linked in research to an increased risk of bladder cancer.
_____ People that consume small amounts of liquids each day have an increased risk for bladder cancer.
_____ Some medications and radiation therapy to treat other cancers can increase the risk for bladder cancer.
_____ In rare cases, certain birth defects involving the bladder contribute to an increased risk for bladder cancer.
_____ A parasite found in developing third world countries, schistosomiasis, is linked to the development of bladder cancer.

Complications

Metastasis can be a complication of bladder cancer. This means that the cancer has spread from the bladder to distant organs. Common sites for bladder metastasis include the lymph nodes, rectum, colon, liver, lungs, and pelvic bones. Bladder cancer is associated with other medical conditions, such as anemia, swelling of the ureters, urinary incontinence, and urethral narrowing.

Bladder cancer that has been treated has a high risk of returning. Most bladder cancers that return respond well to treatment. You should make and attend all follow up appointments with your doctor so that recurrent bladder cancer can be identified and treated early.

Advancements

Researchers have a good understanding of how normal cells in the bladder turn into cancer cells. They are using DNA studies to determine methods to prevent, detect, treat, and predict the course of bladder cancer. They continue to study the effects of second hand smoke and industrial chemicals in efforts to prevent bladder cancer. Researchers are studying medications and vitamins that they hope will prevent recurrent bladder cancer.
The Food and Drug Administration (FDA) has recently approved tumor marker tests and several are being studied. Tumor marker tests identify protein or enzymes from cancer cells in the urine.

Fluorescence in situ hybridization (FISH) is a screening test for recurrent bladder cancer that has recently been approved by the FDA. Researchers hope to increase the sensitivity of these studies and use them for early detection of bladder cancer or recurrent bladder cancer.

Researchers are studying new treatment methods for bladder cancer. Photodynamic therapy (PDT) uses chemicals and a laser to kill early superficial bladder cancer cells. Researchers are also conducting clinical trials for new medications, immunotoxins, and gene therapies to kill bladder cancer cells.

Introduction

Botox Cosmetic is used by both men and women for vanishing frown lines without surgery or downtime. Botox is an injected prescription medication that temporarily improves the appearance of moderate to severe frown lines between the eyebrows (glabellar lines). Approximately 11.8 million Botox Cosmetic procedures have been performed since its FDA approval in 2002.

Causes

Your skin, like the rest of your body, naturally ages over time. The rate and degree of skin aging depends on both intrinsic and extrinsic factors.

Intrinsic factors are controlled by hormone levels, nutrients, and inherited genes that control the natural aging process. For example, with age, the skin begins to lose its supportive collagen, fat, and elasticity. This loss contributes to the formation of wrinkles. With age, new skin cells are created at a slower rate, and dead skin cells do not shed as quickly, leading to rough, dry skin.

Extrinsic factors are the contributing conditions outside of your genetics that intensify the aging process. The greatest extrinsic factor is sun and artificial tanning exposure. Other extrinsic factors include smoking, facial expressions, and the position of your face on your pillow while you sleep.

Diagnosis

During the initial consultation with your healthcare professional, your concerns and expectations will be discussed. Your skin will be examined and overall health reviewed. You may be asked to make over-exaggerated facial expressions to see the extent of your facial lines.

It is common for “Before” photos to be taken for your records. Some facilities may have computer equipment that can simulate a representation of how Botox may help you.

Treatment

No anesthesia is necessary for Botox injections. Your doctor may numb the area with a cold pack or local anesthetic. You may experience minimal brief discomfort during the injections.

Your doctor will inject Botox into a few places in the muscles between the brows. Botox administration is a very short in-office procedure, lasting about only 10 minutes. Many men and women choose to schedule Botox appointments during their lunch hours.

No downtime is required following Botox injections. You can return to your regular activities. Your doctor will provide you with specific after care instructions.

How Botox Works

Botox works to block nerve signals to the injected muscles, which reduces the muscle movements that cause frown line wrinkles.

Continuing Botox Treatment

Regular treatment schedules with Botox Cosmetics can help maintain your new, more youthful appearance. Botox injections can be received every 3 to 4 months. If treatment is discontinued, the moderate to severe frown lines will return between the eyebrows and appear as they did before Botox Cosmetic treatment.

Introduction

Breast cancer is a common type of cancer in women. It is a malignant (cancerous) tumor that begins from the cells in the breast. Breast cancer can rarely develop in men, as well. There are several different types of breast cancer, and they may develop in any part of the breast. Early detection and treatment is very important because some forms of breast cancer are treatable. Advancements in early detection methods and more tolerable cancer treatments have helped to reduce the number of breast cancer related deaths and improve quality of life. Breast cancer is currently the leading cause of cancer death among Hispanic women and the second leading cause of cancer death among White, Black, Asian/Pacific Islander, and American Indian/Alaska Native women. Although breast cancer treatments have come a long way over time, women still need to remain vigilant and should contact their doctor if they notice changes in their breasts.

Anatomy

Both males and females have breasts, but they only develop in adult females. The breast is covered by skin and supported by suspensory ligaments. The nipple and areola consist of pigmented or darker colored skin than the rest of the breast. The nipple contains muscle fibers. The muscle fibers allow the nipple to become erect during lactation to enhance the flow of milk. Lactation is the process of secreting milk from the breast to feed a baby. The areola is the pigmented circle surrounding the nipple. The areola contains glands that may act as a lubricant for a suckling baby.

A woman’s breast is composed of blood vessels, nerves, fatty tissue, connective tissue, lobules, and lymphatic vessels. Lobules are glands that are capable of making breast milk. A group of lobules form a lobe. There are about 15-20 lobes in each breast. Ducts or small tubes from the lobules merge to form lactiferous ducts that lead from the lobe to the nipple. Just below the nipple, the lactiferous ducts form the lactiferous sinuses. The lactiferous sinuses are reservoirs for milk during lactation.

The lymphatic vessels are tubes that carry lymph fluid. Lymph fluid contains waste products, fats from breast milk, and immune system cells. The lymphatic vessels lead to lymph nodes. The lymph nodes filter the lymph fluid. Most of the lymph nodes from the breasts are located in the under arm or armpit area. They are termed axillary nodes.

A healthy breast may contain abnormal growths or cysts that are benign (not cancerous). Benign breast tumors do not spread outside of the breast. Most benign breast lumps are fibrocystic tumors. Fibrocystic tumors are benign fluid filled sacs located in the breast tissue. They can develop scar tissue and cause swelling and discomfort.

Causes

The exact cause of breast cancer is unknown and the subject of intense research. Cancer occurs when cells grow abnormally and out of control, instead of dividing in an orderly manner. Breast cancer originates in the breast and often forms a lump or tumor. Cancerous breast lumps usually feel firm or hard and are painless. There are several different types of breast cancer. Breast cancer is labeled based on where it originated in the breast and if it could potentially spread. Invasive types of breast cancer can spread to other parts of the body. Noninvasive breast cancers are confined to the area they started in and do not spread to other parts of the body.

Some of the most common types of breast cancer include:

Lobular carcinoma in situ (LCIS): LCIS is not a true cancer, but having LCIS increases a woman’s chance of getting cancer. This condition begins in the milk-making glands but does not extend outside of the lobule.
Carcinoma in situ: This is an early type of breast cancer that has not spread from where it started, usually in the ducts or lobules.
Ductal carcinoma in situ (DCIS): This type of breast cancer originates in and is confined to the ducts. This is the most common type of noninvasive breast cancer. Almost all women with DCIS can be cured.
Infiltrating invasive ductal carcinoma (IDC): This is the most common type of breast cancer. IDC originates in a milk passage or duct and spreads into the fatty tissue of the breast. It is an invasive cancer that can also spread to other parts of the body.
Infiltrating invasive lobular carcinoma (ILC): This type of breast cancer originates in the milk glands or lobules and can spread to other parts of the body.

Symptoms

The most common symptom of breast cancer is a new lump or mass. The lump may feel very firm or hard. They are usually painless and have irregular borders. A lump or mass may appear in the breast or armpit.

Your breast may look different. Its size or shape may change. It may appear swollen. The color or texture of your breast, areola, or nipple may change. The skin may appear dimpled, puckered, or retracted in. Your skin may appear scaly, red, or irritated. The symptoms may cause discomfort on just one breast.

Your nipple may be painful and look different. It may turn inward or enlarge. Your nipple may produce an abnormal discharge. An abnormal discharge is fluid other than milk. An abnormal discharge may look bloody, clear to yellow colored, green colored, or purulent, like pus.

Symptoms in men may include a lump, pain, or tenderness.

Symptoms of advanced breast cancer include bone pain, weight loss, swelling of one arm, and skin sores.

Diagnosis

Any breast change in women or men should be brought to their doctor’s attention. Your doctor can begin to diagnose breast cancer after reviewing your medical history and conducting a physical examination. You should tell your doctor about your symptoms and risk factors. Your doctor will conduct a clinical breast exam (CBE) including your breasts, armpits, neck and chest area. Your doctor will look at your breasts to see if they have changed in size or shape. Your doctor will use the pads of his or her fingers to check for lumps or masses. Your doctor may also recommend further tests.

A mammogram is a type of X-ray used to identify breast masses or tumors. For this test, your breast is placed between two plates. The two plates compress your breast to flatten and spread the tissue in order to obtain the best image possible. This test may be uncomfortable, but only for a very brief period of time. A mammogram may only tell if a tumor is present. It cannot tell if a tumor is cancerous or not.

A breast ultrasound is used to determine if a breast lump is solid or fluid filled. It is sometimes used with a mammogram to provide a better look at areas of concern. For this test, an imaging device is gently moved across your skin. Sound waves collected by the device create an image on a monitor for your doctor to examine.

A ductogram or galactogram is used to identify masses inside a duct and the cause of nipple discharge. For this test, a substance is injected into the nipple and an X-ray is taken. The substance outlines the shape of the duct on the X-ray for the doctor to examine.

If cancer is suspected on a mammogram, breast ultrasound, or ductogram, a biopsy will be conducted. A biopsy takes a sample of breast tissue, cells, or fluid for examination. There are several types of biopsies including needle aspiration and surgical biopsy. Needle aspiration uses a fine needle to withdraw fluid out of the lump for testing. Stereotactic core needle biopsies use a thicker needle to remove tissue samples. Surgical biopsies remove all or part of a lump as well as some normal tissue around it. Surgical biopsies are usually done on an outpatient basis.

Stereotactic breast biopsy may be an alternative to open surgical biopsy methods for some women. Stereotactic breast biopsy is used to obtain a tissue sample of suspicious breast tissue for examination for cancer cells. It is especially useful for diagnosing areas of breast tissue that appear suspicious on a mammogram, but that cannot be felt during a clinical breast examination. This short outpatient procedure is performed with local anesthesia. It uses a special mammography machine to pinpoint the suspicious area. A vacuum assisted needle is used to remove the tissue samples. Recovery time is brief and this biopsy method does not distort the breast tissue or make it difficult to read future mammograms.
Stereotactic breast biopsy methods are as accurate as traditional biopsy methods.

If your doctor suspects that your cancer has spread from your breasts to other parts of your body, more tests will be ordered. These may include blood tests and imaging tests. A chest X-ray can determine if the cancer has spread to your lungs. A bone scan can determine if the cancer has spread to the bone. Computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and positron emission tomography (PET) scans are imaging tests that may also be used. The CT scan is helpful for identifying cancer in the liver and other organs. The MRI scan is used to detect cancer in the brain and spinal cord. A PET scan can check the lymph nodes and other areas of the body for cancer.

If you have breast cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests. Staging describes the tumor and how it has grown or metastasized. Staging also includes the axillary lymph nodes because they are the gateway for spreading cancer to the rest of the body. Staging is helpful for treatment planning and recovery prediction.

There are different systems for staging breast cancer, and you should make sure that you understand the system that your doctor is using. The most common staging system for breast cancer is from the American Joint Commission on Cancer. This system uses the Roman numerals I through IV, with a higher number indicating a more serious cancer. Some of the stages are also divided in to sub-stages labeled A-B. The stages of breast cancer, according to the American Joint Commission on Cancer are:

Stage 0: The cancer or pre-cancerous cells are in their original location within normal breast
tissue. This includes ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS).
Stage I: The tumor is smaller than 2 cm. in diameter and has not spread beyond the breast.
Stage IIA: The tumor is 2 to 5 cm. and has not spread to the axillary lymph nodes or the
tumor is less than 2 cm. and has spread to the axillary lymph nodes.
Stage IIB: The tumor is greater than 5 cm. and has not spread to the axillary lymph nodes or the
tumor is 2 to 5 cm. and has spread to the axillary lymph nodes.
Stage IIIA: The tumor is smaller than 5 cm. and has spread to the axillary lymph nodes that are
attached to each other or to other structures, or the tumor is larger than 5 cm. and has spread to the axillary lymph nodes.
Stage IIIB: The tumor has spread outside of the breast to the skin or chest wall or has spread to
the lymph nodes inside the chest wall along the sternum.
Stage IV: A tumor of any size that has spread beyond the breast and chest wall, such as to the liver, bone, or lungs.

Treatment

Your doctor will refer you to a medical and/or surgical oncologist for treatment. An oncologist is a doctor with special training in cancer and cancer treatments. Treatment for breast cancer depends on many factors, including the stage of the cancer and the cancer cell type. Cancer treatments include local treatment, systemic treatment, adjuvant therapy, and neoadjuvant therapy.

Local treatments treat the tumor without affecting the rest of the body. Local treatments include surgery and radiation therapy. Surgery removes the cancer cells from the body. Radiation therapy uses high-energy rays to destroy cancer cells.

Systemic treatments use medications or cancer-fighting drugs to treat cancer. The medications are swallowed or administered directly into the bloodstream. Systemic treatments include chemotherapy, hormone therapy, and immunotherapy.

Adjuvant therapy is used for suspected cancer cells that remain in the body after surgery. In some cases, cancer cells may break away from the main tumor and spread through the bloodstream and start new tumors in other areas. Adjuvant therapy is used to remove these hidden cells. Neoadjuvant therapy includes systemic treatments, such as chemotherapy, that are given before surgery to shrink a tumor.

The goals of treatment for Stage 0 though Stage III breast cancers are to treat the cancer and prevent it from spreading. Stage IV breast cancer is generally not considered curable, and treatments are aimed at preventing symptoms and improving quality of life. Breast cancer surgery and follow up treatments are very individualized. Your doctor will discuss which options are best for you, as well as your expected recovery.

Most breast cancer tumors are treated with surgery. There are several types of surgery for breast cancer. Some of the most common types of breast cancer surgeries include lumpectomy, partial or segmental mastectomy, simple or total mastectomy, modified radical mastectomy, and radical mastectomy.

A lumpectomy removes only the tumor and some healthy tissue around it. It is considered a conservation therapy because only the affected area is removed from the breast. A lumpectomy is typically followed with chemotherapy and/or radiation therapy. A partial or segmental mastectomy removes the tumor and more of the breast tissue than a lumpectomy does.

The entire breast is removed with a simple or total mastectomy. The lymph nodes under the arm and the muscle tissue beneath the breast are not removed. A modified radical mastectomy removes the entire breast and some of the lymph nodes under the arm. A radical mastectomy removes the entire breast, lymph nodes, and chest wall muscles underneath of the breast.

Some further form of treatment usually follows all types of surgery. This may include radiation therapy, chemotherapy, hormone therapy, or combinations of each. These treatments may last for several months.

MammoSite® 5-day Targeted Radiation Therapy is an advanced high-dose radiation treatment that may be an alternative to mastectomy for some women. Traditional radiation methods work to kill cancer cells, but in the process, also destroy some healthy tissue around the targeted area. Mammosite following lumpectomy is a breast conservation therapy. It spares as many healthy cells as possible because it directs a high-dose of radiation to only a specific area surrounding the lumpectomy cavity, the area where cancer recurrence is most likely to occur. Additionally, the duration of treatment time for Mammosite is shorter than other radiation therapies, shortened from several weeks to just five days.

In some cases, even with treatment, breast cancer can return. This is termed “recurrent breast cancer.” Recurrent breast cancer may come back near the original site or in distant organs. Your doctor can explain your risk of recurrent cancer and possible treatments if it does recur.

There are several options for women who choose to modify the appearance of their breast after breast cancer surgery. Professionals can help you select special bras containing breast forms. Breast forms are made of a variety of materials to replicate a natural breast. Some women may choose to consult a cosmetic surgeon that specializes in breast reconstruction to have surgery to change the appearance of their breast. Other women may choose to do nothing at all. Breast modification and reconstruction is an individualized decision. There is no right or wrong answer. You should discuss your concerns with your doctor. Your doctor can provide you with referrals that are appropriate for you.

The experience of cancer and cancer treatments can be an emotional process for people with cancer and their loved ones. It is important that you receive support. Some people find comfort in their family, friends, co-workers, and places of worship. Cancer support groups are another good option. They can be a good source of information and support from people who understand what you are experiencing. Ask your doctor for cancer support group locations in your area.

Prevention

Some types of breast cancer are treatable if detected early. The American Cancer Society has recommended guidelines for breast cancer screening. This includes yearly mammograms for women over the age of 40. They recommend clinical breast exams by a health expert every three years for women in their 20’s and 30’s, and yearly for women over the age of 40. It can be helpful for women to perform breast self-examinations beginning in their 20’s. A health care professional can instruct you on how to perform a breast self-examination. Additionally, instructions for breast self-examination are available from the American Cancer Society.

You can also change your lifestyle to reduce the risk factors for breast cancer that may be controlled. This includes maintaining an appropriate weight, exercising regularly, and not drinking alcohol.

Women with a high risk for breast cancer should talk to their doctor about screening recommendations particular to them. They may need earlier or additional tests. Genetic counselors can determine if a woman has certain genes linked to breast cancer. Some medications may help prevent breast cancer in some women with a high risk. In rare cases, women with an extremely high risk of breast cancer may have a preventative mastectomy. This operation removes both breasts before any evidence of cancer is found.

If you have been diagnosed and treated for breast cancer, you will have regular follow-up visits. It is important that you tell your doctor about any side effects, symptoms, or concerns at these appointments. Your doctor will monitor you for cancer recurrence.

Am I at Risk

Risk factors may increase your likelihood of developing breast cancer, although some people that develop breast cancer do not have any risk factors. People with all of the risk factors may never develop the disease; however, the chance of developing breast cancer increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.
Risk factors for breast cancer:
_____ Females experience the majority of breast cancers. Breast cancer can certainly develop
in men, but they account for less than 1% of all cases.
_____ The majority of breast cancer cases and breast cancer related deaths occur in females
over the age of 50, although breast cancer can develop in people younger than age 50.
_____ Some genetic traits have been linked with the development of breast cancer. Some families appear to have defective genes that can cause breast cancer and reduce the body’s ability to eliminate abnormal cells.
_____ A family history of breast cancer increases a woman’s risk of having breast cancer. Women with a mother, sister, or daughter with breast cancer have about double the risk of developing breast cancer.
_____ Women that have had breast cancer have a greater chance of developing a new case of breast cancer in the same or other breast.
_____ Caucasian women are slightly more likely to get breast cancer than women of other races are. African American women are more likely to die from breast cancer.
_____ Women that took diethylstilbestrol (DES) during pregnancy to prevent miscarriage have a slightly increased risk of getting breast cancer.
_____ Women with early menstruation, before 12 years old, or late menopause, after age 55, have a higher risk for developing breast cancer.
_____ Women who have never had children or who had children after the age of thirty have a higher risk for developing breast cancer.
_____ Oral contraceptives (birth control pills) increase the risk of developing breast cancer depending on the type of pill and the length of time used.
_____ Hormone Replacement Therapy (HRT) increases the risk of breast cancer.
_____ Consuming more than one or two drinks of alcohol per day increases the risk of breast cancer.
_____ People exposed to radiation or who had chest radiation treatments for other cancers have an increased risk for developing breast cancer.
_____ Researchers suggest a link between obesity and the development of breast cancer, although the results of these studies are not conclusive.

Complications

Metastases can be a complication of breast cancer. This means that the cancer has spread from the breast to distant tissues and organs. Common sites for breast cancer metastases include the lungs, liver, and bones. The cancer will need to be treated in the distant organs as well as in the breast.

Recurrent breast cancer can occur after treatment. Recurrent breast cancer may return in the breast, breast area, or in distant organs. Recurrent breast cancer is treated as appropriate.
The side effects of radiation therapy and chemotherapy can be harsh for some people. The type of side effects you experience may depend on the type of radiation therapy or chemotherapy that you receive. Tell your doctor about the side effects you experience. In some instances, steps can be taken to relieve or reduce the amount of side effects.

Side effects from chemotherapy may include temporary hair loss, nausea, vomiting, diarrhea, loss of appetite, mouth sores, fatigue, changes in menstrual cycle, increased risk of infection, and bruising or bleeding from minor cuts. Most side effects subside after treatment. Your hair will grow back, although it may look different. You may experience permanent changes in your menstrual cycle, including early menopause. Additionally, some women experience changes in concentration and memory, which may persist for a long time.

Potential side effects of radiation therapy include breast swelling or tenderness, sunburn-like skin changes, and fatigue. The side effects from radiation may last from six to 12 months. Some women may experience permanent breast changes. In some cases, the breasts become firmer and smaller after radiation.

Advancements

Researchers are continually working on methods to prevent and treat breast cancer. Genetics are a growing area of study. Researchers are trying to pinpoint the cause of breast cancer and medications that may prevent cancer growth. Several new drugs are being studied in clinical trials.

New biopsy methods use MRI imaging to reduce the size and number of biopsy incisions. Breast surgery methods continually strive to reduce the amount of tissue that is removed to retain a more natural looking breast. Reconstructive surgery after mastectomy has evolved to include safer breast implants and improved surgical methods.

Introduction

Breast cancer is a common cancer in women. Breast cancer occurs when cells in the breast grow abnormally or out of control. The exact cause of breast cancer is unknown. Breast examinations are used to help detect breast cancer as early as possible and to ensure that further diagnostic testing and prompt treatment are received. Such detection methods include self-examinations, clinical examination, and mammogram.

Diagnosis
Breast Self-Examination

It is appropriate for self-breast examination to begin in the teen years, but by the age of 20, you should perform regular self-breast exams. A self-breast exam is easy and only takes a few minutes. The best time to perform breast self-examination is one week after your period starts.

There are two parts to a self-breast examination, looking at your breasts for changes and feeling your breasts for changes. Look at your breasts from different angles in front of a mirror. Look for changes in your breast size or shape, swelling, and skin texture. Check for red, scaly, or irritated skin. Look for dimpled, puckered, or retracted skin areas. Evaluate the appearance of your nipple. Note if it turns inward or seems enlarged. Check your nipple for any fluid discharge.

You may perform the second part of the breast self-examination standing up or lying down. Some women prefer to examine their breasts in the shower. Examine your breasts individually. To examine your right breast, raise your right arm and place your right hand behind your head. Examine your right breast with your left hand. Check your armpit tissue as well.

Feel your breast tissue with the pads of your three middle fingers. Use light, medium, and firm pressure to feel the different tissue layers in your breast. You should check for a lump or mass. A suspicious lump may feel very firm or hard. They are usually painless. Squeeze your nipple with your finger and thumb while watching for any discharge. When you have completed examining your right breast, put your left arm behind your head and examine your left breast with your right hand in the same manner.

You may notice normal lumps in your breasts during your self-examination. Some women experience fibrocystic breast changes, especially just before their periods. If you are uncertain about a lump in your breast, talk to your doctor. You should contact your doctor if you notice a new lump or change of appearance in your breasts or armpits, red hot swollen breasts, discharge from your nipple, or pain in your breast that is unrelated to your period.

Clinical Breast Examination

A clinical breast examination is similar to your breast self-examination. Your doctor or a nurse may perform it. It is convenient to have a clinical breast examination at the same appointment that you have your annual pelvic examination. It is recommended that women over the age of 40 have a yearly clinical breast examination and that women under 40 receive it every other year. You should tell your doctor about any changes in your breast and discuss any concerns or risk factors. This is a good time to point out any questionable lumps or ask your doctor questions about self-examination methods.

For your clinical breast examination, you will undress from your waist up and wear a paper or cloth gown with the opening in the front. Your doctor will only uncover the parts of your body that are being examined. Your doctor will examine your breasts, armpits, neck and chest area. Your doctor will look at your breasts to see if they have changed in size or shape. Your doctor will use the pads of his or her fingers to check for lumps or masses.

Mammogram

A mammogram is a type of X-ray used to identify breast masses or tumors. The American Breast Cancer Foundation and American Cancer Society recommend that every woman over 40 years old should receive an annual mammogram. Women with a family history of breast cancer or other high risk factors may talk to their doctor about earlier screening.

A mammogram is a short procedure. A radiation technician will carefully help you place your breast placed between two plates before images are taken. The two plates compress your breast to flatten and spread the tissue in order to obtain the best picture possible. This test may be uncomfortable, but only for a very brief period of time. A mammogram may only tell if a tumor is present. It cannot tell if a tumor is cancerous or not. In many cases, a radiologist can let you know your results before you leave your appointment.

Your doctor will order more tests if the results of your mammogram or clinical breast examination are suspicious. Additional tests are necessary to determine if a mass contains cancer cells or not. Early detection and treatment of breast cancer is important to ensure the best outcomes.

Introduction

Breast reduction for men (reduction mammoplasty) is a cosmetic and reconstructive surgical procedure that is used to reduce the size of the breasts. Men may experience enlarged breasts (gynecomastia) for several reasons, including hormone abnormalities, hereditary conditions, disease, use of certain drugs, and weight gain. Breast enlargement may begin in adolescence or occur at any age. The condition may make some men self-conscious causing them to avoid certain activities. Surgery may be performed as early as adolescence, but in such cases a second surgery may be required after the breasts are fully developed.

There are a few surgical methods for breast reduction. The procedures are similar in that they remove excess tissue and reshape the breast. Tissue may removed by surgery, liposuction, or both. The procedures differ in the specific incision patterns and techniques. Your doctor will determine the most appropriate breast reduction procedure based on your breast characteristics and personal preferences.

At your initial consultation, your doctor will help you decide which breast reduction method is right for you. You should tell your doctor about your concerns and expectations. Your doctor will evaluate your breast size, shape, and skin integrity. A general health evaluation will be performed. Diagnostic testing may help determine if there is an underlying cause for the breast enlargement. It is common for “before” photos to be taken for your medical records. You will need to stop smoking before your surgery and you may be instructed to temporarily discontinue certain medications.

Treatment

Breast reduction is most frequently an outpatient procedure. You should plan to have a person drive you home and stay with you for the first night. Breast reduction may be performed at an accredited plastic surgeon’s outpatient surgical facility, hospital, or outpatient surgery center. You will receive general anesthesia or IV sedation and local anesthetics for the procedure.

If liposuction is used, the liposuction wand is inserted through several small incisions to loosen and vacuum excess breast tissue and/or fat. Based upon the amount of excess skin and residual elasticity of the skin, a decision for excess skin removal will be considered. The nipple and dark skin surrounding it (areola) may need to be surgically repositioned and possibly reduced in size.

At the end of the procedure, temporary drainage tubes may be inserted to remove excess fluids. The incisions in the skin are closed with stitches, tape, or surgical adhesive. The area is gently wrapped with bandages. Elastic wraps or a support garment will help minimize swelling while you heal.

You will receive medication for post procedure pain and specific instructions for wound care. Your stitches will be removed at one or more follow-up appointment(s). Your doctor will gradually increase your activity level. It may take time for swelling to resolve and several months for incision lines to fade. The results of your procedure are immediately visible and are permanent for many men.

Introduction
Bronchitis is a condition of inflammation of the large air passages in the lungs. It occurs when the mucous lining in the airways becomes irritated and swollen. Cigarette smoking, air pollution, and upper respiratory infections are common causes of bronchitis.

Bronchitis can cause coughing, phlegm production, wheezing, and shortness of breath. Acute bronchitis usually resolves on its own. Chronic bronchitis or complications from bronchitis, such as pneumonia, are treated with medications.

Anatomy
Your lungs are located inside the ribcage in your chest. Your diaphragm is beneath your lungs. The diaphragm is a dome-shaped muscle that works to open your lungs when you breathe.

From your nose and mouth, air travels towards your lungs through a series of tubes. The trachea or windpipe is located in your throat. The bottom of the trachea separates into two large tubes called the main stem bronchi. The left main stem bronchus goes into the left lung, and the right main stem bronchus goes into the right lung.

Inside the lung, the bronchi branch off and become smaller. These smaller air tubes are called bronchioles. There are approximately 30,000 bronchioles in each lung. The end of each bronchiole has tiny air sacs called alveoli. There are about 600 million alveoli in your lungs. Each alveolus is covered in small blood vessels called capillaries. The capillaries move oxygen and carbon dioxide in and out of your blood.

When you breathe air in or inhale, your diaphragm flattens and your ribs move outward to allow your lungs to expand. The air that you inhale through your nose or mouth travels down the trachea. Tiny hair like structures in the trachea, called cilia, filter the air to help keep mucus and dirt out of your lungs. The air travels through the bronchi and the bronchioles and into the alveoli. Oxygen in the air passes through the alveoli into the capillaries. The oxygen attaches to red blood cells and travels to the heart. The heart sends the oxygenated blood to the cells in your body.

When you breathe air out or exhale, the process is the opposite of when you inhale. Once your body has used the oxygen in the blood, the deoxygenated blood returns to the capillaries. The blood now contains carbon dioxide and waste products that must be removed from your body. The capillaries transfer the carbon dioxide and wastes from the blood into the alveoli. The air travels through the bronchioles, the bronchi, and the trachea. As you exhale, your diaphragm rises and your ribs move inward. As your lungs compress, the carbon dioxide is released out of your mouth or nose.

Causes
Bronchitis results from irritation or an infection that causes the trachea or large and small bronchi to become inflamed. Acute bronchitis most commonly develops after a viral upper respiratory infection. It occurs more frequently during flu season. Cigarette smoking, air pollution, and allergies also cause irritation and can contribute to bronchitis. Dust, chemicals, and fumes associated with certain occupations, such as coal mining, grain handling, and textile manufacturing, can cause bronchitis.

A common complication of bronchitis is the development of a second infection in the airways and lungs. Bronchitis can lead to bacterial infections, including pneumonia. Bronchitis can become a chronic condition. Chronic bronchitis is categorized as a type of chronic obstructive pulmonary disease (COPD).
Symptoms
Upper respiratory infections commonly precede bronchitis. The infection typically infects the nose, sinuses, and throat before spreading to your lungs. Bronchitis causes coughing. You may cough very hard. Coughing may cause discomfort in your chest. Your cough may be dry or produce phlegm. You may have a dry lingering cough for weeks after your case of bronchitis has resolved.

Bronchitis can cause shortness of breath. Exercise or exertion can cause breathing symptoms to become worse. Bronchitis can cause wheezing noises when you breathe. You may also experience nasal congestion.

Bronchitis can make you feel tired all of the time. You may have a low fever, chills, and muscle aches. You may develop ankle, leg, and foot swelling.

Bronchitis can be acute or chronic. Acute bronchitis usually resolves in 7 to 10 days, although a dry hacking cough can linger for weeks. Chronic bronchitis is a long-term condition. Bronchitis is diagnosed as chronic if you have a cough with mucus for most days in a three-month period in at least 2 consecutive years. As chronic bronchitis gets worse, you will have more trouble breathing and staying active.
Diagnosis
Most cases of acute bronchitis clear up on their own. You should see your doctor if you have severe coughing, wheezing, difficult breathing, or a fever that lasts more than four or five days.

You doctor can usually diagnose bronchitis by simply reviewing your medical history and conducting a physical exam. You should tell your doctor about your symptoms and risk factors.

Your doctor will listen to hear if your lungs make sounds when you breathe. Your doctor may order tests to detect infection, determine the extent of your condition, and rule out other conditions that have similar symptoms. Your doctor may use a pulse oximeter to determine the amount of oxygen in your blood. For this test, a probe is simply placed on your fingertip and a reading is sent to a monitor. Your doctor may check a sample of your phlegm for bacteria. If your doctor suspects that you have pneumonia, a chest X-ray will be ordered.
Treatment
Acute bronchitis usually resolves on its own in about one week. You should rest and drink plenty of fluids. It may be helpful to use a cool mist vaporizer or humidifier. Antibiotics do not work on viruses. Over-the-counter medications can help suppress coughing and loosen secretions. If your symptoms do not improve, your doctor can prescribe an inhaler to help you breathe easier and antibiotics if you develop a bacterial infection.

If you have chronic bronchitis, your doctor can recommend a respiratory therapy program for breathing exercises and physical activity. Your doctor can prescribe inhaler medications to help you breathe. You may need to use oxygen.
Prevention
It is wise to do what you can to prevent complications from acute and chronic bronchitis. You should stop smoking. Talk to your doctor about methods to help you quit smoking, if you are unable to do so yourself. There are many smoking cessation products on the market that your doctor will be happy to recommend. You should also ask your doctor about flu shots and preventative viral and bacterial respiratory vaccines.
Am I at Risk
Risk factors may increase your likelihood of developing bronchitis, although some people that develop the condition do not have any risk factors. People with all of the risk factors may never develop the disease; however, the chance of developing bronchitis increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for bronchitis:

_____ The elderly, infants, young children, and people with suppressed immune systems have the highest risk for developing bronchitis.
_____ Cigarette smoking is a risk factor for bronchitis. Long term exposure to second hand smoke is also associated with bronchitis.
_____ People with heart or lung disease are susceptible to bronchitis.
_____ Air pollution contributes to bronchitis.
_____ If you have allergies, you are at risk for bronchitis.
_____ Certain occupations are associated with bronchitis. If you are exposed to dust, fumes, and chemical irritants on your job, you are at risk for developing bronchitis.
_____ Upper respiratory infections commonly precede bronchitis. Upper respiratory infections occur more frequently during flu season. Common viruses include influenza A and B.
_____ Bacterial infections, such as pneumonia, can cause bronchitis.

Complications
Developing a secondary infection, such as pneumonia, is a risk with acute bronchitis. There is also a small risk for acute bronchitis to turn into chronic bronchitis.

Introduction

Everyone has experienced a bruise at one time or another. A bruise, medically termed a contusion, results when the blood vessels beneath the skin are injured and bleed. Cold packs can help reduce bruising following an injury. Significant bruises should be evaluated by a doctor.

Anatomy

Your skin covers your body and protects it from the environment. Networks of vessels supply blood to your skin and carry waste products away to help keep the skin nourished and healthy. A bruise develops when the blood vessels in the skin are injured, causing bleeding beneath the skin.

Causes

A force that contacts the skin causes bruises. For example, falls, bumping into something or punches can cause bruises. A greater force is required for a bruise to develop in a young person than in an older person because as people age, the blood vessels become more fragile.

Symptoms

A new bruise may be flat or swollen. A bruise hurts and changes color over time. New bruises are red, but after a day or two turn purple or blue. After about six days a bruise turns green. Older bruises are yellow-brown. It takes about two or three weeks for the body to repair a bruise and for the skin to return to a normal color.

Diagnosis

You should seek emergency medical treatment if you have experienced severe trauma.

You should contact a doctor if you have a blood clotting disorder or take blood thinner medications. You should contact your doctor if a bruise gets larger or harder and does not appear to be going away.

A doctor can diagnose a bruise by looking at your skin. You should tell your doctor if you have experienced a fall or trauma. Your doctor may order X-rays if a bone fracture is suspected.

Treatment

You can help decrease bruising if you apply a cold pack right after an injury. Do not apply ice directly to the skin. Instead, place ice cubes in a plastic bag, and wrap the plastic bag in a towel. You may also use a cold pack that is available in most drug stores.

Prevention

Wear appropriate protective gear when playing sports. Older adults who have an increased risk of falls should discuss fall prevention with their doctor or physical therapist.

Am I at Risk

People with certain medical conditions have a higher risk for bruises. Such conditions include:
• Heart valve infections (endocarditis)
• Blood-clotting problems (platelets, hemophilia, liver cirrhosis)
• Autoimmune diseases
• Broken bones (fractures)

Certain medications can increase the risk of bruising, including:
• Prescription arthritis medications
• Over-the-counter non-steroidal anti-inflammatory medications
• Prescription “blood thinner” medication
• Prescription cortisone medications

Complications

Some people may experience bruises by chance, without a traumatic incident. Spontaneous bruising can be the sign of a serious bleeding tendency. You should contact your doctor if you experience bruising without an incident.

In some cases, blood may pool under the skin or a muscle creating a hematoma. A hematoma can cause the bruise to increase in size or raise. A hematoma can cause increased pain.

Introduction

Bulimia is a type of eating disorder. People with eating disorders have problems with their eating behavior, thoughts, and emotions. They have a distorted body image and attempt to control their weight by controlling their food intake. People with bulimia have recurrent episodes of significantly overeating and a sense of loss of control. Purging and feelings of shame or guilt follow the binge-eating. Individuals with bulimia may abuse laxatives, diuretics, enemas, or self-induce vomiting. Bulimia can be a long-term condition. People that participate in therapy to break the binge-eating and purging cycle tend to have the most positive outcomes.

Causes

The exact cause of bulimia is unknown, but it is important to remember that eating disorders are a real illness, not a choice, and they can be treated. Researchers have identified factors that may contribute to the condition. People with bulimia commonly have low-self esteem and are perfectionists. They usually have underlying emotional problems, including depression, and a distorted body image. The family environment may play a role as well. Family conflict, over-controlling parents, and parents that do not allow emotional expression are factors that increase the risk of bulimia. People with bulimia may perceive pressure from family, friends, and society to be thin or equate a thin body with ideal attractiveness. For people with bulimia, controlling food intake may be used as a coping mechanism for negative emotions.

New findings from researchers suggest that brain abnormalities may contribute to bulimia. It may be too much or too little of certain brain chemicals affect the way that the brain processes thoughts and emotions. Researchers think that some people may be genetically predisposed to eating disorders, meaning that they inherit a risk of developing the condition under certain circumstances. Research will continue to investigate inherited factors; however, people with no known family history have developed bulimia.

Bulimia is more common among females than males. It occurs most frequently in teenage girls. People with bulimia tend to know that their actions are inappropriate, but may be unable to stop the destructive cycle without treatment intervention. Bulimia can be a chronic illness; however, treatment can help people control the symptoms and maintain health. Untreated bulimia can lead to serious medical complications and cause death.

Symptoms

It may be difficult for people with bulimia to indicate that they have a problem. People with bulimia are aware of their inappropriate thoughts and behavior, but may work very hard to keep their secret from others. Frequently, the loved ones of a person with bulimia recognize the symptoms and help an individual access treatment.

People with bulimia binge eat frequently. Episodes may occur a couple of times per week or several times per day. An enormous amount of food is eaten in a short amount of time. Some people may eat the entire contents of a refrigerator or their cupboards. They may buy and hide large amounts of food. People with bulimia feel a loss of control while they binge eat. The food may be gulped so fast that it is not even tasted. The food and junk food may contain thousands of calories and is high in fats and sugars.

Following a binge-eating episode, people may feel shame or disgust. They may be sleepy or have stomach pain. They will purge to compensate for the binge-eating. People with bulimia may abuse laxatives, diuretics, enemas, or make themselves throw up to avoid weight gain. They may fast or exercise excessively. Their body weight may remain normal, although the person may think that he or she is overweight. For others, their body weights may range from being underweight to obese. Additionally, depression, anxiety, panic disorder, obsessive compulsive disorder, or substance abuse may accompany bulimia.

Bingeing and purging can cause serious medical complications. Repeated vomiting can cause stomach acid to irritate and inflame the throat. Tooth decay and gum disease can result because the excess stomach acid removes the enamel from teeth and irritates the gums. Repeated vomiting can result in gastroesophageal reflux disorder (GERD), a painful digestive tract condition or tearing of the esophagus. The glands in the neck and below the jaw may become swollen and result in a puffy or chipmunk looking face. Laxative abuse can lead to intestinal problems. It may cause ulcers, constipation, and hemorrhoids. Diuretic abuse can cause kidney problems. Dehydration can result from a lack of or loss of fluids. Bingeing and purging can also lead to severe problems including pancreas, liver, or kidney failure and electrolyte abnormalities, low blood pressure, and heart attack. It can even cause death.

Diagnosis

A psychiatrist can determine if a person meets the diagnostic criteria for bulimia. A psychiatrist can identify co-existing disorders, such as depression, which is essential information for treatment planning. A complete medical examination may be necessary to rule out other disorders and to evaluate the general health of an individual. A dental examination is necessary to assess the teeth and gums.

Treatment

Treatment for bulimia includes addressing the physical and emotional health of the individual. A foremost goal is to attain proper nutrition and hydration while ending the cycle of bingeing and purging. Associated medical and dental conditions must be treated. Psychotherapy is helpful for the emotional, thought, and behavioral problems associated with bulimia. It may include individual therapy, family counseling, or group therapy. Nutritional education, structured meal planning, and healthy exercise training are helpful as well. Medications, such as antidepressants, can be helpful.

Recovery from bulimia is different for everyone. Bulimia is a chronic condition and many people continue to have symptoms despite treatment. People that have fewer medical complications and that participate in treatment tend to experience the best outcomes.

Introduction

Bunions are a common foot deformity, especially in females. They most frequently result from wearing shoes that are too small and or have a high heel. Abnormal pressure from poor fitting shoes causes the bones in the big toe and foot to move out of position. This results in a large painful bump on the side of the foot at the big toe.

Simply changing to wide shoes with a low heel can treat some bunions. If non-surgical treatments fail, surgery may be necessary to restore normal alignment, pain-free movement and function. There are numerous surgical techniques for treating bunions, and the majority of people experience good results.

Anatomy

The base of the bone in your big toe (proximal phalanx) meets with the head of the metatarsal bone in your foot to form the metatarsophalangeal joint. Ligaments connect the two bones together. Tendons attach muscles to the bones and allow movement. The metatarsophalangeal joint bends whenever you walk.

Causes

Bunions are a common foot condition. The vast majority of bunions occur in females, but they may develop in males, as well. Most bunions result from pressure caused by shoes that are too small, narrow, pointed, or have a high heel. Bunions can run in families. Arthritis, particularly osteoarthritis, and polio can contribute to bunion formation.

A bunion occurs when the bones at the base of the big toe move out of alignment. The big toe may lean toward or move underneath the second toe. The second toe may move out of alignment and overlap the third toe. Long term irritation causes the base of the big toe to enlarge and a fluid-filled sac may form. This creates a large bump on the side of the foot at the joint.

Symptoms

A bunion causes the base of your big toe to stick out and form a bump on the side of your foot. A bunion can be large, red, swollen, and painful. The skin on the bottom of your foot may thicken and form a painful callus. It may hurt to bend your toe, walk, or wear shoes.

A bunion causes your foot to look different. Your big toe may lean towards your second toe. The first few toes on your foot may lean and overlap.

Diagnosis

Your doctor can diagnose a bunion after reviewing your medical history, examining your foot, and taking X-rays of your foot. X-rays will show the alignment and condition of your bones. You should tell your doctor about your symptoms and concerns.

Treatment

Simply changing shoes may treat some bunions. It is helpful to wear wide-toed shoes with low heels. Good foot care and felt or foam pads worn between the toes or on the foot may help protect the area and prevent further discomfort. Custom-made shoe inserts can help position the toe and relieve pain.

Surgery

If non-surgical treatments fail, surgery may be necessary to restore normal alignment, pain-free movement and function. Bunion surgery is used to realign the bones, joints, tendons, ligaments, and nerves. The toes are placed in their correct positions and the bony bump is removed. There are numerous surgical techniques for treating bunions. Your doctor will discuss the most appropriate options for you.

Bunion surgery is an outpatient surgical procedure. An ankle-block anesthesia or general anesthesia may be used so that you do not feel pain during the procedure. Following the surgery, the bones are held in position with wires, screws plates, or cast while they heal.

Recovery

You should keep your foot elevated the first few days following your surgery, and apply ice packs as directed. A special cast or orthopedic shoe will protect your foot as it heals. You will temporarily need to use crutches, a walker, or cane as you gradually increase the amount of weight you can put on your foot. Physical therapy can help to restore strength and motion. It can take many weeks to recover from bunion surgery. The majority of people have good outcomes.

Prevention

You may prevent bunions by wearing shoes that fit correctly. It is beneficial to wear wide, low heel shoes. Following bunion surgery, you can prevent future bunions by wearing the same type of shoes. Wearing improper shoes can cause bunions to recur.

Introduction

Minor burns are common skin injuries that affect the outer most layers of the skin. Burns are caused by heat, such as fire, but can occur from several other sources, such as hot liquids, the sun, or certain chemicals. Minor burns can be treated with first aid at home or outpatient care from a physician. Severe burns are a medical emergency and require immediate attention.

Anatomy

Your skin covers your body and protects it from the environment. Your skin is composed of three layers, the epidermis, dermis, and subcutaneous tissue. The epidermis is the outermost layer. It protects your inner skin layers. The dermis is the second layer of skin. It is made up of connective tissue and provides structure. It is composed of collagen and various elements that give your skin strength and elasticity. The dermis contains hair cells, sweat glands, and sebaceous glands that secrete oils to hydrate the skin. Subcutaneous tissue is your inner most layer of skin. Subcutaneous tissue contains fat cells. The fat cells insulate your body and make your skin appear plump and full.

Causes

There are many causes of burns. Dry heat, such as fire or a hot object; wet heat, such as boiling water, steam, or hot liquids; radiation, such as from the sun or nuclear radiation; friction, such as rubbing forces with an object; electricity; and certain chemicals can all cause burns.

Symptoms

Minor burns can cause reddened skin, pain, and swelling. The skin may blister and peel. Severe burns can cause white or blackened and charred skin. With severe burns, the affected area may feel numb.

Diagnosis

Burns are characterized by the degree to which they affect the skin:

First Degree Burns
First Degree Burns only affect the epidermis, the outer layer of skin. The skin may appear red and is painful. The skin may appear swollen.
Second Degree Burns
Second Degree Burns affect the first two layers of the skin, the epidermis and the dermis. In addition to severe pain, swelling, and splotchy redness, second degree burns cause blistering.
Third Degree Burns
Third Degree Burns affect all three layers of the skin. The skin may appear blackened or charred. The skin may feel numb. Third Degree Burns require emergency medical treatment.
Fourth Degree Burns
Fourth Degree Burns affect all three layers of the skin and extend beyond the skin to underlying tissues; muscles, nerves, blood vessels or bones. Fourth Degree Burns require emergency medical treatment.

Treatment

People with First or Second Degree Burns should use first aid and consult their doctor. People with more serious burns should receive emergency medical treatment. First aid for minor burns includes running cool water over the affected area for five minutes. Do not use ice, as it may cause frostbite. Loosely cover the burn with dry sterile gauze. Take over-the-counter pain relieving medication. Consult your doctor about appropriate pain relievers for children.

Recovery from minor burns can take several weeks. It is important to keep the skin clean and dry. Follow your doctor’s instructions carefully.

Introduction
Heart arrhythmias, also called cardiac arrhythmias, are irregular heart rhythms that result when the heart beats too fast, too slow, or unevenly. A heart arrhythmia occurs if there is a disturbance anywhere along the nerve signal pathway in the heart chambers. There are many different types of heart arrhythmias and some are more serious than others, causing heart attack or sudden death. Heart arrhythmias are treated with medications, electrophysiologic ablations, and surgically placed pacemakers or implantable cardioverter-defibrillators.
Anatomy
The heart is the core of the cardiovascular system. Your cardiovascular system consists of your heart and the blood vessels that carry blood throughout your body. Your heart is located to the left of the middle of your chest. It is a large muscle about the size of your fist. It works as a pump. The blood carries nutrients and oxygen that your cells need for energy. It also carries waste products away.

Your heart is divided into four sections called chambers. The chambers are separated by the septum, a thick wall. The two top chambers are called atria, and they receive blood coming into the heart. The two bottom chambers are called ventricles and they send blood out from the heart.

Your heart contains two pumping systems — one on its left side and one on its right side. The left-sided pumping system consists of the left atrium and the left ventricle. Your left atrium receives blood that contains oxygen, which comes from your lungs. Whenever you inhale, your lungs move oxygen into your blood. The oxygenated blood moves from the left atrium to the left ventricle. The left ventricle sends the oxygenated blood out from your heart to circulate throughout your body.

The heart’s right-sided pumping system consists of the right atrium and the right ventricle. Your right atrium receives deoxygenated blood, blood that has circulated throughout your body and no longer has high levels of oxygen in it. The deoxygenated blood moves from the right atrium to the right ventricle. The right ventricle sends the blood to the lungs where it receives oxygen when you breathe.

As the blood travels through the heart chambers, four valves keep the blood from back flowing. The mitral valve and the tricuspid valve regulate blood flow from the atria to the ventricles. The aortic valve and the pulmonary valve control blood as it leaves the ventricles.

The four chambers of the heart contract in a very exact and coordinated manner. The contractions are controlled by electrical impulses from the sinus (SA) node, your heart’s natural pacemaker. The signals travel on a specific path, first from the SA node through the atrium and then through the atrio-ventricular (AV) node and through the ventricles.

Your doctor will listen to your heart with a stethoscope. A healthy heart has a regular rhythm and makes a lub-dub sound each time it beats. The first sound in your heartbeat occurs when the mitral valve and the tricuspid valve close. The second sound in your heartbeat occurs when the aortic valve and the pulmonary valve close after the blood leaves your heart.
Causes
A heart arrhythmia occurs if there is a disturbance anywhere along the nerve signal pathway throughout the heart. There are different types of heart arrhythmias depending on where the interruption in the conduction system occurs. Heart arrhythmias may result from heart conditions, heart attack, blood chemistry imbalances, and endocrine abnormalities. Medications, caffeine, and illegal drugs, such as cocaine or amphetamines, can cause irregular heart rhythms. Untreated heart arrhythmias can be life threatening.

Some of the specific types of heart arrhythmias are described below:

Bradycardia is a slow heart rate that generally results because of problems with the heart’s internal pacemaker, the SA node.
Tachycardia is a fast heart rate that may involve the atria or the ventricles.
Supraventricular tachycardia (SVT) is a fast heart rate that originates in the atria.
Ventricular tachycardia is a fast heart rate that originates in the ventricles.
Atrial fibrillation is an uneven and very fast heart rate. The atria may pump five to seven times faster than normal, causing the heart to pump blood improperly.
Atrial flutter is a very fast and steady heartbeat caused by abnormal nerve firing.
Premature atrial contraction (PAC) is an irregular heartbeat with extra beats or premature beats from problems in the atria.
Sick sinus syndrome is an irregular heartbeat caused when the SA node does not work properly and the heart rate slows down.
Premature ventricular contraction (PVC) is an irregular heartbeat with extra beats or premature beats from problems in the ventricles.
Ventricular fibrillation is a rapid irregular heartbeat. Little or no blood may be pumped from the heart. It requires immediate medical attention and can result in sudden death.
Symptoms
Heart arrhythmias may or may not produce symptoms. Heart arrhythmias can cause heart palpitations—you may feel your heart beating in your chest. Your heart may feel like it is beating fast, slow, or irregularly. It may feel like your heart skips a beat. You may feel faint, lightheaded, or dizzy. You may experience chest pain or shortness of breath. Your skin may become pale and sweaty. In severe cases, a heart attack may occur.

An ambulance should be called immediately if a heart attack is suspected. Symptoms of a heart attack include pain or pressure in the center of the chest, shortness of breath, nausea, vomiting, and pain that radiates from the chest into the teeth, jaws, shoulders, or arms. A heart attack can be fatal. Immediate emergency medical care is necessary.
Diagnosis
Your doctor can begin to diagnose heart arrhythmia by reviewing your medical history and conducting a physical examination and some tests. Your doctor will use a stethoscope to listen to your heart. There are several tests that can be used to diagnose heart arrhythmia.

The tests may include a chest X-ray, electrocardiogram (ECG), and echocardiogram. An ECG records the heart’s electrical activity. An echocardiogram uses sound waves to produce images of the heart on a monitor. An exercise stress test involves monitoring your ECG and blood pressure while you exercise on a treadmill. The exercise stress test provides information about how your heart works with an increased blood flow. You may wear a Holter monitor for periods of 24 hours or more. A loop recorder can also be used to detect rhythm abnormalities over a long period of time. If your arrhythmia is infrequent, you may wear an event recorder that you activate when you feel symptoms. An event recorder may also be surgically placed under the skin for long periods of time. An electrophysiologic (EP) study is an advanced procedure which can diagnose and even treat some arrhythmias.

Tilt table testing is used to check for sudden drops in blood pressure or heart rate that can cause fainting. For this procedure, you are secured to a table, which will be positioned at different inclines for various periods of time. Your blood pressure and ECG will be recorded.

Treatment
The treatment that you receive depends on the type, location, severity, and cause of your arrhythmia. Emergency treatment for arrhythmia includes electrical shock therapy (defibrillation or cardioversion) or intravenous (IV) medications. A pacemaker may be surgically implanted to maintain a regular heartbeat. Ablation is an advanced procedure, which can treat some arrhythmias. Some people may require lifelong medication. An implantable defibrillator may be surgically placed to treat ventricular tachycardia.
Prevention
You may prevent heart disease and decrease your risk of developing arrhythmias by taking steps to keep your heart healthy. It is important not to smoke, use illegal drugs, or abuse alcohol. You should eat a heart healthy diet and exercise regularly. Make and attend all of your doctor appointments and receive regular physicals.
Am I at Risk
People with heart conditions, a history of heart attack, blood chemistry imbalances, or endocrine abnormalities are at risk for heart arrhythmias. Using certain medications, caffeine, or illegal drugs can increase your risk for heart arrhythmias.
Complications
Some arrhythmias can be dangerous and potentially fatal. Some arrhythmias can lead to stroke, heart attack, heart failure, and sudden death. You should contact your doctor if you experience symptoms of arrhythmia. Early treatment is associated with better outcomes. You should call for an ambulance if you suspect that you or someone else is experiencing a heart attack or stroke.

Introduction
Carpal Tunnel Syndrome is a common condition that affects the hand and wrist. It occurs when the Median Nerve in the wrist is compressed. Nerves carry messages between our brains, spinal cord, and body parts. The Median Nerve carries signals for sensation and muscle movement. When the Median Nerve is compressed or entrapped, it cannot function properly. This syndrome has received much attention in the last few years because of suggestions that it may be linked with jobs that require repeated use of the hands. In actual fact, little proof of this exists.
Carpal Tunnel Syndrome is more common in women and people between the ages of 30 and 60 years old. It is the most common nerve entrapment syndrome and affects up to 10% of the population. Individuals with Carpal Tunnel Syndrome may feel numbness, pain, and a “tingly” sensation in their fingers, wrists, and arms. They may have difficulty performing grasping and gripping activities because of discomfort or weakness.

Anatomy
The Median Nerve passes from the arm, through the wrist, and into our fingers. At the center of the wrist joint, the Median nerve goes through a passageway called the Carpal Tunnel. Our wrist bones form the bottom of the Carpal Tunnel. The Transverse Carpal Ligament covers the top. Ligaments are strong bands of tissues that connect bones together. In addition to the Median Nerve, the Carpal Tunnel also contains many tendons. These tendons attach to the muscles that allow our fingers to bend or flex.
The Median Nerve supplies the sense of feeling to our thumb, index finger, middle finger, and half of the ring finger. It also sends messages to the Thenar Muscles that move the thumb. We use the Thenar Muscles when we position our thumb to grasp and hold objects. When compressed in the Carpal Tunnel, the Median Nerve sends faulty messages as it travels into the hand and fingers.

Causes
Carpal Tunnel Syndrome develops when the tissues and tendons in the Carpal Tunnel swell and make the area within the tunnel smaller. This can happen in association with other medical conditions, such as hypothyroidism and diabetes. The increased pressure within the tunnel causes the Median Nerve to become compressed. The pressure disrupts the way the nerve works and causes the symptoms of Carpal Tunnel Syndrome. Usually, the exact cause of carpal tunnel syndrome is unknown.
Rheumatoid arthritis, joint dislocation, and fractures can cause the space in the tunnel to narrow. Some women develop Carpal Tunnel Syndrome because of swelling from fluid retention caused by hormonal changes. This may occur during pregnancy, premenstrual syndrome, or menopause.

Symptoms
The primary symptoms of Carpal Tunnel Syndrome are pain, numbness, and tingling. The numbness and tingling is typically present in the thumb, index, middle, and half of the ring finger. Some people describe the pain as a deep ache or burning. Your pain may radiate into your arms. Your thumb may feel weak and clumsy. You may have difficulty grasping items, and you may drop things. Your symptoms may be more pronounced at night, when you perform certain activities, or in cold temperatures.

Diagnosis
Your doctor can diagnose Carpal Tunnel Syndrome by conducting a medical examination, reviewing your medical history, and asking you about your activities and symptoms. During the physical exam, your doctor will check your wrist and hand for sensation and perform a thorough hand examination.
Your doctor may ask you to perform a couple of simple tests to determine if there is pressure on the Median Nerve. For the Phalen’s Test, you will firmly flex your wrist for 60 seconds. The test is positive if you feel numbness, tingling, or weakness. To test for the Tinel’s Sign, your doctor will tap on the Median Nerve at the wrist. The test is positive if you feel tingling or numbness in the distribution of the median nerve. Lab tests may be ordered if your doctor suspects a medical condition that is associated with Carpal Tunnel Syndrome. Your doctor may take an X-ray to identify arthritis or fractures.
In some cases, physicians use nerve conduction studies to measure how well the Median Nerve works and to help specify the site of compression. Physicians commonly use a test called a Nerve Conduction Velocity (NCV) test. During the study, a nerve is stimulated in one place and the amount of time it takes for the message or impulse to travel to a second place is measured. Your doctor will place sticky patches with electrodes on your skin that covers the Median Nerve. The NCV may feel uncomfortable, but only during the time that the test is conducted.
An Electromyography (EMG) test is often done at the same time as the NCV test. An EMG measures the impulses in the muscles to identify poor nerve input. Healthy muscles need impulses to perform movements. Your doctor will place fine needles through your skin and into the muscles that the Median Nerve controls. Your doctor will be able to determine the amount of impulses conducted when you contract your muscles. The EMG may be uncomfortable, and your muscles may remain a bit sore following the test.

Treatment
The symptoms of Carpal Tunnel Syndrome can often be relieved without surgery. Some medical conditions associated with Carpal Tunnel Syndrome can be treated. Some cases respond to treatments that relieve pain and provide rest. Your doctor may recommend that you wear a splint at night to support your wrist in a neutral position.
Splints may also be worn during activities that aggravate your symptoms to position the wrist properly and provide wrist support. Your doctor may suggest over-the-counter anti-inflammatory medication to help reduce your pain and swelling. Sometimes doctors choose to inject corticosteroid medication, an anti-inflammatory medication, to provide symptom relief.

Surgery
Surgery is recommended when non-surgical options do not work or if the condition becomes worse. There are a few types of outpatient surgery to remove pressure on the Median Nerve. Your doctor will help you decide which option is best for you.
The standard surgery for Carpal Tunnel Syndrome is called an Open Release. The surgeon will use a local or regional anesthetic to numb the hand area. For this procedure, the surgeon makes a two to three inch opening along the palm. This allows the surgeon access to the Transverse Carpal Ligament, the roof of the Carpal Tunnel. The surgeon makes an incision in the Transverse Carpal Ligament to open the tunnel and make it larger. By doing so, pressure is taken off of the median nerve. The surgery time for an Open Release is short, only about fifteen minutes.
Another surgical option is called Endoscopic Carpal Tunnel Release. This type of surgery is done using an endoscope placed in a small incision. An endoscope is small device with a light and a lens that allows the surgeon to view the Carpal Tunnel without disturbing the nearby tissues. It may be used in conjunction with a camera or video system.
Endoscopic Carpal Tunnel Release most often uses a local or regional anesthetic to numb the wrist and hand area. In some cases, individuals are sedated for the surgery. The surgeon makes a small opening below the crease of the wrist and inserts the endoscope to view the Carpal Tunnel. Some surgeons make a second incision in the palm of the hand. Guided by the endoscope, the surgeon places a tube called a cannula along the side of the Median Nerve. A special surgical instrument is inserted through the cannula that makes an incision in the Transverse Carpal Ligament. This surgery also opens the Carpal Tunnel and makes it larger to take pressure off of the Median Nerve. Because Endoscopic Carpal Tunnel Release spares some of the tissue in the palm, individuals may heal faster and experience less discomfort.

Recovery
Following surgery, your incision will be wrapped in a soft dressing. Your physician may recommend that you wear a splint to provide support and promote healing. You will be able to move your fingers immediately after surgery. You will need to avoid heavy grasping or pinching motions for about six weeks. Your doctor may recommend that you participate in occupational or physical therapy to gain strength, joint stability, and coordination. It may take several months for strength in the wrist and hand to return to normal.

Recovery from Carpal Tunnel Surgery is individualized and depends on the extent of the condition and the type of surgery performed. Your doctor will tell you what to expect.​​

Prevention
There are several things that you can do that may help prevent the symptoms of Carpal Tunnel Syndrome. A general physical examination could identify medical conditions that are associated with Carpal Tunnel Syndrome. An early diagnosis may allow for optimal treatment.

Introduction

Carpal Tunnel Syndrome is a common condition that affects the hand and wrist. It occurs when the Median Nerve in the wrist is compressed. Nerves carry messages between our brains, spinal cord, and body parts. The Median Nerve carries signals for sensation and muscle movement. When the Median Nerve is compressed or entrapped, it cannot function properly. This syndrome has received much attention in the last few years because of suggestions that it may be linked with jobs that require repeated use of the hands. In actual fact, little proof of this exists.

Carpal Tunnel Syndrome is more common in women and people between the ages of 30 and 60 years old. It is the most common nerve entrapment syndrome and affects up to 10% of the population. Individuals with Carpal Tunnel Syndrome may feel numbness, pain, and a “tingly” sensation in their fingers, wrists, and arms. They may have difficulty performing grasping and gripping activities because of discomfort or weakness.

Anatomy

The Median Nerve passes from the arm, through the wrist, and into our fingers. At the center of the wrist joint, the Median nerve goes through a passageway called the Carpal Tunnel. Our wrist bones form the bottom of the Carpal Tunnel. The Transverse Carpal Ligament covers the top. Ligaments are strong bands of tissues that connect bones together. In addition to the Median Nerve, the Carpal Tunnel also contains many tendons. These tendons attach to the muscles that allow our fingers to bend or flex.
The Median Nerve supplies the sense of feeling to our thumb, index finger, middle finger, and half of the ring finger. It also sends messages to the Thenar Muscles that move the thumb. We use the Thenar Muscles when we position our thumb to grasp and hold objects. When compressed in the Carpal Tunnel, the Median Nerve sends faulty messages as it travels into the hand and fingers.

Causes

Carpal Tunnel Syndrome develops when the tissues and tendons in the Carpal Tunnel swell and make the area within the tunnel smaller. This can happen in association with other medical conditions, such as hypothyroidism and diabetes. The increased pressure within the tunnel causes the Median Nerve to become compressed. The pressure disrupts the way the nerve works and causes the symptoms of Carpal Tunnel Syndrome. Usually, the exact cause of carpal tunnel syndrome is unknown.
Rheumatoid arthritis, joint dislocation, and fractures can cause the space in the tunnel to narrow. Some women develop Carpal Tunnel Syndrome because of swelling from fluid retention caused by hormonal changes. This may occur during pregnancy, premenstrual syndrome, or menopause.

Symptoms

The primary symptoms of Carpal Tunnel Syndrome are pain, numbness, and tingling. The numbness and tingling is typically present in the thumb, index, middle, and half of the ring finger. Some people describe the pain as a deep ache or burning. Your pain may radiate into your arms. Your thumb may feel weak and clumsy. You may have difficulty grasping items, and you may drop things. Your symptoms may be more pronounced at night, when you perform certain activities, or in cold temperatures.

Diagnosis

Your doctor can diagnose Carpal Tunnel Syndrome by conducting a medical examination, reviewing your medical history, and asking you about your activities and symptoms. During the physical exam, your doctor will check your wrist and hand for sensation and perform a thorough hand examination.

Your doctor may ask you to perform a couple of simple tests to determine if there is pressure on the Median Nerve. For the Phalen’s Test, you will firmly flex your wrist for 60 seconds. The test is positive if you feel numbness, tingling, or weakness. To test for the Tinel’s Sign, your doctor will tap on the Median Nerve at the wrist. The test is positive if you feel tingling or numbness in the distribution of the median nerve. Lab tests may be ordered if your doctor suspects a medical condition that is associated with Carpal Tunnel Syndrome. Your doctor may take an X-ray to identify arthritis or fractures.

In some cases, physicians use nerve conduction studies to measure how well the Median Nerve works and to help specify the site of compression. Physicians commonly use a test called a Nerve Conduction Velocity (NCV) test. During the study, a nerve is stimulated in one place and the amount of time it takes for the message or impulse to travel to a second place is measured. Your doctor will place sticky patches with electrodes on your skin that covers the Median Nerve. The NCV may feel uncomfortable, but only during the time that the test is conducted.

An Electromyography (EMG) test is often done at the same time as the NCV test. An EMG measures the impulses in the muscles to identify poor nerve input. Healthy muscles need impulses to perform movements. Your doctor will place fine needles through your skin and into the muscles that the Median Nerve controls. Your doctor will be able to determine the amount of impulses conducted when you contract your muscles. The EMG may be uncomfortable, and your muscles may remain a bit sore following the test.

Treatment

The symptoms of Carpal Tunnel Syndrome can often be relieved without surgery. Some medical conditions associated with Carpal Tunnel Syndrome can be treated. Some cases respond to treatments that relieve pain and provide rest. Your doctor may recommend that you wear a splint at night to support your wrist in a neutral position.
Splints may also be worn during activities that aggravate your symptoms to position the wrist properly and provide wrist support. Your doctor may suggest over-the-counter anti-inflammatory medication to help reduce your pain and swelling. Sometimes doctors choose to inject corticosteroid medication, an anti-inflammatory medication, to provide symptom relief.

Surgery

Surgery is recommended when non-surgical options do not work or if the condition becomes worse. There are a few types of outpatient surgery to remove pressure on the Median Nerve. Your doctor will help you decide which option is best for you.
The standard surgery for Carpal Tunnel Syndrome is called an Open Release. The surgeon will use a local or regional anesthetic to numb the hand area. For this procedure, the surgeon makes a two to three inch opening along the palm. This allows the surgeon access to the Transverse Carpal Ligament, the roof of the Carpal Tunnel. The surgeon makes an incision in the Transverse Carpal Ligament to open the tunnel and make it larger. By doing so, pressure is taken off of the median nerve. The surgery time for an Open Release is short, only about fifteen minutes.

Another surgical option is called Endoscopic Carpal Tunnel Release. This type of surgery is done using an endoscope placed in a small incision. An endoscope is small device with a light and a lens that allows the surgeon to view the Carpal Tunnel without disturbing the nearby tissues. It may be used in conjunction with a camera or video system.
Endoscopic Carpal Tunnel Release most often uses a local or regional anesthetic to numb the wrist and hand area. In some cases, individuals are sedated for the surgery. The surgeon makes a small opening below the crease of the wrist and inserts the endoscope to view the Carpal Tunnel. Some surgeons make a second incision in the palm of the hand. Guided by the endoscope, the surgeon places a tube called a cannula along the side of the Median Nerve. A special surgical instrument is inserted through the cannula that makes an incision in the Transverse Carpal Ligament. This surgery also opens the Carpal Tunnel and makes it larger to take pressure off of the Median Nerve. Because Endoscopic Carpal Tunnel Release spares some of the tissue in the palm, individuals may heal faster and experience less discomfort.

Recovery

Following surgery, your incision will be wrapped in a soft dressing. Your physician may recommend that you wear a splint to provide support and promote healing. You will be able to move your fingers immediately after surgery. You will need to avoid heavy grasping or pinching motions for about six weeks. Your doctor may recommend that you participate in occupational or physical therapy to gain strength, joint stability, and coordination. It may take several months for strength in the wrist and hand to return to normal.

Recovery from Carpal Tunnel Surgery is individualized and depends on the extent of the condition and the type of surgery performed. Your doctor will tell you what to expect.

Prevention

There are several things that you can do that may help prevent the symptoms of Carpal Tunnel Syndrome. A general physical examination could identify medical conditions that are associated with Carpal Tunnel Syndrome. An early diagnosis may allow for optimal treatment.

Introduction

Articular cartilage is a substance that covers the ends of many of your bones. It cushions them during movement and provides a smooth surface for the bones in a joint to glide on. The meniscal cartilages in the knee differ from articular cartilage, and function as stabilizers and shock absorbers. Injury or certain medical conditions can cause the meniscal cartilage to tear.

Cartilage tears cause joint pain, swelling, locking, giving way, and loss of function. Arthroscopic surgery is commonly used to treat cartilage tears. Arthroscopic surgery is associated with relatively minimal pain and short recovery periods.

Anatomy

Cartilage covers the ends of many of your bones. It forms a smooth surface for the bones in a joint to glide on during movement. It acts as a shock absorber to cushion impacts. The menisci are specialized cartilage structures in the knee that aid stability and act as shock absorbers.

Causes

Cartilage in the knee and shoulder is especially vulnerable to tears from injury, particularly during sports. Arthritis can cause the cartilage to wear away. Chondromalacia is a term referring to cartilage softening and deterioration. Obesity puts extra stress on joints and can lead to cartilage tears, especially in the knees. Bone malalignments in the knee can contribute to uneven pressure and cartilage tears.

Symptoms

A cartilage tear causes pain, swelling, and tenderness in a joint. Your pain may increase with movement. It may feel like your joint has a catch in it when you move it. Your joint may not function as it did before. A torn piece of cartilage may move abnormally within a joint. It may prohibit movement and cause your joint to “give out,” particularly in the knee.

Diagnosis

A doctor can diagnose a cartilage tear by reviewing your medical history, performing a physical examination, and viewing medical images. You should tell your doctor about your symptoms, activities, and circumstances that lead to an injury. Your doctor will perform a thorough examination of your joint.

Your doctor will order X-rays to see the condition of your bones and identify arthritis. Your doctor may order a magnetic resonance imaging (MRI) scan. A MRI scan provides a very detailed picture of your joint, particularly showing the cartilage and ligaments.

Treatment

Cartilage does not have a good blood supply and is not able to heal itself. Tears cause the cartilage to deteriorate over time. Consequently, most cartilage tears require surgery for treatment.

Surgery

Arthroscopic surgery is commonly used to treat meniscal cartilage tears. It allows surgeons to see, diagnose, and treat problems inside a joint. Arthroscopic surgery uses an arthroscope and narrow surgical instruments that are inserted through small incisions. An arthroscope contains a lens and lighting system that allow a surgeon to view inside of a joint. The arthroscope is attached to a miniature camera. The camera allows the surgeon to view the magnified images on a video screen or take photographs and record videotape.

Recovery

Arthroscopy is less invasive than open surgical procedures. It is associated with a decreased risk of infection, minimal bleeding, less pain, and a shorter recovery period. Your doctor will let you know what to expect.

Introduction
Celiac sprue is an inherited disease that affects the way nutrients are absorbed in the small intestine. It occurs when people with the genetic condition eat foods that contain gluten and other proteins.

Gluten is contained in wheat, barley, rye, and some oat products. The gluten causes an autoimmune reaction that damages the inner lining of the small intestine and impedes its role with nutrient absorption. Because of this, celiac sprue is termed a malabsorption condition.

Symptoms of celiac sprue vary from person to person. Symptoms may include abdominal pain and changes in bowel habits. Numerous non-gastrointestinal symptoms may occur as well including joint pain, bone fractures, and complications from nutritional deficiencies.

The treatment for celiac sprue is to not consume gluten products. If celiac sprue is not treated, it can lead to serious medical complications including an increased risk for developing cancer.

Anatomy
Whenever you eat and drink, food travels through your digestive system for processing. Your body absorbs nutrients and removes waste products via your digestive system. When you eat, your tongue moves chewed food to the back of your throat. When you swallow, the food moves into the opening of the esophagus. Your esophagus is a tube that moves food from your throat to your stomach.

Your stomach produces acids to break down food for digestion. Your stomach processes the food you eat into a liquid form. The processed liquid travels from your stomach to your small intestine.

The small intestine is a tube that is about 20-22 feet long and 1 ½ to 2 inches around. The duodenum is the first part of the small intestine. It is a short C-shaped structure that extends off of the stomach. The jejunum and the ileum are the middle and final sections of the small intestine.

Your small intestine breaks down the liquid from your stomach even further so that your body can absorb the nutrients. Your small intestine is lined with villi. Villi are tiny projections that absorb nutrients. Their finger-like shape increases the surface area of absorption in the small intestine. The villi are more dense in the first part of the small intestine and are sparse or absent in the last section of the small intestine.

The remaining waste products from the small intestine travel to the large intestine. The liquid solidifies as it moves through the large intestine, forming a stool. The stool is eliminated from your body when you have a bowel movement.
Causes
Celiac sprue is a chronic autoimmune disease of the digestive tract. People with celiac sprue have an inherited genetic disorder. The condition results when people with the genetic condition eat foods that contain gluten and other proteins.

Gluten is contained in wheat, barley, rye, and some oat products. The gluten causes an autoimmune reaction that damages the inner lining of the small intestine. When the intestinal lining is damaged, it is unable to produce the enzymes necessary for digestion and nutrient absorption.

Further, the villi in the small intestine become flattened, which further impedes the absorption process. Because of this, celiac sprue is termed a malabsorption disorder. The function of other body organs may be affected when malabsorption occurs.

Symptoms
Symptoms of celiac sprue can vary from person to person. Symptoms may be gastrointestinal or non-gastrointestinal. You may experience diarrhea, constipation, vomiting, gas, and bloating. You may have pain in your abdomen and feel nauseated. Your stools may be “fatty,” float, contain blood, or have a foul smell. You may lose your appetite and lose weight.

Non-gastrointestinal symptoms include muscle cramps, joint pain, bone pain, and bone conditions such as osteoporosis and fractures. You may experience skin disorders, hair loss, and bruise easily. Your teeth may become discolored and develop enamel problems. Sores may appear in your mouth.

You may feel depressed, irritable, and tired. It may be difficult for you to breathe, or you may feel fatigued if you develop anemia, a shortage of red blood cells. Malnutrition and vitamin deficiencies can occur, particularly of iron, folate, and vitamin K.

Women may experience hormonal changes, infertility, and miscarriage. Men may experience hormonal changes, infertility, and impotence. Additionally, you may experience low blood sugar levels, nosebleeds, seizures, and general or abdominal swelling.

Symptoms in children develop when they begin to eat cereal. Childhood symptoms include abdominal pain, vomiting, diarrhea, depression, irritability, and behavior problems. Because celiac sprue interferes with nutrient absorption, children may have impaired growth and be short.
Diagnosis
Your doctor can start to diagnose celiac sprue by reviewing your medical history and conducting a physical examination. You should tell your doctor about your symptoms, what you typically eat, and your risk factors for celiac sprue.

Your doctor will test your blood for the antibodies associated with celiac sprue. Your doctor will also test your blood and stool for signs of malabsorption and related complications. If your antibody tests indicate that you have celiac sprue, your doctor may take a biopsy of your small intestine.

A biopsy involves the removal of a very small piece of your small intestine for examination with an upper gastrointestinal (GI) endoscopy. This test is also called an esophagogastroduodenoscopy (EGD).

An upper GI endoscopy uses an endoscope to view the esophagus, stomach, and upper duodenum, the first part of the small intestine. An endoscope is a long thin tube with a light and a viewing instrument that sends images to monitor. After you receive relaxing medication, the endoscope is inserted through your mouth. The endoscope allows a doctor to examine the inside of the upper gastrointestinal tract for bleeding, tumors, polyps, and other abnormal conditions.

For celiac sprue, the doctor will look at the villi for structural and functional changes. The condition of the villi may show mild, moderate, or severe damage. A tissue sample or biopsy can be taken with the endoscope for examination.
Treatment
Treatment for celiac sprue is to remove gluten products from your diet. You will need to follow a gluten-free diet for the rest of your life. Your doctor may refer you to a dietician that can educate you about reading product labels and menu planning.

Your doctor may prescribe vitamins and mineral supplements to help correct nutritional imbalances. A small percentage of people with celiac sprue may fail to respond to a gluten-free diet. These people are typically treated with corticosteroid medications.

Symptoms of celiac sprue improve quickly, in just a few days, for most people who follow a gluten-free diet. It usually takes three to six months for the small intestine to heal. In older adults, it may take up to two years to heal.
Prevention
It is helpful to become educated about gluten-free eating. Learn how to read product labels to detect gluten. A registered dietician can help you identify products and substitutes for your recipes.
Am I at Risk
Researchers believe that celiac sprue is greatly under diagnosed. Previously believed to be rare, it appears that it may actually be a common condition.

Celiac sprue is more common in Western Europe, North America, and Australia. Celiac sprue occurs most frequently in Caucasians and people of Northern European ancestry. It is more common in women than men and generally begins in people between the ages of 30 and 50 years old.

Celiac sprue can develop in children when they begin to eat cereal. Lactose intolerance appears to be common in people with celiac sprue. Because it is inherited genetically, your risk of developing celiac sprue is greater if other members of your family have the condition.

Complications
If untreated, celiac sprue can lead to life-threatening medical complications including an increased risk for cancer. If you do not follow a strict gluten-free diet, you have an increased risk for developing associated medical conditions including infertility, miscarriage, and bone fractures.
Advancements
Improvements in antibody testing have led to an increased diagnosis of celiac sprue. Further, gluten-free product labeling and gluten-free baking products are becoming more common on grocery store shelves.

Introduction

Cervical cancer occurs when the cells in the cervix grow abnormally or out of control. The cervix is part of the female reproductive system. The exact cause of cervical cancer is unknown. Certain strains of the human papillomavirus (HPV), a sexually transmitted disease, cause the majority of cervical cancer.

A new vaccine is available to prevent infection against the two types of HPV that are responsible for the majority of cervical cancer cases and the two types of HPV that are responsible for the majority of genital wart cases. A pap smear test is a preventive measure that can detect precancerous or cancerous cells. Precancerous cells are 100% curable.

Anatomy

The internal female reproductive system includes the ovaries, fallopian tubes, uterus, cervix, and vagina. The ovaries are two small organs that produce eggs (ova) and hormones. An ovary typically releases one mature egg each month. Two fallopian tubes extend from near the ovaries to the uterus. The fallopian tubes transport the mature eggs to the uterus (womb).

The uterus is a pear-shaped organ where a baby grows in during pregnancy. The cervix is located at the bottom of the uterus. The cervix joins the uterus to the vagina and opens during childbirth. The vagina is a muscular passageway that extends from the cervix to the external female genitalia.

Causes

The exact cause of cervical cancer is unknown. Cancer occurs when cells grow abnormally and out of control, instead of dividing in an orderly manner. Cervical cancer starts as precancer in the cells on the cervix surface. Precancerous changes are called dysplasia. The development of cervical cancer is very slow. Untreated cervical cancer can spread to the bladder, intestines, lymph nodes, bones, lungs, and liver. Untreated cervical cancer can lead to death.

Certain strains of the human papillomavirus (HPV) cause most cases of cervical cancer. HPV is a sexually transmitted disease. There is a vaccine to prevent infection against the two types of HPV that are responsible for the majority of cervical cancer cases and the two types of HPV that are responsible for the majority of genital wart cases.

Precancerous cervical cells are generally completely treatable. A pap smear test screens for precancer or cancerous cells. Pap smear testing should begin after the age of 21.

Symptoms

Early cervical cancer may not have symptoms. Early symptoms may include a continuous vaginal discharge, abnormal bleeding, and changes in your period patterns. Vaginal discharge may be watery, pale, pink, brown, bloody, or smell bad. You may experience abnormal vaginal bleeding between your periods, after intercourse, or after menopause. Your periods may become heavier and last longer than they usually do.

Symptoms of advanced cervical cancer may include weight loss and a loss of appetite. You may feel very tired and have pelvic, back, or leg pain. One of your legs may become swollen. You may experience heavy bleeding, urine leakage, or feces leakage from the vagina. Your bones may hurt or fracture.

Diagnosis

You should report any unusual vaginal discharge, bleeding, or changes in your periods to your doctor. Pap smear testing should begin after the age of 21. If a pap smear identifies abnormal cellular changes, precancerous cells, or cancerous cells, your doctor will conduct additional tests.

A colposcopy is a procedure that uses a colposcope to view the cervix. A colposcope is a magnifying device. The colposcope can biopsy an area of concern. A biopsy entails removing a tissue sample for examination for cellular changes. A biopsy is necessary to correctly diagnose cervical cancer.

In addition to colposcopy, there are several different methods for obtaining a biopsy. For example, a cone biopsy removes a plug of tissue for examination. Endocervical curettage (ECC) examines cells at the opening of the cervix.

If you are diagnosed with cervical cancer, your doctor will order tests to learn more information about your cancer. Your doctor will check for metastasized cancer. Cancer that has spread from its site of origin is termed metastasized. Imaging tests are used to identify if cervical cancer has spread to other organs. An intravenous pyelogram (IVP), X-ray, cystoscopy, proctoscopy, computed tomography (CT) scan, and magnetic resonance imaging (MRI) scan may be used.

An IVP uses X-rays and contrast dye to check for cancer or blockages in the urinary tract. A chest X-ray can reveal cancer that has spread to the lungs. A cystoscopy uses a thin viewing instrument to examine the bladder for cancer. A proctoscopy uses a lighted camera device to check for cancer in the rectum. CT scans take pictures of the organs from different angles, and MRI scans take pictures with even more details.

If you have cervical cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests. Staging describes the cancer and how it has metastasized. Staging is helpful for treatment planning and recovery prediction. There is more than one type of staging system for cancer, and you should make sure that you and your doctor are referring to the same one.

Your doctor will classify your cervical cancer in a stage labeled from 0-4. Lower numbers indicate a less serious cancer, and higher numbers indicate a more serious cancer. The stages 1 to 4 may be subdivided into classifications that use letters and numbers.

Treatment

Your doctor may refer you to an oncologist for treatment. An oncologist is a doctor with special training in cancer and cancer treatments. Treatment for cervical cancer depends on many factors, including the stage of the cancer, the cancer cell type, your general health, and desire to have children in the future. You may opt to receive a second opinion about the best kind of cancer treatment for you. Cancer treatments include surgery, radiation therapy, chemotherapy, or a combination of therapy types. Most people with cervical cancer receive surgery and another type of treatment.

There are several surgical options for treating very early cervical cancer. Cryosurgery freezes abnormal cells. Laser surgery uses a beam of light to burn cells or obtain a tissue sample. The loop electrosurgical excision procedure (LEEP) uses electricity to remove abnormal tissues.

For more advanced stages of cervical cancer, the uterus may need to be removed with a simple hysterectomy. A radical hysterectomy and pelvic lymph node dissection removes the uterus, nearby tissues, the upper part of the vagina, and nearby lymph nodes. A pelvic exenteration removes the same structures as in a radical hysterectomy plus the bladder, vagina, rectum, and part of the colon. In this case, reconstructive surgery will create alternative ways to collect and void urine and feces. Following hysterectomy, a woman will not be able to become pregnant.

Radiation therapy uses high-energy rays to kill cancer cells. Radiation can be delivered from outside of the body or from radioactive materials that are temporarily placed inside of the body. Chemotherapy uses cancer-fighting drugs to destroy cancer cells. There are different types of radiation therapies and chemotherapies.

Cervical cancers that are found in pregnant women are addressed with special regard for the life of the mother and unborn baby. In some cases of very early cervical cancer, the pregnancy may continue to term. If the cancer is at a later stage, the decision to continue the pregnancy or not must be made. If the pregnancy is continued, the baby is delivered by cesarean section as soon as it is able to survive outside of the womb. For very advanced cervical cancer, immediate treatment may be the best option.

Even with treatment, some cases of treated cervical cancer may return. This is termed “recurrent cervical cancer.” The cancer may come back in your cervix or in other parts of the body. Your doctor can explain your risk for recurrent cervical cancer and possible treatments if it does recur.

The experience of cancer and cancer treatments can be an emotional process for people with cancer and their loved ones. It is important that you receive support from a positive source. Some people find comfort in their family, friends, counselors, co-workers, and faith. Cancer support groups are another good option. They can be a good source of information and support from people who understand what you are experiencing. Ask your doctor for cancer support group locations in your area.

Prevention

Cervical cancer can be prevented by early detection of precancerous cells. Precancerous cells are 100% curable. For women under 21-29, a Pap smear should be conducted once every 3 years. For women 30-65, cervical cancer screening should include a Pap smear and HPV test once every 5 years. For older women, Pap and HPV testing should only be performed if there is a history two or three abnormal test results in the last 5 or 10 years.

A vaccine is available to prevent infection against the two types of HPV responsible for most cases of cervical cancer and the two types of HPV responsible for most cases of genital warts. HPV is a sexually transmitted disease. The vaccine is approved for females ages 9-26 years old. However, HPV testing is not required for girls younger than 30 because the virus typically goes away on its own. Ask your doctor about receiving the vaccine.

You can prevent cervical cancer by not engaging in sexual acts with people that have HPV or genital warts. Condoms do not protect against HPV, but should be used to prevent other types of sexually transmitted diseases. To further reduce the risk of HPV and cervical cancer, it is wise to limit your number of sexual partners and avoid partners that participate in high risk sexual activities.

Quitting smoking may reduce your risk of developing cervical cancer. If you are unable to quit smoking on your own, ask your doctor for resources to help you quit. There are a variety of smoking cessation products and methods that your doctor will be delighted to refer you to.

Am I at Risk

Risk factors may increase your likelihood of developing cervical cancer, although some people that experience this cancer may not have any risk factors. People with all of the risk factors may never develop cervical cancer; however, the likelihood increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for cervical cancer:

_____ The most important risk factor for cervical cancer is infection with the HPV virus that causes cervical cancer. HPV is a sexually transmitted disease.
_____ Females that are not vaccinated against HPV and are sexually active have a higher risk of contracting HPV that can lead to cervical cancer.
_____ Smokers have a higher risk of developing cervical cancer.
_____ The human immunodeficiency virus (HIV) can be a risk factor for cervical cancer. HIV, the virus that causes AIDS, weakens the immune system and makes it more difficult to fight early cancers and viruses.
_____ Some studies indicate that women with genital herpes or Chlamydia, sexually transmitted diseases, have an increased risk for developing cervical cancer.
_____ Long term use of birth control pills increases the risk of cervical cancer.
_____ Having many full term pregnancies is associated with an increased risk for cervical cancer.
_____ Daughters of women who took diethylstilbestrol (DES) between 1940 and 1971 to prevent miscarriage have a slightly higher risk of cervical and vaginal cancer.
_____ If your mother or sister experienced cervical cancer, you have an increased risk for developing it.
____ Having sex at an early age, multiple sex partners, or sex partners that have had multiple partners increases your risk for cervical cancer.

Complications

Cervical cancer can have several complications. Hysterectomy treatment for surgical cancer ends the chance of pregnancy, which may be a concern for women desiring to give birth to their children. Some cervical cancers may be resistant to treatments. In some cases, cervical cancer may come back following treatment. Further, some treatments can cause problems with sexual, bowel, and bladder function.

Advancements

In June 2006, the US Food and Drug Administration (FDA) approved Gardasil as a vaccine to prevent infection against the two types of HPV responsible for most cervical cancer cases and the two types of HPV responsible for causing the majority genital warts cases. The vaccine is approved for females ages 9-26 years old. It is received in a series of three injections over a six month period.

Researchers found that Gardasil prevented cervical cancer, precancerous lesions, and genital warts due to HPV types 6, 11, 16, and 18. Gardasil is not protective for females that are already exposed to HPV. It also does not protect against the less common types of HPV that can cause cervical cancer or genital warts.

Introduction
Chronic Obstructive Pulmonary Disease (COPD) is an irreversible lung condition. Diseases classified as COPD cause swelling of the large airways in the lungs, which obstructs or blocks the flow of air. Symptoms of COPD include shortness of breath, coughing, wheezing, and decreased activity levels. Emphysema and chronic bronchitis are common forms of COPD. Cigarette smoking is the main cause of COPD.

COPD is a long-term condition that gets worse over time. Quitting smoking, lung rehabilitation therapy, and medications, including oxygen, may help to improve symptoms. Lung surgery or lung transplantation may be appropriate for select people with severe COPD.

Anatomy
Your lungs are located inside the ribcage in your chest. Your diaphragm is beneath your lungs. The diaphragm is a dome-shaped muscle that works to open your lungs when you breathe.

From your nose and mouth, air travels towards your lungs through a series of tubes. The trachea or windpipe is located in your throat. The bottom of the trachea separates into two large tubes called the main stem bronchi. The left main stem bronchus goes into the left lung, and the right main stem bronchus goes into the right lung.

Inside the lung, the bronchi branch off and become smaller. These smaller air tubes are called bronchioles. There are approximately 30,000 bronchioles in each lung. The end of each bronchiole has tiny air sacs called alveoli. There are about 600 million alveoli in your lungs. Each alveolus is covered in small blood vessels called capillaries. The capillaries move oxygen and carbon dioxide in and out of your blood.

When you breathe air in or inhale, your diaphragm flattens and your ribs move outward to allow your lungs to expand. The air that you inhale through your nose or mouth travels down the trachea. Tiny hair-like structures in the trachea, called cilia, filter the air to help keep mucus and dirt out of your lungs. The air travels through the bronchi and the bronchioles and into the alveoli. Oxygen in the air passes through the alveoli into the capillaries. The oxygen attaches to red blood cells and travels to the heart. The heart sends the oxygenated blood to the cells in your body.

When you breathe air out or exhale, the process is the opposite of when you inhale. Once your body has used the oxygen in the blood, the deoxygenated blood returns to the capillaries. The blood now contains carbon dioxide and waste products that must be removed from your body. The capillaries transfer the carbon dioxide and wastes from the blood into the alveoli. The air travels through the bronchioles, the bronchi, and the trachea. As you exhale, your diaphragm rises and your ribs move inward. As your lungs compress, the carbon dioxide is released out of your mouth or nose.
Causes
COPD is a life long condition that impairs the function of the lungs. Forms of COPD, such as emphysema and chronic bronchitis, cause swelling of the large airways in the lungs. Over time, this destroys certain lung structures and reduces the flow of air in and out of the lungs.

Cigarette smoking is the most common cause of COPD. In particular, cigarette smoking can damage the alveoli in the lungs and the cilia in the airways. As the condition progresses, the lungs do not exchange oxygen and carbon dioxide efficiently. Mucous that builds up can lead to an infection.
Symptoms
Symptoms of COPD include coughing, wheezing, shortness of breath, and decreased activity levels. You may or may not produce phlegm when you cough. As your condition progresses, breathing may become increasingly difficult. You may not have the energy to perform or tolerate activities like you used to. COPD can limit your lifestyle and quality of life.

As COPD worsens, you may experience episodes more frequently and develop serious complications. Your skin may have a bluish discoloration. You may have a pneumothorax, a condition where the lung collapses and air is on the outside of the lung. You may experience a significant weight loss. COPD can affect your heart. You may have an abnormal heartbeat. COPD can cause the heart to enlarge and lead to right sided heart failure.
Diagnosis
Your doctor can start to diagnose COPD by reviewing your medical history and conducting a physical examination. If you have already been diagnosed with COPD you should contact your doctor if your breathing becomes very difficult or if you experience other severe symptoms. You should tell your doctor about your risk factors, symptoms, and any changes in previous symptoms. Your doctor may order tests to detect infection, determine the extent of your condition, and decide on a treatment plan.

Your doctor will listen to the sound your lungs make while you breathe. You will be checked for rapid breathing or difficult breathing during simple activities. A sample of your phlegm will be checked for infection. A chest X-ray or high-resolution computerized tomography scan (HRCT scan) may be used to check for infection or structural changes in your lungs.

Your doctor may ask you to under go some tests called pulmonary function testing (PFTs). For example, your doctor will have you breathe into a hand-held device called a spirometer. A spirometer measures how much air you breathe out and how forcefully you breathe the air out. Your doctor will also have you breathe into a peak flow meter. A peak flow meter is a hand-held device that monitors the airflow through your bronchi. The peak flow meter measures your ability to expel air from your lungs under the best or peak conditions. Other more complex PFTs may be performed to further define your breathing condition. By monitoring the changes in your breathing patterns your doctor can identify how well your lungs are functioning, the severity of your symptoms, and appropriate treatment.

Your doctor may use a pulse oximeter to determine the amount of oxygen in your blood. For this test, a probe will simply be placed on your fingertip. A medical device attached to the probe displays the percentage of oxygen in your blood.
Treatment
The goals of treatment are to optimize your lung function, increase your activity tolerance, and improve your quality of life. The best thing you can do to improve your situation is to quit smoking. Talk to your doctor about methods to help you quit smoking if you are unable to do so yourself. Your doctor is happy to make recommendations and referrals to help you.
Your doctor can prescribe medications to help ease your symptoms and make it easier for you to breathe. Antibiotics may be used to fight infections. You may need to use a steady flow of oxygen.

It can be beneficial to participate in a lung rehabilitation or respiratory therapy program. Respiratory therapists can show you ways to optimize your breathing. Exercises can help to improve your endurance.

In severe cases, some people may need the help of a breathing tube or breathing devices. Some people with advanced COPD may be candidates for surgery. Lung reduction surgery is used to remove the damaged portion of a lung, allowing the remaining portion to perform better. Select people may be candidates for lung transplant surgery. Lung transplant surgery can improve activity levels and quality of life.

The experience of COPD can be an emotional process for people with the condition and their loved ones. It is important that you receive support from a positive source. Some people find comfort in their family, friends, co-workers, and faith. Lung disease support groups are another good option. They can be a good source of information and support from people who understand what you are experiencing. Ask your doctor for a lung disease support group locations in your area.
Prevention
Quitting smoking and avoiding second hand smoke can prevent COPD. You should follow your doctor’s treatment instructions, participate in your home respiratory therapy program, and call your doctor if your symptoms intensify to help prevent medical complications.
Am I at Risk
Risk factors may increase your likelihood of developing COPD, although some people that develop the condition do not have any risk factors. People with all of the risk factors may never develop the disease; however, the chance of developing COPD increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for COPD:

_____ Cigarette smoking or exposure to second hand smoke is the main cause of COPD.
_____ Air pollution appears to contribute to COPD.
_____ People with alpha-1 antitrypsin deficiency are at an increased risk for the COPD.

Alpha-1 antitrypsin is a substance in the lungs that may protect against lung destruction leading to emphysema.

Complications
As COPD worsens, you may experience episodes more frequently and develop serious complications. Your skin may have a bluish discoloration. You may develop a pneumothorax, a condition where the lung collapses and air is on the outside of the lung. You may experience a significant weight loss.

COPD can affect your heart. You may have an abnormal heartbeat. COPD can cause the heart to enlarge over time and lead to right sided heart failure. You should call the emergency medical services in your area, usually 911, or have someone drive you to a hospital emergency department if you are having a significant problem breathing or are experiencing a heart attack.

Introduction
Cluster headaches are named so because they occur in predictable patterns, often as regular as clockwork. They are one of the most painful types of headaches. Fortunately, treatments and medication can help reduce symptoms and the number of headache episodes.
Anatomy
Researchers believe that cluster headaches may be related to several factors, including problems with the body’s biological clock located in the brain (hypothalamus). The biological clock regulates sleep cycles, wake cycles, and hormones. Another possible factor, nerve impulses from the trigeminal nerve send signals about pain and also causes the blood vessels (arteries) in the head to open wider (dilate) and cause pain.
Causes
Cluster headaches are a rare type of primary headache, meaning that they are not caused by an underlying medical condition. In some cases, cluster headaches run in families and may have a genetic component. In other instances, multiple factors may be involved, including disrupted sleep patterns, alcohol consumption, smoking, brain structure (hypothalamus) abnormalities, hormones, blood vessel inflammation, and nerve sensitivity.
Symptoms
Cluster headaches cause abrupt severe intense pain. You may feel sharp burning pain behind your eye or on one side of your head. You may feel restless and have a stuffy or runny nose. Your eye may produce tears and turn red. The pupil (black area) of your eye may become small. Your skin may be pale, flushed, or sweaty. Your eyelid may droop or swell. Some people become sensitive to light or sound.

A single cluster headache may last from 5 minutes to several hours. They frequently begin at the same time and are more common between 9 PM and 9 AM. They may disrupt sleep as they are more likely to occur during Rapid Eye Movement (REM) sleep. Episodes of cluster headaches may last from 2 to 12 weeks. Episodic cluster headaches are followed by a headache-free period of at least one month. Chronic cluster headaches can last for years without a headache-free month.
Diagnosis
Your doctor can diagnose cluster headache by reviewing your medical history and symptoms and conducting an examination, including a neurological examination. Imaging tests, such as CT scans or MRI scans, may be used to rule out other medical conditions. Your doctor may have you keep a record of your headaches.
Treatment
Although there is no cure for cluster headaches, there are many medications that can provide symptom relief. Over-the-counter headache medication usually does not provide relief for cluster headache pain. Instead, your doctor may provide injectable, inhaled, or intravenous (IV) prescription medication. Oxygen may provide dramatic quick relief. In rare cases, conventional surgery or radiosurgery is used to destroy the nerves that transmit pain.
Prevention
Your doctor may prescribe medication to prevent or reduce the episodes of cluster headache. It may help to:

• Maintain a regular sleep schedule. Avoid napping.
• Do not smoke or use alcohol.
• Avoid solvents, such as gasoline or oil-based paints. These products can trigger a headache.
• Avoid glare and bright lights.
• Avoid or be cautious of high altitudes, the reduced oxygen can trigger cluster headaches.
Am I at Risk
Cluster headaches occur more frequently in men than in women. They most commonly occur between the ages of 20 and 40.

Risk factors or triggers for cluster headache:

• Heavy alcohol drinking
• Smoking
• Poor sleep patterns or sleep apnea
• Hormonal changes

Advancements
Researchers are studying devices that are surgically implanted in the brain. One such device stimulates the hypothalamus. Another device is implanted to stimulate one nerve (occipital nerve) to override the affects of another nerve (trigeminal nerve). To date, both devices appear promising.

Introduction
Coccydynia is an uncommon painful condition that originates from the coccyx, the tailbone at the end of the spine. Trauma and falls are the most frequent causes of coccydynia. In the vast majority of cases, nonsurgical treatment, such as medications and physical therapy work well to ease symptoms.

Anatomy

The spine is composed of a series of bones called vertebrae. Joints that allow movement while providing stability connect the vertebrae. The end of the spine, the coccyx, has 3-5 small bones.

The coccyx bones align in a curve like a small tail. Some of the coccyx bones may be fused together. However, fewer than 10% of people have a completely fused coccyx.

Muscles, ligaments, and tendons attach to the coccyx. It plays a role in weight bearing when seated.

Causes

Coccydynia is caused by trauma to the coccyx, such as from a fall, injury during childbirth, or prolonged sitting. Trauma can cause ligament inflammation or injure the coccyx where it attaches to the spine. In some cases, the cause is unknown.

Symptoms

The primary symptom of coccydynia is pain. You may experience increased sensitivity to pressure, especially when sitting and leaning backwards. The area around your tailbone may ache. Coccydynia can cause pain that shoots down the legs. It can also contribute to pain during sexual intercourse or bowel movements.

Diagnosis

A doctor can diagnose coccydynia by reviewing your medical history and examining you. You should tell your doctor if you have fallen or given birth recently. Imaging tests, such as X-ray or MRI, may be used to rule out other sources of pain. Electromyography (EMG) and nerve conduction studies may be used to assess nerve function.

Treatment

Coccydynia is typically first treated with non-steroidal anti-inflammatory medications. Your doctor may recommend that you sit on a donut shaped pillow to help relieve tailbone pressure. It may take several weeks or months for the pain to decrease.

For persistent or severe pain, your doctor may prescribe pain medications. Local medication injections are used to place numbing and anti-inflammatory medications near the source (joint or bursa) of the pain. Nerve blocks are used to interrupt a nerve’s ability to transmit pain signals.

Your doctor may gently move (manipulate) the coccyx after you receive a pain relieving injection. You may be referred to physical therapy for gentle stretching. Ultrasound therapy may be used, which soothes pain with warmth.

If treatments fail to relieve symptoms, surgery may be used to remove a portion of the coccyx (coccygectomy). The short outpatient surgery is successful for relieving symptoms for most people. However, surgery is very rarely used.

Introduction

Colon and rectal polyps are small growths that project out from the inside lining of the large intestine or rectum. They usually are noncancerous and produce no symptoms. However, some polyps can turn into cancer. Polyps that turn into cancer typically take several years to do so. Screening for colon cancer allows polyps to be detected and removed early, which may prevent the development of cancer.

Anatomy

Your body absorbs nutrients and removes waste products via your digestive system. Whenever you eat and drink, food travels through your digestive system for processing. As water from the waste product is absorbed, the product becomes more solid and forms a stool or feces. It is eventually eliminated from your body when you have a bowel movement.

After you swallow food, it moves through your esophagus and into your stomach. Chemicals in your stomach break down the food into a liquid form. The processed liquid travels from your stomach to your small intestine. Your small intestine breaks down the liquid even further so that your body can absorb the nutrients from the food you ate. The remaining waste products from the small intestine travel to the large intestine.

Your large intestine, also called the large bowel or colon, is a tube that is about 5 feet long and 3 or 4 inches around. The lower GI tract is divided into sections, including the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal, and anus. The appendix is located on the cecum, but it does not serve a purpose in the digestive process.

The first part of the colon absorbs water and nutrients from the waste products that come from the small intestine. As the colon absorbs water from the waste product, the product becomes more solid and forms a stool. The large intestine moves the stool into the sigmoid colon, where it may be stored before traveling to the rectum. The rectum is the final 6-inch section of your digestive tract. No significant nutrient absorption occurs in the rectum or anal canal. From the rectum, the stool moves through the anal canal. It passes out of your body through your anus when you have a bowel movement.

Causes

A polyp is a small growth that projects out from the inner mucus lining of the colon or rectum. Most polyps are noncancerous. Polyps that turn into cancer typically take several years to do so. A hyperplastic polyp is generally noncancerous but can be of concern if it grows large. An adenoma is a type of polyp that can turn into cancer. Cancer of the cells that line the inside of the colon is called adenocarcinoma. Adenocarcinomas are the most common type of colon cancer.

The exact cause of colon cancer is unknown. Cancer occurs when cells in the interior lining of the colon grow abnormally and out of control, instead of dividing in an orderly manner. Some people may inherit a genetic variation cannot control the division of cells in the colon and promotes the growth of polyps and cancer. Polyps that may be associated with certain hereditary disorders include Gardner’s Syndrome, Peutz-Jeghers Syndrome, Juvenille Polyposis, Familial Adenomatous Polyposis, and Lynch Syndrome.

Symptoms

Most people with colorectal polyps or early colorectal cancer do not have symptoms. Symptoms may include changes in bowel movement patterns. You may develop diarrhea, constipation, or narrow stools that last for more than a few days. You may experience rectal bleeding or have blood in your stools. However, it is also common for the stools to remain normal looking. Lower abdominal pain or cramps are rare but may occur. Weight loss may occur for no apparent reason. You may feel weak or tired. Additionally, some people develop anemia, a condition characterized by a decrease in red blood cells.

Diagnosis

Your doctor can diagnose colon polyps after reviewing your medical history and by conducting a physical examination. You should tell your doctor about your symptoms and risk factors. Your doctor will rule out other conditions with similar symptoms, such as hemorrhoids or infection. There are several tests for colorectal polyps.

Your doctor will examine your abdomen to feel for growths or enlarged organs. Your doctor may also perform a digital rectal examination. To do so, your doctor will briefly insert a gloved, lubricated finger into your rectum to check for a growth or mass. A mass may be indicative of rectal cancer, but not colon cancer.
A stool blood test can detect small amounts of blood in your stool. The fecal occult blood test (FOBT) or the fecal immunochemical test (FIT) is commonly used. You will receive a kit and instructions for taking a stool sample at home. The kit is sent to a laboratory for testing. If the test results are positive, your doctor may order a colonoscopy to identify the exact cause of bleeding.

A flexible sigmoidoscopy is used to view the rectum and part of the colon for cancer or polyps. A sigmoidscope is a thin tube with a light and viewing instrument. It is about two feet long. The sigmoidscope is placed in the colon, through the anus. This test can be uncomfortable, but should not be painful. Any abnormal results are followed up with a colonoscopy.

A colonoscopy is used to view the entire colon. A colonoscopy is similar to a sigmoidoscopy, but it is much longer. A colonoscopy allows a doctor to examine the colon for cancer or polyps. A tissue sample or biopsy can be taken with the colonoscopy. A colonoscopy can be uncomfortable, and you will receive medication to relax you prior to and during the test.

A virtual colonoscopy is a newer way to view the colon with a computed tomography (CT) scan. A CT scan takes a series of images to compose a detailed picture. A virtual colonoscopy involves filling the colon with air and then taking the CT scans. The CT images construct a visual depiction of the interior of the colon. The colon can also be viewed with a barium enema with air contrast test. For this test, the barium, a chalky substance, and air are used to fill and expand the colon. Next, X-rays are taken. These tests can be uncomfortable. Any abnormal results are followed up with a colonoscopy.
Treatment
Tissue from polyps can be sampled or even removed and then examined to see if they are cancerous. Most polyps are removed during a colonoscopy. In rare cases, a section of the colon may be surgically removed if the polyps are cancerous. Early detected cancer has excellent cure rates. People found to have polyps are then examined on a regular basis, usually every three to five years.
Prevention
In most cases, colon cancer is treatable if it is detected early. The American Cancer Society recommends that people be screened for colon cancer beginning at age 50. Screening may be warranted earlier for people with a history of polyps or inflammatory bowel disease and a personal or family history of certain cancers. Screening may include fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, and barium enema testing.

Some studies suggest that lifestyle changes may be helpful as well in the prevention of colon and rectal cancer. This includes not smoking and maintaining a healthy weight. These studies are not conclusive, but they suggest that eating fruits and vegetables that are high in fiber and reducing high-fat foods may reduce the risk of colorectal cancer. Other studies suggest that vitamins or a diet containing folic acid or folate, vitamin D, magnesium, and calcium may help lower colorectal cancer risk. Exercising for 30 minutes for five or more days during the week is also recommended.

Aspirin and similar medications may help reduce polyp formation in some people. However, not everyone can tolerate the side effects of aspirin. You should talk to your doctor before taking aspirin to see if it is right for you.
Am I at Risk
Certain risk factors may increase your likelihood of developing colorectal polyps. People with all of the risk factors may never develop polyps; however, the chance of developing the condition increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for colorectal polyps:

_____ People over the age of 50 are more likely to develop colorectal polyps.
_____ If you had colorectal polyps or cancer before, even if it was removed, you are at risk for developing colorectal polyps or cancer again.
_____ Ulcerative colitis and Crohn’s Disease increase the risk for colon polyps.
_____ If you have family members that have colorectal polyps or cancer, especially before the age of 60, you are at a higher risk.
_____ Certain genetic syndromes in some families cause the development of hundreds of polyps in the colon. The high number of polyps increases the risk of developing cancer.
_____ What you eat may increase your risk for colon cancer, although the cause of the link is not clear. Diets that are low in fiber, high in fat and animal products, such as meat, appear to increase the risk of colorectal polyps and cancer.
_____ People who are overweight have an increased risk of developing polyps and a higher rate of dying from colorectal cancer.
_____ People who smoke are more likely than non-smokers to develop polyps and die of colorectal cancer.

Complications
The majority of colon cancers begin as a benign or non-cancerous polyp. Polyps that turn into cancer typically take several years to do so. Screening for colon cancer allows polyps to be detected and removed early, which may prevent the development of cancer.

Introduction

Colon cancer is a common type of cancer. Colon cancer occurs when cells in the interior lining of the colon or large intestine grow abnormally and out of control. The exact cause of colon cancer is unknown.

In most cases, colon cancers begin as a benign or non-cancerous polyp. A polyp is a small growth that projects out from the inside lining of the colon. Not all polyps turn into cancer. Polyps that turn into cancer typically take several years to do so. Screening for colon cancer allows polyps to be detected and removed early, which may prevent the development of cancer.
Anatomy

Your colon is located at the end part of your digestive system. Whenever you eat and drink, food travels through your digestive system for processing. Your body absorbs nutrients and removes waste products via your digestive system.

When you eat, your tongue moves chewed food to the back of your throat. When you swallow, the food moves into the opening of the esophagus. Your esophagus is a tube that moves food from your throat to your stomach. Muscles in your esophagus wall slowly squeeze the food toward your stomach.

Chemicals in your stomach begin to break down the food. Your stomach processes the food you eat into a liquid form. The processed liquid travels from your stomach to your small intestine. The small intestine is a tube that is about 20-22 feet long and 1 ½ to 2 inches around. Your small intestine breaks down the liquid even further so that your body can absorb the nutrients from the food you ate. The remaining waste products from the small intestine travel to the large intestine.

Your large intestine, also called the large bowel, is a tube that is about 5 feet long and 3 or 4 inches around. The large intestine is divided into sections, including the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal, and anus. The appendix is located on the cecum, but it does not serve a purpose in the digestive process.

The first part of the colon absorbs water and nutrients from the waste products that come from the small intestine. As the colon absorbs water from the waste product, the product becomes more solid and forms stool or feces. The large intestine moves the stool into the sigmoid colon, where it may be stored before traveling to the rectum. The rectum is the final 6-inch section of your large intestine. No significant nutrient absorption occurs in the rectum or anal canal. From the rectum, the stool moves through the anal canal. It passes out of your body through your anus when you have a bowel movement.

Causes

The exact cause of colon cancer is unknown. Cancer occurs when cells in the interior lining of the colon grow abnormally and out of control, instead of dividing in an orderly manner. Because the colon and rectum are both part of the large intestine, cancers are sometimes referred to together as “colorectal cancer,” although their treatments may differ.

In rare cases, colon cancer can develop as a result of genetic mutations. However, the majority of colon cancers begin as a benign or non-cancerous polyp. A polyp is a small growth that projects out from the inside mucus lining of the colon. A type of polyp called an adenoma can turn into cancer. Cancer in the cells that line the inside of the colon are called adenocarcinomas. Adenocarcinomas are the most common type of colon cancer. However, not all polyps turn into cancer. Polyps that turn into cancer typically take several years to do so.

Symptoms

Most people with early colon cancer do not have symptoms. Symptoms tend to appear as colon cancer advances. Some people do not develop any symptoms. Symptoms may include changes in bowel movement patterns. You may develop diarrhea, constipation, or narrow stools that last for more than a few days. You may experience rectal bleeding or have blood in your stools. However, it is also common for the stools to remain normal looking. You may have the feeling that you need to have a bowel movement even after you have just completed one.

You may also experience lower abdominal pain or cramps. You may feel weak or tired. Some people develop anemia, a decrease in red blood cells.

Diagnosis

Your doctor can diagnose colon cancer after reviewing your medical history and by conducting a physical examination. You should tell your doctor about your symptoms and risk factors. Your doctor will rule out other conditions with similar symptoms, such as hemorrhoids or infection. There are several tests for colorectal cancer.

Your doctor will examine your abdomen to feel for growths or enlarged organs. Your doctor may also perform a digital rectal examination. A mass may be indicative of rectal cancer, but not colon cancer.

A stool blood test can detect small amounts of blood in your stool. The fecal occult blood test (FOBT) or the fecal immunochemical test (FIT) is commonly used. You will receive a kit and instructions for taking a stool sample at home. The kit is sent to a laboratory for testing. If the test results are positive, your doctor may order a sigmoidoscopy or colonoscopy to identify the exact cause of bleeding.

A flexible sigmoidoscopy is used to view the rectum and part of the colon for cancer or polyps. A sigmoidscope is a thin tube with a light and viewing instrument. It is about two feet long. The sigmoidscope is placed in the colon, through the anus. This test can be uncomfortable, but should not be painful.

A colonoscopy is used to view the entire colon. A colonoscopy is similar to a sigmoidscope, but it is much longer. A colonoscopy allows a doctor to examine the colon for cancer or polyps. A tissue sample or biopsy may also be taken with the colonoscopy. A colonoscopy can be uncomfortable however you will receive medication to relax you for the test.

A virtual colonoscopy is a newer way to view the colon with a computed tomography (CT) scan. A CT scan takes a series of images to compose a detailed picture. A virtual colonoscopy involves filling the colon with air and then taking the CT scans. The CT images construct a visual depiction of the interior of the colon. The colon can also be viewed with a barium enema with air contrast test. For this test, the barium, a chalky substance, and air are used to fill and expand the colon. Next, X-rays are taken. These tests can be uncomfortable. Any abnormal results are followed up with a colonoscopy.

Your doctor may order blood tests to see if you have anemia. Anemia is a condition that results from a low red blood cell count. Some people with colorectal cancer develop anemia as a result of bleeding from a tumor.

If your tests are positive for colorectal cancer, your doctor will order tests to determine if the cancer has spread to other parts of your body. In some cases, cancer that originates in the colon can spread or metastasize to other organs. Blood tests can assess your liver function. CT scans and chest X-rays can see if the cancer has spread to the liver, lungs, or other organs.

If you have colon cancer, your doctor will determine what stage of growth your cancer is in and if it has spread or metastasized. Your doctor will assign a number to label your cancer stage. Staging is helpful for treatment planning and recovery prediction. There are different systems for staging colon cancer, and you should make sure that you understand the system that your doctor is using. The stages of colon cancer are most commonly labeled with the Roman numerals I through IV, with a higher number indicating a more serious cancer. The stages of colon cancer, according to the American Cancer Society, are:
Stage 0: The cancer has not grown beyond the inner lining of the colon.
Stage I: The cancer has grown through several inner layers of the colon.
Stage II: The cancer has grown through the wall of the colon and may extend to nearby tissues,
but it has not spread to the lymph nodes.
Stage III: The cancer has grown through the colon and to nearby lymph nodes, but it has not
spread to other parts of the body.
Stage IV: The cancer has grown through the colon and has metastasized to distant
tissues and organs, such as the liver, lungs, peritoneum, or ovaries.

Treatment

Your doctor may refer you to an Oncologist for treatment. An Oncologist is a doctor with special training in cancer and cancer treatments. Treatment for colon cancer depends on the stage of the cancer.

Surgery is the primary treatment for colon cancer. Surgery removes the cancerous mass from the body. Advanced cancers may need adjuvant therapy or additional treatments. Adjuvant therapies are used if there is a chance that cancer cells may exist outside of the surgical site or if there is a chance that the cancer might come back.

Adjuvant therapies for colon cancer include radiation therapy and chemotherapy. Radiation therapy uses high-energy rays to destroy cancer cells. Chemotherapy uses cancer-fighting drugs to destroy cancer cells. There are several different types of radiation therapy and chemotherapy. Treatments usually last for several weeks or months. Your doctor will let you know what to expect.

Stage 0 colon cancer is treated with the surgical removal of the lesion or polyp. The surgery is frequently done with the colonoscopy. Stage I colon cancer can also be treated with surgery. Stage I colon cancer may require the removal of the segment of the colon containing the cancer, after which the colon is reattached. Stage 0 and Stage I colon cancers do not require additional therapy.

Stage II colon cancer is usually treated with surgical resection of a portion of the colon. In some cases radiation therapy or chemotherapy is recommended if the cancer has a high likelihood of returning. Stage III colon cancer is first treated with surgical resection of the colon and then with chemotherapy. In some cases, radiation may also be used.

Treatment of Stage IV colon cancer depends on how extensively the cancer has metastasized. Treatment choices may also depend on the overall health of the individual. The goal of Stage IV colon cancer treatments are to prevent complications, extend life, and to improve the quality of life. Stage IV treatments are usually not curative in nature. Stage IV colon cancer surgery is usually performed to prevent colon complications, such as a blockage. In come cases a stent or tube is inserted through the cancer tumor to prevent or help manage blockages.

Stage IV colon cancer surgery may involve resection of the colon or a colostomy. A colostomy involves surgically creating an opening in the abdominal wall for the elimination of stools. This diverts the process from the anus. A colostomy may be necessary if the colon is extensively damaged.

Surgery in Stage IV also includes removing cancer metastases from other organs if possible. Metastases may also be treated with nonsurgical methods, such as freezing or heating with microwaves. Chemotherapy and/or radiation therapy may also be given.

In some cases, colon cancer returns after treatment. This is termed “recurrent colon cancer.” Recurrent colon cancer may come back near the original site or in distant organs. It most commonly returns in the liver first. Recurrent colon cancer may be treated with surgery and chemotherapy.

If the colon cancer does not return in five years after treatment, it is considered cured. Stage 0-III colon cancers are potentially curable. In most cases, Stage IV colon cancer is not curable. Your doctor will let you know what to expect.

The experience of cancer and cancer treatments can be an emotional process for people with cancer and their loved ones. It is important that you receive emotional support. Some people find comfort in their family, friends, co-workers, and place of worship. Cancer support groups are another good option. They can be a good source of information and support from people who understand what you are experiencing. Ask your doctor about cancer support group locations in your area.

Prevention

In most cases, colon cancer is treatable if it is detected early. The American Cancer Society recommends that people be screened for colon cancer beginning at age 50. Screening may be warranted earlier for people with a history of polyps or inflammatory bowel disease, and a personal or family history of certain cancers. Screening may include a fecal occult blood test, flexible sigmoidoscopy, colonoscopy, and barium enema testing.

If you have been diagnosed and treated for colon cancer, you will have regular follow-up appointments to check for recurrence. Some studies suggest that lifestyle changes may be helpful as well. These studies are not conclusive, but they suggest that eating fruits and vegetables that are high in fiber and reducing high-fat foods may reduce the risk of colorectal cancer. Other studies suggest that vitamins or a diet containing folic acid or folate, vitamin D, magnesium, and calcium may help lower colorectal cancer risk. Exercising for 30 minutes for five or more days during the week is also recommended.

Aspirin and similar medications may help reduce polyp formation in some people. However, not everyone can tolerate the side effects of aspirin. You should talk to your doctor before taking aspirin to see if it is right for you.

Am I at Risk

Risk factors may increase your likelihood of developing colon cancer. People with all of the risk factors may never develop the disease; however, the chance of developing colon cancer increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for colon cancer:

_____ People over the age of 50 are more likely to develop colon cancer.
_____ If you had colon cancer before, even if it was removed, you are at risk for developing colon cancer again.
_____ If you have had polyps in your colon or rectum you have an increased risk for cancer in your colon or rectum. Numerous polyps or large polyps are associated with a higher risk.
_____ Ulcerative colitis and Crohn’s Disease, digestive tract diseases, increase the risk for colon cancer.
_____ If you have family members that have colon or rectal cancer, especially before the age of 60, you are at a higher risk for colon cancer.
_____ Certain genetic syndromes in some families cause the development of hundreds of polyps in the colon. The high number of polyps increases the risk of developing cancer.
_____ People who are Ashkenazi Jews or African American appear to have a higher risk of developing colon cancer than people of other ethnicity or racial backgrounds.
_____ What you eat may increase your risk for colon cancer, although the cause of the link is not clear. Diets that are low in fiber, high in fat and animal products, such as meat, appear to increase the risk for colon cancer.
_____ People who do not exercise have a higher risk of developing colorectal cancer.
_____ People who are overweight have an increased chance of dying from colorectal cancer.
_____ People who smoke are more likely than non-smokers to die of colorectal cancer.
_____ Consuming a large amount of alcohol is linked with colorectal cancer.

Researchers suggest that people with diabetes, breast cancer, and testicular cancer may have a higher risk for developing colorectal cancer, although the results of such studies are not conclusive. Researchers also suspect that long-term female night shift workers may also be at risk because of the role of light on body cell development, but more studies are needed.

Complications

Metastases are a complication of Stage IV colon cancer. This means that the cancer has grown through the colon and spread to distant tissues and organs. Common sites for colon cancer metastases include the liver, lungs, peritoneum, or ovaries. The cancer must be treated in the distant organs as well as in the colon.

Recurrent colon cancer can be a complication after treatment. Recurrent colon cancer may return near the original site in the colon and in the distant organs, usually the liver first. Recurrent colon cancer is ideally treated with surgery first along with radiation therapy.

The side effects of radiation therapy and chemotherapy can be harsh for some people. The type of side effects you experience may depend on the type of radiation therapy or chemotherapy that you receive. Tell your doctor about the side effects you experience. In some instances, steps can be taken to relieve or reduce the amount of side effects.

The side effects from chemotherapy may include temporary hair loss, nausea, vomiting, diarrhea, loss of appetite, mouth sores, rashes, fatigue, low blood counts, hand swelling, and foot swelling. Most side effects subside after treatment. Your hair will grow back, although it may look different.

Potential side effects of radiation therapy include mild skin irritation, nausea, diarrhea, rectal irritation, bladder irritation, loss of bowel control, fatigue, vaginal irritation in women, and impotence in men. Some of the side effects from radiation may be temporary, but others may persist and become permanent.

Advancements

Researchers are continually working on methods to prevent, detect, and treat colon cancer. Researchers are working on chemoprevention, methods of using diet and medications to lower the risk of getting cancer. Scientists are also studying the genetic changes that take place during cancer. They hope to identify gene therapies that can correct such problems.

In the area of immunotherapy, researchers are studying ways to boost a person’s immune system to fight colon cancer better. Medications are also being studied that can detect fast and slow growing cancer cells. Finally, researchers are looking for new ways to perfect the screening process for colon cancer and to inform the public about such screening methods.

Introduction

A colonoscopy is a procedure that uses a scope to view the inside lining of the entire colon. A scope is a long thin tube with a light and a viewing instrument that sends images to a monitor. The scope allows a doctor to examine the inside of your colon for cancer, polyps, and disease. A tissue sample or biopsy can be taken with the scope. A colonoscopy is an outpatient procedure. You will receive medication to relax you prior to the test.

Test Use

A colonoscopy may be ordered for several reasons. It most frequently is used as a screening tool for colon polyps or colon cancer. A colonoscopy may also be used to identify digestive or inflammatory disease. It is helpful for determining the cause of bleeding, pain, or changes in bowel habits. Additionally, a scope is used for taking photographs, obtaining tissue samples, surgically removing polyps, or specialized laser surgeries.

PREPARATION

A colonoscopy is an outpatient procedure that can be performed at a doctor’s office or a hospital. Another person will need to drive you home because you will receive sedation medication for the procedure. Preparation instructions for a colonoscopy generally consist of methods to empty or clean your bowel prior to the test including the use of laxatives, enemas, or a liquid diet. You should not eat or drink on the night before your test. Your doctor will provide you with specific instructions.

THE PROCEDURE

You will wear an examination gown for your colonoscopy. The healthcare staff will monitor your blood pressure, heart rate, breathing rate, and temperature during the test. You will receive pain-relieving medication and a sedative through an IV line. The medication will relax you and make you feel drowsy.

A digital rectal examination may be performed before the test. You will lie on your left side with your knees bent for the procedure.

Your doctor will carefully insert the scope into your colon through your anus. Air will be inserted to open the folds of the colon to provide a better view. Your doctor will gently and slowly advance the scope into your colon. You may need to change positions during the procedure to allow your doctor to best place the scope.

The procedure may cause temporary discomfort. It is common to experience gas during and after a colonoscopy. You may feel nauseous, bloated, and drowsy after the procedure. Your doctor will instruct you on how to increase your food and liquid intake. Your doctor will also discuss unexpected symptoms related to the test that may occur and a plan to address them.

Your doctor will review the results of your colonoscopy with you at a follow-up appointment. It may take time for biopsy results to be received. If abnormal results were found during your test, your doctor will discuss treatment options with you.

Anatomy

Your body absorbs nutrients and removes waste products via your digestive system. Whenever you eat and drink, food travels through your digestive system for processing. As water from the waste product is absorbed, the product becomes more solid and forms a stool or feces. It is eventually eliminated from your body when you have a bowel movement.

After you swallow food, it moves through your esophagus and into your stomach. Chemicals in your stomach break down the food into a liquid form. The processed liquid travels from your stomach to your small intestine. Your small intestine breaks down the liquid even further so that your body can absorb the nutrients from the food you ate. The remaining waste products from the small intestine travel to the large intestine.

Your large intestine, also called the large bowel, is a tube that is about 5 feet long and 3 or 4 inches around. The first part of the large intestine is the colon. The large intestine is divided into sections, including the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal, and anus. The appendix is located on the cecum, but it does not serve a purpose in the digestive process.

The first part of the colon absorbs water and nutrients from the waste products that come from the small intestine. As the colon absorbs water from the waste product, the product becomes more solid and forms a stool. The large intestine moves the stool through the large intestine into the sigmoid colon, where it may be stored before being traveling to the rectum. The rectum is the final 6-inch section of your large intestine. No significant nutrient absorption occurs in the rectum or anal canal. From the rectum, the stool moves through the anal canal. It passes out of your body through your anus when you have a bowel movement.

Introduction
Colds are a very common medical condition. There are over two hundred viruses that can cause the common cold. The viruses are easily transmitted from person to person. Coughing, sneezing, a sore throat, and a runny nose are typical cold symptoms. There is no cure for the common cold. Symptoms may be relieved with rest, over-the-counter medications, and by drinking plenty of fluids.
Anatomy
A cold virus can affect your upper respiratory system. Your upper respiratory system includes your ears, nose, and throat. A mucus membrane lines your nose and secretes mucus that filters germs and dust when you breathe. Your sinuses are behind your nose and in the bones of your head and face. Sinuses are filled with air and are also lined with a mucus membrane.
Causes
Colds are very common. A cold is contagious; meaning it can pass from one person to another. A cold develops when a cold virus comes in contact with the lining inside of the nose. The cold virus multiplies in the warm moist environment. In turn, your body produces white blood cells to fight the cold virus. Not only do white blood cells combat the virus, but they also cause the symptoms of a cold.

The cold virus can spread from person to person. When a person sneezes or coughs, mucus drops containing the virus float in the air. You can catch a cold by breathing in the virus. However, colds are most frequently transmitted by hand to hand contact or by touching a surface that the virus is on and then touching your nose or eyes.
Symptoms
A runny nose, nasal congestion, and sneezing are classic symptoms of the common cold. Colds can cause coughing, headache, sinus congestion, and a sore throat. A common cold usually lasts from seven to ten days.
Diagnosis
You usually do not need to contact a doctor if your cold symptoms are mild to moderate. If you experience severe symptoms or if your cold lasts a long time, you should contact your doctor. Your doctor will examine your ears, nose, and throat and determine if your symptoms are the result of other conditions.
Treatment
There is no cure for the common cold. You should drink plenty of fluids and get plenty of rest. You can ease your symptoms with over-the-counter cold medications. Prescription antibiotic medications do not work on cold viruses.
Prevention
You can prevent colds with thorough frequent hand washing. Avoid touching your eyes or nose when you are around people that have colds. Disinfect shared surfaces, such as telephones, keyboards, counter tops, doorknobs, and faucet handles. Use disposable paper towels instead of shared fabric hand towels. Wear gloves during the winter and when on public transportation.
Am I at Risk
Certain situations may place you at a higher risk for contracting a cold. Essentially, the more people you are around the more likely you are to catch a cold. Being near people with colds that cough, sneeze, and blow their noses increases your risk. Cold incidences increase during the winter months or rainy season when people spend more time indoors. You are at a higher risk of contracting colds if you touch public items, such as grocery carts, office phones, keyboards, and bus or subway railings. Shaking hands with a person that has a cold increases your risk of catching a cold.
Complications
You should contact your doctor if your cold symptoms do not improve after seven to ten days. One exception is a dry cough which may last up to a month after symptoms begin. You should contact your doctor if you experience difficulty breathing or severe symptoms. The elderly and people with serious medical conditions may need to be monitored by their doctors if they get a cold.

Computed tomography (CT) is a noninvasive procedure that is used to provide detailed views of the bones, blood vessels, brain, and dense tissues. With CT, cross-sectional images are produced in a series of slices similar to the slices that make up a loaf of bread. These images can then be manipulated in a computer to create 3D images. The detailed images help doctors diagnose abnormalities, such as tumors, bleeding, bone calcification, and cysts. Select areas or the whole body can be imaged in a short amount of time. CT is a painless procedure.

Preparation

CT is usually performed at an outpatient radiology center or the radiology department of a hospital. Depending on the area that is to be imaged, you may need to fast prior to the procedure and arrive early to drink a contrast solution. Contrast solution helps to enhance the CT images. Contrast solution may also be administered via an IV. You will receive specific preparation instructions when you make your appointment.

Procedure

You will lie on a narrow table, and your body will be positioned by the technician. Your body positioning may be adjusted or changed during the procedure. The table will glide into the scanner for a short time when the pictures are taken. You will be asked to remain motionless and to occasionally hold your breath for short periods to prevent blurring the pictures. CT scans are fast. Depending on the type of equipment, the whole body can be imaged in less than 30 seconds.

A radiology technician may perform your test, but is not qualified to diagnose or discuss your condition or results with you. A radiologist or your doctor will review your results with you.

Introduction
Conjunctivitis is an inflammation or infection of the conjunctiva. The conjunctiva is a thin film that covers the inside of your eyelids and the whites of your eyes. There are many causes and types of conjunctivitis. Some kinds are contagious and can occur in widespread outbreaks, including certain types of conjunctivitis that are commonly called Pink Eye. You should contact your doctor if you suspect that you or your child has conjunctivitis. You should not try to “self-treat” this condition. The treatment for conjunctivitis depends on its type and cause.
Anatomy
The conjunctiva is a thin membrane that covers the inside of your eyelids and the outer layer of the white part of the eye, called the sclera. The sclera is a tough protective coat that covers most of your eye. Irritants are washed away from the conjunctiva by your tear system. Tears contain enzymes and antibodies that fight bacteria.
Causes
Viruses are the most common cause of conjunctivitis. Pink Eye is a common term for a type of contagious conjunctivitis caused by a viral infection. Bacteria, fungus, parasites, and Chlamydia are other causes of conjunctivitis. People that wear contact lenses, especially extended wear lenses, are susceptible to conjunctivitis. Allergies, environmental causes, certain diseases, and chemical exposure can cause noncontagious forms of conjunctivitis.
Symptoms
The symptoms of conjunctivitis vary according to its type. You may have symptoms in one or both of your eyes. A common symptom is red painful eyes. Your eyes may produce more tears than usual. Your eyes may produce a discharge. Your eyes may feel gritty and burn or itch. You may have blurred vision. Your eyes may be sensitive to light. Additionally, your eyelids may be inflamed and swollen.

Diagnosis
You should contact your doctor for diagnosis and treatment of conjunctivitis. Your doctor can diagnose conjunctivitis by examining your eyes and the inside of your eyelids. You should tell your doctor about your or your child’s symptoms. Your doctor may swab a sample from your eye for lab testing to determine the cause of your condition.
Treatment
The treatment that you receive for conjunctivitis depends on the type and extent of your condition. You should not try to “self-treat” conjunctivitis. Bacterial forms of conjunctivitis are treated with antibiotic eye drops or ointments. Symptoms from viral conjunctivitis may be relieved with warm compresses (cloths), but antibiotics do not work on viruses. Viruses take time to go away on their own. Avoiding what causes the allergy, allergy treatments, and medications are methods to treat conjunctivitis caused by allergies.

Good hygiene and household or school cleaning can help prevent contagious conjunctivitis from spreading. It is important to wash your hands frequently, and avoid touching your eyes with your hands. You should not share eye cosmetics, hand towels, handkerchiefs, or pillows. Clean or replace such items regularly. Be vigilant about keeping your contact lenses clean and use only fresh contact lens solutions.
Am I at Risk
Viral conjunctivitis is very contagious. It is important to keep your hands clean and have the person infected use separate towels or paper towels. Do not rub your eyes as the virus is easily transmitted from the conjunctiva to your hands.

Introduction
Constipation refers to a change and decrease in bowel movements. Constipation can be very uncomfortable but is rarely linked to a serious medical condition. It can cause hard stools that are difficult and painful to pass. A poor diet, poor bowel habits, physical inactivity, and older age are common factors associated with constipation. Constipation is treated with dietary changes, lifestyle changes, and in some cases, medications.
Anatomy
Your body absorbs nutrients and removes waste products via your digestive system. Whenever you eat and drink, food travels through your digestive system for processing. As water from the waste product is absorbed, the product becomes more solid and forms a stool or feces. It is eventually eliminated from your body when you have a bowel movement.

After you swallow food, it moves through your esophagus and into your stomach. Chemicals in your stomach break down the food into a liquid form. The processed liquid travels from your stomach to your small intestine. Your small intestine breaks down the liquid even further so that your body can absorb the nutrients from the food you ate. The remaining waste products from the small intestine travel to the large intestine.

Your large intestine, also called the large bowel, is a tube that is about 5 feet long and 3 or 4 inches around. The first part of the large intestine is the colon. The large intestine is divided into sections, including the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal, and anus. The appendix is located on the cecum, but it does not serve a purpose in the digestive process.

The first part of the colon absorbs water and nutrients from the waste products that come from the small intestine. As the colon absorbs water from the waste product, the product becomes more solid and forms a stool. The large intestine moves the stool through the large intestine into the sigmoid colon, where it may be stored before being traveling to the rectum. The rectum is the final 6-inch section of your large intestine. No significant nutrient absorption occurs in the rectum or anal canal. From the rectum, the stool moves through the anal canal. It passes out of your body through your anus when you have a bowel movement.
Causes
Constipation refers to a change and decrease in bowel movements. Stools become hard because they contain less water than usual. This makes the stools difficult and painful to pass. A poor diet, poor bowel habits, physical inactivity, older age, and certain diseases or medical conditions can cause constipation.

Diets that are high in fats, refined sugar, and low in fiber can cause constipation. Not drinking enough water can contribute to constipation.

Poor bowel habits are associated with constipation. For healthy bowels, you should go to the bathroom when you feel the urge to have a bowel movement. Holding a bowel movement can lead to progressive constipation. This may occur in people who are apprehensive about using public restrooms or in children that are resisting toilet training.

Certain medical conditions including irritable bowel syndrome, intestinal obstruction, pregnancy, thyroid conditions, and neurological disorders can cause constipation. It can occur as a side effect of some medications. It can also occur as a consequence of laxative abuse.
Symptoms
Constipation can be very uncomfortable because of changes in your stools and bowel habits. Your bowel movements may occur more infrequently than usual. It may be difficult to start a bowel movement. Your stools may become hard and take a long time to pass. Passing a stool may be difficult and painful. Constipation can lead to hemorrhoids or rectal prolapse. Rectal prolapse is a condition that occurs when part of the intestinal lining comes out through the rectum.

You should contact your doctor if you experience rectal prolapse, blood in your stool, very thin stools, unexplained weight loss, or severe pain, which may be symptoms of other medical conditions. You should receive immediate emergency medical attention for symptoms of an intestinal blockage including a sudden inability to pass gas or stools, abdominal pain, and vomiting.
Diagnosis
Your doctor can diagnose constipation by reviewing your medical history and asking you questions about your bowel movements. You should tell your doctor about your symptoms and risk factors. Your doctor will conduct a physical examination and test your stools and blood. Your thyroid functioning may also be assessed, as hypothyroidism can contribute to constipation.

Your doctor may refer you to a gastroenterologist for special tests. A gastroenterologist is a doctor that specializes in digestive tract conditions. Additional tests may be ordered to help determine the cause of your constipation and to rule out other conditions with similar symptoms, such as an intestinal blockage.

Your doctor will examine your abdomen to feel for growths or enlarged organs. Your doctor may also perform a digital rectal examination.

An X-ray of your abdomen may reveal an intestinal obstruction or other problems. An X-ray simply requires that you remain motionless while a camera takes a picture. In some cases, doctors may order additional imaging tests such as a sigmoidoscopy or a colonoscopy.

A flexible sigmoidoscopy is used to view the rectum and part of the colon. A sigmoid scope is a thin tube with a light and viewing instrument. It is about two feet long. The sigmoid scope is placed in the colon, through the anus. This test can be uncomfortable, but should not be painful.

A colonoscopy is used to view the entire colon. A colon scope is similar to a sigmoidscope, but it is much longer. A tissue sample or biopsy may also be taken with the colon scope. A colonoscopy can be uncomfortable, and you will receive medication to relax you prior to the test.

A virtual colonoscopy is a newer way to view the colon with a computed tomography (CT) scan. A CT scan takes a series of images to compose a detailed picture. A virtual colonoscopy involves filling the colon with air and then taking the CT scans. The CT images construct a visual depiction of the interior of the colon. The colon can also be viewed with a barium enema with air contrast test. For this test, the barium, a chalky substance, and air are used to fill and expand the colon. Next, X-rays are taken. These tests can be uncomfortable. Any abnormal results are followed up with a colonoscopy.
Treatment
Your doctor will first treat any underlying medical condition that is contributing to your constipation. A dietary component is always a part of the treatment plan. Recommendations usually include eating more foods that are high in fiber and drinking plenty of water and fruit juices. It is also important that you get plenty of exercise, including increased activity for older adults and regular exercise for younger people. Additionally, you should go to the bathroom as soon as you feel the need to have a bowel movement.

Initially, doctors may recommend some medications. Your doctor may prescribe bulk-forming agents, stool softeners, or laxatives. You should discuss long-term medication options with your doctor, if necessary. Over-the-counter laxatives are not recommended for long-term use.
Prevention
There are several steps you can take to prevent constipation. Eat a diet that is high in fiber including fresh fruits, vegetables, and whole grains. Drink plenty of water and fruit juices. Exercise regularly or increase your activity level. Establish healthy bowel habits. Go to the bathroom when you feel the need to void.

Am I at Risk
Certain factors can lead to constipation. They include eating a poor diet, physical inactivity, older age, certain medical conditions, and some medications. You should tell your doctor about your risk factors and discuss your concerns. There may be changes you can make to eliminate selected risk factors.
Complications
You should receive immediate emergency medical attention for symptoms of an intestinal blockage including a sudden inability to pass gas or stools, abdominal pain, and vomiting.

You should contact your doctor if you experience blood in your stool, very thin stools, unexplained weight loss, or severe pain, which may be symptoms of other medical conditions. Constipation can lead to hemorrhoids or rectal prolapse. Rectal prolapse is a condition that occurs when part of the intestinal lining comes out through the rectum.

Introduction

For some people, objects as common as rubber soled shoes, jewelry, or cleaning products can cause contact dermatitis, a type of skin reaction. Contact dermatitis appears as an itchy red rash on the skin. It develops when the skin touches a substance that causes an allergic reaction or has direct contact with a harmful material. In many cases, contact dermatitis is relieved with good washing and over-the-counter medications. You should contact your doctor if your symptoms are severe or do not improve. Skin testing by an allergist can identify substances that you are allergic to and should avoid to help prevent future outbreaks.

Anatomy

Your immune system usually fights germs to keep you healthy. If you have allergies, your immune system overreacts to ordinary substances that normally are not harmful. The substances that trigger an allergic reaction are called allergens.

When you are exposed to an allergen, your white blood cells produce antibodies. The antibodies trigger the release of histamine and other chemicals in your blood called mediators. The mediators can cause a rash to appear on the skin.

Causes

Allergic contact dermatitis is a type of contact dermatitis that is caused by direct contact with an allergen, such as poison ivy, metals in jewelry, makeup, skin medications, or latex. Irritant contact dermatitis is a second type of contact dermatitis that is caused by direct contact with substances that damage the skin, such as chemicals, cleaning products, and detergents.

Symptoms

Contact dermatitis causes a red rash that itches or burns. A widespread rash appears immediately with irritant contact dermatitis. A localized rash may take a couple days to appear with allergic contact dermatitis. The rash may form blisters or hives.

Diagnosis

Your doctor can diagnose contact dermatitis by reviewing your medical history and examining your rash. You should tell your doctor with what you have been in contact. If you experience frequent or significant rashes, skin testing by an allergist can identify the specific allergens that cause your reactions.

Treatment

You should wash the affected skin thoroughly with soap and water. Over-the-counter soaps are available specifically to remove poison oak, poison ivy, and poison sumac oils. Over-the-counter oral antihistamines, antihistamine lotions, or hydrocortisone creams can help relieve itching and inflammation. In severe cases, prescription strength antihistamines and corticosteroid medication may be received as pills or through injection.

Prevention

You should avoid the items or substances that cause your contact dermatitis. Wear long sleeved shirts, gloves, and pants when you are in weeded areas. Wash exposed clothes, towels, bath linens, and pets in the special soaps that remove poison oak, poison ivy, and poison sumac oils. Follow the safety instructions on the labels of harmful chemicals. Wash your skin immediately with soap and cool water if an allergen or harmful substance contacts your skin.

Am I at Risk

You are at risk for contact dermatitis if:
• You are in direct contact with allergens.
• You are in direct contact with harmful chemicals or substances.
• You have another skin condition, such as eczema.
• You have had contact dermatitis rashes in the past.

Complications

You should avoid scratching to help prevent spreading the inflammation. Open rashes are at risk for bacterial infections, such as staph infections. Poison ivy should never be burned. The smoke can cause infections in the eyes and lungs. If you experience frequent or severe contact dermatitis, you should seek evaluation from an allergist.

Continuous Positive Airway Pressure or CPAP (pronounced “see – pap”) is a treatment used for breathing problems where mild air pressure flows constantly into the patient’s mouth and/or nose to keep airways open. A machine works in conjunction with a mask to provide a stream of air while the patient sleeps.
Conditions Treated with CPAP

CPAP is considered the gold standard of therapy for obstructive sleep apnea, where a patient suffers from repeated episodes of stopped breathing, and startling or gasping for air during sleep. CPAP can also be used for premature infants with underdeveloped lungs.
How It Works

A CPAP machine consists of a mask that fits over only the nose or the nose and mouth. The machine is electrically powered. Tubing attaches the machine to the mask. The patient wears the CPAP mask when going to sleep, and the machine emits a stream of constant air pressure that prevents the collapse of airways during sleep.
What to Expect

It may take some time to get used to the feeling of the mask and the airflow. You may remove the mask in the middle of the night without realizing it. With consistent use, most patients become accustomed to the feeling and it does not interfere with comfortable sleep. You may wake up with a dry mouth and nose. This can be alleviated with a nasal saline spray at bedtime.
Benefits of Treatment

-You may immediately notice a decrease in daytime sleepiness, and an increased feeling of alertness
-Lack of snoring from partially-obstructed airways can help you and your partner to sleep better
-Lowered blood pressure
-A decrease in the incidence of serious conditions associated with sleep apnea, such as heart disease, stroke, and depression

Introduction

Contraception can reduce the risk of pregnancy. There are many types of birth control methods. Some forms of birth control require a doctor’s prescription or a medical procedure, while others may be purchased as over-the-counter products. Some forms of birth control are temporary and others are permanent and cannot be reversed. You may want to use more than one form of birth control to increase the effectiveness. Common forms of contraception in the United States include behavioral methods, over-the-counter products, prescription products, and permanent procedures. Your healthcare professional can help you determine which one is best for you.

Treatment

Continuous abstinence is the only way to guarantee that pregnancy will not occur. Periodic abstinence involves avoiding vaginal intercourse on days that a woman is likely to be fertile. A woman can use fertility awareness-based methods to chart her fertility pattern from month to month.

Over-the-Counter Products

Condoms are barriers that prevent sperm from contacting an egg. Male condoms are placed over the penis before sexual contact. Female condoms are placed deep in the vagina and a ring extends outside of the vaginal opening. There are a variety of condoms to choose from, and they also can help to prevent sexually transmitted diseases.

A contraceptive sponge is another barrier method of birth control. Prior to vaginal intercourse, the sponge is moistened with water and inserted into the vagina. The sponge blocks the entrance to the uterus and releases spermicide, a chemical that immobilizes sperm and prevents it from reaching an egg. The sponge needs to remain in place for at least six hours after intercourse. It is removed by gently pulling on a nylon loop. The sponge can be inserted up to 24 hours before intercourse and is effective for 24 hours after insertion.

Spermicides are barrier methods that block the entrance to the uterus and use chemicals to immobilize sperm and prevent it from contacting an egg. Spermicides come in a variety of forms that are inserted into the vagina shortly before sexual intercourse. Types of preparations include foams, creams, jellies, film, and suppositories. Most types of spermicides need to be used again each time vaginal intercourse takes place.

Prescription Products

Your doctor can prescribe prescription contraception after conducting a pelvic examination and reviewing the risks, side effects, and effectiveness of the product with you. Birth control pills are taken daily to control hormone levels to prevent pregnancy. Combination pills contain estrogen and progestin and prevent a woman from releasing an egg. Progestin only pills cause the cervical mucus to thicken, preventing sperm from reaching an egg. There are many different types of birth control pills, and they must be taken every day. It is important to note these products do not protect against sexually transmitted diseases.

The Patch by Ortho Evra contains hormones that release synthetic estrogen and progestin to prevent pregnancy. The patch is worn for three weeks in a row, followed by a week when it is not worn. A new patch is needed each month. The patch is thin and may be worn on the skin of the buttocks, stomach, upper arm, or upper torso.

The Ring by NuvaRing® releases synthetic estrogen and progesterin to prevent pregnancy. The ring is inserted into the vagina and worn for three weeks. It is removed for one week. A new ring must be used each month.

The Shot, Depo-Provera, uses an injected dose of progestin only to prevent pregnancy. One shot of Depo-Provera can prevent pregnancy for 12 weeks, at which time another shot is needed. The Shot is one of the most effective methods of birth control.

The implant by Nexplanon; uses a small thin implant that is surgically placed under the skin in the upper arm. It releases progestin to prevent the release of an egg and to thicken the cervical mucus. Nexplanon is effective for up to three years, at which time it needs to be removed and replaced by another implant. Nexplanon can be removed at any time during the three-year period, returning a woman to her pre-use fertility status.

Diaphragms, caps, and shields are devices that are placed in the vagina before sexual intercourse. The devices cover the cervix and prevent the entry of sperm. Each device must be used with spermicide cream or jelly. The diaphragm is a dome-shaped cup that must be sized by your doctor. A FemCap is a silicone device that also must be sized by your doctor. Lea’s Shield is a silicone cup that comes in one size.

Intrauterine Devices (IUDs) are small T-shaped plastic devices prevent pregnancy with or without hormones. ParaGard is a type of IUD that can be left in place for up to 10 years, and is non-hormonal (made out of copper). Mirena is effective for five years and also releases a small amount of progesterone. Skyla is another progesterone-only IUD (similar to Mirena) that is approved for 3 years. IUDs need to be placed and removed by your doctor.

Permanent Procedures

Permanent procedures are for men and women who are certain that they do not want to ever have a child. Permanent procedures are termed “sterilization.” They are not intended to be reversed.

Vasectomy is a permanent birth control method for men. A vasectomy is a short, safe, and simple surgical procedure. A vasectomy does not limit sexual pleasure, masculinity, or sexual performance for men. It simply prevents sperm from being released in semen and prevents pregnancy.

Tubal sterilization is a permanent form of birth control for women. Tubal sterilization surgery closes the fallopian tubes and prevents an egg from contacting sperm. Following tubal sterilization surgery, you will still get your period and ovulate, but your body will absorb the eggs. Tubal sterilization does not alter your hormone levels or change your sexual response.

Essure® is a minimally invasive sterilization procedure that women may receive in their doctor’s office. Essure uses tiny coils that are gently placed in the fallopian tubes. The micro-inserts and your body form a tissue barrier that prevents sperm from reaching an egg.

Introduction
A deep vein thrombosis (DVT) is a blood clot that forms in the deep large veins of the pelvis, legs, thighs, or arms. A DVT can reduce or block the flow of blood in a vein. It may dislodge and travel in the bloodstream, causing a stroke, pulmonary embolism, heart attack, or death. DVT is a potentially life-threatening condition and requires immediate medical attention. DVTs may be treated with medications or surgery.
Anatomy
The heart has several large arteries and veins connected to it that branch out and become smaller as they travel throughout your body. Your arteries and veins are blood vessels that deliver blood throughout your body in a process called circulation. Arteries carry oxygenated blood away from your heart. Veins carry deoxygenated blood from your body and lungs back to your heart.
Causes
DVTs can occur in the deep large veins of the pelvis, legs, thighs, or arms. They may develop after prolonged bed rest or immobility, such as after long plane or car trips. Risk factors may increase the likelihood of DVT development.
Symptoms
A DVT can cause pain or tenderness, redness, warmth, and swelling. A DVT in the leg may cause the one leg to swell, discolor, and cramp like a “charley horse.” A DVT in the arm may cause upper arm or neck swelling.

Because of the life-threatening medical complications, you should contact your doctor immediately if you suspect that you have a DVT. The concern is that sometimes clots can break off and travel through the bloodstream. This is termed an embolism. Embolisms can reduce or block the flow of blood in a blood vessel. Depending on their location, an embolism can cause a stroke, lung damage, heart attack, or death. You should call the emergency medical services in your area, usually 911, if you are having a stroke or heart attack.

After experiencing a DVT, some people develop phlebitis or “post-thrombotic syndrome,” a painful leg condition. This causes a vein to feel hard and extremely sensitive to pressure. Deep vein thrombophlebitis in the leg can cause aching or cramping, especially when walking or flexing the foot.
Diagnosis
You should contact your doctor immediately if you suspect that you have a DVT. Your doctor will examine you and conduct some tests to determine if a clot is present. If a clot is present, your doctor will determine the severity of the clot. Blood tests and imaging tests are commonly conducted. A Doppler ultrasound of the legs may identify a blood clot by using sound waves to create an image when a device is gently placed on your skin. A venography is used to identify blood clots in a procedure that uses X-rays and dye administered through a catheter that is inserted into a vein. You may receive a general or local anesthesia for the procedure. An impedance plethysmography is a non-invasive blood circulation test used to detect the presence of a blood clot. It may be used as an alternative to a venography.
Treatment
The goal of treatment is to prevent an embolism and another DVT. The treatment that you receive depends on the severity of your DVT. DVTs may be treated with blood thinning medications called anticoagulants or clot busting medications termed thrombolytic therapy. In some cases, clots are removed with a catheter or surgery. People that cannot tolerate or do not respond to anticoagulation may have a permanent filter inserted in their vein. The filter prevents large embolisms from entering the lungs but it does not stop blood clots from developing.
Prevention

Your doctor may recommend that you receive blood thinning medications or anticoagulants if you are at risk for DVT. You can minimize immobility during plane or car trips by walking frequently and pumping your feet while sitting. It may also be helpful to drink plenty of water, quit cigarette smoking, and achieve and maintain a healthy weight.
Am I at Risk
Risk factors may increase your likelihood of developing DVT, although some people that develop the condition do not have any risk factors. People with all of the risk factors may never develop DVT; however, the chance of developing the condition increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for DVT:

_____ People with a history of cardiovascular disease, stroke, and blood clots have an increased risk of developing DVT.
_____ Prolonged inactivity, such as sitting, bed rest, immobilization, or paralysis increases the risk of blood clots.
_____ Recent surgery, particularly knee, hip, and gynecological surgery, is a risk factor for DVT.
_____ Bone fractures increases the risk of DVT.
_____ A female may have an increased risk of blood clotting after childbirth or miscarriage.
_____ Cigarette smoking increases the risk of DVT.
_____ Using birth control pills or estrogen pills increases the risk of DVT. Cigarette smoking and the use of birth control pills together can increase the risk even further.
_____ Hypercoagulability, a blood clotting condition, is associated with an increased risk of DVT.
_____ People with a history of polycythemia vera, a condition that causes excess red blood cell, white blood cell, and platelet production, have an increased risk for DVT.
_____ Some cancer tumors may increase the risk of DVT.
_____ Sitting in an airplane for several hours can increase the risk of DVT because of inactivity, the cabin pressure, low humidity, and dehydration. DVT development as a consequence of a plane ride is referred to as “economy-class syndrome” or “coach-class syndrome.”
_____ DVT occurs most frequently in people that are over the age of 60; however, it can occur at any age.
_____ High blood pressure is a risk factor for DVT.
_____ Obesity is a risk factor for DVT.
_____ People with hypercoagulability, a condition that increases the likelihood of blood clots, have an increased risk of developing DVTs.

Complications
If you experience one DVT you are at risk for developing another. Be aware of the signs and symptoms of DVT and contact your doctor if you suspect that you have one.

Because of the life-threatening medical complications, you should contact your doctor immediately if you suspect that you have a DVT. The concern is that sometimes clots can break off and travel through the bloodstream. This is termed an embolism. Embolisms can reduce or block the flow of blood in a blood vessel. Depending on their location, an embolism can cause a stroke, lung damage, heart attack, or death. You should call the emergency medical services in your area, usually 911, if you are having a stroke or heart attack.

After experiencing a DVT, some people develop phlebitis or thrombophlebitis. This causes a vein to feel hard and extremely sensitive to pressure. Deep vein thrombophlebitis in the leg can cause aching or cramping, especially when walking or flexing the foot.

Introduction

Degenerative Disc Disease is a condition that causes the intervertebral discs in the spine to deteriorate or break down. Intervertebral discs are the shock-absorbing pads located between your vertebrae. The vertebrae are the series of bones that make up your spine.

Degenerative Disc Disease can occur in any part of the spine. It develops more frequently in the lower back. Aging can cause the discs to lose fluid, collapse and sometimes rupture. This decreases the space between the vertebrae, which is why some people become shorter as they age. As the disc deteriorates, it affects the structure of the vertebrae. These changes can lead to conditions that put pressure on the spinal cord and nerves. Most symptoms of pain can be treated non-surgically. However, surgery is recommended if the spine is unstable or when pain cannot be relieved by other means.

Anatomy

The spine is made up of a series of bones called vertebrae. There are different areas of the spine, defined by their curvature and function. Your neck contains the cervical spine. It is composed of seven small vertebrae. Your chest area contains the thoracic spine, with 12 vertebrae. The lumbar spine is located at and below your waist. It contains five large vertebrae. The remainder of the lower vertebrae in the spine are fused or shaped differently in formation with your hip and pelvis bones.

The back part of each vertebra arches to form the lamina. The lamina creates a roof-like cover over the back opening in each vertebra. The opening in the center of each vertebra forms the spinal canal. Your spinal cord, nerves, and arteries travel through the protective spinal canal. The spinal cord and nerves send messages between your body and brain.

Intervertebral discs are located in between the cervical, thoracic, and lumbar vertebrae. The discs are made up of strong connective tissue. Their tough outer layer is called the annulus fibrosus. Their gel-like center is called the nucleus pulposus. A healthy disc contains about 80% water.

The discs and two small spinal facet joints connect one vertebra to the next. The discs and joints allow movement and provide stability. The discs also act as a shock-absorbing cushion to protect the vertebrae.

Causes

As we age, our discs lose water content. Our discs become shorter and less flexible. Once the discs are injured, they do not have the blood supply to repair themselves and they deteriorate. Without the protective disc, the spine can become structurally unstable and unable to tolerate stress, which may lead to other conditions.

Normally, the intervertebral discs act as a cushion between the vertebrae. When a disc degenerates, painful bone on bone rubbing can occur. Abnormal bone growths, called spurs or osteophytes, can grow in the joint and enter the spinal canal. The bone spurs add to pain and swelling, while disrupting movement. The changes in spine structure can cause one vertebra to shift forward and out of place, a condition called Spondylolisthesis.

Without the disc to act as a cushion, the ligaments and facet joints on the vertebrae may enlarge to help compensate for the stress on the spine. The overgrowth can extend into the spinal canal causing it to narrow. The narrowed spinal canal can compress the spinal cord and nerves, resulting in pain and loss of function, a condition called Spinal Stenosis.

Degenerative Disc disease can also lead to a herniated disc. The outer disc layer, the annulus, can tear or rupture under stress. A herniated disc occurs when the annulus ruptures and the inner contents, the nucleus pulposus, comes out of the disc. When the inner contents come in contact with the spinal nerves they become irritated and swell, resulting in pain.

Degenerative Disc Disease can occur in any region of the spine. It most commonly occurs in the lumbar area. Doctors are not sure of the exact cause of Degenerative Disc Disease. It appears that the aging process, trauma, and arthritis contribute to the condition. Doctors suspect that genetic, environmental, and autoimmune factors play a role. Additionally, lifestyle factors, including smoking or strenuous repetitive activities, such as gymnastics or lifting, may contribute to disc degeneration as well. Degenerative Disc Disease develops most frequently in middle aged or young adults with active lifestyles.

Symptoms

Degenerative Disc Disease may or may not cause symptoms. If you have symptoms, you may feel various types of pain in your back or neck. You may experience sudden pain after an injury or your pain may start gradually and increase over time. Your pain may be so intense that it interferes with your daily activities. You may feel burning pain, pressure, numbness, or tingling. Sitting may make your symptoms increase, whereas lying down may help to relieve pain.

Depending on where your degenerative disc is located in your spine, your arms or legs may be affected as well. In rare cases, the loss of bowel and bladder control accompanied by significant arm and leg weakness indicates a possible serious problem. In this rare case, you should seek immediate medical attention.

Diagnosis

Your doctor can diagnose a degenerative disc by performing a physical examination and viewing medical images. Your doctor will ask you about your symptoms and medical history. You will be asked to perform simple movements to help your doctor assess your muscle strength, joint motion, and stability. Since the nerves from the spine travel to the body, your doctor will perform a neurological examination of your arms and or legs to see how the nerves are functioning.

Your doctor will order X-rays to see the condition of the vertebrae in your spine. Sometimes doctors inject dye into the spinal column to enhance the X-ray images in a procedure called a myelogram. A myelogram can indicate if there is pressure on your spinal cord or nerves from herniated discs, bone spurs, or tumors.

Your doctor may also order Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) scans to get a better view of your spinal structures. CT scans provide a view in layers, like the slices that make up a loaf of bread. The CT scan shows the shape and size of your spinal canal and the structures in and around it. A CT scan is useful for determining which disc is damaged. Your doctor may inject dye into the disc in a procedure called a discogram. A discogram provides a view of the internal structure of a disc and can help to identify if it is a source of pain. It is usually immediately followed by a CT scan. The MRI scan is very sensitive. It provides the most detailed images of the discs, ligaments, spinal cord, nerve roots, or tumors. X-rays, myelograms, CT scans, and MRI scans are painless procedures.

Treatment

Most people with Degenerative Disc Disease can be treated with non-surgical methods aimed at pain relief and activity modification. Over-the-counter medication or prescription medication may be used to ease your pain. If your symptoms do not improve significantly with these medications, your doctor may inject your joint with corticosteroid medication. Corticosteroid medication is a relatively safe pain reliever.

Your doctor may recommend that you rest and wear a back or neck brace. Occupational or physical therapists can provide treatments to reduce your pain, muscle spasms, and swelling. The therapists will also show you exercises to strengthen your back or neck muscles.

Surgery

Non-surgical treatments for Degenerative Disc Disease are designed to relieve pain and restore function, but they can not correct structural deformities, such as narrowing of the spinal canal. Surgery is recommended when non-surgical treatments have provided minimal or no improvement of your symptoms. Surgery is advised if the disc is pressing directly on a nerve or the spinal cord, causing considerable loss of function. Surgery is also advised if your leg weakness becomes progressively worse or if you experience associated bladder and bowel problems.

The type of surgery that you have will depend on the location of the degenerative disc in your spine and the extent of your condition. Spinal Fusion is the type of surgery most frequently used for degenerative disc disease. Spinal Fusion involves removing the degenerative disc and fusing or securing two or more vertebrae together to stop movement and relieve pain caused by movement. There are various techniques for spinal fusion surgery and the area of the spine that is involved determines the approach. Your doctor will let you know what to expect.

You will be sedated for the surgery. Your doctor will perform the surgery from the front or back of your spine, depending on the region of the spine that is affected. For a posterior surgery used for the lumbar region, your surgeon will make an incision on the middle of your spine. For an anterior surgery used for the cervical area, your surgeon will make an incision on the middle of your neck. Your muscles and other structures will be moved aside with care to allow access to the vertebrae. Your surgeon will remove all or part of the degenerative or herniated disc.

Next, the surgeon places a bone graft or interbody fusion cage in the empty disc space. A bone graft consists of small strips of bone taken from your hip during surgery. Sometimes allograft bone from a donor is used. The bone grafts are placed between the vertebrae. An interbody fusion cage may be used. It is a small container filled with bone shavings and placed between the vertebrae. The bone grafts or interbody fusion cage are surgically secured to the spinal column with surgical hardware, such as screws and plates in the neck, and screws and rods in the lumbar spine. The surgical hardware secures the vertebrae together and allows the bone grafts to heal, fusing together the vertebrae.

At the completion of your spinal fusion, your surgeon will close your incision with stitches. You will receive pain medication immediately following your surgery. You will wear a back or neck brace, depending on the location of your surgery, while your fusion heals.

Recovery

The recovery process is different for everyone. It depends on the type of surgery that you had, the area of your spine affected, and the extent of your condition. Generally, the recovery time for a fusion in the cervical area is four to six weeks. Spinal fusion in the lumbar area has a longer recovery time. Your surgeon will let you know what to expect.

You should expect to stay overnight or a few days in the hospital, depending on the type and location of your surgery. You may need a little help from another person during the first few days or weeks at home. If you do not have family members or a friend nearby, talk to your doctor about possible alternative arrangements.

Your doctor will initially restrict your activity level and body positioning. You should avoid lifting, housework, and yard-work until your doctor gives you the okay to do so. You will wear a neck or back brace for support. You will gradually increase your activity level. Once your fusion has healed, physical therapists will teach you strengthening exercises. You will also learn body mechanics, proper postures for your spine, to use when you stand, sit, sleep, and lift objects.

Prevention

It is important that you adhere to your restrictions and exercise program when you return home. You should use proper body mechanics during all activities. Do not smoke. Smoking increases the risk of surgical complications and hinders bone fusing.

Introduction

Depression is a real medical condition that is treatable. Depression is not a “normal part” of every day life. Common symptoms of depression include feeling sad, irritable, tired, and uninterested in activities that used to be enjoyable. Everyone feels this way now and then, but with depression these feelings last longer, do not go away, and interfere with daily life. There are several types of depression and the degree of depression can vary from having mild symptoms to very severe debilitating symptoms or feeling suicidal.

Causes

People of all ages can develop depression. It occurs more frequently in females, teenagers, and older adults. It is not clear why some people develop depression and others do not. It appears that several factors may contribute to the development of depression.

Researchers are studying the role of brain chemicals and brain functions. It appears that abnormal levels of certain brain chemicals, serotonin and norepinephrine, may contribute to depression. It appears that some people may inherit a genetic predisposition for depression, which increases the risk for developing depression under certain circumstances.

Life events, such as the death of a loved one, unemployment, divorce or relationship breakup, abuse, violence, and neglect may make certain people more vulnerable to depression. People that are overwhelmed with stress and have low self-esteem, poor positive support systems, or generally negative attitudes may be more likely to develop depression. Further, depression may be caused by vitamin deficiencies, substance abuse, some medical conditions, and as a side effect of some medications.

Symptoms

Depression can vary in severity. It may range from mild, moderate, or severe. Symptoms of depression include feeling sad, hopeless, helpless, or worthless. You may feel anger, self-hate, restlessness, irritability, and inappropriate guilt. You may experience a lack of interest or pleasure in activities that you used to enjoy. You may withdraw from others and become inactive. You may feel tired and have a general lack of energy. You may have problems sleeping. It may be difficult to fall asleep, stay asleep, or you may oversleep. It may be difficult to concentrate. Your appetite may significantly change, and you may lose or gain weight.

In some cases, people may have unusual symptoms, such as hearing voices that are not really there or delusional irrational thoughts. People with severe depression may think about death a lot or feel suicidal or feel like harming others. If you experience such symptoms, you should contact emergency medical services, usually 911, or go to the nearest emergency department.

There are several different types of depression including major depression, minor depression, dysthymia, atypical depression, postpartum depression, and seasonal affective disorder. A major depression involves the presence of more than six symptoms of depression that last for at least two weeks, but the depression lasts for more than six months. Minor depression consists of less than five depressive symptoms that last less than five weeks. Dysthymia is a mild form of depression that lasts a long time, usually about two years. Unusual symptoms, such as hearing things and delusional thoughts, characterize atypical depression. Postpartum depression is a rare but very serious condition that women may experience after childbirth. Seasonal affective disorder (SAD) is likely related to the amount of sunlight. It occurs during the fall and winter seasons and resolves during the spring and summer.

Diagnosis

It is important to discuss your concerns with a psychiatrist or general medicine doctor if you feel depressed for two weeks or longer. A psychiatrist can begin to diagnose depression after reviewing your medical history, listening to your symptoms, and by conducting an interview or questionnaire. A physical examination may be necessary to rule out other medical conditions. A psychiatrist can also diagnose other psychological conditions that may co-exist with depression.

Treatment

Depression is a very treatable condition. The type of treatment that you receive depends on several factors, including the cause, severity, and type of depression that you have. Common treatments for depression are therapy and medications. Medications may be used on a short-term or long-term basis.

Introduction
Gestational Diabetes is the most common pregnancy complication. Diabetes is a disease that affects how the body uses glucose, a sugar that is a source of fuel. Normally, insulin, a hormone, helps glucose get into the body cells where it is used for energy. Women with Gestational Diabetes either do not produce enough insulin or the insulin does not work like it should. As a result, glucose does not get into the body cells. Too much sugar in the blood can make people ill and result in medical complications.

There are different types and causes of diabetes. Gestational Diabetes is a temporary condition that occurs in a small percentage of women during pregnancy. Uncontrolled Gestational Diabetes is dangerous to both the mother and the fetus. However, when blood glucose levels are closely controlled, women with Gestational Diabetes can have healthy pregnancies and healthy babies.

Anatomy
Your body is composed of millions of cells. The cells need energy to function. One way the cells receive energy is from the food that you eat. Whenever you eat or drink, some of the food is broken down into glucose. Glucose is a sugar that is released into your blood. It is a major source of energy for your body cells. Glucose is transported from your bloodstream and into your cells with the help of insulin.

Insulin is a hormone that is produced by the beta cells in your pancreas. Your pancreas is a gland located near your stomach that produces chemicals for food digestion. Insulin regulates the amount of glucose in your blood in a continual process. When you eat, the amount of glucose in your bloodstream rises. In response to the elevated blood glucose level, your beta cells produce insulin. The insulin moves the glucose out of the bloodstream and into your cells. In turn, a lower level of glucose is left in the blood stream. To prevent your blood glucose level from getting too low, your body signals you to eat. This starts the process again so that your body cells continually receive the energy that they need.
Causes
Gestational Diabetes occurs in a small percentage of pregnant women. The placenta, which supports the baby, produces hormones to help the baby develop. However, Gestational Diabetes results when the hormones produced by the placenta cause insulin resistance in the mother. Insulin resistance makes it difficult for her body to use the insulin that she produces. She may need to up to three times as much insulin because her body does not recognize or respond to the insulin that is produced. As a result, glucose is unable to get into the cells for energy. The glucose accumulates in the blood and causes high blood glucose levels. This condition is called hyperglycemia.

Gestational Diabetes develops most frequently during the last three months of pregnancy, when the baby’s body has been formed. Because Gestational Diabetes generally occurs later in pregnancy, it does not cause the type of birth defects associated with mothers that had diabetes before pregnancy. However, untreated or poorly controlled Gestational Diabetes can harm both the mother and the baby. Gestational Diabetes usually does not continue after pregnancy.
Symptoms
Frequent urination, excessive hunger, and excessive thirst are symptoms that suggest Gestational Diabetes. This happens as your body tries to remove the excess blood sugar by passing it out of your body in urine. In turn, you feel extremely thirsty. Because your body is not getting energy from blood sugar, it signals you to eat a lot. You may feel tired and weak because your body cells cannot use glucose for energy.
Diagnosis
It is important that you tell your doctor the symptoms you experience and discuss your concerns. Women with a high risk for Gestational Diabetes should be screened as early as possible during their pregnancies. For these women, a normal screening test should be followed by a repeat test between the 24th and 28th week of pregnancy. All other women should be screened between the 24th and 28th week of pregnancy. Your doctor can diagnose Gestational Diabetes by testing your urine and blood.

Your doctor will test your urine for glucose and ketones. Ketones are acids that accumulate in the blood and appear in urine when the body does not have enough insulin. The tests are simple to conduct. Test strips are simply placed in your urine sample. Your doctor will read the results after a short period of time.

Your doctor can also determine if you have diabetes by conducting blood glucose tests. The Fasting Plasma Glucose Test (FPG) or the Oral Glucose Tolerance Test (OGTT) are commonly used. The FPG measures blood glucose levels after you have fasted or not eaten for a period of time. The OGTT test measures blood glucose levels after fasting and again a few hours after you drink a high-glucose beverage. The FPG and the OGTT test indicate your blood glucose level for one time on a given day.

Because blood glucose levels fluctuate from day to day, your doctor can also test how your blood glucose levels have been over a period of three months. To do so, your doctor will use an A1C test, also called glycated hemoglobin or HbA1c test. The A1C test measures how much extra glucose has glycated or attached to your red blood cells over the last 120 days, the lifespan of a red blood cell.
Treatment
You need to follow your doctor’s instructions for carefully monitoring your blood glucose levels. You will need to check your blood glucose levels throughout the day. Your doctor will help you establish a schedule. Make sure that you write down the time that you tested your blood and the result. Bring your logbook to each of your doctor appointments.

To test your blood glucose, you will prick your finger with a small sharp needle. You will place a drop of blood on a test strip. A glucose meter will display your results.

Depending on the results of your blood test, you may need to inject yourself with insulin. The insulin will help to control your blood glucose levels. Your doctor will let you know how much insulin to use. It will depend on your weight, what you eat, and how active you are. As your pregnancy progresses, the placenta will produce more hormones, and you may need to use more insulin. Your doctor will let you know how much more to use, based on the records in your logbook.

You may also need to check your urine, according to your doctor’s instructions. You should test your urine for ketones when your blood glucose level is high. Urine testing involves placing test strips in your urine sample and reading the results after a short period of time.

Managing Gestational Diabetes also includes a nutritional component. Your doctor or a registered nutritionist can help you plan what to eat to help regulate your blood glucose levels and weight. It can be helpful to eat several small meals throughout the day. Your health care professional can help you learn to make good food selections, read nutrition labels, measure portion sizes, and plan well-balanced meals.

Exercise is another important element for managing Gestational Diabetes. Exercise may help to lower your blood glucose level, blood pressure, and cholesterol. It also may help your body to use insulin better. All pregnant women should consult with their doctor prior to beginning an exercise program. Your doctor will let you know how much to exercise and the type of exercises that are safe for you.

In addition to managing your blood sugar, eating smart, and exercising, you should also maintain appropriate cholesterol and blood pressure levels. It is important not to smoke. Not only is smoking unhealthy for your developing baby, but smoking can also increase blood sugar levels and contribute to the development of medical complications.

Treatment for Gestational Diabetes can prevent symptoms from happening. However, even with treatment, some problems associated with Gestational Diabetes may occur. These conditions include hyperglycemia, ketoacidosis, and hypoglycemia.

Hyperglycemia, also called high blood glucose, happens occasionally to people with diabetes. Untreated hyperglycemia can lead to medical complications. Hyperglycemia can occur for many reasons. Women with Gestational Diabetes may experience it if their body is not using insulin effectively, if they do not have enough insulin, or if they ate more than planned and exercised less than planned.

The warning signs and symptoms of hyperglycemia include high blood glucose levels, high levels of sugar in the urine, frequent urination, and increased thirst. You should follow your doctor’s instructions for treating hyperglycemia as soon as you detect high blood sugar levels or ketones in your urine—this is very important. If you fail to do so, ketoacidosis could occur. If you have ketones in your urine, do not exercise. Exercising will only make the situation worse.

Ketoacidosis is a serious condition—it can lead to diabetic coma or death. Ketones are acids that accumulate in the blood when your body breaks down fats. Your body releases ketones through urine. Ketones appear in urine when the body does not have enough insulin. Ketoacidosis occurs when all of the ketones cannot be released through urine and the amount of ketones remaining in the blood becomes high enough to poison the body. Ketoacidosis usually develops slowly, but when vomiting occurs, the condition can develop in just a few hours.

The first symptoms of ketoacidosis include thirst, dry mouth, frequent urination, high blood glucose levels, and high levels of ketones in the urine. These symptoms are followed by dry or flushed skin; continual tiredness; nausea, abdominal pain, or vomiting; difficulty breathing; impaired attention span or confusion; and fruity smelling breath. If you have any of the symptoms contact your doctor immediately; call emergency services, usually 911; or go to the nearest emergency room. Treatment for ketoacidosis usually involves a hospital stay.

You can help prevent ketoacidosis by monitoring yourself for warning signs and checking your urine and blood regularly. Follow your doctor’s instructions if you detect high levels of ketones. If you have high levels of ketones, do not exercise. Exercise increases the levels of ketones.

Hypoglycemia, also called low blood sugar or insulin reaction, is not always preventable. Hypoglycemia can occur even if you do everything that you can to manage your diabetes. Symptoms of hypoglycemia include shakiness, dizziness, sweating, hunger, headache, pale colored skin, sudden moodiness, clumsiness, seizure, poor attention span, confusion, and tingling sensations around your mouth.

Check your blood if you suspect that your blood glucose level is low. You should treat hypoglycemia immediately. The quickest way to treat hypoglycemia is to raise your blood sugar level with some form of sugar—glucose tablets, fruit juice, or hard candy. Ask your doctor for a list of appropriate foods. Once you have checked your blood glucose level and treated your hypoglycemia, repeat the process again until your signs and symptoms have cleared.

It is important to treat hypoglycemia immediately or you could pass out. If you pass out, you need immediate treatment. You should receive an injection of glucagon. Glucagon is a medication that raises blood sugar. You should tell those around you how and when to use it. If glucagon is not available, you need emergency medical assistance. Someone should take you to the emergency room or call emergency medical services, usually 911. If you pass out from hypoglycemia, you should not inject insulin or consume food or fluids.

Usually, blood glucose levels return to normal following the childbirth. This is because the placenta, which was producing the hormones that caused insulin resistance, is delivered. Your doctor will check to make sure that your blood sugar levels have returned to normal. Additionally, your doctor will test you for diabetes several weeks after your delivery. You should also be tested for Type 2 Diabetes in the future. Women who develop Gestational Diabetes during pregnancy are at a higher risk for developing Type 2 Diabetes as they age.
The insulin will help to control your blood glucose levels. Your doctor will let you know how much insulin to use. It will depend on your weight, what you eat, and how active you are. As your pregnancy progresses , the placenta will produce more hormones, and you may need to use more insulin. Your doctor will let you know how much more to use, based on the records in your logbook.

You may also need to check your urine, according to your doctor’s instructions. You should test your urine for ketones when your blood glucose level is high. Urine testing involves placing test strips in your urine sample and reading the results after a short period of time.

Managing Gestational Diabetes also includes a nutritional component. Your doctor or a registered nutritionist can help you plan what to eat to help regulate your blood glucose levels and weight. It can be helpful to eat several small meals throughout the day. Your health care professional can help you learn to make good food selections, read nutrition labels, measure portion sizes, and plan well-balanced meals.

Exercise is another important element for managing Gestational Diabetes. Exercise may help to lower your blood glucose level, blood pressure, and cholesterol. It also may help your body to use insulin better. All pregnant women should consult with their doctor prior to beginning an exercise program. Your doctor will let you know how much to exercise and the type of exercises that are safe for you.

In addition to managing your blood sugar, eating smart, and exercising, you should also maintain appropriate cholesterol and blood pressure levels. It is important not to smoke. Not only is smoking unhealthy for your developing baby, but smoking can also increase blood sugar levels and contribute to the development of medical complications.

Treatment for Gestational Diabetes can prevent symptoms from happening. However, even with treatment, some problems associated with Gestational Diabetes may occur. These conditions include hyperglycemia, ketoacidosis, and hypoglycemia.

Hyperglycemia, also called high blood glucose, happens occasionally to people with diabetes. Untreated hyperglycemia can lead to medical complications. Hyperglycemia can occur for many reasons. Women with Gestational Diabetes may experience it if their body is not using insulin effectively, if they do not have enough insulin, or if they ate more than planned and exercised less than planned.

The warning signs and symptoms of hyperglycemia include high blood glucose levels, high levels of sugar in the urine, frequent urination, and increased thirst. You should follow your doctor’s instructions for treating hyperglycemia as soon as you detect high blood sugar levels or ketones in your urine—this is very important. If you fail to do so, ketoacidosis could occur. If you have ketones in your urine, do not exercise. Exercising will only make the situation worse.

Ketoacidosis is a serious condition—it can lead to diabetic coma or death. Ketones are acids that accumulate in the blood when your body breaks down fats. Your body releases ketones through urine. Ketones appear in urine when the body does not have enough insulin. Ketoacidosis occurs when all of the ketones cannot be released through urine and the amount of ketones remaining in the blood becomes high enough to poison the body. Ketoacidosis usually develops slowly, but when vomiting occurs, the condition can develop in just a few hours.

The first symptoms of ketoacidosis include thirst, dry mouth, frequent urination, high blood glucose levels, and high levels of ketones in the urine. These symptoms are followed by dry or flushed skin; continual tiredness; nausea, abdominal pain, or vomiting; difficulty breathing; impaired attention span or confusion; and fruity smelling breath. If you have any of the symptoms contact your doctor immediately; call emergency services, usually 911; or go to the nearest emergency room. Treatment for ketoacidosis usually involves a hospital stay.

You can help prevent ketoacidosis by monitoring yourself for warning signs and checking your urine and blood regularly. Follow your doctor’s instructions if you detect high levels of ketones. If you have high levels of ketones, do not exercise. Exercise increases the levels of ketones.

Hypoglycemia, also called low blood sugar or insulin reaction, is not always preventable. Hypoglycemia can occur even if you do everything that you can to manage your diabetes. Symptoms of hypoglycemia include shakiness, dizziness, sweating, hunger, headache, pale colored skin, sudden moodiness, clumsiness, seizure, poor attention span, confusion, and tingling sensations around your mouth.

Check your blood if you suspect that your blood glucose level is low. You should treat hypoglycemia immediately. The quickest way to treat hypoglycemia is to raise your blood sugar level with some form of sugar—glucose tablets, fruit juice, or hard candy. Ask your doctor for a list of appropriate foods. Once you have checked your blood glucose level and treated your hypoglycemia, repeat the process again until your signs and symptoms have cleared.

It is important to treat hypoglycemia immediately or you could pass out. If you pass out, you need immediate treatment. You should receive an injection of glucagon. Glucagon is a medication that raises blood sugar. You should tell those around you how and when to use it. If glucagon is not available, you need emergency medical assistance. Someone should take you to the emergency room or call emergency medical services, usually 911. If you pass out from hypoglycemia, you should not inject insulin or consume food or fluids.

Usually, blood glucose levels return to normal following the childbirth. This is because the placenta, which was producing the hormones that caused insulin resistance, is delivered. Your doctor will check to make sure that your blood sugar levels have returned to normal. Additionally, your doctor will test you for diabetes several weeks after your delivery. You should also be tested for Type 2 Diabetes in the future. Women who develop Gestational Diabetes during pregnancy are at a higher risk for developing Type 2 Diabetes as they age.
Prevention
You should wear a MedicAlert bracelet and carry a MedicAlert card in your wallet. In the case of an emergency, the MedicAlert information will be helpful to the medical professionals treating you.

Women who had Gestational Diabetes during pregnancy have an increased risk for developing Type 2 Diabetes in the future. These women should discuss their concerns with their doctors and be screened for Pre-Diabetes and Type 2 Diabetes. People may reduce their risk of developing Type 2 diabetes by maintaining a healthy weight, exercising, and eating healthy.

Additionally, women that had Gestational Diabetes during pregnancy are at risk for developing it again in future pregnancies. Women that are planning on getting pregnant again should talk with their doctor. Making lifestyle changes before the next pregnancy may be helpful.
Am I at Risk
Many women who develop Gestational Diabetes have no known risk factors. Women who are
members of ethnic minority groups including African Americans, Native Americans, Hispanics,
Latinos, Asians, and Pacific Islanders develop Gestational Diabetes more frequently than
Caucasians. The following factors appear to increase the risk of developing Gestational Diabetes during pregnancy:

_____ A family history of diabetes is associated with an increased chance of developing Gestational Diabetes. If your parents, brothers, or sisters have diabetes your risk increases.
_____ Women that had Gestational Diabetes with a previous pregnancy are at risk for developing it with each future pregnancy.
_____ Women that are overweight before they become pregnant have an increased risk of developing Gestational Diabetes when they are pregnant.
_____ Having glucose in your urine, an impaired glucose tolerance, or impaired fasting glucose tolerance are risk factors for diabetes.
_____ Polyhydramnios, a condition when you have too much amniotic fluid, is a risk factor for diabetes.
_____ Previously giving birth to a stillborn baby or a baby that weighed more than nine pounds increases your risk for Gestational Diabetes during pregnancy.

Complications
Untreated or poorly controlled Gestational Diabetes can harm both the mother and the baby. The mother is at risk for hyperglycemia, ketoacidosis, and hypoglycemia, as explained above. Mothers with Gestational Diabetes need to maintain their blood glucose levels. By doing so, she ensures a healthy pregnancy and delivery.

Because Gestational Diabetes generally occurs later in pregnancy, it does not cause the type of birth defects associated with mothers that had diabetes before pregnancy. However, high blood glucose levels in the mother can affect the baby during development and after delivery.

If your blood glucose levels are out of control during pregnancy, the extra glucose can travel across the placenta and to your developing baby. In turn, the baby’s blood glucose level rises. This causes the developing baby to produce more insulin to get rid of the extra blood glucose. The excess glucose is stored as fat in the baby. The excess fat can lead to a condition called macrosomia, making the baby larger than normal.

Babies with macrosomia have an increased risk for damage to their shoulders during birth, breathing problems, and very low blood glucose levels at birth. Your baby’s blood glucose level will be tested immediately after birth. If your baby’s blood glucose level is low, your baby will be given sugar water and sent to the neonatal intensive care unit for observation for a short period of time. The medical staff will monitor the baby for signs of a low blood glucose reaction.

Babies with mothers who had Gestational Diabetes have a higher risk of developing jaundice. Jaundice is a yellow discoloration of the skin, eyes, and mucous membranes. Jaundice occurs when there is too much bilirubin in the baby’s blood. Bilirubin is released when too many red blood cells accumulate in the blood. Jaundice can be treated in a few days with light therapy. Light therapy involves exposing your baby to special lights for select periods throughout the day and night.

Babies with mothers who had Gestational Diabetes also have a higher risk for developing diabetes in the future. Babies with excess insulin are at risk for childhood obesity. Additionally, mothers that experienced Gestational Diabetes during one pregnancy have an increased risk for developing it again in future pregnancies. Further, mothers that experienced Gestational Diabetes have an increased risk for developing Type 2 Diabetes years later. People with Type 2 Diabetes produce insulin, but they either do not produce enough or the insulin does not work like it should. People with Type 2 Diabetes need to diligently manage their disease to remain healthy and reduce the risk of medical complications.

Again, Gestational Diabetes usually ceases shortly after delivery. However, for a few women, pregnancy uncovers Type 1 or Type 2 Diabetes. In some cases, it may be difficult to determine exactly what form of diabetes a woman has during pregnancy. After delivery, women with Type 1 or Type 2 Diabetes will need to continue treatment for diabetes.
Advancements
Prevention, technology, and research have greatly improved the management of this diabetes. Sugar-free foods and new medicines have made diabetes management more convenient. New forms of insulin include fast-acting insulin and 24-hour forms. Further, insulin administration is easier with pens, pumps, and inhalers.

Introduction
Diabetes is a disease that affects how the body uses glucose, a sugar that is used as a source of fuel for the body. Normally, the hormone insulin helps glucose enter the cells where it is used for energy. People with diabetes do not produce insulin, do not produce enough insulin, or the insulin does not work like it should. As a result, glucose does not get into the body’s cells and stays in the bloodstream. Too much sugar in the blood makes people ill and can result in medical complications.

There are different types of diabetes. Type 1 diabetes is an auto-immune disorder. During the disease process, the body mistakenly recognizes the cells that produce insulin as foreign and kills them off. As a result, people with type 1 diabetes do not produce insulin. There is no cure for type 1 diabetes, and it cannot be prevented. It is a lifelong condition. Type 1 diabetes must be treated with insulin. In the case of type 1 diabetes, a person’s diet or lifestyle does not contribute to the development of the disease.

Type 1 diabetes usually appears before the age of 20, although people older than this may be diagnosed with the disease. It was formerly called “juvenile diabetes” or “insulin dependent diabetes”. People with diabetes need to diligently manage their disease to remain healthy and reduce the risk of medical complications. Many people with type 1 diabetes can lead long healthy lives with proper management and blood sugar control. Technology and improvements in insulin therapy have greatly improved the management of this condition.

Anatomy
Your body is composed of millions of cells. The cells need energy to function. One way the cells receive energy is from the food that you eat. Whenever you eat or drink, some of the food is broken down into glucose. Glucose is a sugar that is released into your blood. It is a major source of energy for your body’s cells and is transported from your bloodstream and into your cells with the help of insulin.

Insulin is a hormone that’s made in the pancreas. Your pancreas is a gland located near your stomach that produces chemicals for food digestion. Insulin is produced by the beta, or islet cells inside your pancreas and works continuously to regulate the amount of glucose in your blood. When you eat, the amount of glucose in your bloodstream rises. In response to the elevated blood glucose level, your islet cells produce insulin. The insulin moves the glucose out of the bloodstream and into your cells. In turn, a lower level of glucose is left in the blood stream. To prevent your blood glucose level from getting too low, your body signals you to eat. This starts the process again so that your body’s cells continually receive the energy that they need.

Causes
The exact cause of type 1 diabetes is not clear. Type 1 diabetes is triggered when islet cells of the pancreas are destroyed by the immune system and insulin is no longer produced. Researchers do not know why this happens. They suspect it may be an inherited genetic condition or triggered by a toxin or virus.

Without insulin, glucose remains in the blood and cannot get into the body’s cells for energy. The glucose accumulates and makes the blood sugar levels high. High blood sugar causes both immediate and long-term problems and requires patients to take insulin by injection to help regulate the blood sugar levels and keep them normal or as close to normal as possible.

Symptoms
The symptoms of type 1 diabetes tend to develop rapidly. Even after diagnosis, it is important to know the signs of elevated blood sugar. It is especially important that parents or guardians of children with diabetes pay close attention to the warning signs. Here are some specific signs to look for:

Frequent urination
Extreme thirst and dry mouth
Extreme hunger
Unexplained weight loss
Fruity smelling breath
Abdominal pain
Nausea or vomiting
Urinary tract/vaginal infections
Blurred vision
Headaches
Drowsiness, lethargy
Stupor, unconsciousness
The symptoms of type 1 diabetes are usually prominent before a person is diagnosed. While each of the symptoms alone might not signal diabetes, it is important to be aware of changes in routines, behaviors or habits and to address them if they occur.

As the blood sugar rises, the symptoms become more pronounced. The ones usually noticed first are frequent urination, constant thirst, a voracious appetite and rapid weight loss.

The body tries to over-compensate by removing the excess blood sugar by passing it out of the body in urine. If you notice your child or loved one urinating more frequently and feeling extremely thirsty and drinking more, this may be a sign. Because the body is not getting energy from blood sugar, it increases the appetite. However, even though the person is eating more and drinking enough, they may actually lose weight. This is because the body starts to use fat and muscle for fuel when it cannot access the blood sugar. People may also feel tired and weak because the body’s cells cannot use glucose for energy.

If diabetes goes undetected or untreated, the symptoms may get worse and more dangerous and the person may experience abdominal pain, nausea, and vomiting and could go into ketoacidosis. Ketoacidosis is a serious condition that can lead to diabetic coma and even death.

Understanding Blood Sugar Swings and Management

Once someone is diagnosed and on proper insulin therapy, the treatment for type 1 diabetes can prevent symptoms from happening. However, even with treatment, some problems associated with type 1 diabetes may occur. These conditions include ketoacidosis, hyperglycemia (high blood sugar), and hypoglycemia (low blood sugar).

Ketoacidosis

Ketoacidosis is extremely dangerous. Ketones are acids that accumulate in the blood when your body breaks down fats. Your body releases ketones through urine. Ketones appear in urine when the body does not have enough insulin. Ketoacidosis occurs when all of the ketones cannot be released through urine and the amount of ketones remaining in the blood becomes high enough to poison the body. Ketoacidosis usually develops slowly, but when vomiting occurs, the condition can develop in just a few hours.

The first symptoms of ketoacidosis are similar to those for diabetes itself and include thirst, dry mouth, frequent urination, high blood glucose levels, and high levels of ketones in the urine. However, if ketoacidosis is present these symptoms can be severe. These symptoms are followed by: dry or flushed skin, continual tiredness, nausea, abdominal pain, or vomiting; difficulty breathing, impaired attention span or confusion, and fruity smelling breath. If your child or loved one has any of these symptoms contact your doctor immediately, call emergency services, usually 911; or go to the nearest emergency room. Treatment for ketoacidosis usually involves a hospital stay and is a serious and sometimes life-threatening condition.

You can help prevent ketoacidosis by monitoring for warning signs and checking the urine and blood regularly. Follow your doctor’s instructions if you detect high levels of ketones. If there is a high level of ketones, do not allow exercise. Exercise increases ketone levels. It is also important to note that extra monitoring is required whenever a diabetic is sick or has an infection. Infection can lead to high blood glucose and if left unchecked, ketoacidosis can occur.

Hyperglycemia (High Blood Sugar)

Hyperglycemia, the term for high blood glucose, happens to people with diabetes. A number of factors can affect the blood sugar and even those whose disease is properly managed may experience bouts of high blood glucose levels. People with type 1 diabetes may experience hyperglycemia if they did not administer enough insulin, ate more than planned, exercised less than planned, or were sick or stressed. Fluctuating hormones in teenagers, pregnant women and women whose bodies are preparing for menopause can also cause problems with blood sugar.

Some medications will cause hyperglycemia. Cortisone and other steroids are a good example. It is critically important that individuals with type 1 diabetes check or have their blood sugar checked several times daily. Knowing what blood sugar levels are at various times throughout the day will go a long way to detecting patterns of low or high blood sugar levels.

The warning signs and symptoms of hyperglycemia include high blood glucose levels, high levels of sugar in the urine, frequent urination, and increased thirst. It is important to understand however, that a single spike in blood sugar may not always produce overt symptoms in someone who is well controlled. This is why regular blood sugar monitoring is critical in maintaining good control and avoiding those high blood sugar levels. You should follow your doctor’s instructions for treating hyperglycemia as soon as you detect high blood sugar levels or ketones in the urine—this is very important. If you fail to do so, ketoacidosis could occur.

Hypoglycemia (Low Blood Sugar)

Hypoglycemia or low blood sugar occurs when the body has too little food/glucose and too much insulin. It is a very common condition for many people with type 1 diabetes. Very low blood sugar may lead to insulin shock, which can be life threatening if not promptly treated.

The following are all reasons that a person with type 1 diabetes might have low blood sugar:

Taking too much insulin
Not eating enough
Eating later than usual
Waiting too long between the time an insulin injection is taken and the time one eats
Insulin was given at a site on the body where the absorption rate is faster than usual
Taking insulin after forgetting about a previous dose
More exercise than normal or planned
Illness or injury
Other hormonal issues
Medication interaction
Symptoms of hypoglycemia include shakiness, dizziness, sweating, hunger, nervousness, blurry vision, headache, pale colored skin, sudden moodiness and irrational behavior, erratic responses to questions, crying, clumsiness, seizure, poor attention span, confusion, and tingling sensations around the mouth. Check blood sugar levels if you suspect that the blood glucose level is low. You should treat hypoglycemia immediately. The quickest way to treat hypoglycemia is to raise the blood sugar level with some form of sugar—glucose tablets, fruit juice, or hard candy. Ask your doctor for a list of appropriate foods. Be sure to give the body enough time to recover and for the blood sugar to rise to normal levels before testing again. It is important not to over-treat the symptoms as this can cause a rebound effect and turn into a high blood sugar.

It is important to treat hypoglycemia immediately to avoid unconsciousness. If the person passes out, they will need immediate treatment. For this rare occasion, you should always have glucagon available. Glucagon is a hormone that raises blood glucose levels by causing the release of glycogen (a form of stored carbohydrate) from the liver. Glucagon does not contain any sugar. It is administered through an injection into the thigh, buttocks or upper arm muscle. Be sure you know how to use it and be sure your child’s teachers and coaches and even baby sitters know how to use it. It is advisable to give a glucagon kit to any insulin dependent child’s school to be kept by the school nurse. If glucagon is not available, seek emergency medical assistance by either going to the emergency room of a hospital or calling emergency medical services, usually 911. You should never try to force food or drink into anyone’s mouth if they are experiencing severe hypoglycemia, because choking can occur.

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a serious condition that most frequently occurs in older persons and those with type 2 diabetes. However, it can also occur in individuals with type 1 diabetes. An illness or infection usually brings on HHNS. HHNS can cause severe dehydration and lead to seizures, coma, and death.

For people with HHNS, dehydration occurs as the body tries to remove excess blood sugar by passing it out of the body in urine. The rate of urination may be frequent at first, but then decrease. Unquenchable thirst and dark urine are both symptoms. Warning signs and symptoms of HHNS include a blood sugar level of over 600 mg/dl. Other symptoms include a dry parched mouth, extreme thirst that may gradually disappear, warm dry skin that does not sweat, a high fever, over 101° Fahrenheit, sleepiness or confusion, vision loss, auditory or visual hallucinations, seeing or hearing things that are not there, and weakness on one side of the body. Call your doctor immediately if your child or loved one experiences any of these symptoms.

HHNS can be avoided by checking blood glucose levels regularly. You need to check blood glucose levels more often when sickness occurs or an infection is present. You should work with your doctor and health care professionals to develop a monitoring plan for when a loved one or child becomes sick.

Diagnosis
There is no test to screen for type 1 diabetes. If you are the parent of a child, keep track of your child’s symptoms and report them to your doctor. Your doctor can diagnose type 1 diabetes by testing urine and blood.

Urine Tests for Diabetes

Your doctor will test the urine for glucose and ketones. Ketones are acids that accumulate in the blood and appear in urine when the body does not have enough insulin. The tests are simple to conduct. Test strips are simply placed in your urine sample. Your doctor will read the results after a short period of time.

Blood Tests for Diabetes

Your doctor can also determine if diabetes is present by conducting blood glucose tests. The Fasting Plasma Glucose Test (FPG) and the Oral Glucose Tolerance Test (OGTT) are commonly used. The FPG measures blood glucose levels after you have fasted or not eaten for a period of time, usually 6-8 hours. A normal fasting blood sugar is 70 to 100 milligrams per deciliter. The OGTT test measures blood glucose levels after fasting and again a few hours after you drink a high-glucose beverage. The FPG and the OGTT test indicate your blood glucose level for one time on a given day.

Because blood glucose levels fluctuate from day to day, your doctor can also test how your blood glucose levels have been over a period of three months. To do so, your doctor will use a Hemoglobin A1c test, also called a glycated hemoglobin or HbA1c test. The A1c test measures your average hourly blood sugar during the past 90 days. For someone who doesn’t have diabetes, a normal A1C level can range from 4.5 to just below 6 percent. Someone who has had uncontrolled diabetes for a long time might have an A1c level at 9 percent or above.

When the A1c test is used to diagnose diabetes, an A1c level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered pre-diabetes, which indicates a high risk of developing diabetes.

For most people who have previously diagnosed diabetes, an A1c level of 7 percent or less is a common treatment target.

Treatment
There is no cure for Type 1 diabetes but it can be treated and managed. Type 1 diabetes must be treated with insulin. Treatment can help prevent swings in blood sugar and may prevent or delay the development of medical complications associated with diabetes. Your doctor and health care team will teach you how to keep your blood glucose levels as near to normal as possible with medication, nutrition, and exercise.

You should carefully follow your doctor’s instructions for monitoring your blood glucose levels. A normal blood sugar ranges from 70-100 mg/dl. You will need to check your blood glucose levels throughout the day as it fluctuates based on eating habits, exercise levels and stress to the body. To test your blood glucose level, you will prick your finger with a needle or lancet. Some newer monitoring devices allow you to prick your forearm or other sites on your body, which may be less painful. You will place a small amount of blood on a test strip and then insert it into a glucose meter. The meter will display your results.

Your doctor will help you establish a schedule for checking your blood glucose. Make sure that you write down the time that you tested your blood and the result. Bring your logbook to each of your doctor appointments. It is recommended that you keep a written log even if your glucose meter can store your results.

There are also sensors that can be worn on the body that instantly deliver blood sugar results every five minutes without the need for a finger stick. These sensors are small and are generally used in conjunction with blood glucose monitoring machines to allow doctors to see what blood sugars are doing in the overnight hours when patients are sleeping.

Understanding Insulin

Depending on the results of your blood glucose test, you may need to inject yourself with insulin. The insulin will help lower your blood glucose level. Your doctor will let you know how much insulin to use. It will depend on your weight, what you eat, and how active you are. Most people with type 1 diabetes need insulin injections two to four times a day.

There are different types of insulin that differ in onset, peak time, and duration. Onset refers to how long it takes the insulin to reach the bloodstream and begin lowering the blood glucose level. The peak time indicates when the insulin is at its maximum strength. Insulin duration describes the length of time that the insulin works to lower blood glucose levels.

Some types of insulin may be used alone or with another type of insulin for maximum effect. Additionally, there are new types of medications that enhance the way that insulin works. Medications may require mixing or they may be purchased in a convenient premixed pen. Ask your doctor about which medications are right for you.

Before meal rapid-acting insulins should be injected 15 minutes before a meal. These types of insulins work about 15 minutes after they are injected, peak in an hour, and continue to work for 2 to 4 hours. Before meal rapid-acting insulins leave the bloodstream quickly and reduce the chance of hypoglycemia after meals. After meal rapid-acting insulins are well-suited for children because it can be difficult to predict how many calories a child will eat prior to a meal. After meal rapid-acting insulins are also useful for people with delayed stomach emptying.

Short or regular-acting insulins reach the bloodstream within 30 minutes after they are injected, peak in 2 to 3 hours, and continue to work for 3 to 6 hours. Short-acting insulin is often used with another type of insulin, intermediate-acting insulin. Intermediate-acting insulins reach the bloodstream 2 to 4 hours after they are injected, peak 4 to 12 hours later, and continue to work for about 12 to 18 hours.

Insulin Delivery Methods

Insulin can be administered in a variety of ways that are easy and relatively painless. Insulin delivery methods include small needles, a pen, or a pump. Needles are smaller than ever before and have special coatings that make injecting easy and nearly pain-free.

An infuser may be used to reduce the number of daily injections. An infuser or a portal is a catheter device that is placed into your skin. Insulin injections are given into the infuser instead of your skin. An infuser can remain in place for 48 to 72 hours.

The insulin pump is a small device that you can wear on your belt or carry in a

pocket. Insulin travels through soft plastic tubes to a catheter that is placed in the skin. Some insulin pumps allow the catheter to remain in place while only needles are removed. The insulin pumps hold a pre-set amount of insulin and are generally changed every three days or so. They are completely computerized to deliver steady doses of insulin and surge (or bolus) doses, per your instructions when you eat. Essentially it counts carbohydrates for you and calculates the dosage of insulin based on a formula set by your doctor. This continual release with boluses is most like the normal insulin production your body would make on its own. You will need to check your blood glucose levels more frequently than with other delivery methods. However, many people prefer the pump because it allows them to have a more flexible lifestyle. Newer pumps now offer a wireless version which can be worn directly on a body part such as the thigh, belly or arm. This pump also holds a pre-set amount of insulin and stays in place for athletics, and even swimming. Many diabetics enjoy the freedom a wireless pump gives.

Jet injectors deliver insulin without using needles. Jet injectors force insulin through the skin with pressure. In some cases, this method may cause bruising. This method is used less often than injections or pumps.

Counting Carbs for Better Control

Blood sugar management is further improved with carbohydrate counting and bolus insulin doses at meals. This method works best for type 1 diabetics who use an insulin pump or take several injections throughout the day. Most diabetics will have a basal dose of insulin that is released steadily around the clock, but will also require bolus doses at meal time. Carbohydrate counting gives diabetics more flexibility at meal time by counting the carbs in the meal and then giving a bolus or extra dose of insulin for it. This prevents blood sugar highs and lows and gives steadier blood sugar management.

Carbohydrates are the component of food that contribute most to the post-meal blood sugar reading and are the main factor that determines how much insulin should be taken. For some patients, a nutritionist or other medical provider will establish a ratio of insulin to carbohydrate to follow for meals. Based on blood sugar readings over time, ratios may be adjusted by your doctor but can range from 1 unit per every 5 carbohydrates consumed to 1 unit for every 30 units consumed or anything in between. Diabetics will base their insulin dose on the number of carbohydrates in the meal. To count carbohydrates, diabetics must use the nutritional information on the food’s package or carry a reference to determine the number of carbohydrates in a particular food paying close attention to portion sizes. Books may be purchased for this, or you may even purchase an app for your phone.

Diabetes Supplies and Tools

Purchasing diabetes care supplies can be confusing. You should select the products that you are most comfortable with and that you will use. The American Diabetes Association has an extensive list of diabetes care supplies in their Resource Guide. The Resource Guide provides detailed information that allows you to compare the features of various products. You should also talk to your health care professionals for product advice, demonstration, and trial.

Blood glucose meters have advanced over the past 20 years. They have become easier to use and there are many types. Some meters are easier to use than others. Most meters provide results in less than a minute. Some of the newer meters display results in just five seconds. “Talking” meters are helpful for people with visual impairments. The talking meters provide verbal instructions and results. Some of the units are available in Spanish and other languages.

You should take your time when deciding on a glucose meter. You should select the one that you are the most comfortable with because you will be using it regularly. When purchasing a blood glucose meter, check to see if your insurance company covers the meter and the care supplies, such as the test strips. You should compare prices for items not covered by insurance.

For many years, insulin was given with a syringe and needle, but newer alternatives offer delivery with an insulin pen. Insulin pens are convenient for active people or those with visual or coordination problems. The pens contain accurate pre-measured doses of insulin. The insulin is easy to deliver. Simply “dial up” your dose, and with the push of a button, a spring-loaded device quickly inserts the needle into your skin and delivers the correct does of insulin.

Data management systems are an alternative for storing the results of your glucose monitoring. Data management systems are a convenience, but not a requirement. You may keep your own records in a written log. Some of the newer blood glucose meters have a built in data management system that can store the results of 500 blood glucose checks. Data management systems vary. They can record such variables as when you checked your blood glucose, the type and dose of insulin used, your meals and exercise.

There are several things to consider if purchasing a data management system. You should talk to your doctor to see if your unit is compatible with the doctor’s computer. You should also ask your doctor what type of records he or she would like the data management system to track. As always, try the equipment before you purchase it. Data management systems can be expensive.

Scheduled Screenings and Maintenance

Every few months, you will need to have your doctor check your blood glucose average with the A1c test. The A1c test measures your blood glucose level average for the course of about three months. Your doctor will use this information to alter your course of treatment, if necessary.

You will also need to test your urine per the guidelines set by your doctor. People with type 1 diabetes should test their urine for ketones when their blood glucose level is high. Urine testing involves placing test strips in your urine sample and reading the results after a short period of time.

A microalbuminuria kit is used to measure the amount of protein in your urine. The presence of microalbuminuria in the urine can be an indicator of kidney disease. People with type 1 diabetes are at risk for kidney damage. The American Diabetes Association recommends that people with diabetes be tested for microalbuminuria every year. Some people may need to perform the test more frequently to monitor the progression of kidney

disease. Microalbuminuria tests may be done in your doctor’s office or are now available in home testing kits. You apply your urine sample to the test kit and mail it to the company. A physician must interpret your test results. The home testing kit allows you the convenience of testing your urine at home.

Healthy Lifestyle Tips

Managing type 1 diabetes also includes a nutritional component. Your doctor or a registered nutritionist can help you plan what to eat to help regulate your blood glucose levels, cholesterol, and blood pressure. A balanced meal plan includes a wide variety of foods, particularly vegetables, whole grains, non-fat dairy products, beans, lean meats, poultry, and fish. Your health care professional can help you learn to read nutrition labels, measure portion sizes, and plan balanced meals.

Exercise is another important element for managing type 1 diabetes. Exercise may help to lower your blood glucose level, blood pressure, and cholesterol. It also may help your body use insulin better. You should strive for a combination of aerobic activity, strength training, and stretching. Ideally you should exercise aerobically for 30 minutes a day, five days per week. You can break the time period into three ten minute segments throughout the day or exercise for the entire 30 minutes. Aerobic exercise includes physical activities that work your heart, lungs, and vascular system, such as quick walking, riding a stationary bike, or running.

Prevention
Type 1 Diabetes cannot be prevented. There is no test to screen for type 1 diabetes. You should contact your doctor if you experience the symptoms of type 1 diabetes.

Because the medical complications associated with diabetes can be very serious and life threatening, people with diabetes need to diligently manage their disease to remain healthy. The following are suggestions for preventing complications from diabetes.

Preventing Complications

Wear a Medic Alert bracelet and carry a Medic Alert card in your wallet. In the case of an emergency, the Medic Alert information will be helpful to the healthcare professionals treating you.

Monitor your blood glucose levels carefully, and treat yourself with insulin daily, as instructed by your doctor. Make sure that your write down the time that you tested your blood and the result. Take your logbook to each of your appointments. See a physician regularly to prevent and stay on top of any problems that might develop.

Eat a balanced diet and consult a nutrition expert for help with meal planning. Exercise regularly and reduce your weight if you are overweight. Even losing small amounts of weight is helpful for diabetes management.

Monitor your blood pressure. Ask your doctor what your blood pressure should be, and contact your doctor when it is out of range. You should also keep your cholesterol within normal limits. Have regular cholesterol checks throughout the year, and follow your doctor’s instructions for lowering cholesterol.

People with diabetes should have an eye exam at least once a year. The eye examination should include screening for glaucoma, cataracts, and diabetic retinopathy.

Attend all of your scheduled medical appointments. Your feet should be inspected at every visit. Discuss any concerns about depression with your doctor as well.

Am I at Risk
The risk factors for Type 1 diabetes are unknown. It appears to develop more frequently in Caucasians and people younger than 20 years old, although it may occur at any age.

Researchers have also found some patients to be at a higher risk based on family history. If there is a parent with type 1 diabetes, the risk for their children is higher. Other more complicated causes including changes in specific genes and the presence of immune system disorders like adrenal or thyroid disease may also play a role.

There is advanced testing that can be done for siblings of type 1 diabetics to look for antibodies to insulin, or antibodies to islet cells of the pancreas to help determine if they are at risk. Some school age children may have a test to evaluate how the body responds to glucose but none of these tests is guaranteed to detect type 1 diabetes and provides no prevention for the disease.

Complications
In addition to managing your blood sugar, eating smart, and exercising, you should also maintain appropriate cholesterol and blood pressure levels. It is also important to not smoke. Smoking increases blood sugar and can contribute to the development of medical complications. It is important that you take care of yourself daily and keep all of your doctor appointments. Type 1 diabetes is a lifelong condition; however, people with type 1 diabetes can live healthy, happy, and long lives with good care.

Many people with diabetes also have high cholesterol and high blood pressure. These three factors combined—diabetes, high cholesterol, and high blood pressure, increase the risk of developing a variety of serious medical complications. Some of the symptoms may be obvious, while others may be subtle and develop over time. It is important that you monitor yourself for signs and symptoms of medical complications and complete all screenings recommended by your doctor. Report any concerns to your doctor promptly. The following paragraphs describe some of the medical complications associated with type 1 diabetes.

Heart and Cardiovascular System

Type 1 diabetes is associated with an increased risk of coronary artery “heart” disease, heart attack, and stroke. Heart disease is the leading cause of diabetes related death in the United States. Coronary artery disease causes the vessels that carry blood to your heart to narrow. They can also become completely or partially blocked by fatty deposits. A heart attack occurs when the heart does not receive blood or does not receive enough blood. A stroke occurs when the brain does not receive blood or does not receive enough blood. A heart attack or stroke can be fatal. They can also cause permanent or temporary impairments and disability.

Kidney and Renal System

Kidney disease, also called nephropathy, can also be caused by diabetes. Your kidneys remove waste products from your blood. Diabetes can damage the filtering system in the kidneys resulting in kidney disease or kidney failure. Persons with kidney failure need dialysis, a process in which a machine filters the blood. Some people may even need a kidney transplant.

Eye Health

People with diabetes have a higher risk of eye problems and blindness than people without diabetes. A long history of diabetes and older age are factors associated with developing glaucoma. Glaucoma occurs when pressure builds up in the eye and causes gradual vision loss. People with diabetes tend to develop cataracts at a younger age and at a quicker rate than people without diabetes. Cataracts cause the clear lens in the eye to become cloudy, diminishing vision.

Diabetic retinopathy or retinal disorders can also be caused by diabetes. The retina is the part of your eye that receives images. Nonproliferative retinopathy is a condition that affects the capillaries in the retina. Retinal swelling can cause vision loss. In some people, retinopathy progresses to a more serious condition called proliferative retinopathy. The blood vessel damage caused by proliferative retinopathy causes scarring and eventual retinal detachment destroys vision.

Nerves and Neurologic System

Nerve damage caused by diabetes is called diabetic neuropathy. Nerves carry messages between your brain and body about pain, temperature, and touch. They also control your muscle movements and organ systems, such as the processes for food digestion and urination. Sensorimotor neuropathy and autonomic neuropathy are two common types of nerve damage.

Sensorimotor neuropathy affects sensation and movement. It may cause your feet and hands to feel weak, tingly, numb, or painful. Autonomic neuropathy affects the nerves that regulate involuntary functions or actions that you cannot directly control, such as your heartbeat. Of great concern, it can cause a loss of the typical warning signs of a heart attack or low blood glucose levels. Autonomic neuropathy can cause dizziness or faintness. It can also create problems with digesting food; vomiting, diarrhea, or constipation; bladder function; sex; increased or decreased sweating; and changes in the way the eyes function in the dark or light.

Diabetes can often lead to nerve damage called peripheral neuropathy. Peripheral neuropathy is a condition in which nerve function deteriorates in the limbs. This leads to a gradual loss of feeling in the hands, arms, legs, and feet. This is often problematic because pain is what enables you to know when something is wrong. Without pain, you may not realize that you have bruises, cuts, blisters or burns and seek medical treatment. It is important that people with diabetes receive medical treatment for foot sores because diabetes-related circulation problems can lead to more medical conditions.

Conditions of the Feet

The feet are very vulnerable to diabetes-related complications. There are a variety of foot problems that can occur. Foot problems are the leading reason for diabetes-related hospitalization. Further, diabetes is the leading cause of lower leg and foot amputation. Diabetes-related foot conditions are most frequently caused by poor blood circulation, infection, and nerve damage that can result in ulcers or sores, deformities, and trauma.

Peripheral vascular disease is a common diabetes-related circulation disorder. Poor circulation results in reduced blood flow to the feet. It can restrict the delivery of oxygen and nutrients that are required for normal wound maintenance and repair. As a result, foot injuries, infections, and ulcers may heal slowly or poorly. Minor skin problems on the feet can become worse and lead to infection.

Wounds and injuries can be difficult to heal if diabetes is uncontrolled. This can be especially true of wounds in the feet. Infections tend to get worse or remain undetected, especially in the presence of diabetic neuropathy or vascular disease.

Neuropathy can cause you to be unaware of wounds. Additionally, the increased pressure from the feet carrying the body weight aggravates foot wounds. Further, shoes can cause skin friction, rubbing, and tearing. The hot moist environment of shoes is favorable to infection and foot ulcers. Foot ulcers are sores caused by skin breakdown. They can be exacerbated by infection. Foot ulcers tend to develop over areas of high pressure, such as bony prominences or foot deformities.

Foot deformities are another common problem associated with diabetes. They occur when the ligaments and muscles that stabilize the foot bones deteriorate. This can cause the bones to shift out of position or an arch to collapse.

A hammertoe deformity is a common condition that occurs most frequently in the second toe, although it can be present in more than one toe. Increased pressure on the tips of the toes and the lack of muscle stability causes a joint in the toe to become permanently flexed with a claw-like appearance. The toe deformity and pressure displacement makes the toe susceptible to skin ulcers.

Charcot foot is another common foot deformity associated with diabetic neurogenic arthropathy. Neurogenic arthropathy is a progressive degenerative arthritis that results from nerve damage. Charcot foot most frequently affects the metatarsal and tarsal bones located in the midfoot and forefoot.

Charcot foot causes the foot muscles, ligaments, and joints to degenerate or break down. Without support, the foot becomes wider and deformed. Without joint stability, the foot becomes unstable, making walking difficult. Inflammation and pressure eventually can cause bone dislocation.

People with Charcot foot have impaired or absent abilities to feel pain, temperature, and trauma. They may not be able to sense the position of their foot. This makes them vulnerable to injury, such as fractures, sprains, joint dislocation, bone erosion, cartilage damage, and foot deformity. They may even continue to walk on a broken bone without knowing it, because they cannot feel it.

Skin Conditions

People with diabetes are generally more prone to skin infections and skin disorders than people without diabetes. People with diabetes have a greater tendency to get bacterial infections, fungal infections, and itchy skin. Some skin problems happen mostly to or only to people with diabetes.

Bacterial infections tend to manifest as sties on the eyelid, boils, infected hair follicles, deep infections under the skin, and nail infections. Bacterial infections cause the skin to become hot, swollen, red, and painful. Fungal infections are caused by yeast-like organisms that can grow and spread in diabetics whose sugar levels are uncontrolled. They create itchy rashes in moist areas of the skin. Common fungal infections include jock itch, athlete’s foot, ringworm, and vaginal infections. Both bacterial infections and fungal infections can be treated with prescription medication.

Diabetic dermopathy and necrobiosis lipoidica diabeticorum (NLD) are similar skin disorders caused by changes in the blood vessels. Both conditions cause brown spots to appear on the skin. Diabetic dermopathy is harmless, but NLD can cause the skin to crack and bleed. NLD is a rare condition affecting mostly adult women. Open sores need to be treated by a doctor.

People with diabetes tend to get atherosclerosis at a younger age than people without diabetes. Atherosclerosis causes the arteries to thicken, narrowing the route for blood flow. It results in skin changes. The skin becomes hairless, thin, cool, and shiny. The toes become cold, and the toenails thicken and discolor. Atherosclerosis can also cause wounds to heal slower or become infected because of lack of blood flow.

Eruptive xanthomatosis usually occurs among young men with type 1 diabetes. It typically develops when diabetes is not controlled, in conjunction with high cholesterol and fat in the blood. Eruptive xanthomatosis causes firm, yellow, pea-sized bumps in the skin. The bumps may have a red ring and itch. They occur most often on the backs of the hands, feet, arms, legs, and buttocks. The condition usually resolves when the diabetes is controlled.

Digestive System

People with type 1 and type 2 diabetes can experience gastroparesis, a stomach disorder in which the movement of food is slowed or stopped. Gastroparesis occurs when high blood glucose levels damage the vagus nerve and the nerves that regulate stomach functioning over a period of time. The muscles in the stomach and intestines stop working properly. Signs and symptoms of gastroparesis include heartburn, nausea, vomiting, feeling full early when eating, weight loss, bloating, erratic blood glucose levels, lack of appetite, reflux, and stomach spasms.

If food stays in the stomach too long it can be dangerous. Delayed stomach emptying can lead to bacterial overgrowth and stomach or intestinal obstructions. Medications and nutritional changes can treat gastroparesis. In severe cases, a feeding tube may need to be inserted to deliver nutrients to the small intestine.

Mental and Psychological

Finally, people with diabetes have a greater risk of depression than people without diabetes. Depression is a real medical condition that can be treated. Depression is not a “normal part” of everyday life. Symptoms of depression include continually feeling sad, irritable, tired, and uninterested in activities that you used to find enjoyable. Other common symptoms of depression include changes in appetite, having difficulty getting a good night’s sleep, moving the body at a much slower pace, and not being able to remember things or concentrate as easily as before.

Doctors are not exactly sure why people with diabetes are at risk for developing depression. They suspect that people cope with diabetes management differently. Additionally, some of the symptoms of low or high blood sugar can cause symptoms that look like depression. You should discuss your concerns with your doctor in order to receive appropriate diagnosis and treatment.

Advancements
Prevention, technology, and research have greatly improved the management of diabetes and lengthened the lives of diabetes patients. In fact, results of a 30-year study released by the American Diabetes Association show that people living with diabetes between 1965 and 1980 lived 15 years longer than the generation before them. As advancements improve, these numbers will likely improve even more. Diabetes is no longer the limitation that it used to be many years ago.

Sugar-free foods, new types of insulin, and easy-to-use insulin delivery methods have made diabetes management more convenient. The American Diabetes Association’s Resource Guide is a great resource for new products.

Wireless insulin pumps are offering diabetics more freedom than ever before. Easily hidden under clothing or even a swimsuit, there are no wires to manage or see. Some wireless pumps are also waterproof and can be worn for swimming or other water activities without worrying about damage to the electronics inside. The pump communicates with a remote handheld device that looks a bit like a small cell phone where diabetics can calculate insulin doses, program insulin delivery and even check their blood sugar.

New technology like continuous glucose monitoring systems (CGMS) may also help you monitor and track your blood sugar readings over time. This can give your doctor a better idea of how you are managing your blood sugar. A CGMS has a sensor that is placed under your skin to read your blood sugar every few seconds. This information is then transmitted to a control module where the information is stored. These systems can work with some types of insulin pumps, provide real-time readings, and signal an alarm when levels get too low or too high.

Pancreatic transplants are an option for select people with type 1 diabetes. In some people, transplanting the pancreas can “cure” type 1 diabetes. However, there are high risks involved with pancreatic transplantation; some people do not survive. The transplanted pancreas is at risk for being rejected by the body. Further, people must take anti-rejection medications that have their own risks. Researchers are studying the effects of transplanting just the islet or beta cells from the pancreas, in hopes that it is more effective.

Introduction
Type 2 diabetes, also known as non-insulin dependent diabetes is the most common form of diabetes. Diabetes is a disease that affects how the body uses glucose, a sugar that is a source of fuel. Normally, the hormone insulin helps glucose get into the body’s cells where it is used for energy. People with Type 2 diabetes produce insulin, but they either do not produce enough or the cells of the body are resistant to the absorption of insulin, and glucose remains in the bloodstream. Unlike type 1 diabetics, type 2 diabetics may not have to rely entirely on insulin to control their symptoms, though many diabetics do eventually end up taking insulin injections. Too much sugar in the blood can cause a variety of different medical complications and make diabetics very ill.

While many cases of type 2 diabetes may be controlled, it is the leading cause of diabetes-related complications such as blindness, lower leg amputations, and chronic kidney failure. There is no cure for diabetes. People with diabetes should diligently manage their disease to stay as healthy as possible and reduce the risk of medical complications.

Anatomy
Your body is composed of millions of cells. The cells need energy to function. One way the cells receive energy is from the food that you eat. Whenever you eat or drink, some of the food is broken down into glucose. Glucose is a sugar released into your blood. It is a major source of energy for your body cells. Glucose is transported from your bloodstream and into your cells with the help of insulin.

Insulin is a hormone that is produced by the beta cells of your pancreas. Your pancreas is a gland located near your stomach that produces chemicals for food digestion. Insulin regulates the amount of glucose in your blood continually. When you eat, the amount of glucose in your bloodstream rises. In response to the elevated blood glucose level, your beta cells produce insulin. The insulin moves the glucose out of the bloodstream and into your cells. In turn, a lower level of glucose is left in the blood stream. To prevent your blood glucose level from getting too low, your body signals you to eat. This starts the process again so that your body cells receive the exact energy that they need.

Causes
Type 2 diabetes occurs because the pancreas does not produce enough insulin or the body’s cells are not allowing the insulin to be absorbed. This is known as insulin resistance. Insulin resistance is a condition in which the body does not recognize or respond to the insulin that is produced. This results in elevated blood glucose levels because the glucose cannot get into the body cells for energy and remains in the bloodstream.

Type 2 diabetes most frequently develops in people who are over 40 years old and overweight but it can occur in people who are not overweight. Overweight children can also develop type 2 diabetes and these rates are continuing to climb thanks to rising childhood obesity rates. People with type 2 diabetes must manage their condition with weight control, diet, exercise, and medication. They may use insulin or an oral medication that helps their body make the most of their own insulin.

Before most people develop type 2 diabetes, they will experience “pre-diabetes.” Pre-diabetes, also known as impaired glucose tolerance or impaired fasting glucose, is a condition in which blood glucose levels are elevated, but are not high enough to meet the criteria for type 2 diabetes. A diagnosis of pre-diabetes means that you are likely to develop diabetes and may already experience adverse health effects. Research shows that long-term damage to the heart and circulatory system may begin to occur during pre-diabetes. People with pre-diabetes can delay or prevent type 2 diabetes if blood glucose levels are managed with nutrition and exercise during pre-diabetes and should use this time to take control of their health and lose weight.

Some research has shown that type 2 diabetes is most likely to occur when poor health habits (lack of exercise, high calorie diets, and obesity) combine with an underlying genetic risk for the disease.

Major risk factors for type 2 diabetes include:

Age greater than 45 years (but remember it is happening more in children)
Weight greater than 120% of desirable body weight
Family history of type 2 diabetes in a first-degree relative
Hispanic, Native American, African American, Asian American, or Pacific Islander descent
History of a previous abnormal glucose tolerance or impaired fasting glucose test
High blood pressure (>140/90 mm Hg) or high cholesterol (HDL cholesterol level < 40 mg/dL or triglyceride level >150 mg/dL)
History of gestational diabetes or delivering a baby with a birth weight of over 9 pounds
Polycystic ovarian syndrome (which results in insulin resistance)
Symptoms
Most people with pre-diabetes do not have any symptoms. Symptoms of diabetes include increased thirst, frequent urination, blurred vision, or extreme tiredness. Type 2 diabetes may or may not produce symptoms. Many people with type 2 diabetes do not know that they have it. In most cases, the symptoms develop gradually when blood sugar levels become high. Symptoms and complications of type 2 diabetes are nearly identical to those of type 1 diabetes and they are:

Frequent urination
Thirst and dry mouth
Excessive hunger
Weight loss
Fatigue
Slow healing of cuts or sores or new sores that develop on the body
Itchy, red skin in the groin or vaginal area
Frequent yeast infections
Dark, velvety skin on the neck, in the armpits or groin
Erectile dysfunction in men
Sudden weight gain (for some people)
Numbness or tingling of the hands and/or feet
Loss of vision/blurry vision
These symptoms may develop slowly and may even take years to develop significantly enough for you to notice.

Treatment for type 2 diabetes can prevent symptoms from happening. However, even with treatment, some problems associated with type 2 diabetes may occur. These conditions include hyperglycemia, ketoacidosis, hypoglycemia, and hyperosmolar hyperglycemic nonketotic syndrome.

High Blood Sugar

Hyperglycemia, also called high blood glucose, can lead to medical complications. Hyperglycemia can occur for many reasons. People with type 2 diabetes may have high blood sugar if their body is not using insulin effectively, if they ate more than planned and exercised less than planned, or were sick or stressed.

The warning signs and symptoms of hyperglycemia include high blood glucose levels, high levels of sugar in the urine, frequent urination, and increased thirst. You should follow your doctor’s instructions for treating hyperglycemia as soon as you detect high blood sugar levels or ketones in your urine—this is very important. If you fail to do so, ketoacidosis could occur. If you have ketones in your urine, do not exercise. Exercising will only make the situation worse.

Ketoacidosis

Ketoacidosis is a serious condition and it can lead to diabetic coma or death. Ketoacidosis occurs rarely in people with type 2 diabetes. Ketones are acids that accumulate in the blood when your body breaks down fats. Your body releases ketones through urine. Ketones appear in urine when the body does not have enough insulin. Ketoacidosis occurs when all of the ketones cannot be released through urine and the amount of ketones remaining in the blood becomes high enough to poison the body. Ketoacidosis usually develops slowly, but when vomiting occurs, the condition can develop in just a few hours.

The first symptoms of ketoacidosis include thirst, dry mouth, frequent urination, high blood glucose levels, and high levels of ketones in the urine. These symptoms are followed by dry or flushed skin; continual tiredness; nausea, abdominal pain, or vomiting; difficulty breathing; impaired attention span or confusion; and fruity smelling breath. If you have any symptoms contact your doctor immediately; call emergency services, usually 911; or go to the nearest emergency room of a hospital. Treatment for ketoacidosis usually involves a hospital stay.

You can help prevent ketoacidosis by monitoring yourself for warning signs and checking your urine and blood regularly. Follow your doctor’s instructions if you detect high levels of ketones. If you have high levels of ketones, remember not to exercise.

Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a serious condition that most frequently occurs in older persons with type 2 diabetes. An illness or infection usually brings on HHNS. HHNS can cause severe dehydration and lead to seizures, coma, and death.

HHNS triggers dehydration as your body tries to remove excess blood sugar by passing it out of your body in urine. Urination may be frequent at first, but then decrease. You may become very thirsty. Your urine will become very dark. It is important to drink plenty of liquids to remain hydrated. Warning signs and symptoms of HHNS include a blood sugar level of over 600 mg/dl, a dry parched mouth, extreme thirst that may gradually disappear, warm dry skin that does not sweat, fever over 101° Fahrenheit, sleepiness or confusion, vision loss, auditory or visual hallucinations, seeing or hearing things that are not there, and weakness on one side of the body. Call your doctor immediately if you experience any of these symptoms.

You can avoid HHNS by checking your blood glucose levels regularly. You need to check your blood glucose levels more often when you are sick or have an infection. You should work with your doctor and health care professionals to develop a monitoring plan for when you are sick.

Hypoglycemia

Hypoglycemia, also called low blood sugar or insulin reaction, is not always preventable. Hypoglycemia can occur even if you do everything that you can to manage your diabetes. Symptoms of hypoglycemia include shakiness, dizziness, sweating, hunger, headache, pale colored skin, sudden moodiness, clumsiness, seizure, poor attention span, confusion, and tingling sensations around your mouth.

Check your blood if you suspect that your blood glucose level is low. You should treat hypoglycemia immediately. The quickest way to treat hypoglycemia is to raise your blood sugar level with some form of sugar—glucose tablets, fruit juice, or hard candy. Ask your doctor for a list of appropriate foods. Once you have tested checked your blood glucose level and treated your hypoglycemia, repeat the process again until your signs and symptoms have cleared.

It is important to treat hypoglycemia immediately or you could pass out. If you pass out, you need immediate treatment. You should receive an injection of glucagon. Glucagon is a medication that raises blood sugar. You should tell those around you how and when to use it. If glucagon is not available, you need emergency medical assistance. Someone should take you to the emergency room of a hospital or call emergency medical services, usually 911. If you pass out from hypoglycemia, you should not inject insulin or consume food or fluids.

Diagnosis
Because the symptoms of type 2 diabetes can come on slowly, your diagnosis may be delayed. However, if you have risk factors for type 2 diabetes, or have been told by your doctor that you have pre-diabetes, you may be monitored more closely for the development of diabetes.

Urine Tests for Diabetes

Your doctor will test the urine for glucose and ketones. Ketones are acids that accumulate in the blood and appear in urine when the body does not have enough insulin. The tests are simple to conduct. Test strips are simply placed in your urine sample. Your doctor will read the results after a few seconds.

Blood Tests for Diabetes

Your doctor can also determine if diabetes is present by conducting blood glucose tests. The Fasting Plasma Glucose Test (FPG) and the Oral Glucose Tolerance Test (OGTT) are commonly used. The FPG measures blood glucose levels after you have fasted or not eaten for a period of time, usually 6-8 hours. A normal fasting blood sugar is 70 to 100 milligrams per deciliter. The OGTT test measures blood glucose levels after fasting and again a few hours after you drink a high-glucose beverage. The FPG and the OGTT test indicate your blood glucose level for one time on a given day.

Because blood glucose levels fluctuate from day to day, your doctor can also test how your blood glucose levels have been over a period of three months. To do so, your doctor will use a Hemoglobin A1c test, also called a glycated hemoglobin or HbA1c test. The A1c test measures your average hourly blood sugar during the past 90 days. For someone who doesn’t have diabetes, a normal A1C level can range from 4.5 to just below 6 percent. Someone who’s had uncontrolled diabetes for a long time might have an A1c level at 9 percent or above.

When the A1c test is used to diagnose diabetes, an A1c level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered pre-diabetes, which indicates a high risk of developing diabetes.

For most people who have previously diagnosed diabetes, an A1c level of 7 percent or less is a common treatment target.

Treatment
Treatment of pre-diabetes can return blood glucose levels back to normal and prevent or delay the onset of type 2 diabetes. Treatment for pre-diabetes includes good nutrition, weight loss, and exercise. Even a small amount of weight loss, as little 5-10% of your total body weight, can help. You should also make an effort to participate in moderate exercise, such as walking, for 30 minutes each day, five days per week.

Because people with pre-diabetes have an increased risk for heart disease or stroke, they should be screened and treated for high blood pressure and high cholesterol. Smokers should find a way to stop. Not only does smoking raise blood glucose levels, but it can also contribute to heart disease, stroke, high blood pressure, and high cholesterol.

There is no cure for type 2 diabetes, but it can be treated and managed. Treatment can help stop the symptoms from happening. Treatment may also prevent or delay the development of medical complications associated with diabetes. Your doctor and health care team will teach you how to keep your blood glucose levels as near to normal as possible with medication, nutrition, and exercise.

You should carefully follow your doctor’s instructions for monitoring your blood glucose levels. You will need to check your blood glucose levels throughout the day. To test your blood glucose level, you will prick your finger with a sharp needle or lancet. Some newer monitoring devices allow you to prick your forearm or other sites on your body, which may be less painful. You will place a small amount of blood on a test strip and then insert it into a glucose meter. The meter will display your results.

Your doctor will help you establish a schedule for checking your blood glucose. Make sure that you write down the time that you tested your blood and the result. Bring your logbook to each of your doctor appointments. It is recommended that you keep a written log even if your glucose meter can store your results.

Understanding Insulin

Many type 2 diabetics start out with a pill that’s taken by mouth to try to control blood sugar. But if this approach, along with weight loss, healthy diet and exercise are unsuccessful, you may need to inject yourself with insulin. The insulin will help lower your blood glucose level. Your doctor will let you know how much insulin to use. It will depend on your weight, what you eat, and how active you are.

There are different types of insulin that differ in onset, peak time, and duration. Onset refers to how long it takes the insulin to reach the bloodstream and begin lowering the blood glucose level. The peak time indicates when the insulin is at its maximum strength. Insulin duration describes the length of time that the insulin works to lower blood glucose levels.

Some types of insulin may be used alone or with another type of insulin for maximum effect. Additionally, there are new types of medications that enhance the way that insulin works. Medications may require mixing or they may be purchased in a convenient premixed pen. Ask your doctor about which medications are right for you.

Before meal rapid-acting insulins should be injected 15 minutes before a meal. These types of insulins work about 15 minutes after they are injected, peak in an hour, and continue to work for 2 to 4 hours. Before meal rapid-acting insulins leave the bloodstream quickly and reduce the chance of hypoglycemia after meals. After meal rapid-acting insulins are well-suited for children because it can be difficult to predict how many calories a child will eat prior to a meal. After meal rapid-acting insulins are also useful for people with delayed stomach emptying.

Short or regular-acting insulins reach the bloodstream within 30 minutes after they are injected, peak in 2 to 3 hours, and continue to work for 3 to 6 hours. Short-acting insulin is often used with another type of insulin, intermediate-acting insulin. Intermediate-acting insulins reach the bloodstream 2 to 4 hours after they are injected, peak 4 to 12 hours later, and continue to work for about 12 to 18 hours.

Insulin Delivery Methods

Insulin can be administered in a variety of ways that are easy and relatively painless. Insulin delivery methods include small needles, a pen, or a pump. Needles are smaller than ever before and have special coatings that make injecting easy and nearly pain-free.

An infuser may be used to reduce the number of daily injections. An infuser or a portal is a catheter device that is placed into your skin. Insulin injections are given into the infuser instead of your skin. An infuser can remain in place for 48 to 72 hours.

The insulin pump is a small device that you can wear on your belt or carry in a pocket. Insulin travels through soft plastic tubes to a catheter that is placed in the skin. Some insulin pumps allow the catheter to remain in place while only needles are removed. The insulin pumps are computerized to deliver steady doses of insulin and surge doses, per your instructions. This continual release is most like the normal insulin production your body would make on its own. You will need to check your blood glucose levels more frequently than with other delivery methods. However, many people prefer the pump because it allows them to have a more flexible lifestyle. Newer pumps now offer a wireless version that holds a pre-set amount of insulin and stays in place for athletics, and even swimming. Many diabetics enjoy the freedom a wireless pump gives.

Jet injectors deliver insulin without using needles. Jet injectors force insulin through the skin with pressure. In some cases, this method may cause bruising. This method is used less often than injections or pumps.

Counting Carbs for Better Control

Blood sugar management is further improved with carbohydrate counting and bolus insulin doses at meals. This method works best for type 2 diabetics who use an insulin pump or take several injections throughout the day, but carbohydrate control is also extremely helpful for diabetics who do not take insulin. Most diabetics will have a basal dose of insulin that is released steadily around the clock, but will also require bolus doses with meals. Carbohydrate counting gives diabetics more flexibility at meals by counting the carbs in the meal and then giving a bolus or extra dose of insulin for it. This prevents blood sugar highs and lows and gives steadier blood sugar management.

Carbohydrates are the component of food that contribute most to the post-meal blood sugar reading and are the main factor that determines how much insulin should be taken. For some patients, a nutritionist or other medical provider will establish a ratio of insulin to carbohydrate to follow for meals. Based on blood sugar readings over time, ratios may be adjusted by your doctor but can range from 1 unit per every 5 carbohydrates consumed to 1 unit for every 30 units consumed or anything in between. Diabetics will base their insulin dose on the number of carbohydrates in the meal. To count carbohydrates, diabetics must use the nutritional information on the food’s package or carry a reference to determine the number of carbohydrates in a particular food paying close attention to portion sizes. Books may be purchased for this, or you may even purchase an app for your phone.

Diabetes Supplies and Tools

Purchasing diabetes care supplies can be confusing. You should select the products that you are most comfortable with and that you will use. The American Diabetes Association has an extensive list of diabetes care supplies in their Resource Guide. The Resource Guide provides detailed information that allows you to compare the features of various products. You should also talk to your health care professionals for product advice, demonstration, and trial.

Blood glucose meters have advanced over the past 20 years. They have become easier to use and there are many types to choose from. Some meters are easier to use than others. Most meters provide results in less than a minute. Some of the newer meters display results in just five seconds. “Talking” meters are helpful for people with visual impairments. The talking meters provide verbal instructions and results. Some of the units are available in Spanish and other languages.

You should take your time when deciding on a glucose meter. You should select the one that you are the most comfortable with because you will be using it regularly. When purchasing a blood glucose meter, check to see if your insurance company covers the meter and the care supplies, such as the test strips. You should compare prices for items not covered by insurance.

For many years, insulin was given with a syringe and needle, but newer alternatives offer delivery with

Some methods of insulin delivery have been approved that allow the patient to spray insulin into his nostrils. Speak to you doctor and find out if this method is an appropriate treatment option for you.

Scheduled Screenings and Maintenance

Every few months, you will need to have your doctor check your blood glucose average with an A1c test. The A1c test measures your blood glucose level average for the course of about three months. Your doctor will use this information to alter your course of treatment, if necessary.

You will also need to test your urine per the guidelines set by your doctor. People with type 2 diabetes should test their urine for ketones when their blood glucose level is high. Urine testing involves placing test strips in your urine sample and reading the results after a short period of time.

Managing type 2 diabetes also includes a nutritional component. Your doctor or a registered nutritionist can help you plan what to eat to help regulate your blood glucose levels, cholesterol, and blood pressure. A balanced meal plan includes a wide variety of foods, particularly vegetables, whole grains, non-fat dairy products, beans, lean meats, poultry, and fish. Your health care professional can help you learn to read nutrition labels, measure portion sizes, and plan balanced meals.

Exercise is another important element for managing Type 2 diabetes. Exercise may help to lower your blood glucose level, blood pressure, and cholesterol. It also may help your body use insulin better. You should strive for a combination of aerobic activity, strength training, and stretching. Ideally you should exercise aerobically for 30 minutes a day, five days per week. You can break the time period into three ten minute segments throughout the day or exercise for the entire 30 minutes. Aerobic exercise includes physical activities that work your heart, lungs, and vascular system, such as quick walking, riding a stationary bike, or running.

In addition to managing your blood sugar, eating smart, and exercising, you should also maintain appropriate cholesterol and blood pressure levels. It is also important not to smoke. Smoking increases blood sugar and can contribute to the development of medical complications. It is important that you take care of yourself daily and keep all of your doctor appointments.

Prevention
Pre-diabetes can be treated and prevented. You may even be able to return your blood glucose level to the normal range. If you are at risk for pre-diabetes or suspect that you may be having symptoms talk to your doctor as soon as possible and ask to be tested.

Some doctors suggest that people at risk for type 2 diabetes be screened starting at age 30. If you are at risk or experience the symptoms of type 2 diabetes, you should contact your doctor. Some factors such as heredity, ethnicity, and family history cannot be changed. However, you can change your lifestyle to help prevent or delay type 2 diabetes.

Generally, it is helpful to reduce your weight and pay special attention to the “big belly”. Having a large abdomen can be indicator a high amount of visceral fat—or fat that surrounds the organs inside the belly. Visceral fat and obesity has been shown to impair the way that insulin works and contributes to insulin resistance. Ask your doctor to recommend diet changes, nutrition plans, and exercise programs that are right for you.

Am I at Risk
Risk factors may increase your likelihood of developing type 2 diabetes. People with all of the risk factors may never develop the disease; however, the chance of developing diabetes increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Type 2 diabetes is occurring in children and adults of all ages as obesity rates increase. Additionally, people of ethnic minority groups, including African Americans, Native Americans, Hispanics, Latinos, Asians, and Pacific Islanders, develop diabetes more frequently than Caucasians.

Risk factors for Type 2 diabetes include:

Family History of diabetes is associated with an increased chance of developing type 2 diabetes. If your parents, brothers, or sisters have diabetes, your risk increases.
Obesity and particularly carrying weight on the abdomen is a risk factor. Obesity can promote insulin resistance and reduce the use of insulin.
People over the age of 45 have an increased risk because as people age, they are less able to process glucose appropriately.
High blood pressure increases the risk of developing diabetes. The mechanism is unclear, but it appears that the higher the blood pressure, the worse the insulin resistance.
High cholesterol increases the risk of developing diabetes. Insulin resistance is associated with low HDL levels or good cholesterol, and high triglyceride levels.
Inactive people or people who do not exercise regularly are at an increased risk for diabetes. They may have higher blood sugar levels from lack of exercise. Exercise helps to move glucose out of the bloodstream.
Women who developed gestational diabetes during pregnancy or delivered a baby weighing over nine pounds have an increased risk of developing type 2 diabetes later on in life.
Women with Polycystic Ovary Syndrome (PCOS) have an increased risk because of irregular hormone production that can cause insulin resistance and diabetes.
Many doctors believe in testing for pre-diabetes at age 30 for people with a family history of diabetes or who are overweight. You should be tested for pre-diabetes if you have any of the risk factors for diabetes that are listed above or if you have previously had an abnormal glucose tolerance test or impaired fasting glucose level.

Complications
In addition to managing your blood sugar, eating smart, and exercising, you should also maintain appropriate cholesterol and blood pressure levels. It is also important to not smoke. Smoking increases blood sugar and can contribute to the development of medical complications. It is important that you take care of yourself daily and keep all of your doctor appointments. Type 2 diabetes may be a lifelong condition however, you can still live a healthy, happy, and long life with good care.

Many people with diabetes also have high cholesterol and high blood pressure. These three factors combined—diabetes, high cholesterol, and high blood pressure, increase the risk of developing a variety of serious medical complications. Some of the symptoms may be obvious, while others may be subtle and develop over time. It is important that you monitor yourself for signs and symptoms of medical complications and complete all screenings recommended by your doctor. Report any concerns to your doctor promptly. The following paragraphs describe some of the medical complications associated with type 2 diabetes.

Heart and Cardiovascular System

Type 2 diabetes is associated with an increased risk of coronary artery “heart” disease, heart attack, and stroke. Heart disease is the leading cause of diabetes related death in the United States. Coronary artery disease causes the vessels that carry blood to your heart to narrow. They can also become completely or partially blocked by fatty deposits. A heart attack occurs when the heart does not receive blood or does not receive enough blood. A stroke occurs when the brain does not receive blood or does not receive enough blood. A heart attack or stroke can be fatal. They can also cause permanent or temporary impairments and disability.

Kidney and Renal System

Kidney disease, also called nephropathy, can also be caused by diabetes. Your kidneys remove waste products from your blood. Diabetes can damage the filtering system in the kidneys resulting in kidney disease or kidney failure. Persons with kidney failure need dialysis, a process in which a machine filters the blood. Some people may even need a kidney transplant.

Eye Health

People with diabetes have a higher risk of eye problems and blindness than those who do not have diabetes. A long history of diabetes and older age are factors associated with developing glaucoma. Glaucoma occurs when pressure builds up in the eye and causes gradual vision loss. People with diabetes tend to develop cataracts at a younger age and at a quicker rate than people without diabetes. Cataracts cause the clear lens in the eye to become cloudy, diminishing vision.

Diabetic retinopathy or retinal disorders can also be caused by diabetes. The retina is the part of your eye that receives images. Nonproliferative retinopathy is a condition that affects the capillaries in the retina. Retinal swelling can cause vision loss. In some people, retinopathy progresses to a more serious condition called proliferative retinopathy. The blood vessel damage caused by proliferative retinopathy causes scarring and eventual retinal detachment destroys vision.

Nerves and Neurologic System

Nerve damage caused by diabetes is called diabetic neuropathy. Nerves carry messages between your brain and body about pain, temperature, and touch. They also control your muscle movements and organ systems, such as the processes for food digestion and urination. Sensorimotor neuropathy and autonomic neuropathy are two common types of nerve damage.

Sensorimotor neuropathy affects sensation and movement. It may cause your feet and hands to feel weak, tingly, numb, or painful. Autonomic neuropathy affects the nerves that regulate involuntary functions or actions that you cannot directly control, such as your heartbeat. Of great concern, it can cause a loss of the typical warning signs of a heart attack or low blood glucose levels. Autonomic neuropathy can cause dizziness or faintness. It can also create problems with digesting food; vomiting, diarrhea, or constipation; bladder function; sex; increased or decreased sweating; and changes in the way the eyes function in the dark or light.

Diabetes can often lead to nerve damage called peripheral neuropathy. Peripheral neuropathy is a condition in which nerve function deteriorates in the limbs. This leads to a gradual loss of feeling in the hands, arms, legs, and feet. This is often problematic because pain is what enables you to know when something is wrong. Without pain, you may not realize that you have bruises, cuts, blisters or burns and seek medical treatment. It is important that people with diabetes receive medical treatment for foot sores because diabetes-related circulation problems can lead to more medical conditions.

Conditions of the Feet

The feet are very vulnerable to diabetes-related complications. There are a variety of foot problems that can occur. Foot problems are the leading reason for diabetes-related hospitalization. Further, diabetes is the leading cause of lower leg and foot amputation. Diabetes-related foot conditions are most frequently caused by poor blood circulation, infection, and nerve damage that can result in ulcers or sores, deformities, and trauma.

Peripheral vascular disease is a common diabetes-related circulation disorder. Poor circulation results in reduced blood flow to the feet. It can restrict the delivery of oxygen and nutrients that are required for normal wound maintenance and repair. As a result, foot injuries, infections, and ulcers may heal slowly or poorly. Minor skin problems on the feet can become worse and lead to infection.

Wounds and injuries can be difficult to heal if diabetes is uncontrolled. This can be especially true of wounds in the feet. Infections tend to get worse or remain undetected, especially in the presence of diabetic neuropathy or vascular disease. Neuropathy can cause you to be unaware of wounds. Additionally, the increased pressure from the feet carrying the body weight aggravates foot wounds. Further, shoes can cause skin friction, rubbing, and tearing. The hot moist environment of shoes is favorable to infection and foot ulcers. Foot ulcers are sores caused by skin breakdown. They can be exacerbated by infection. Foot ulcers tend to develop over areas of high pressure, such as bony prominences or foot deformities.

Foot deformities are another common problem associated with diabetes. They occur when the ligaments and muscles that stabilize the foot bones deteriorate. This can cause the bones to shift out of position or an arch to collapse.

A hammertoe deformity is a common condition that occurs most frequently in the second toe, although it can be present in more than one toe. Increased pressure on the tips of the toes and the lack of muscle stability causes a joint in the toe to become permanently flexed with a claw-like appearance. The toe deformity and pressure displacement makes the toe susceptible to skin ulcers.

Charcot foot is another common foot deformity associated with diabetic neurogenic arthropathy. Neurogenic arthropathy is a progressive degenerative arthritis that results from nerve damage. Charcot foot most frequently affects the metatarsal and tarsal bones located in the midfoot and forefoot.

Charcot foot causes the foot muscles, ligaments, and joints to degenerate or break down. Without support, the foot becomes wider and deformed. Without joint stability, the foot becomes unstable, making walking difficult. Inflammation and pressure eventually can cause bone dislocation.

People with Charcot foot have impaired or absent abilities to feel pain, temperature, and trauma. They may not be able to sense the position that their foot is in. This makes them vulnerable to injury, such as fractures, sprains, joint dislocation, bone erosion, cartilage damage, and foot deformity. They may even continue to walk on a broken bone without knowing it, because they cannot feel it.

Skin Conditions

People with diabetes are generally more prone to skin infections and skin disorders compared to those without the disease. People with diabetes have a greater tendency to get bacterial infections, fungal infections, and itchy skin. Some skin problems happen mostly to or only to people with diabetes.

Bacterial infections tend to manifest as sties on the eyelid, boils, infected hair follicles, deep infections under the skin, and nail infections. Bacterial infections cause the skin to become hot, swollen, red, and painful. Fungal infections are caused by yeast-like organisms that can grow and spread in diabetics whose sugar levels are uncontrolled. They create itchy rashes in moist areas of the skin. Common fungal infections include jock itch, athlete’s foot, ringworm, and vaginal infections. Both bacterial infections and fungal infections can be treated with prescription medication.

Diabetic dermopathy and necrobiosis lipoidica diabeticorum (NLD) are similar skin disorders caused by changes in the blood vessels. Both conditions cause brown spots to appear on the skin. Diabetic dermopathy is harmless, but NLD can cause the skin to crack and bleed. NLD is a rare condition affecting mostly adult women. Open sores need to be treated by a doctor.

People with diabetes tend to get atherosclerosis at a younger age than people without diabetes. Atherosclerosis causes the arteries to thicken, narrowing the route for blood flow. It results in skin changes. The skin becomes hairless, thin, cool, and shiny. The toes become cold, and the toenails thicken and discolor. Atherosclerosis can also cause wounds to heal more slowly or become infected because of a lack of blood flow.

Digestive System

People with type 2 diabetes can experience gastroparesis, a stomach disorder in which the movement of food is slowed or stopped. Gastroparesis occurs when high blood glucose levels damage the vagus nerve and the nerves that regulate stomach functioning over a period of time. The muscles in the stomach and intestines stop working properly. Signs and symptoms of gastroparesis include heartburn, nausea, vomiting, feeling full early when eating, weight loss, bloating, erratic blood glucose levels, lack of appetite, reflux, and stomach spasms.

If food stays in the stomach too long it can be dangerous. Delayed stomach emptying can lead to bacterial overgrowth and stomach or intestinal obstructions. Medications and nutritional changes can treat gastroparesis. In severe cases, a feeding tube may need to be inserted to deliver nutrients to the small intestine.

Mental and Psychological

Finally, people with diabetes have a greater risk of depression than people without diabetes. Depression is a real medical condition that can be treated. Depression is not a “normal part” of every ay life. Symptoms of depression include continually feel sad, irritable, tired, and uninterested in activities that you used to find enjoyable. Other common symptoms of depression include changes in appetite, having difficulty getting a good night’s sleep, moving the body at a much slower pace, and not being able to remember things or concentrate as easily as before.

Doctors are not exactly sure why people with diabetes are at risk for developing depression. They suspect that people cope with diabetes management differently. Additionally, some of the symptoms of low or high blood sugar can cause symptoms that look like depression. You should discuss your concerns with your doctor in order to receive appropriate diagnosis and treatment.

Preventing Complications

Wear a MedicAlert bracelet and carry a MedicAlert card in your wallet. In the case of an emergency, the MedicAlert information will be helpful to the healthcare professionals treating you. Because the medical complications associated with diabetes can be serious and life-threatening, people that develop type 2 diabetes need to diligently manage their disease to remain healthy. The following are suggestions for preventing complications from diabetes.

Monitor your blood glucose levels carefully, and treat yourself with insulin daily, as instructed by your doctor. Make sure that your write down the time that you tested your blood and the result. Take your logbook to each of your appointments. See a physician regularly to prevent and stay on top of any problems that might develop.

Eat a balanced diet and consult a nutrition expert for help with meal planning. Exercise regularly and reduce your weight if you are overweight. Even losing small amounts of weight is helpful for diabetes management.

Monitor your blood pressure. Ask your doctor what your blood pressure should be, and contact your doctor when it is out of range. You should also keep your cholesterol within normal limits. Have regular cholesterol checks throughout the year, and follow your doctor’s instructions for lowering cholesterol.

People with diabetes should have an eye exam at least once a year. The eye examination should include screening for glaucoma, cataracts, and diabetic retinopathy.

Attend all of your scheduled medical appointments. Your feet should be inspected at every visit. Discuss any concerns about depression with your doctor as well.

Advancements
Prevention, technology, and research have greatly improved the management of this diabetes. Sugar-free foods, new types of insulin, and easy-to-use insulin delivery methods have made diabetes management more convenient.

Increasing knowledge and more aggressive detection and management of diabetes by physicians is also helping patients live longer lives with fewer complications. Over the last decade, more and more new classes of medications have been introduced to the market that change the way the body absorbs and manages its glucose stores. Some of these methods include injecting specific hormones or taking combination drugs that lower blood sugar and reduce the number of medications patients take every day.

The American Diabetes Association’s Resource Guide is a great resource for new products, treatment plans, medications and lifestyle suggestions that may be beneficial in your fight against the development of type 2 diabetes or management of the disease if you already have it.

Introduction

Diabetes Insipidus (DI) is a body water balance disorder. DI, also called “water diabetes,” is not the same type of diabetes as “sugar diabetes,” or Type 1 Diabetes, Type 2 Diabetes, or Gestational Diabetes. The diseases resemble each other because both have similar symptoms of increased urination and increased thirst. Other than that, the diseases are completely unrelated. They have different causes and treatments.

DI is an uncommon condition. It occurs when the brain does not produce enough antidiuretic hormone (ADH) or when the ADH does not work with the kidneys like it should. As a result, people with DI can experience excessive urination, fluid intake, and thirst. If treated, severe complications and a reduced life expectancy may be avoided.

Anatomy

Your kidneys filter your blood. Waste products from your blood and extra fluids from your body are eliminated in urine. Urine is composed mainly of water and metabolic waste products. Your kidneys also return purified fluids to your blood. This keeps your body hydrated.

Your body continually works to keep your body fluids balanced. When fluid volumes need to increase, your body signals you to be thirsty. In turn, you consume more fluids.

At certain times, urine production may need to decrease and the reabsorption of fluids may need to increase. This may occur when your blood volume is low, or when concentrations of blood sodium or other metabolites are high. Antidiuretic hormone (ADH), also called vasopressin, directs the rate of urine excretion. ADH is produced in the hypothalamus in your brain. ADH is stored and released into your bloodstream from a nearby structure, your pituitary gland. Once in the bloodstream, ADH travels to the kidneys. ADH directs the kidneys to decrease the production of urine by increasing the amount of water that is returned to the bloodstream.

Causes

DI occurs when the kidney’s system for balancing body fluids is disrupted. There are four types of DI. Each type has it own cause and treatment. The types include Central DI, Nephrogenic DI, Dipsogenic DI, and Gestational DI.

Central DI, also known as Pituitary DI or Neurogenic DI, results in a lack of ADH production. Central DI is caused by damage to the pituitary gland or the hypothalamus. The damage can occur from neurosurgery, infection, diseases, brain injury, tumor, or genetic disorders.

With Nephrogenic DI the kidneys do not respond to ADH like they should. As a result, the kidneys do not return fluids back to the bloodstream. Nephrogenic DI can be caused by kidney disease, sickle cell disease, kidney failure, and certain drugs. Nephrogenic DI can be an inherited disorder, particularly in male children that inherit an abnormal gene from their mother. In some cases of Nephrogenic DI, the cause is not known.

Dipsogenic DI is caused by damage to the thirst mechanism located in the hypothalamus. People with Dipsogenic DI experience an abnormal increase in thirst. The excessive fluid intake suppresses ADH secretion. It also increases the amount of urine output, resulting in excess urination at night or bedwetting. Further, water intoxication can occur. Water intoxication is a condition that lowers the amount of sodium in the blood and can cause brain damage.

Gestational DI can develop in some women during pregnancy. The placenta, which supports the baby, exchanges nutrients and waste products with the mother to help the baby develop. Gestational DI results when an enzyme produced by the placenta destroys the ADH in the mother. In rare cases, an abnormality in the thirst mechanism causes Gestational DI. Gestational DI often resolves four to six weeks after pregnancy, but can develop again in future pregnancies.

Symptoms

Symptoms of DI include excessive thirst, fluid intake, and urination. You may feel extremely thirsty even though you are drinking large amounts of fluids. You may even crave ice water. You may expel large amounts of urine. Ask your doctor how much is too much for you. You may also experience nocturia, the frequent need to urinate during the night, or bedwetting.

Diagnosis

Your doctor can diagnose the type of DI that you have. Tell your doctor your symptoms and medical history. Your doctor may measure your urine output by having you collect your urine in a special container for a period of time. Your doctor will also conduct a series of tests, including a urinalysis, a fluid deprivation test, and in some cases, a Magnetic Resonance Imaging (MRI) scan of your brain.

The urinalysis is an examination of your urine sample. People with DI have low concentrations of sodium and waste products. Their urine also has a high amount of water.

A fluid deprivation test is used to help identify the cause of the DI. The fluid deprivation test can determine if the DI is caused by excessive fluid intake, abnormal ADH production, or a problem in the way that the kidney responds to ADH. For the test, you will not drink fluids for a period of time. Your doctor will measure changes in your body weight, your urine output, and your urine composition.

Your doctor may order a MRI scan to provide a very detailed view of your brain structures. This can help your doctor identify any problems with your pituitary gland or hypothalamus.

Treatment

Your doctor will treat the underlying cause of your condition, if possible, and your symptoms of DI.
The goal of treatment is to regulate the water balance in your body. This may be achieved in different ways, depending on the type of DI that you have.

Central DI and most cases of Gestational DI may be treated with a synthetic “created” hormone called desmopressin. Desmopressin is used to treat ADH deficiency. It can be taken by injection, nasal spray, or a pill. You should drink fluids only when you are thirsty and not at other times while you are taking desmopression. Cases of Gestational DI that are caused by a thirst mechanism impairment should not be treated with desmopressin. Nephrogenic DI and Dipsogenic DI cannot be treated with desmopressin. However, medications can treat some of the symptoms. People with Nephrogenic DI may need to follow a low sodium or low protein diet.

Prevention

Some forms of DI may not be prevented. Prompt treatment of underlying medical causes may help reduce the risk of developing DI. Untreated DI may result in confusion and changes in mental functioning.

You should wear a MedicAlert bracelet and carry a MedicAlert card in your wallet. In the case of an emergency, the MedicAlert information will be helpful to the medical professionals treating you.

It is important to take your medication as directed and to follow the precautions set by your doctor. If using desmopressin, it is important that you get the exact dose that you need.

You should consume fluids as directed by your doctor. It may be helpful to have a supply of drinking water on hand to avoid dehydration.

Am I at Risk

Certain underlying conditions are associated with the development of DI. However, people with an underlying cause of DI may never develop the disease. You should tell your doctor about your medical history and discuss your concerns.

Overall, underlying conditions associated with DI include injury to the pituitary gland or the hypothalamus in the brain. Such conditions include neurosurgery, infection, diseases, brain injury, tumor, or genetic disorders. Certain medications can cause DI. Such medications include lithium, amphotericin B, and demeclocycline. Additionally, Gestational DI can develop in women during pregnancy.

Complications

Dipsogenic DI can lead to water intoxication. Excessive water in the blood stream can cause low sodium levels in the blood and suppressed ADH production, resulting in a condition called hyponatremia. In severe cases, people can develop water intoxication. Water intoxication is very dangerous. Symptoms of water intoxication include shortness of breath, headache, confusion, loss of appetite, feeling tired all of the time, and nausea. It can lead to seizures, coma, and death.

Inadequate fluid consumption can result in dehydration and electrolyte imbalance. Symptoms of dehydration include dry skin, dry mouth, sunken appearing eyes, fever, rapid heart rate, and unintentional weight loss. Severe dehydration can lead to shock. Electrolytes are compounds that help to maintain body metabolism and function. Symptoms of an electrolyte imbalance include feeling tired all of the time, headache, irritability, and muscle pains.

Introduction

Foot problems are a common complication of Diabetes. Diabetes is a disease that affects how the body uses glucose, a sugar that is a source of fuel for the body. Normally, insulin, a hormone, helps glucose get into the body cells so that it is used for energy. People with diabetes either do not produce enough insulin or the insulin does not work like it should. Therefore, glucose does not get into the body cells. As a result, there is too much sugar in the blood, which can make people ill and result in medical complications. Diabetes is manageable. People with diabetes need to be aware of the possible associated medical problems.

Diabetes-related foot problems are most frequently caused by nerve damage and poor blood circulation. Infections, ulcers or sores, deformities, and trauma can all be the result. Foot problems are the leading reason for diabetes-related hospitalization. Further, diabetes is the leading cause of lower leg and foot amputation. Technology, research, and most importantly, diligence by individuals with diabetes can greatly improve the management of diabetes and reduce the risk of foot complications.

Anatomy

Your foot is a complex structure. It contains 28 bones that form 25 joints. The foot is divided into three regions: the forefoot, midfoot, and hindfoot. The hindfoot contains your calcaneus bone or heel. The forefoot contains your toes. Your toes are composed of small bones called phalanges. Your forefoot and midfoot bones, along with muscles and ligaments, form the arches in your foot.

Arches are important for absorbing shock and balancing your body. Your forefoot is a source of mobility. You push off the ground with your forefoot whenever you take a step. Your foot also bears the weight of your body and provides a base of support.

Nerves transmit impulses or messages between your foot and brain about sensation, positioning, and movement. Your circulatory system supplies blood to keep your foot structures healthy. Like the rest of your body, your feet are covered with skin. The skin on the sole or bottom of your foot is thicker than the skin on the dorsal or upper side of your foot.

Causes

The feet are very vulnerable to diabetes-related complications. Further, there are a variety of foot problems that can occur. Diabetes-related foot conditions are most frequently caused by poor blood circulation, infection, and nerve damage that can result in ulcers or sores, deformities, and trauma.

Diabetes can often lead to nerve damage called peripheral neuropathy. Peripheral neuropathy is a condition in which nerve function deteriorates in the limbs. This leads to a gradual loss of feeling in the hands, arms, legs, and feet. This is often problematic because pain is what enables you to know when something is wrong. Without pain, you may not realize that you have bruises, cuts, blisters or burns and seek medical treatment. It is important that people with diabetes receive medical treatment for foot sores because diabetes-related circulation problems can lead to more problems.

Peripheral vascular disease is a common diabetes-related circulation disorder. Poor circulation results in reduced blood flow to the feet. It can restrict the delivery of oxygen and nutrients that are required for normal wound maintenance and repair. As a result, foot injuries, infections, and ulcers may heal slowly or poorly. Minor skin problems on the feet can become worse and lead to infection.

People with diabetes are generally more prone to infections than people without diabetes. Wounds and injuries can be difficult to heal if diabetes is uncontrolled. This can be especially true of wounds in the feet. Infections tend to get worse or remain undetected, especially in the presence of diabetic neuropathy or vascular disease. Neuropathy can cause you to be unaware of wounds. Additionally, the increased pressure from the feet carrying the body weight aggravates foot wounds. Further, shoes can cause skin friction, rubbing, and tearing. The hot moist environment of shoes is favorable to infection and foot ulcers. Foot ulcers are sores caused by skin breakdown exacerbated by infection. Foot ulcers tend to develop over areas of high pressure, such as bony prominences or foot deformities.

Foot deformities are another common problem associated with diabetes. They occur when the ligaments and muscles that stabilize the foot bones deteriorate. This can cause the bones to shift out of position or for a series of bones that make up an arch to collapse. A hammertoe deformity is a common condition that occurs most frequently in the second toe, although it can be present in more than one toe. Increased pressure on the tips of the phalanges and the lack of muscle stability causes a joint in the toe to become permanently flexed with a claw-like appearance. The toe deformity and pressure displacement makes the toe susceptible to skin ulcers.

Charcot foot is another common foot deformity associated with diabetic neurogenic arthropathy. Neurogenic arthropathy is a progressive degenerative arthritis that results from nerve damage. Charcot foot most frequently affects the metatarsal and tarsal bones located in the midfoot and forefoot.

Charcot foot causes the foot muscles, ligaments, and joints to degenerate or break down. Without support, the foot becomes deformed. Without joint stability, the foot becomes unstable making walking difficult. Inflammation and pressure eventually can cause bone dislocation. The arches in the foot can collapse creating a rocker-bottom appearance.

People with Charcot foot have impaired or absent abilities to feel pain, temperature, and trauma. They may not be able to sense the position that their foot is in. This makes them vulnerable to injury, such as fractures, sprains, joint dislocation, bone erosion, cartilage damage, and foot deformity. They may even continue to walk on a broken bone without knowing it, because they cannot feel it.

Diagnosis

Your doctor can diagnose diabetic foot problems with a physical examination. Your doctor will ask you about your symptoms. There are a variety of tests your doctor may use to diagnose a problem with your foot. Testing is individualized depending on your symptoms and examination findings. Some of the most common assessments are described below.

Non-invasive vascular tests can provide information about the blood circulation in your feet. Your doctor can measure the amount of oxygen in your blood with a transcutaneous oxygen measurement. Your doctor will simply place sticky patches on your skin for this assessment. The blood pressure in your arm and ankle can be compared using the ankle-brachial index (ABI).

Another common assessment used during a foot exam is sensitivity testing. Nylon monofilament testing is useful to determine the degree of sensation in your foot. The test does not hurt. Your doctor will simply place the tip of a very thin piece of nylon, similar to a plastic thread, against the skin of your foot. Your doctor will test your foot in various places and alter the thickness of the filament. You will tell your doctor when you feel the filament touch your skin. A similar procedure using wands of random temperatures can be used to determine to what degree you can feel hot or cold temperatures.

In most cases, imaging tests are ordered to identify fractures, degeneration, and deformities. An X-ray may be ordered to show the type and location of your fracture. Some fractures, such as stress fractures, may not show up on an X-ray. In such cases, Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) scans may be used to take a more detailed look at your bones. X-rays, CT scans, and MRI scans are painless procedures.

Your doctor may order an angiography to see the condition of the blood vessels in the legs and feet. An angiogram is a type of X-ray for the blood vessels. You will receive a small harmless injection of a radioactive substance that will highlight the blood vessels on the X-ray image.

A bone scan is useful for identifying bone abnormalities that are often associated with diabetes. A bone scan may show fractures, tumors, infection, and bone deterioration. A bone scan requires that you receive a small harmless injection of a radioactive substance. The substance collects in areas where the bone is breaking down or repairing. Further, three-phase bone scans and radiolabeled leukocyte scans are tests for determining the presence of infection.

Wound classification is very important for the treatment of diabetic-related ulcers. If you have an ulcer, your doctor will grade its progression with a diabetic foot or wound classification system. A wound is classified based on its stage of formation, from being visible on the skin to penetrating through the skin and to the bone. Additionally, your doctor may order sensitivity testing and wound cultures to identify or rule out infection.

Treatment

Overall, people with diabetes must monitor their blood glucose levels carefully, eat a balanced diet, exercise regularly, and see a physician routinely to prevent and stay on top of any problems that might develop. There are several options for diabetes-related foot problems. Treatment is individualized. It will depend on the source and severity of your foot problem. Your doctor will discuss appropriate treatment options with you.

Non-surgical treatments for diabetes-related foot problems include splinting, casting, or bracing to correct bone deformities. Your doctor can recommend proper footwear to provide structure and improve blood circulation. This may include a custom-walking boot. Your doctor can also provide medications or treatments for infections and skin ulcers.

Surgery

The main goal of treatment is to improve the integrity of the foot and reduce the risk of surgery and amputation. Surgery is considered for deformities that are too severe for a brace or shoe. Surgery may also be required to resolve advanced skin ulcers. In extreme cases, surgical amputation of the toes, foot, or leg is required to prevent further health problems and protect the remaining limb.

Recovery

Recovery from diabetes-related foot problems is different for everyone. It depends on the type of problem you experienced and the type of treatment you received. Because diabetes-related foot problems can be progressive, it is extremely important that you reduce your risk of complications and amputation by following preventive measures.

Prevention

The following are tips to help prevent diabetes-related foot problems:

• Monitor your blood glucose levels carefully, eat a balanced diet, and exercise regularly. See a physician regularly to prevent and stay on top of any problems that might develop.
• Inspect your feet daily. Examine your feet for redness, warmth, blisters, ulcers, scratches, cuts, and nail problems. Feel for hard or dry skin. Look at the bottoms of your feet and between your toes. Use a mirror or have someone else look for you to check the bottom of your feet for redness or cracking.
• Examine the inside of your shoes for foreign objects, protruding nails, and rough spots before putting them on.
• Have custom-molded orthotics or shoes made by a foot specialist. The special footwear can help prevent ulcerations and infections in the feet.
• Buy shoes late in the day and never buy shoes that need “breaking in.” Shoes should be comfortable the minute you put them on. Select shoes with deep toe boxes and made of leather upper material. Do not wear new shoes for more than two hours at a time and do not wear the same shoes every day.
• Contact your foot doctor immediately if you experience ANY injury to your foot or if you notice any changes in your feet. Even a minor injury is important for a person with diabetes.
• Do not file down, shave or remove calluses or corns yourself. This should ONLY be done by a foot specialist.
• DO NOT SMOKE! It decreases the blood supply to your feet. • Ask your doctor about precautions for soaking your feet.
• Do not trim your own toenails. Your foot specialist should do this.
• Do not use any strong antiseptic solutions on your feet. Iodine, salicylic acid, and corn or callus removers can be dangerous.
• Do not wear socks or stockings with tight elastic backs and never use garters. Do not wear any socks with holes and always wear shoes with socks.
• You should never use any type of sticky product such as tape or corn plasters on your feet. They can tear your skin.
• In the winter, wear warm socks and protective footwear. Avoid getting your feet wet in the snow and rain and avoid letting your toes get cold.
• Keep feet away from heat–hot water bottles, heating blankets, radiators, and heating pads. Burns can occur without your knowledge. Water temperature should always be less than 92 degrees. Estimate the water temperature with your elbow or bath thermometer.
• Lubricate your entire foot if your skin is dry but avoid putting cream between your toes.
• NEVER walk barefoot.

Introduction

Diaper rash is type of dermatitis that occurs on your baby’s bottom and genitals. It is typically bright red and may include bumps such as blisters or pimples. Diaper rash may be irritating or mildly painful for your baby, but most cases respond well to over-the-counter ointments or creams and clear up within a few days. Diaper rash will not be a problem once your child is potty trained and no longer wears diapers or pull-ups.

Causes

Diaper rash is most common in babies between 4 and 15 months old. There are a number of causes of diaper rash:

-Wearing a wet or soiled diaper for too long
-Introduction of solid foods or new foods in the diet – as the content of stool changes, your baby is more prone to diaper rash
-More frequent bowel movements or diarrhea
-Diapers that are too tight
Antibiotics taken by baby or mother while breastfeeding
-New products such as a different brand of disposable baby wipes or diapers, or certain chemicals in detergents, bleach or fabric softeners used to wash cloth diapers
-Bacterial, yeast or fungal infection (Candida)

Diaper rashes caused by a fungus known as Candida are very common in babies. This fungus grows best in warm, moist places, making the area covered by a diaper the perfect breeding ground for a yeast infection.

Symptoms

Diaper rash is easily identified by:

-Bright red rash or scaly areas on the buttocks, scrotum and penis in boys, or labia and vagina in girls
-Bumps, pimples, blisters, ulcers, or pus-filled sores

Diaper rash may appear in patches or cover the entire buttocks or genitals. It may be itchy, tender or sore to the touch.

Diagnosis

Diaper rashes are typically diagnosed by their appearance. If your child’s diaper rash is long-lasting or does not respond to over-the-counter treatment, your doctor may test for Candida.

Treatment

Most diaper rashes respond to over-the-counter ointments and creams made specifically to treat diaper rash. Most of these contain Zinc oxide or petroleum jelly. Be sure to clean the affected area and let it dry before applying the cream. You should also change diapers frequently and keep the diaper area clean and dry. If your baby’s diaper rash is caused by a yeast infection, you can use an over-the-counter topical antifungal skin cream or ointment such as nystatin, miconazole, clotrimazole, or ketoconazole. If your baby’s diaper rash doesn’t clear up, your doctor may prescribe a stronger antifungal cream or a mild hydrocortisone cream.

Prevention

The best way to prevent diaper rash is to change diapers frequently to keep your baby’s diaper area as clean and dry as possible. Other tips include:

-Try to avoid scented wipes or those that contain alcohol, as they tend to dry out or irritate the skin. Using water and a soft cloth is ideal.
-Gently pat the diaper area dry before putting a new diaper on your baby.
-Do not use corn starch, as it can make a yeast diaper rash worse.
-Do not use talcum powder; it can be dangerous if your baby breathes it in.
-Let your baby “air dry” or spend some time without a diaper on, if possible.
-Make sure diapers are not too tight or too small.
-Use a diaper rash ointment or petroleum jelly at each diaper change, even when your baby doesn’t have a diaper rash. It will act as a barrier against your baby’s skin.

If you use cloth diapers:

-Do not use plastic or rubber pants over the diaper. They do not allow enough air to pass through.
-When washing cloth diapers, be sure to rinse them thoroughly to ensure there is no soap residue left behind. Also, do not use fabric softeners or dryer sheets, as they can irritate diaper rash.

Complications

A simple diaper rash may turn into a yeast infection. Diaper rash may occasionally become severe, with raw, open sores that may take a couple weeks to heal.

Introduction
Diarrhea is a very common condition for people of all ages. A viral infection, such as the stomach flu, or a bacterial infection most frequently causes diarrhea. Less commonly, diarrhea is associated with an underlying medical condition. Symptoms include the passing of frequent stools that are loose, watery, and soft. Diarrhea may also cause bloating, pain, cramps, and gas.

Most cases of diarrhea are treated at home and resolve in a few days. Maintaining hydration is the goal of home care. Severe diarrhea can be associated with serious medical complications and require hospitalization

Anatomy
Whenever you eat and drink, food travels through your digestive system for processing. Your body absorbs nutrients and removes waste products via your digestive system. When you eat, your tongue moves chewed food to the back of your throat. When you swallow, the food moves into the opening of the esophagus. Your esophagus is a tube that moves food from your throat to your stomach.

Your stomach produces acids to break down food for digestion. Your stomach processes the food you eat into a liquid form. The processed liquid travels from your stomach to your small intestine. The liquid solidifies as it moves through the large intestine, forming a stool. The stool is eliminated from your body when you have a bowel movement.
Causes
Diarrhea is a very common condition for people of all ages. Diarrhea is the passing of frequent stools that are loose, watery, and soft. It may be associated with bloating, pain, cramps, and gas.

Diarrhea is most frequently caused by a viral infection, such as the stomach flu. There are many viruses that cause the stomach flu. Rotavirus and Norwalk virus are the most common ones. The viruses are found in contaminated food or drinking water. Poor hand washing frequently spreads the viruses. The viruses can spread among groups of people, such as schools, employers, or families. Symptoms typically appear within 4 to 48 hours after exposure to the virus.

Bacteria are another common cause of diarrhea and cause the most severe symptoms. Bacterial causes include traveler’s diarrhea, food poisoning, handling undercooked meat or poultry, and handling reptiles with the bacteria. Bacteria related conditions typically last from a few days to a week or more, depending on the cause, and can be associated with bloody bowel movements.

Parasites and chemical toxins can cause diarrhea. Parasites are found in contaminated drinking water or swimming pools. Chemical toxins are most frequently contained in seafood, certain medications, and metals including lead, mercury, and arsenic.

Diarrhea is associated with certain medical conditions. Malabsorption syndromes such as lactose intolerance, gluten malabsorption (celiac disease), and other food intolerances can cause diarrhea. Diarrhea is symptom of inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis. Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder that causes alternating periods of diarrhea and constipation. Immune deficiency, such as with HIV or AIDS infection, can also result in diarrhea.

Certain medications can cause diarrhea, especially some antibiotics. Laxatives used to treat constipation can sometimes result in diarrhea. Diarrhea is a common side effect of chemotherapy used to treat cancer.

Less common causes of diarrhea include Zollinger-Ellison Syndrome, neuropathy, and carcinoid syndrome. Diarrhea can be a symptom of colon cancer. It may also occur after gastrectomy, the surgical removal of part or all of the stomach. Further, diarrhea can be a side effect of high dose radiation therapy for cancer.
Symptoms
Symptoms of diarrhea include loose, watery soft or liquid stools. You may need to go to the bathroom frequently. Gas and abdominal bloating, cramps, or pain may precede the diarrhea.

Your stools may be any color. Passing blood or red stools can be a sign of a severe infection or other medical condition. Black tarry stools may indicate bleeding in the stomach and may not be a sign of infection. Diarrhea is usually not accompanied by a fever. You should contact your doctor if you experience diarrhea with a fever, bloody stools, or black tarry stools.

Diarrhea can cause dehydration from loss of fluids. Dehydration can be severe and life threatening. It is especially concerning for infants, children, and older adults. Dehydration can cause sleepiness, thirst, and dry mouth. Infants and children may appear to have sunken eyes. An infant’s fontanels, the “soft spots” on the head, may also appear sunken. They may refuse to eat or drink. Older adults with dehydration may experience behavior changes and confusion. Their skin may appear to be loose. Consult your doctor if you or your loved one experiences signs of dehydration.
Diagnosis
Most cases of diarrhea can be treated at home. Contact your doctor if you become dehydrated. In cases of severe dehydration, you should have someone take you to the emergency room of a hospital. You should consult your doctor if you are unable to tolerate food or drink, have a high fever, or experience abdominal pain. Contact your doctor if you have black stools, bloody stools, or pus with stools. You should call your doctor if your diarrhea does not improve after a few days or if it becomes worse.

Your doctor will review your medical history and conduct a physical examination to determine the cause of your diarrhea in order to provide appropriate treatment. You should tell your doctor about your symptoms, risk factors, travel history, and if you have been around people with similar symptoms.

Your doctor will ask you questions about your lifestyle, diet, bowel movement patterns, and stools to help make a diagnosis. You doctor may order stool tests, blood tests, and urine tests.
Treatment
Treatment depends on the cause and severity of your diarrhea. Most cases of diarrhea caused by bacteria or viruses can be treated at home. You should drink plenty of fluids to avoid dehydration. You should avoid drinks that contain caffeine and milk. Milk may make diarrhea worse. Your doctor may recommend hydration drinks for your infant or child. People with severe dehydration may need fluid replacement via an IV line and hospitalization.
Avoid eating greasy foods, fatty foods, and alcohol. Bananas, applesauce, rice, and toast are helpful foods to eat. If you feel too sick to eat, try sucking on ice chips until you can tolerate food.

Your doctor may prescribe antibiotics to treat some types of bacterial infections. However, antibiotics do not work on viruses. Stomach viruses usually go away on their own in a few days. Generally, anti-diarrhea medications should not be given for the stomach flu as they only prolong the infection. You should not take over-the-counter diarrhea medications unless your doctor instructs you to.

Treatments vary for diarrhea caused by other medical conditions. Lifestyle and dietary changes may help some conditions. Ask your doctor for suggestions specific to your condition.

If you have a serious medical condition including HIV, AIDS, diabetes, heart disease, kidney disease, or liver disease, contact your doctor as soon as your diarrhea starts. You may need prompt treatment. You may be at risk for developing complications from diarrhea.
Prevention
The stomach flu can be prevented with good hand washing. Hands should be washed thoroughly after going to the bathroom and before handling food. You should avoid contaminated food or water. Enzyme supplements are available to help digest foods with lactose. Additionally, there are many lactose-free products and some gluten-free products available on the market.

If you travel to underdeveloped countries, drink only bottled water and do not use ice. Ice made with contaminated water can contain bacteria. Eat only well-cooked foods including meats, vegetables, and shellfish. Do not consume dairy products. Do not eat fruit that does not have a peel.
Am I at Risk
Infants, children, the elderly, and people with suppressed immune systems have the highest risk for getting diarrhea caused by viruses and bacteria. Your risk is increased if you travel or live in areas with poor sanitation. You are at risk if you eat or drink contaminated food or water.
Complications
Severe symptoms can lead to severe dehydration and death. You should consult your doctor if your infant or child has prolonged or severe diarrhea. You should contact your doctor if you are elderly and experiencing severe symptoms.

Call your doctor if your diarrhea lasts longer than a few days. You should call your doctor if you experience symptoms including faintness, dizziness, dry mouth, and blood or pus in your stools. More serious symptoms include a swollen or painful abdomen, fever higher than 101°, vomiting that lasts for more than 48 hours, and dehydration. Extreme thirst, dry mouth, little urine production, and a lack of tears are signs of dehydration. The eyes of children and infants may appear sunken. An infant’s fontanels, the “soft spots” on the head, may also appear sunken. You should have someone take you to a hospital emergency room if you are sleepy or unaware of your surroundings.
Advancements
In 2006, a vaccine was approved to prevent the rotavirus in infants. Vaccines are available for Salmonella typhi, Vibrio cholerae, and rotavirus. Doctors administer the vaccines selectively, based on your foreign travel plans and medical history.

Introduction
Dysmenorrhea is the medical term for very painful menstrual cramps. All females may experience cramps at one time or another, but for those with dysmenorrhea, severe pain and stomach problems may interfere with their daily activities. Dysmenorrhea may or may not be caused by an underlying condition, such as endometriosis or fibroids. There are many treatments to help dysmenorrhea, including self-care measures, medications, or surgery to treat the underlying causes.
Anatomy
The menstrual cycle is a regular process that is regulated by hormones. The average menstrual cycle lasts around 28 days, but it varies among individuals and may be either longer or shorter. Each month the uterine lining thickens as it builds up extra blood and tissue in preparation for a potential fertilized egg. An egg that is fertilized by a sperm cell may implant itself in the nourishing uterine lining and develop into a baby. An unfertilized egg or a fertilized egg that does not implant in the uterus passes through the reproductive system. During menstruation prostaglandins, a hormone-like substance, cause the uterus to contract. The uterine lining sheds and the blood leaves the body through the vagina.
Causes
Dysmenorrhea is classified as primary or secondary. Primary dysmenorrhea is not caused by an underlying condition. It usually begins three to four years after a female has started menstruating. It is suspected that prostaglandins may contribute to painful cramps by creating greater uterine contractions. Primary dysmenorrhea usually decreases with age and disappears after childbirth.

An underlying medical condition or disease causes secondary dysmenorrhea. It usually begins when women are in their twenties. Secondary dysmenorrhea may be caused by a physical condition, such as uterine fibroids, uterine polyps, ovarian cysts, or endometriosis. Sexually transmitted diseases, pelvic inflammatory disease, or an intrauterine device (IUD) are other causes.
Symptoms
Dysmenorrhea causes severe painful cramps in the lower abdomen. It may be a sharp pain that comes and goes or a dull aching pain. Pain may be felt in the back and legs. Pain usually begins one or two days before a period begins and lasts for one or two days into the period. Dysmenorrhea may cause stomach problems, including nausea, vomiting, diarrhea, and constipation. It may also cause sweating or dizziness. For some people, severe symptoms prevent participation in daily activities, such as going to work or school.
Diagnosis
To help diagnose dysmenorrhea, your doctor will review your medical history and conduct a physical and pelvic examination. Determining the cause of secondary dysmenorrhea is important for treatment planning. Your doctor will check your reproductive organs for any structural abnormalities or signs of infection. Samples of your vaginal cells may be collected to identify sexually transmitted diseases.

Imaging tests or special procedures may be used to look for abnormal growths or conditions. Ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans may be used to create pictures of your internal pelvic structures. A laparoscopy is a surgical procedure that allows your doctor to view your pelvic cavity. It involves inserting a thin tube with a lighting device through a small incision in your abdomen. A laparoscopy is an outpatient test that uses general anesthesia. A hysteroscopy uses a viewing instrument that is inserted through your vagina and cervix to examine the inside of the uterus.
Treatment
Treatment for dysmenorrhea may depend on the extent of your symptoms and if you have primary or secondary dysmenorrhea. In some cases, self-care measures may help relieve your symptoms. You may want to try placing a heating pad on your abdomen or soaking in a hot bath. It is important to get plenty of rest and relaxation. Regular exercise is helpful to release endorphins, your body’s natural painkillers. It may be helpful to participate in stress-relieving activities, such as massage or yoga. Vitamins B-6, calcium, and magnesium may help prevent pain associated with PMS. In 1998 the National Institutes of Health issued a statement that acupuncture may help relieve menstrual pain.

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) including, aspirin, ibuprofen, or naproxen, may help relieve pain. Your doctor may prescribe low dose birth control pills for 6 to 12 months to help reduce the production of prostaglandins.

Treatment for the underlying cause of secondary dysmenorrhea depends on the type of condition or disease. Cysts, polyps, fibroids, and endometriosis may be removed with surgery. Antibiotics are used to treat sexually transmitted diseases. An IUD may be removed if it is causing pain.
Prevention
You may be able to prevent secondary dysmenorrhea by avoiding contact with sexually transmitted diseases. This can be achieved by abstinence. Female or male condoms may help reduce the spread of some types of sexually transmitted diseases.
Am I at Risk
Risk factors may increase your likelihood of developing dysmenorrhea, although some people that develop the condition do not have any risk factors. People with all of the risk factors may never develop the dysmenorrhea; however, the chance of developing the condition increases with the more risk factors you have. You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for dysmenorrhea:

_____ Females with an early onset of puberty (before 11 years old) have an increased risk of developing dysmenorrhea.
_____ A family history of dysmenorrhea increases your risk for the condition.
_____ Endometriosis is a cause of secondary dysmenorrhea.
_____ Pelvic inflammatory disease (PID) is an infection of the female reproductive organs that is caused by sexually transmitted bacteria. PID can cause secondary dysmenorrhea.
_____ Uterine fibroids or polyps can cause secondary dysmenorrhea.
_____ Ovarian cysts can cause secondary dysmenorrhea.
_____ Premenstrual syndrome (PMS) may contribute to dysmenorrhea.

Complications
Severe dysmenorrhea may cause severe symptoms that impair a female’s ability to participate in her daily activities. Severe dysmenorrhea is a leading cause of work or school absence for females.

Introduction

Earache, medically termed otalgia, is pain that occurs in the ear. Ear infections are a frequent cause of earache, especially in infants and children. Air pressure changes and earwax buildup are also common causes. There are varities of treatments for earaches, depending on the cause.

Anatomy

The ear is divided into three parts: the outer, middle, and inner ear. Your ear not only enables you to hear, but it plays a role in balance as well. Your outer and middle ear are separated by your eardrum.

The medical term for eardrum is tympanic membrane. Located just behind your eardrum is your middle ear. The eustachian tube in the middle ear drains fluid and equalizes air pressure. This allows the eardrum to vibrate and send nerve messages to the brain that are interpreted into sound.

Causes

Earaches can happen to anyone, but are more common among infants and children. There are several causes of earache. An infection in the middle ear is a frequent cause of earaches in infants and children. Fluid accumulation in the outer ear from swimming or showering can cause an outer ear problem, commonly known as swimmer’s ear. Wax buildup or a foreign object in the ear can cause pain. Eardrum perforation or pressure changes during flying or diving can cause earache. An earache may also be caused by jaw problems, tooth infection, sinus infection, sore throat, or arthritis.

Symptoms

An earache is pain in the ear. You may feel sharp, dull, or burning pain. Infants may become irritable, cry, and have trouble sleeping.

You may experience other symptoms depending on the cause of your earache. Infections or injury may cause a decrease in hearing, dizziness, and impaired balance. You may develop ringing in the ear, called tinnitus.

Diagnosis

An examination by your doctor is the best way to determine the cause of your earache. Your doctor will review your medical history and ask you questions about your symptoms and recent activities.

Your ear will be examined with an otoscope. An otoscope is a lighted device with a magnifying glass. If pus is present, it will be tested to determine what type of infection it is. A hearing test may be recommended for children with repeated ear infections.

Tests may be conducted to check for fluid in the middle ear. A pneumatic otoscope delivers a puff of air inside the ear while the doctor checks if the eardrum moves or not. Fluid in the middle ear will prevent the eardrum from moving. Tympanometry is another test to measure eardrum movement based on changes in air pressure. Acoustic reflectometry uses sound frequencies to provoke eardrum movement.

Treatment

The treatment you receive depends on the cause of your earache. Some ear infections go away within a few days without treatment. Your doctor can recommend a pain reliever. Children and infants should not receive aspirin. Antibiotics may be used for persistent ear infections. Children with chronic ear infections may have surgery or tubes placed in their ears to drain fluid and equalize pressure. A doctor should remove impacted earwax or foreign objects in the ear. Treating causes of referred ear pain, such as arthritis or TMJ syndrome in the jaw, is helpful as well.

Am I at Risk

Middle ear infections have a tendency to develop after a cold, sinusitis, or allergies. Outer ear infections tend to develop after swimming in polluted water. Pressure changes associated with flying or diving increase the risk of earache.

Complications

Untreated persistent causes of earache may contribute to hearing loss, balance disorders, and speech delays in children. You should contact your doctor if an earache is sudden, severe, and does not go away in a couple of days or becomes increasingly worse.

An echocardiogram is usually also be referred to as a transthoracic echocardiogram (TTE), Doppler ultrasound of the heart, or surface echo. An echocardiogram is an ultrasound of the heart. During the procedure, sound waves create a “live” picture of the heart beating.

An echocardiogram is used to show a detailed moving picture of the heart. It is used to evaluate the functioning of the heart valves and chambers, assess heart pumping, and check for heart murmurs. An echocardiogram is commonly used to check for heart disease and evaluate the heart functioning of people that have had heart attacks.

Test Procedure

There is no special preparation prior to an echocardiogram. You will wear a hospital gown and disrobe from the waist up for the procedure. Conducting gel will be placed on your chest. A cardiologist or sonographer will place a transducer device on your chest. The device transmits sound waves to a monitor that produces moving pictures of your heart. In some cases, dye may be delivered through an IV to provide more contrast in the pictures. Your doctor will review the results with you. It is important to know that this procedure is different than a transesophageal echocardiogram (TEE) in which the ultrasound probe is passed through the mouth into the feeding tube to take images of the heart.

Introduction
Eczema is a chronic hypersensitive skin reaction, similar to an allergy. Atopic dermatitis is a common form of eczema. The hallmark symptoms of eczema are intense itching and a red rash. Environmental irritants, stress, water, and temperature changes may worsen the symptoms. Fortunately, there are a variety of medications and preventative measures that can help ease your symptoms.
Anatomy
Your skin covers your body and protects it from the environment. It is composed of three layers, the epidermis, dermis, and subcutaneous tissue. The epidermis is the outermost layer of your skin. It protects the inner layers. The cells at the bottom layer of the epidermis continually move upward to the outer layer. They eventually wear off and are replaced by the next layer of cells.
Causes
The exact cause of eczema is unknown, but it appears to be an inherited condition in some families.
Symptoms
Eczema causes very itchy rash-like areas on the skin. Your skin may blister, ooze, and become raw or crusty. The skin may be very dry, leathery, or inflamed. Eczema occurs most commonly on the cheeks, elbows, and knees of infants and on the inside of the knees and elbows of adults.
Diagnosis
Your doctor can diagnose eczema by examining your skin. A biopsy may be taken to analyze the skin cells and help confirm the diagnosis.
Treatment
Treatment for eczema depends on the symptoms. Oozing skin is treated with moisturizers and dressings. Anti-itch or corticosteroid lotions are used to treat healing or dry areas. Tar compounds, anti-inflammatory medications, topical immunomodulators (TIMs) or corticosteroid medications are used to treat chronic eczema or thickened skin. Your doctor will recommend a specific skin care regime for you. Continue your skin care routine even after the eczema has healed.
Prevention
There are many ways you may help to prevent eczema, including:

• Avoid environmental irritants that cause your symptoms, such as water or temperature changes.
• Moisturize your skin to prevent dryness.
• Manage daily stress, participate in relaxation techniques
• Avoid household irritants, such as cleaners, soaps, aftershave lotion, and solvents
• Wear gloves when your hands are exposed to water, irritants, or cold temperatures
• Wear clothes made of cotton or a cotton blend
• Use mild soap and moisturize after bathing
• Avoid moisturizers and skin products with perfume, extra ingredients, or preservatives
• Avoid getting hot and sweaty.
Back to Top

Am I at Risk
A family history of eczema may increase your risk for the condition. As may a family history of:
• Allergies
• Asthma
• Hay Fever
Complications
Chronic eczema can lead to bacterial skin infections or scarring.

Introduction
Endometriosis is the abnormal growth of uterine-lining tissue outside of the uterus. Endometriosis frequently develops on the outside of the uterus, fallopian tubes, ovaries, or pelvic lining. It is a common problem that needs monitoring and treatment because complications may lead to pain and infertility. Treatment for endometriosis involves medication or surgery.
Anatomy
The internal female reproductive system includes the ovaries, fallopian tubes, uterus, cervix, and vagina. The ovaries are two small organs that produce eggs (ova) and hormones. An ovary typically releases one mature egg each month. Two fallopian tubes extend from near the ovaries to the uterus. The fallopian tubes transport the mature eggs to the uterus.

The uterus is a pear-shaped organ where a baby grows in during pregnancy. The lining of the uterus undergoes cyclic changes to facilitate and maintain pregnancy. Each month the uterine lining thickens as it builds up extra blood and tissue in preparation for a potential fertilized egg. An egg that is fertilized by a sperm cell may implant itself in the nourishing uterine lining and develop into a baby. An unfertilized egg or a fertilized egg that does not implant in the uterus passes through the reproductive system. During menstruation the uterine lining sheds and the blood leaves the body through the vagina. The uterus is joined to the vagina by the cervix. The vagina is a muscular passageway that extends from the cervix to the external female genitalia.
Causes
The exact cause of endometriosis is unknown. Researchers suspect that hormones and the immune system may somehow contribute to the development of endometriosis. Endometriosis occurs when the tissue that normally lines the uterus grows outside of the uterus. Common sites for endometriosis include the outside of the uterus, fallopian tubes, ovaries, bowel, rectum, bladder, and tissue lining the pelvic region. In response to monthly hormonal changes, the endometrial cells may bleed and cause pain or form cysts. Overtime, this can lead to adhesion and scar tissue formation. Endometriosis in the fallopian tubes and ovaries can cause infertility.
Symptoms
Endometriosis may or may not cause symptoms. Symptoms include lower abdominal pain or cramps that may begin a week or two before your period starts. Pelvic or back pain may continue during your period. Y our periods may become increasingly painful. The pain may feel dull or quite severe. You may experience pain during or after sexual intercourse or bowel movements. You may spot blood before your period begins. You may bleed quite heavily during your period or bleed between periods. You may experience infertility, the inability to become pregnant after a year of trying. Symptoms of endometriosis go away during pregnancy and after menopause.
Diagnosis
You should contact your doctor if you have the signs and symptoms of endometriosis. Your doctor will review your medical history and conduct a pelvic examination. An ultrasound may be performed to create images of your reproductive organs. A laparoscopy may be used to confirm the diagnosis and determine the extent of your condition. A laparoscopy is a minimally invasive surgical procedure that uses a laparoscope to view the reproductive organs. A laparoscope is a thin tube with a light and viewing instrument that is inserted through a small incision in your abdomen. Images from the laparoscope are sent to a video monitor.
Treatment
Treatment for endometriosis depends on several factors, including the extent of your condition and your desire to have children in the future. Mild endometriosis may be monitored with regular examinations. Your doctor may prescribe or recommend medication for pain relief. You may find it helpful to use a heating pad or warm baths. This can relax muscles and relieve pain.

Birth control pills may be used to stop menstruation and prevent the condition from getting worse. Hormonal therapy may be used to prevent symptoms and the growth of endometriosis. However, certain types of hormone medications may prevent pregnancy. If you desire to get pregnant or have severe symptoms, you may consider surgical treatment.

Surgical treatment for endometriosis involves traditional or laparoscopic surgery to remove growth, scar tissue, or adhesions. Laparoscopic surgery is minimally invasive and associated with short recovery times. I n severe cases of endometriosis, a total hysterectomy is performed to remove the uterus, both fallopian tubes, and both ovaries. In some cases, just the uterus may be removed. You will not be able to become pregnant after a hysterectomy.
Prevention
There is no proven way to prevent endometriosis. Birth control pills may help to prevent the onset or slow the growth of the condition.
Am I at Risk
Endometriosis is a common condition. Women with a family history of endometriosis have a higher risk of developing it. Women that did not give birth to children may have a higher risk. Women with periods that last longer than seven days or had their first period at an early age may be at risk for endometriosis.

Complications
Endometriosis may cause infertility in some women. Endometriosis may come back after surgical treatment, including hysterectomy. Endometrial growths on the bladder or bowel may cause blockages or incontinence.

X-Rays

X-rays use radiation energy to create images of internal body structures. X-rays are a non-invasive procedure, meaning that the body does not have to be surgically opened to see a bone or tissue. X-rays are used to help diagnose a condition, such as a broken bone or some types of tumors. X-rays are used to screen for some types of diseases, such as lung cancer. Doctors also use the information from X-rays to help formulate treatment plans.

Procedure

X-rays can be performed in your doctor’s office, an outpatient radiology center, or a hospital radiology department. An X-ray is a quick, painless procedure. You will be asked to remove metal objects, such as jewelry or watches, from the area being X-rayed. An X-ray technician will position your body in accordance with the X-ray camera. The parts of your body that are not being X-rayed may be shielded with a lead apron or blanket. In some cases, a contrast dye may be injected to add contrast to the X-ray image. You will be asked to remain motionless while the X-ray is taken.

Results

Your doctor and/or a radiologist will review your X-ray results. When your doctor receives the results, he or she will review them with you and discuss your treatment plan.

Introduction
Vaginal yeast infections are common. They most frequently result from the overgrowth of a fungal organism. Common symptoms include itching, irritation, abnormal discharge, and painful urination. Yeast infections are treated with over-the-counter or prescription medications.
Anatomy
The vagina normally contains a balanced amount of organisms, including Candida albicans, the fungus that causes most yeast infections.
Causes
Yeast infections develop because of changes in the normal balance of organisms in the vagina. Hormonal changes from pregnancy, birth control pills, or menopause can contribute to yeast infections. Uncontrolled diabetes can cause yeast infections. Yeast infections are common for people with HIV or AIDS. Certain antibiotics or steroid medications can lead to infections. Bubble baths, vaginal contraceptives, damp or tight clothes, and feminine hygiene products do not directly cause yeast infections, but they may create an environment that is favorable for infection.
Symptoms
Yeast infections can cause vaginal and external genital itching and irritation. Your genital area may be red and inflamed. You may experience pain during urination or sexual intercourse. Your vaginal discharge may change in color, appearance, odor, or amount. Vaginal discharge may appear slightly watery or thick white and chunky (cottage cheese appearance). You may have light vaginal bleeding.
Diagnosis
Your first yeast infection, recurrent yeast infections, or symptoms that do not respond to over-the-counter yeast infection medications should brought to the attention of your doctor. You should contact your doctor if you are not sure if your symptoms are related to a yeast infection or not. Other types of vaginal infections may cause similar symptoms and need to be treated as well. Your doctor will examine your cervix, vagina, and external genital area. Your doctor will confirm the presence of yeast cells and rule out other types of infections by viewing a sample of your vaginal discharge with a microscope.
Treatment
Yeast infections may be treated with over-the-counter vaginal medication. Your doctor may prescribe pills or vaginal medication. Your symptoms should go away with treatment. Some yeast infections may recur or require a different type of medication than what you used. You should contact your doctor if your symptoms return or do not go away.
Prevention
Adding cranberry juice and yogurt that contains live lactobacillus cultures, a “good” bacterium, to your diet may help prevent yeast infections. You should avoid wearing wet swimsuits or exercise clothing for long periods of time. Wash and dry your sportswear in between uses. Do not wear underwear while you sleep; yeast thrives in a warm moist environment. Wearing dry cotton underwear, loose fitting pants, and panty hose with a cotton crotch may help prevent vaginal yeast infections as well.
Am I at Risk
If you use birth control pills or are experiencing menopause, your risk is increased. Yeast infections are common during pregnancy. You may develop a yeast infection after taking certain antibiotics or steroid medications. You may be at risk for yeast infections if you have uncontrolled diabetes, HIV, or AIDS.
Complications
In some cases, chronic or recurrent yeast infections may occur. You should contact your doctor if this happens to you. A yeast infection is not classified as a sexually transmitted disease. Although it is not common, a yeast infection can be spread to your partner during sexual activity. Your partner should be treated if symptoms occur.