PATIENT EDUCATION LIBRARY

We invite you to explore our comprehensive list of resources and educational materials designed to help educate you about the various medical conditions we treat. Simply click on a topic below to learn more.

If you have any questions or concerns regarding your condition or treatment, please feel free to contact MedPlus Urgent Clinic at (662) 841-0002 - Tupelo Location or (662) 269-8000 - Fulton Location. No appointment is necessary, but for the fastest care you may call ahead or check in online to let us know you are coming.

This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation, examination or the medical advice of your doctor. This information should not be relied upon to determine a diagnosis or course of treatment.

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Acne


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.




Acute Stress Disorder


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.




Allergies


Introduction An allergic reaction occurs when the immune system overreacts to a normally nonthreatening substance. There are many types, causes, and symptoms of allergic reactions. Different areas of the body can be affected depending on the allergic trigger. Some allergic reactions can be life threatening and require emergency medical attention. Allergy treatments include avoiding the triggers of an allergic reaction, medications, and desensitizing shots. Anatomy Your immune system normally fights germs to keep you healthy. If you have allergies, your immune system overreacts to 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 chemicals and hormones called mediators. Mediators, such as histamine, cause the symptoms of an allergic reaction. Causes In some cases, allergies run in families. Some people with allergies may have no family history at all. People with certain medical conditions are more likely to have allergies. Such conditions include asthma, lung problems, nasal polyps, eczema, and frequent ear, respiratory tract, or nasal sinus infections. Foods, pets, dust, plants, cold air, medications, peanuts, grass, and latex—anything can be an allergen. The type of allergic reaction that you experience depends on the allergen and the part of the body that it affects. People can have more than one type of allergy. Symptoms The type of allergy symptoms that you have depends on the allergen and the area of your body that the allergen affects. For instance, food allergens can cause stomach pain, nausea, vomiting, and diarrhea. Environmental allergens, such as plants, can affect the skin and cause itchy bumps, rashes, redness, and swelling. Inhaled allergens, such as cold air or pollen, cause shortness of breath, wheezing, and coughing. Some allergens can cause itchy watery eyes. Others may cause a stuffy nose or dangerous throat swelling. Sudden, rapid, and severe allergic reactions can cause a potentially life threatening condition called anaphylaxis. If you suspect that you or someone else is experiencing anaphylaxis you should call an ambulance immediately. Anaphylaxis is known as "going into shock." Shock consists of low blood pressure, pale or red skin color, sweaty or dry skin, and anxiousness. Diagnosis Your doctor can diagnose allergies or you may be referred to a doctor that specializes in allergies. An allergist can perform tests to find out what you are allergic to and how severe your allergic reaction is. The doctor will make several minor scratches on your skin and apply a small sample of a possible allergen. If you are allergic to the allergen, your skin will react to form a small itchy red bump. Your blood may be tested for antibodies. Treatment You can avoid allergic reactions by avoiding the allergens that trigger them. You may not be able to avoid all allergens. Your doctor can recommend medications to relieve your symptoms. Allergy shots can make your immune system less sensitive to allergens, which can help to reduce symptoms. You may be instructed to carry emergency medication with you to use in case of a severe allergic reaction. Prevention You should wear a Medical Alert bracelet or necklace and carry a Medical Alert card in your wallet indicating the type of allergy that you have. In the case of an emergency, the Medical Alert information will be helpful to the healthcare professionals treating you. Because the medical complications associated with some types of allergies can be very serious and life threatening, it is helpful for people with allergies to inform their school, employer, family, and friends of what they are allergic to and what should be done in the case of an emergency. Your doctor can prescribe a shot that you can carry with you in case of an emergency. You can prevent some allergic reactions by avoiding the allergens that trigger them. Your doctor can make helpful recommendations specific to you. Am I at Risk Risk factors may increase your likelihood of developing allergies, although some people that develop the condition do not have any risk factors. You should tell your doctor about your risk factors and discuss your concerns.
Risk factors for allergies:
_____ Some people are born with a family tendency for allergies. If your parents or close relatives have allergies, you have an increased risk for developing them.
_____ If you have one allergic trigger, you are more likely to have another.
_____ You may be at risk for allergies if you have certain medical conditions including asthma, eczema, lung problems, and nasal polyps.
_____ Frequent ear, respiratory, and sinus infections are associated with an increased risk of allergies.
_____ If you have sensitive skin you may have an increased risk for allergies. Complications Anaphylactic shock is a severe allergic reaction that can be fatal. You should call an ambulance if you or someone else is experiencing anaphylactic shock. If left untreated, anaphylactic shock can cause unconsciousness, heart attack, and death. Advancements Researchers are continually studying methods to prevent and treat allergies. In recent studies, researchers suggest that babies who are breastfed, experience a fever before they are one year old, and have certain environmental exposures are less likely to develop allergies as they grow older. As researchers gather more information, they hope to make general recommendations for all children.




Anal Cancer


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.




Anaphylaxis & Anaphylactic Shock


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.




Anemia


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.




Ankle Sprain & Instability


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.




Anorexia Nervosa


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.




Aortic Aneurysm


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.




Appendicitis


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.




Arthritis


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.




Arthroscopy


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.




Asthma


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.




Athlete's Foot


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.




Atrial Fibrillation


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.




Attention Deficit Disorder (ADD)


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.




Attention Deficit Hyperactive Disorder (ADHD)


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.









B

Bacterial Vaginosis - Vaginal Infection


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.




Balanced Diet and Nutrition


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.




Bile Duct Cancer


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.




Binge-Eating Disorder


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.




Bipolar Disorder


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.




Bite Injuries - Animal Bites


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.




Bite Injuries - Human Bites


Introduction Human bite injuries result from fist fighting or the intentional act of biting to inflict harm. Bite injuries occur during fist fighting if the fist of one person strikes the teeth of another person. Hand injuries from human bites can result in lacerations and injuries to the bones, joints, ligaments, tendons, nerves, blood vessels, and muscles. Human bites are more dangerous than animal bites because they transmit higher concentrations of infectious bacteria. Human bites require prompt medical attention. Hand surgery may be necessary to properly clean wounds, and or to repair structural injuries. Anatomy The 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.

The "knuckles" as they are commonly known, are the metacarpal phalangeal joints of the hand. Simply put, these are the joints where the hand attaches to the fingers. These joints are the ones most commonly affected when a tooth causes an injury after a punch in the mouth. Causes Human bite injuries can result from fist fighting or one person biting another. A penetrating injury can occur if one person’s fist hits another person in the teeth. If the impact breaks the skin, it is considered a bite injury. Human bite injuries can occur from one person biting the other. Toddlers may bite each other, but they generally do not cause significant injury. Bite injuries most frequently occur as intentional acts of violence during child abuse or domestic abuse. Hand injuries from human bites can result in cuts and injuries to the hand bones, joints, ligaments, tendons, nerves, blood vessels, and muscles. Human bites are more dangerous than animal bites because they transmit higher concentrations of infectious bacteria. Additionally, HIV, the virus that causes AIDS and hepatitis are transmittable from one person to another by blood and saliva contact.

Human bite bacterial infections are usually caused by a staphylococcus or streptococcus species. However, Eikenella species are common organisms causing human bite infections. Symptoms A human bite can cause pain and swelling. It may be difficult for you to move your fingers following such an injury. You should inspect your hand for puncture wounds and bleeding. Signs of infection include warmth, redness, pain, tenderness, and a pus discharge. Infections can also cause a fever, chills or sweats. Infection can occur rapidly following a human bite. You should contact your doctor if you or your child receives a human bite. You should carefully wash the wound with soap and water, unless the area is actively bleeding. If you experience bleeding apply direct pressure and elevate your hand above the level of your heart. You should go to your doctor or an emergency department for immediate treatment in such instances. Diagnosis You should tell your doctor that you received a human bite. Your doctor will examine your hand and arm for signs of injury and infection. An X-ray will be ordered to rule out fractures or indentations of bone caused by teeth. Treatment Your doctor will carefully wash and remove any foreign substances from your wound. You may need to get a tetanus shot and prescription antibiotics to fight infection. Your doctor will instruct you on home care for your wound. You should make and attend all of your follow up appointments. If there is risk of the bite entering a joint, you will require surgery to completely wash out the joint. If infection has already set in, surgical drainage is mandatory, with the wound left open to drain. Intravenous antibiotics will be necessary. Surgery 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. Unfortunately, if joint infection from a human bite is not treated promptly, significant functional problems can occur. Recovery Recovery from human 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 your doctor and hand therapy appointments to ensure the best recovery possible. Prevention You can prevent human bite injuries by not hitting other people. You should talk to your doctor about resources that can help you learn more appropriate coping techniques. Physical fighting is often associated with alcohol and substance abuse. Talk to your doctor if you are unable to quit alcohol or drugs on your own. Your doctor is happy to provide you with referrals to professionals that can help you.




Bladder Cancer


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.




BOTOX® Cosmetics


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.




Breast Cancer


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.




Breast Examination


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.




Breast Reduction for Men with Gynecomastia


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.




Bronchitis


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.




Bruises - Contusions


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.




Bulimia


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.




Bunion


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.




Burns


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.





C

Cardiac Arrhythmia - Irregular Heartbeat


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.




Carpal Tunnel Syndrome - Endoscopic Release Surgery


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.




Carpal Tunnel Syndrome - Open Release Surgery


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.




Cartilage Tears


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. A natomy 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.




Celiac Disease


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).