What is it?
Arthritis, meaning inflammation of a joint, can occur at any joint in the human body. Degenerative arthritis means inflammation of a joint due to wear and tear. This condition is called osteoarthritis. Doctors may also use the term “arthrosis” to describe the condition of a worn-out joint. There are many causes for arthritis, and the term is used to describe inflammatory conditions, such as gout, infection, and rheumatoid arthritis.
Who gets it?
In recent years, there has been increasing evidence that osteoarthritis is genetic and has a tendency to occur in families. Research suggests that osteoarthritis that occurs without any injury may be related to the chemical make-up of the cartilage in the joint.
What are the symptoms?
When the joint sustains an injury, the cartilage holding the joint together becomes damaged. The patient does not typically know that damage has been done, and they may not be experiencing significant pain. When asked if the pain limits their activities, the first answer may be “no”. However, in careful questioning, one would ask a patient “what activities are they doing now that they were doing five years ago that they cannot do now because of discomfort in their ankle”. The patient may be surprised by their response.
Because cartilage does not heal or grow back, this causes a defect in the joint. Over time, these defects fill with scar tissue, causing more pain and instability to the joint. The joint ultimately reaches a point when it is no longer able to properly function without significant pain because of the continual damage, resulting in increased inflammation and severe pain.
Diagnosis
Your orthopaedic physician will obtain a family history, considering all factors important in determining the type of arthritis you may have. He will also conduct a thorough physical examination of the joint to evaluate and determine the type and extent of damage to the joint. In this physical examination, the physician will measure the range of motion at the joint, and may draw fluid from the joint to determine if an infection is present. X-rays will then be taken to assess the amount of damage to the joint and determine the proper diagnosis.
Non-Operative Treatment
Arthritis in its mildest form may not need any treatment whatsoever except simple activity modification – avoiding impact activities such as jumping – and recommending activities that are more controlled with less impact such as swimming, cycling, and walking on cushioned surfaces. When arthritis becomes more severe, then the next appropriate step may be medication such as non-steroidal anti-inflammatories (NSAIDs), or other types of medications which are usually prescribed by a rheumatologist. There are many types of mediations that can be utilized as the first line of defense for arthritis prior to considering any surgical procedure.
For patients with stiff and painful joints, bracing is another form of treatment. The bracing may be simple, such as a brace that one would typically use for an ankle sprain.
Operative Treatment
When all these above measures fail and the patient still has significant arthritis limiting lifestyle, then there are three different types of surgical options that can be undertaken to help the patient improve their quality of life. If the joint destruction is on one side of the joint (asymmetric), then the physician can consider an osteotomy (or cutting the bone to change the weight-bearing surface of the joint and help distribute the weight more evenly). This is usually not successfully performed in the ankle, however, it is sometimes considered.
If you suspect that you may have arthritis, then you should see your family physician or internist, as most problems can be treated effectively with anti-inflammatory medications and/or bracing. However, if it is severe enough for surgical intervention, then you should consider being referred to a surgeon
Thursday, April 2, 2009
Cerebral AVM
Also known as: Cerebral Arteriovenous Malformation; High Flow AVM
What is it?
A Cerebral AVM (arteriovenous malformation) is an abnormal collection of tangled blood vessels. High-pressure blood in distorted abnormal arteries flows directly into large draining veins without the presence of an intervening network of capillaries. These are congenital lesions, which occur in less than 1% of the population. AVMs usually cause medical problems by bleeding or leaking blood. AVMs, may also cause seizures or progressive neurological dysfunction.
Who gets it?
Cerebral AVMs are congenital lesions which arise during fetal development. They occur in less than 1% of the population. AVMs can run in families and can be associated with other vascular lesions of the brain such as cerebral aneurysms.
What causes it?
Cerebral AVMs are the result of abnormal development of cerebral circulation. They result in a “tangle” of abnormal arteries connected to large draining veins, without the benefit of an intervening capillary network. These congenital lesions may then enlarge by recruiting more blood vessels throughout childhood and into adulthood.
What are the symptoms?
Many patients with cerebral AVMs have no symptoms. However, the most common reason brain AVMs come to medical attention is through bleeding (rupture). Common symptoms of a bleeding brain AVM include, severe headache, nausea/vomiting and a new neurological deficit, such as numbness, weakness or paralysis. Patients may also present with seizures or progressive neurological decline in the absence of AVM bleeding.
How is it diagnosed?
Cerebral AVMs can be seen on CT scans, MRI/MRA, and CTAs. Specific sequences on the MRI can further help evaluate these vascular malformations. Cerebral angiography remains the gold standard in the evaluation and grading of cerebral AVMs. Cerebral angiography aids in better understanding the AVM’s inflow and outflow. An angiogram is essential to planning any treatment for the AVM.
What is the treatment?
There are three major treatment options for cerebral AVMs. These include a combination of open microsurgery, endovascular surgery, and stereotactic radiosurgery. Microsurgery uses traditional open surgical techniques with the help of a microscope and sometimes with computerized image guidance to remove the AVM. Some lesions may be too large, too deep, or located in too important of an area of the brain for safe microsurgical excision. In such cases other treatments may be necessary. In endovascular surgery, treatment is performed from within the affected blood vessel. Specially designed microcatheters are navigated by means of an angiogram into the nidus of the AVM. The lesion is then occluded from the inside using a process of embolization with either particles or glue. Some forms of endovascular treatment may be investigational and therefore require a special consent. Although very effective in reducing the size of an AVM, endovascular embolization is rarely able to completely obliterate all but the smallest of AVMs. Endovascular therapy, therefore, is usually combined with either microsurgery or stereotactic radiosurgery to give the best chance. Stereotactic radiosurgery involves the delivery of a highly focused beam of radiation to the AVM. The two most common forms of radiosurgery are linear accelerator based radiosurgery (also known as LINAC or photon knife) and gamma ray based radiosurgery (gamma knife). Radiosurgery may be less risky when compared to microsurgery, for patients with AVMs that are deep or located in important brain areas. However, the ability of conventional radiosurgery to cure an AVM drops off sharply as the AVM diameter goes above 2.5 cm (1 inch). With radiosurgery cure is not immediate and may take up to two or three years. During this time, the patient may require follow-up tests and will still be at risk for problems from the AVM. For these reasons, radiosurgery is especially appropriate for small lesions that are located in or near critical brain areas or are very deep.
What is it?
A Cerebral AVM (arteriovenous malformation) is an abnormal collection of tangled blood vessels. High-pressure blood in distorted abnormal arteries flows directly into large draining veins without the presence of an intervening network of capillaries. These are congenital lesions, which occur in less than 1% of the population. AVMs usually cause medical problems by bleeding or leaking blood. AVMs, may also cause seizures or progressive neurological dysfunction.
Who gets it?
Cerebral AVMs are congenital lesions which arise during fetal development. They occur in less than 1% of the population. AVMs can run in families and can be associated with other vascular lesions of the brain such as cerebral aneurysms.
What causes it?
Cerebral AVMs are the result of abnormal development of cerebral circulation. They result in a “tangle” of abnormal arteries connected to large draining veins, without the benefit of an intervening capillary network. These congenital lesions may then enlarge by recruiting more blood vessels throughout childhood and into adulthood.
What are the symptoms?
Many patients with cerebral AVMs have no symptoms. However, the most common reason brain AVMs come to medical attention is through bleeding (rupture). Common symptoms of a bleeding brain AVM include, severe headache, nausea/vomiting and a new neurological deficit, such as numbness, weakness or paralysis. Patients may also present with seizures or progressive neurological decline in the absence of AVM bleeding.
How is it diagnosed?
Cerebral AVMs can be seen on CT scans, MRI/MRA, and CTAs. Specific sequences on the MRI can further help evaluate these vascular malformations. Cerebral angiography remains the gold standard in the evaluation and grading of cerebral AVMs. Cerebral angiography aids in better understanding the AVM’s inflow and outflow. An angiogram is essential to planning any treatment for the AVM.
What is the treatment?
There are three major treatment options for cerebral AVMs. These include a combination of open microsurgery, endovascular surgery, and stereotactic radiosurgery. Microsurgery uses traditional open surgical techniques with the help of a microscope and sometimes with computerized image guidance to remove the AVM. Some lesions may be too large, too deep, or located in too important of an area of the brain for safe microsurgical excision. In such cases other treatments may be necessary. In endovascular surgery, treatment is performed from within the affected blood vessel. Specially designed microcatheters are navigated by means of an angiogram into the nidus of the AVM. The lesion is then occluded from the inside using a process of embolization with either particles or glue. Some forms of endovascular treatment may be investigational and therefore require a special consent. Although very effective in reducing the size of an AVM, endovascular embolization is rarely able to completely obliterate all but the smallest of AVMs. Endovascular therapy, therefore, is usually combined with either microsurgery or stereotactic radiosurgery to give the best chance. Stereotactic radiosurgery involves the delivery of a highly focused beam of radiation to the AVM. The two most common forms of radiosurgery are linear accelerator based radiosurgery (also known as LINAC or photon knife) and gamma ray based radiosurgery (gamma knife). Radiosurgery may be less risky when compared to microsurgery, for patients with AVMs that are deep or located in important brain areas. However, the ability of conventional radiosurgery to cure an AVM drops off sharply as the AVM diameter goes above 2.5 cm (1 inch). With radiosurgery cure is not immediate and may take up to two or three years. During this time, the patient may require follow-up tests and will still be at risk for problems from the AVM. For these reasons, radiosurgery is especially appropriate for small lesions that are located in or near critical brain areas or are very deep.
Appendicitis
What is it?
Appendicitis is the inflammation of the appendix. The appendix is a worm-shaped pouch that projects from the cecum, which is the point at which the large intestine joins the small intestine. The appendix is located in the lower right abdomen and is not essential to the body’s function.
Who gets it?
Anyone can get appendicitis, and it is the most common reason for emergency abdominal surgery. Appendicitis is most likely to occur between the ages of 10 and 30. It occurs most often in boys between the ages of 10 and 14 and girls 15 to 19. It is less common in the elderly and infants.d
What causes it?
Researchers are not sure what causes appendicitis, but think it may be a blockage between the large intestine and appendix, or a viral or bacterial infection.
What are the symptoms?
An inflamed appendix causes mild to severe pain that moves from the navel to the lower right abdomen. The lower right abdomen may be extremely sensitive to touch and the pain is often worse with movement and strain, such as sneezing, coughing, or taking a deep breath. Other symptoms may include nausea, vomiting, loss of appetite, fever, diarrhea, constipation, weight loss, and a swollen abdomen. However, some people may not experience all of these symptoms. An inflamed appendix can become so swollen that it ruptures, spilling its infected contents into the abdominal cavity. This can cause a life-threatening infection called peritonitis. Never treat appendicitis symptoms with laxatives or enemas because they can cause the inflamed appendix to rupture. A ruptured appendix that is not treated immediately can cause death.
How is it diagnosed?
A diagnosis of appendicitis is based upon a physical examination and the patient’s symptoms. The doctor will ask you about the location of the pain and how long you have felt it. He or she will press gently on your abdomen to check for tenderness and swelling in the area of the appendix. The doctor may order blood tests to check for a high white blood count, which is a sign of infection, and ultrasound or computed tomography (CT) scans to check the condition of the appendix. He or she may order additional tests to rule out other disorders, such as urinary tract infections, tubal pregnancies, and bowel obstructions, that can cause similar symptoms. If you are a woman and your doctor suspects a cause other than appendicitis, he or she might recommend a laparoscopic study. A small, lighted viewing tube, called a laparoscope, is inserted into a small incision in the abdomen to check for disorders of the reproductive system.
What is the treatment?
Appendicitis is treated with surgery to remove the appendix, called an appendectomy. This surgery is usually performed as soon as possible after the diagnosis has been made to avoid a rupture. In many cases, appendectomies can be performed with laparoscopic surgery. The surgeon makes a small incision in the abdomen and inserts the laparoscope. The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to remove the appendix. Because the appendix is not necessary to the body’s function, people who have an appendectomy make a full recovery and are able to continue with life as usual.
Self-care tips
There is no known way to prevent appendicitis. However, a healthy lifestyle, including a diet high in fiber and antioxidants, as well as moderate exercise, goes a long way in preventing illness and disease.
Appendicitis is the inflammation of the appendix. The appendix is a worm-shaped pouch that projects from the cecum, which is the point at which the large intestine joins the small intestine. The appendix is located in the lower right abdomen and is not essential to the body’s function.
Who gets it?
Anyone can get appendicitis, and it is the most common reason for emergency abdominal surgery. Appendicitis is most likely to occur between the ages of 10 and 30. It occurs most often in boys between the ages of 10 and 14 and girls 15 to 19. It is less common in the elderly and infants.d
What causes it?
Researchers are not sure what causes appendicitis, but think it may be a blockage between the large intestine and appendix, or a viral or bacterial infection.
What are the symptoms?
An inflamed appendix causes mild to severe pain that moves from the navel to the lower right abdomen. The lower right abdomen may be extremely sensitive to touch and the pain is often worse with movement and strain, such as sneezing, coughing, or taking a deep breath. Other symptoms may include nausea, vomiting, loss of appetite, fever, diarrhea, constipation, weight loss, and a swollen abdomen. However, some people may not experience all of these symptoms. An inflamed appendix can become so swollen that it ruptures, spilling its infected contents into the abdominal cavity. This can cause a life-threatening infection called peritonitis. Never treat appendicitis symptoms with laxatives or enemas because they can cause the inflamed appendix to rupture. A ruptured appendix that is not treated immediately can cause death.
How is it diagnosed?
A diagnosis of appendicitis is based upon a physical examination and the patient’s symptoms. The doctor will ask you about the location of the pain and how long you have felt it. He or she will press gently on your abdomen to check for tenderness and swelling in the area of the appendix. The doctor may order blood tests to check for a high white blood count, which is a sign of infection, and ultrasound or computed tomography (CT) scans to check the condition of the appendix. He or she may order additional tests to rule out other disorders, such as urinary tract infections, tubal pregnancies, and bowel obstructions, that can cause similar symptoms. If you are a woman and your doctor suspects a cause other than appendicitis, he or she might recommend a laparoscopic study. A small, lighted viewing tube, called a laparoscope, is inserted into a small incision in the abdomen to check for disorders of the reproductive system.
What is the treatment?
Appendicitis is treated with surgery to remove the appendix, called an appendectomy. This surgery is usually performed as soon as possible after the diagnosis has been made to avoid a rupture. In many cases, appendectomies can be performed with laparoscopic surgery. The surgeon makes a small incision in the abdomen and inserts the laparoscope. The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to remove the appendix. Because the appendix is not necessary to the body’s function, people who have an appendectomy make a full recovery and are able to continue with life as usual.
Self-care tips
There is no known way to prevent appendicitis. However, a healthy lifestyle, including a diet high in fiber and antioxidants, as well as moderate exercise, goes a long way in preventing illness and disease.
Aphasia
What is it?
Aphasia is the partial or total loss of the ability to understand words and use language because of a brain injury
Who gets it?
Aphasia often occurs in people who have had a stroke. In fact, 20% of all people who have a stroke each year, develop some type of aphasia. People who have suffered brain damage from a head injury, infection (such as encephalitis), or brain tumor may develop aphasia. Aphasia also occurs in people with Alzheimer's disease. Researchers have found no connection between aphasia and age, gender, or race.
What causes it?
To understand what causes aphasia, it helps to know a little bit about the structure of the brain. The main portion of the brain, the cerebrum, is divided into halves called the left and right hemispheres. The cerebrum is further divided into lobes, the frontal, parietal, occipital, and temporal. In most people, language control is located in the left hemisphere of the brain, called the language dominant area of the brain. It is here that we store information about word meaning, how to formulate spoken and written language, and how and when to use words properly. So, damage to the left hemisphere most often results in the symptoms of aphasia. However, research has shown that many left-handed people have language areas in both the left and right hemispheres of the brain. These people can develop aphasia from damage to either side of the brain. Injuries that result in aphasia can be caused by stroke, head injury, brain tumor, or infection.
Types of aphasia are classified according to the area of the brain that is injured. One type, called Broca's aphasia, results from damage to the frontal lobe of the language-dominant area of the brain. Wernicke's aphasia is caused by damage to the temporal lobe, or the side portion, of the language-dominant area of the brain. Global aphasia is caused by damage to both the left temporal and frontal lobes. Transcortical aphasia is caused by damage to the language areas of the left hemisphere that are outside the primary language areas. Subcortical aphasia results from damage to areas of the brain that are not language-dominant areas.
What are the symptoms?
The symptoms of aphasia may be temporary or permanent, depending upon the amount of brain damage. Aphasia affects one or more of a person's language functions. These could include speech, naming, repetition, hearing comprehension, reading, and writing. The functions affected depend upon the type of aphasia an individual has. For example, people with Broca's aphasia may not be able to speak at all. Or they may be able to use single-word statements or full sentences after great effort. They frequently omit words that are conjunctions and articles (and, or, but, the, a), which results in speech that sounds abrupt and choppy. People with Broca's aphasia can understand and process what others are saying, so they often become depressed and frustrated by their own inability to communicate. They may have difficulty reading, and weakness on the right side of the body may make writing difficult. Broca's aphasia is also called motor aphasia.
People with Wernicke's aphasia speak in long, run-on sentences that include words that aren't needed, difficult to understand, or simply made up. These patients are completely unaware of their language difficulties, and may not even understand what other people say at all. While they may still be able to write, what they write may not be understandable. People with Wernicke's aphasia also have difficulty reading. Because global aphasia affects more than one area of the brain, it can affect all language areas, and is the most severe form of aphasia. However, symptoms vary depending on the location and extent of injury.
There are three types of transcortical aphasia: transcortical motor aphasia, transcortical sensory aphasia, and mixed transcortical aphasia. People with transcortical aphasia suffer partial or total loss of the ability to communicate verbally or use written words, but can still repeat words, phrases, or sentences. Subcortical aphasia results in either the partial or total loss of the ability to speak or use written words. It is typical of a person who has had a stroke or other injury to the brain to have difficulty naming people or objects. This is called anomic or nominal aphasia. The patient might describe the object or person instead of naming it. All other language functions are unaffected. People with conduction, or associative, aphasia cannot repeat words, sentences, and phrases. While they can understand what others say, they may have difficulty finding the right words when speaking, and so may correct themselves frequently and skip or repeat words. Conduction aphasia is uncommon. Aphasia is rare in children, but the symptoms can begin with speech delays and progress to the loss of communication skills in all areas.
How is it diagnosed?
Anyone who has suffered a stroke or any type of brain injury is assessed for any effects on language skills. The doctor will listen to the patient speak, and ask him or her to identify and name common objects, repeat words or phrases, and demonstrate understanding of things that are said. It is important to determine whether the patient is having difficulty with speaking or difficulty with understanding. The patient will also be asked to write down some thoughts to assess written language skills. Standardized tests, administered by a speech pathologist or neuropsychologist, are often used in the diagnosis. These tests might include the Boston Diagnostic Aphasia Examination, the Western Aphasia Battery, and the Porch Index of Speech Ability. Test results are used to pinpoint the area of the brain that has been injured and to develop a speech therapy program best suited to the patient. Magnetic resonance imaging (MRI) and computed tomography scans (CT) are also helpful in mapping the area of the brain that is affected and to diagnose a brain tumor.
What is the treatment?
The primary treatment for most causes of aphasia is speech therapy, which is begun as soon as the patient's condition allows. There are no drugs available to cure or treat aphasia. The speech therapist works with the patient to strengthen his or her remaining language skills and to find ways to compensate for the skills that have been lost. Techniques might include exercising the facial muscles, repetition of words, using flash cards to improve memory of object names, using pictures of objects and activities to communicate with others, completing reading and writing exercises in workbooks, and using computer programs to aid in speech, hearing, and reading comprehension, as well as recall. Recovery from aphasia depends upon the severity of the brain injury. More than half of the patients who have symptoms of aphasia after a stroke, infection, head injury, or as a result of a brain tumor will recover. While people who are left handed are more likely to develop aphasia after a brain injury, they tend to recover more fully. This is because they have language centers on the right and left side of the brain so language abilities can be recovered from either side. Surgery is only used to treat the cause of aphasia, such as to reduce pressure from a brain tumor or to reduce swelling from head trauma.
Self-care tips
The types of events that cause aphasia, such as stroke and head injury, are difficult to predict or prevent. For this reason, there are no guidelines for preventing aphasia. However, individual and family commitment to a physician-guided speech therapy program can result in full to partial recovery.
Aphasia is the partial or total loss of the ability to understand words and use language because of a brain injury
Who gets it?
Aphasia often occurs in people who have had a stroke. In fact, 20% of all people who have a stroke each year, develop some type of aphasia. People who have suffered brain damage from a head injury, infection (such as encephalitis), or brain tumor may develop aphasia. Aphasia also occurs in people with Alzheimer's disease. Researchers have found no connection between aphasia and age, gender, or race.
What causes it?
To understand what causes aphasia, it helps to know a little bit about the structure of the brain. The main portion of the brain, the cerebrum, is divided into halves called the left and right hemispheres. The cerebrum is further divided into lobes, the frontal, parietal, occipital, and temporal. In most people, language control is located in the left hemisphere of the brain, called the language dominant area of the brain. It is here that we store information about word meaning, how to formulate spoken and written language, and how and when to use words properly. So, damage to the left hemisphere most often results in the symptoms of aphasia. However, research has shown that many left-handed people have language areas in both the left and right hemispheres of the brain. These people can develop aphasia from damage to either side of the brain. Injuries that result in aphasia can be caused by stroke, head injury, brain tumor, or infection.
Types of aphasia are classified according to the area of the brain that is injured. One type, called Broca's aphasia, results from damage to the frontal lobe of the language-dominant area of the brain. Wernicke's aphasia is caused by damage to the temporal lobe, or the side portion, of the language-dominant area of the brain. Global aphasia is caused by damage to both the left temporal and frontal lobes. Transcortical aphasia is caused by damage to the language areas of the left hemisphere that are outside the primary language areas. Subcortical aphasia results from damage to areas of the brain that are not language-dominant areas.
What are the symptoms?
The symptoms of aphasia may be temporary or permanent, depending upon the amount of brain damage. Aphasia affects one or more of a person's language functions. These could include speech, naming, repetition, hearing comprehension, reading, and writing. The functions affected depend upon the type of aphasia an individual has. For example, people with Broca's aphasia may not be able to speak at all. Or they may be able to use single-word statements or full sentences after great effort. They frequently omit words that are conjunctions and articles (and, or, but, the, a), which results in speech that sounds abrupt and choppy. People with Broca's aphasia can understand and process what others are saying, so they often become depressed and frustrated by their own inability to communicate. They may have difficulty reading, and weakness on the right side of the body may make writing difficult. Broca's aphasia is also called motor aphasia.
People with Wernicke's aphasia speak in long, run-on sentences that include words that aren't needed, difficult to understand, or simply made up. These patients are completely unaware of their language difficulties, and may not even understand what other people say at all. While they may still be able to write, what they write may not be understandable. People with Wernicke's aphasia also have difficulty reading. Because global aphasia affects more than one area of the brain, it can affect all language areas, and is the most severe form of aphasia. However, symptoms vary depending on the location and extent of injury.
There are three types of transcortical aphasia: transcortical motor aphasia, transcortical sensory aphasia, and mixed transcortical aphasia. People with transcortical aphasia suffer partial or total loss of the ability to communicate verbally or use written words, but can still repeat words, phrases, or sentences. Subcortical aphasia results in either the partial or total loss of the ability to speak or use written words. It is typical of a person who has had a stroke or other injury to the brain to have difficulty naming people or objects. This is called anomic or nominal aphasia. The patient might describe the object or person instead of naming it. All other language functions are unaffected. People with conduction, or associative, aphasia cannot repeat words, sentences, and phrases. While they can understand what others say, they may have difficulty finding the right words when speaking, and so may correct themselves frequently and skip or repeat words. Conduction aphasia is uncommon. Aphasia is rare in children, but the symptoms can begin with speech delays and progress to the loss of communication skills in all areas.
How is it diagnosed?
Anyone who has suffered a stroke or any type of brain injury is assessed for any effects on language skills. The doctor will listen to the patient speak, and ask him or her to identify and name common objects, repeat words or phrases, and demonstrate understanding of things that are said. It is important to determine whether the patient is having difficulty with speaking or difficulty with understanding. The patient will also be asked to write down some thoughts to assess written language skills. Standardized tests, administered by a speech pathologist or neuropsychologist, are often used in the diagnosis. These tests might include the Boston Diagnostic Aphasia Examination, the Western Aphasia Battery, and the Porch Index of Speech Ability. Test results are used to pinpoint the area of the brain that has been injured and to develop a speech therapy program best suited to the patient. Magnetic resonance imaging (MRI) and computed tomography scans (CT) are also helpful in mapping the area of the brain that is affected and to diagnose a brain tumor.
What is the treatment?
The primary treatment for most causes of aphasia is speech therapy, which is begun as soon as the patient's condition allows. There are no drugs available to cure or treat aphasia. The speech therapist works with the patient to strengthen his or her remaining language skills and to find ways to compensate for the skills that have been lost. Techniques might include exercising the facial muscles, repetition of words, using flash cards to improve memory of object names, using pictures of objects and activities to communicate with others, completing reading and writing exercises in workbooks, and using computer programs to aid in speech, hearing, and reading comprehension, as well as recall. Recovery from aphasia depends upon the severity of the brain injury. More than half of the patients who have symptoms of aphasia after a stroke, infection, head injury, or as a result of a brain tumor will recover. While people who are left handed are more likely to develop aphasia after a brain injury, they tend to recover more fully. This is because they have language centers on the right and left side of the brain so language abilities can be recovered from either side. Surgery is only used to treat the cause of aphasia, such as to reduce pressure from a brain tumor or to reduce swelling from head trauma.
Self-care tips
The types of events that cause aphasia, such as stroke and head injury, are difficult to predict or prevent. For this reason, there are no guidelines for preventing aphasia. However, individual and family commitment to a physician-guided speech therapy program can result in full to partial recovery.
Congenital Aortic Valve Stenosis
What is it?
Aortic valve stenosis is a narrowing of the aortic valve. The aortic valve opens to allow blood to flow from the left ventricle of the heart to the aorta, and then to the body. Because the opening is narrowed, the left ventricle has to pump extra hard to propel blood through the valve. This causes the left ventricle to become enlarged. The valve may also have two leaflets, instead of three, or may have an abnormal funnel shape. The narrowed valve may not be a problem during infancy, but becomes one as the child grows and the heart cannot keep up with the body’s demand for blood. “Congenital” aortic valve stenosis means the condition is present at birth.
Who gets it?
Males are four times more likely to get this disease. Aortic valve stenosis accounts for approximately 7% of all cases of congenital heart disease.
What causes it?
Aortic valve stenosis can run in families or may be due to something that happened to the fetus during pregnancy.
Unless it is severe, the condition is often not detected until later in life.
What are the symptoms?
Most children with aortic valve stenosis have no symptoms, so it’s difficult to detect. In general, many patients will be easily fatigued, but show no other symptoms until their thirties to fifties. A small number of children may be prone to dizziness and fainting (syncope) within the first ten years of life. If the obstruction is great, infants may suffer from severe heart failure. Sudden death is uncommon, but possible. Adolescents with hypertrophic cardiomyopathy, a type of aortic stenosis where the left ventricle is noticeably enlarged, have the greatest risk of sudden heart failure. How is it diagnosed? Children with aortic valve stenosis usually have a heart murmur that can be heard with a stethoscope. A doctor can also detect pulse abnormalities and will see irregularities on an electrocardiogram (ECG). A chest x-ray may also show an enlarged left ventricle. An echocardiogram may also be ordered. This technique uses ultrasound waves to create an image of the heart and its function. In cases where severe blockage is suspected and surgery most likely, doctors may do a left heart cardiac catheritization. In this procedure, a thin tube (catheter) is inserted through an artery and moved into the heart chambers. This procedure will measure the pressure difference between the left ventricle and the aorta.
What is the treatment?
Children with aortic valve stenosis require close medical supervision and should undergo yearly exercise testing after the age of six. Most children with mild to moderate aortic valve stenosis can engage in normal physical activities. Surgery is only performed in cases of severe obstruction. The most common treatments are surgical valve repair and balloon valvuloplasty. A balloon-tipped catheter is inserted into the aortic valve. The balloon is then inflated to expand the valve opening. Some forms of aortic valve stenosis require medical management with beta-blockers or calcium channel blockers.
Self-care tips
If your child has been diagnosed with aortic valve stenosis, follow your doctor’s recommendations for treatment and physical activity.
Aortic valve stenosis is a narrowing of the aortic valve. The aortic valve opens to allow blood to flow from the left ventricle of the heart to the aorta, and then to the body. Because the opening is narrowed, the left ventricle has to pump extra hard to propel blood through the valve. This causes the left ventricle to become enlarged. The valve may also have two leaflets, instead of three, or may have an abnormal funnel shape. The narrowed valve may not be a problem during infancy, but becomes one as the child grows and the heart cannot keep up with the body’s demand for blood. “Congenital” aortic valve stenosis means the condition is present at birth.
Who gets it?
Males are four times more likely to get this disease. Aortic valve stenosis accounts for approximately 7% of all cases of congenital heart disease.
What causes it?
Aortic valve stenosis can run in families or may be due to something that happened to the fetus during pregnancy.
Unless it is severe, the condition is often not detected until later in life.
What are the symptoms?
Most children with aortic valve stenosis have no symptoms, so it’s difficult to detect. In general, many patients will be easily fatigued, but show no other symptoms until their thirties to fifties. A small number of children may be prone to dizziness and fainting (syncope) within the first ten years of life. If the obstruction is great, infants may suffer from severe heart failure. Sudden death is uncommon, but possible. Adolescents with hypertrophic cardiomyopathy, a type of aortic stenosis where the left ventricle is noticeably enlarged, have the greatest risk of sudden heart failure. How is it diagnosed? Children with aortic valve stenosis usually have a heart murmur that can be heard with a stethoscope. A doctor can also detect pulse abnormalities and will see irregularities on an electrocardiogram (ECG). A chest x-ray may also show an enlarged left ventricle. An echocardiogram may also be ordered. This technique uses ultrasound waves to create an image of the heart and its function. In cases where severe blockage is suspected and surgery most likely, doctors may do a left heart cardiac catheritization. In this procedure, a thin tube (catheter) is inserted through an artery and moved into the heart chambers. This procedure will measure the pressure difference between the left ventricle and the aorta.
What is the treatment?
Children with aortic valve stenosis require close medical supervision and should undergo yearly exercise testing after the age of six. Most children with mild to moderate aortic valve stenosis can engage in normal physical activities. Surgery is only performed in cases of severe obstruction. The most common treatments are surgical valve repair and balloon valvuloplasty. A balloon-tipped catheter is inserted into the aortic valve. The balloon is then inflated to expand the valve opening. Some forms of aortic valve stenosis require medical management with beta-blockers or calcium channel blockers.
Self-care tips
If your child has been diagnosed with aortic valve stenosis, follow your doctor’s recommendations for treatment and physical activity.
Wednesday, April 1, 2009
Aortic Aneurysm
What is it?
An aneurysm is an area of enlargement of a blood vessel due to the weakening of the vessel wall thus causing a bulge. If the aneurysm remains undetected, the area could rupture which is referred to as a dissection. In Cardiothoracic Surgery we specifically deal with aneurysms in the chest (thorax), not abdominal aneurysms. [These may be referred to as an ascending aortic aneurysm, or an aortic arch aneurysm] The type of aneurysm refers to its location in the chest. For example, an aortic arch aneurysm is a bulge along the arch of the aorta.
What are the symptoms?
The symptoms of an aneurysm are often vague, or nonexistent. In some instances if the aneurysm grows rapidly, the patient may experience chest or back pain.
Aneurysms are often without any definitive symptoms. However, if the patient should have a pre-existing medical condition such as Marfan's Syndrome, they should be checked regularly with chest x-ray or CT scan.
Diagnosis
Aneurysms are associated with certain medical conditions, such as Marfan's Syndrome or untreated hypertension. In the case of Marfan's, the patient should be evaluated regularly with chest x-ray or CT scan since aneurysms are very often without definitive symptoms. In most instances aneurysms are usually detected as a result of a chest x-ray done for some other medical evaluation. It will show up as a mass. A CT scan or an MRI is then used to determine the exact size and location of the aneurysm.
Treatment
If an aneurysm is diagnosed, a surveillance protocol is initiated to chart the size of the aneurysm along with medical management which may include a combination of diet, exercise, and medication aimed at reducing blood pressure. If the aneurysm continues to grow and reaches the calculated size (usually 6 cm) indicative of possible rupture, then surgery is discussed with the patient. Surgery is the only cure for an aortic aneurysm. However, the timing of surgery is based on the risk of surgery versus the risk of rupture.
Surgical repair of the aneurysm is done through an incision made along the left side of the chest, under the arm (left lateral thoracotomy) and the repair is made. Recovery from this procedure is usually 5 to 7 day stay in the hospital with a 4 to 6 week complete recovery.
An aneurysm is an area of enlargement of a blood vessel due to the weakening of the vessel wall thus causing a bulge. If the aneurysm remains undetected, the area could rupture which is referred to as a dissection. In Cardiothoracic Surgery we specifically deal with aneurysms in the chest (thorax), not abdominal aneurysms. [These may be referred to as an ascending aortic aneurysm, or an aortic arch aneurysm] The type of aneurysm refers to its location in the chest. For example, an aortic arch aneurysm is a bulge along the arch of the aorta.
What are the symptoms?
The symptoms of an aneurysm are often vague, or nonexistent. In some instances if the aneurysm grows rapidly, the patient may experience chest or back pain.
Aneurysms are often without any definitive symptoms. However, if the patient should have a pre-existing medical condition such as Marfan's Syndrome, they should be checked regularly with chest x-ray or CT scan.
Diagnosis
Aneurysms are associated with certain medical conditions, such as Marfan's Syndrome or untreated hypertension. In the case of Marfan's, the patient should be evaluated regularly with chest x-ray or CT scan since aneurysms are very often without definitive symptoms. In most instances aneurysms are usually detected as a result of a chest x-ray done for some other medical evaluation. It will show up as a mass. A CT scan or an MRI is then used to determine the exact size and location of the aneurysm.
Treatment
If an aneurysm is diagnosed, a surveillance protocol is initiated to chart the size of the aneurysm along with medical management which may include a combination of diet, exercise, and medication aimed at reducing blood pressure. If the aneurysm continues to grow and reaches the calculated size (usually 6 cm) indicative of possible rupture, then surgery is discussed with the patient. Surgery is the only cure for an aortic aneurysm. However, the timing of surgery is based on the risk of surgery versus the risk of rupture.
Surgical repair of the aneurysm is done through an incision made along the left side of the chest, under the arm (left lateral thoracotomy) and the repair is made. Recovery from this procedure is usually 5 to 7 day stay in the hospital with a 4 to 6 week complete recovery.
Generalized Anxiety Disorder
What is it?
Generalized anxiety disorder is the name for excessive worry and fear about common activities or things, such as work, money, or health. Often, this anxiety is not linked to a specific cause or situation. Anxiety can become so overwhelming that it is difficult to carry on with normal daily activities. If you spend the majority of your time feeling anxious and even have difficulty sleeping because of unrealistic fear and worry, you may have generalized anxiety disorder.
Who gets it?
Generalized anxiety disorder affects between 2 to 3% of people of all ages, even children and teenagers. Women are twice as likely as men to experience generalized anxiety.
What causes it?
A number of events can cause generalized anxiety disorder, although it is believed that some people are genetically predisposed to developing it. Other causes can include childhood psychological traumas, moving, changing jobs, divorce, or the death of a loved one. People who grow up in a family where constant worrying is the norm may learn this behavior. Sometimes a chemical imbalance in the brain cause problems with two neurotransmitters called dopamine and serotonin. Neurotransmitters are the brains chemical message carriers, but sometimes their messages can’t get through because the nerve cells they talk to can’t answer for some reason. This causes an imbalance, and an imbalance of dopamine and serotonin can cause anxiety.
What are the symptoms?
The symptoms of generalized anxiety disorder range from feelings of being tense, constantly tired, afraid, and being unable to make decisions, to feeling restless and irritable. You may also have physical symptoms, such as nausea, vomiting, diarrhea, stomach pain, lack of appetite, shortness of breath, chest pain, shaking, sweating, or muscle tension. Symptoms can cause difficulty with concentration, loss of sleep, missed work, and avoidance of social activities.
How is it diagnosed?
Generalized anxiety disorder is diagnosed when symptoms are observed for six months or longer. Your doctor will perform a complete physical exam and may order tests to rule out other possible causes, such as thyroid disease, hypoglycemia, heart-related conditions, high caffeine intake, depression, or drug or alcohol abuse.
What is the treatment?
Generalized anxiety disorder can be treated very effectively with drugs and psychotherapy. Anti-anxiety drugs called benzodiazepinescan help ease the anxiety very quickly but are generally prescribed for only a short time, then tapered off slowly to prevent addiction. Antidepressant drugs may also be used. Psychotherapy can be very effective because it helps people look to the source of the anxiety and solve their underlying problems. You may also find relaxation and biofeedback techniques very helpful.
Self-care tips
While it is normal and even motivating to sometimes feel anxious, especially before an important event, you should see your doctor if you feel that anxiety is taking over your life. You can help manage normal anxiety by using relaxation techniques, breathing exercises, and changing your focus to something else.
Generalized anxiety disorder is the name for excessive worry and fear about common activities or things, such as work, money, or health. Often, this anxiety is not linked to a specific cause or situation. Anxiety can become so overwhelming that it is difficult to carry on with normal daily activities. If you spend the majority of your time feeling anxious and even have difficulty sleeping because of unrealistic fear and worry, you may have generalized anxiety disorder.
Who gets it?
Generalized anxiety disorder affects between 2 to 3% of people of all ages, even children and teenagers. Women are twice as likely as men to experience generalized anxiety.
What causes it?
A number of events can cause generalized anxiety disorder, although it is believed that some people are genetically predisposed to developing it. Other causes can include childhood psychological traumas, moving, changing jobs, divorce, or the death of a loved one. People who grow up in a family where constant worrying is the norm may learn this behavior. Sometimes a chemical imbalance in the brain cause problems with two neurotransmitters called dopamine and serotonin. Neurotransmitters are the brains chemical message carriers, but sometimes their messages can’t get through because the nerve cells they talk to can’t answer for some reason. This causes an imbalance, and an imbalance of dopamine and serotonin can cause anxiety.
What are the symptoms?
The symptoms of generalized anxiety disorder range from feelings of being tense, constantly tired, afraid, and being unable to make decisions, to feeling restless and irritable. You may also have physical symptoms, such as nausea, vomiting, diarrhea, stomach pain, lack of appetite, shortness of breath, chest pain, shaking, sweating, or muscle tension. Symptoms can cause difficulty with concentration, loss of sleep, missed work, and avoidance of social activities.
How is it diagnosed?
Generalized anxiety disorder is diagnosed when symptoms are observed for six months or longer. Your doctor will perform a complete physical exam and may order tests to rule out other possible causes, such as thyroid disease, hypoglycemia, heart-related conditions, high caffeine intake, depression, or drug or alcohol abuse.
What is the treatment?
Generalized anxiety disorder can be treated very effectively with drugs and psychotherapy. Anti-anxiety drugs called benzodiazepinescan help ease the anxiety very quickly but are generally prescribed for only a short time, then tapered off slowly to prevent addiction. Antidepressant drugs may also be used. Psychotherapy can be very effective because it helps people look to the source of the anxiety and solve their underlying problems. You may also find relaxation and biofeedback techniques very helpful.
Self-care tips
While it is normal and even motivating to sometimes feel anxious, especially before an important event, you should see your doctor if you feel that anxiety is taking over your life. You can help manage normal anxiety by using relaxation techniques, breathing exercises, and changing your focus to something else.
Anthrax
Submitted by John N. Goldman, M.D., chief, division of Infectious Diseases, Penn State Hershey Medical Center
What is it?
Anthrax is a disease caused by Bacillus anthracis, bacteria that lives in the soil. Animals such as cattle, sheep and goats are the usual hosts for anthrax and contact with infected animals or animal products infect humans secondarily. It can infect the skin, lungs, and gastrointestinal tract. In the year 2001, terrorists spread anthrax by sending spores through the mail in the United States. A spore is a dormant (inactive) form of bacteria that can survive under poor conditions, such as high temperatures and dryness. When the conditions are right, these spores can then become active again.
Who gets it?
Outbreaks of anthrax among cattle or people are rare in the United States because most animals are vaccinated against the disease. It occurs most often in agricultural regions outside the United States, such as the Caribbean, southern and eastern Europe, South and Central America, Asia, Africa, and the Middle East. People who handle the contaminated animals, such as farmers, veterinarians, or butchers, are more likely to get the disease. However, anthrax spores can be grown in a laboratory, and we have seen that people can contract anthrax when it is used as a weapon in biological warfare.
What are the forms of anthrax and what are the symptoms of each form?
There are three forms of anthrax in humans:
Cutaneous – or skin anthrax
Pulmonary – or inhalation anthrax
Gastrointestinal – or ingested anthrax
The cutaneous, or skin, anthrax results from spores getting on the skin and then getting into a break in the skin. There is a 1-7 day incubation period. In this environment, the spores begin to grow and cause a small raised area – known as a papule – a person may have localized itching that may then form a small blister that then develops into an ulcerated area that becomes covered with a black scab – or eschar in about 2-6 days. The area is commonly seen on the head, forearm and hands. There may be fever, local redness and swollen lymph glands in the area. Even if untreated, skin anthrax has a relatively low mortality and, if treated with antibiotics, is rarely ever fatal. This is the most common form of anthrax.
Pulmonary, or inhalation, anthrax results from inhalation of the spores into the lungs. The incubation period can be from 2-60 days for the symptoms to occur. The spores then grow and get into the local lymph nodes and lymphatic vessels and cause an aggressive inflammation in the tissues of the chest – known as the mediastinum. There may be hemorrhage locally as well as spread of the bacteria to the brain resulting in meningitis in as many as 50% of affected individuals. The earliest symptoms of pulmonary, or inhalation, anthrax are very nonspecific and may resemble the early phases of the flu – with fever, muscle aches and pains, and mild respiratory complaints. If untreated and these symptoms progress, it may lead to death. Pulmonary anthrax has been quite rare in this country with only 18 cases reported prior to the events of September 11th.
The gastrointestinal form of anthrax results from eating meat from infected animals. The incubation period is typcially 1-7 days and includes symptoms such as abdominal pain, nausea, vomiting and fever following ingestion of contaminated food or water bloody diarrhea, and vomiting blood. This results in infected areas of the intestines with death of tissues and is almost always fatal. Gastrointestinal anthrax has never been seen in this country.
Is anthrax contagious?
Anthrax is not contagious, that is, it cannot be spread from person to person. The reason it cannot be spread is because infected persons have only the actively growing bacteria and do not have the infectious spores.
How many spores does it take to get infected?
The best evidence on this suggests that it takes between 8,000 and 40,000 spores to be inhaled, perhaps fewer to cause the cutaneous form of anthrax. One would guess that it takes many more organisms to cause the gastrointestinal form, since it is so rare and since infected meat may contain millions of organisms.
What is the difference between “exposed to” and “infected with” anthrax?
One can be exposed to anthrax without getting infected with the bacteria, and, in fact, this is probably the most common occurrence. One becomes infected only when the spores grow successfully and multiply in tissues. The spores may not grow or the body’s natural defenses may kill the bacteria before they cause disease. Having the spores recovered from the nose or skin indicates exposure only – but unless the bacteria successfully grow in the skin, lungs or gastrointestinal tract, there is no infection.
How is it diagnosed?
To diagnose anthrax, your doctor will evaluate your symptoms, taking into consideration any possibility that you could have had contact with the Bacillus anthracis bacterium. He or she may take samples of any skin infections, or respiratory secretions, called sputum. However, there are no tests that can be used to reliably detect the presence of anthrax in exposed persons. This is because the bacteria are present in only small numbers on the skin or on mucous membranes of the nose or pharynx before an infection is established. Without the locus of infection on the skin or in the lungs, the usual tests are just not sensitive enough to find the organism in a high percentage of those exposed. Some of these tests are used for epidemiological studies to see if any persons within a group that may have been exposed are positive. If any are positive, then one may consider that all of those exposed have been put at risk and treatment of the entire group with prophylactic antibiotics may be considered.
How quickly must a possible exposure be treated?
The usual incubation period of anthrax is from several days to as many as 60 days from a single discrete exposure. This gives several days to assess the risks involved. Assessment by a physician or other person knowledgeable in this area should be undertaken sooner rather than later. No preventative measure needs to be given in these first few days, even for true exposure. This is especially true since all antibiotics, as well as other drugs, have the potential to cause serious side effects in some people.
What is the treatment ?
While anthrax usually kills infected animals, it can be successfully treated in humans if caught in the early stages. Penicillin has been the drug of choice for years and remains effective, even for the infections we have all read about recently. Other drugs from the penicillin family such as amoxicillin should be equally effective. Doxycycline, one of the tetracycline family of antibiotics – and most recently listed as the CDC’s drug of choice in treating anthrax, is also effective. Ciprofloxacin – more commonly known as Cipro – is one of the quinolone antibiotics and is also effective. Cipro has made news since the September 11th terrorist attack and is recommended as the first drug to use until the sensitivities of the organisms are known because the Soviet Union was known to produce anthrax bacilli that were resistant to penicillin and tetracycline in their germ warfare program. The anthrax used in the most recent incidents, however, has all been sensitive to all antibiotics listed above. Lung infections may be treated with intravenous antibiotics. It is important to take the full course of prescribed antibiotics to prevent complications. If untreated, cutaneous anthrax may result in death. Untreated inhalation anthrax always results in death.
According to the American Medical Association and other authorities, physicians should not prescribe antibiotics for patients as a preventive measure against anthrax. This may lead patients to initiate unnecessary treatment and could contribute to the development of antibiotic resistant organisms.
Is there an anthrax vaccine?
The vaccine is a cell-free filtrate vaccine, which means it contains no dead or live bacteria in the preparation. Anthrax vaccines intended for animals should not be used on humans. The vaccine is reported to be 93 percent effective in protecting against anthrax and is not recommended for the general public.
Self-care tips
People who work in professions that involve frequent contact with animals or animal products that could be infected with anthrax can get an anthrax vaccine that is highly effective against the disease. People who will be visiting countries where there is poor control of the disease should not eat meat that has not been properly prepared or cooked, and should avoid contact with animals or animal products that could be contaminated.
What is it?
Anthrax is a disease caused by Bacillus anthracis, bacteria that lives in the soil. Animals such as cattle, sheep and goats are the usual hosts for anthrax and contact with infected animals or animal products infect humans secondarily. It can infect the skin, lungs, and gastrointestinal tract. In the year 2001, terrorists spread anthrax by sending spores through the mail in the United States. A spore is a dormant (inactive) form of bacteria that can survive under poor conditions, such as high temperatures and dryness. When the conditions are right, these spores can then become active again.
Who gets it?
Outbreaks of anthrax among cattle or people are rare in the United States because most animals are vaccinated against the disease. It occurs most often in agricultural regions outside the United States, such as the Caribbean, southern and eastern Europe, South and Central America, Asia, Africa, and the Middle East. People who handle the contaminated animals, such as farmers, veterinarians, or butchers, are more likely to get the disease. However, anthrax spores can be grown in a laboratory, and we have seen that people can contract anthrax when it is used as a weapon in biological warfare.
What are the forms of anthrax and what are the symptoms of each form?
There are three forms of anthrax in humans:
Cutaneous – or skin anthrax
Pulmonary – or inhalation anthrax
Gastrointestinal – or ingested anthrax
The cutaneous, or skin, anthrax results from spores getting on the skin and then getting into a break in the skin. There is a 1-7 day incubation period. In this environment, the spores begin to grow and cause a small raised area – known as a papule – a person may have localized itching that may then form a small blister that then develops into an ulcerated area that becomes covered with a black scab – or eschar in about 2-6 days. The area is commonly seen on the head, forearm and hands. There may be fever, local redness and swollen lymph glands in the area. Even if untreated, skin anthrax has a relatively low mortality and, if treated with antibiotics, is rarely ever fatal. This is the most common form of anthrax.
Pulmonary, or inhalation, anthrax results from inhalation of the spores into the lungs. The incubation period can be from 2-60 days for the symptoms to occur. The spores then grow and get into the local lymph nodes and lymphatic vessels and cause an aggressive inflammation in the tissues of the chest – known as the mediastinum. There may be hemorrhage locally as well as spread of the bacteria to the brain resulting in meningitis in as many as 50% of affected individuals. The earliest symptoms of pulmonary, or inhalation, anthrax are very nonspecific and may resemble the early phases of the flu – with fever, muscle aches and pains, and mild respiratory complaints. If untreated and these symptoms progress, it may lead to death. Pulmonary anthrax has been quite rare in this country with only 18 cases reported prior to the events of September 11th.
The gastrointestinal form of anthrax results from eating meat from infected animals. The incubation period is typcially 1-7 days and includes symptoms such as abdominal pain, nausea, vomiting and fever following ingestion of contaminated food or water bloody diarrhea, and vomiting blood. This results in infected areas of the intestines with death of tissues and is almost always fatal. Gastrointestinal anthrax has never been seen in this country.
Is anthrax contagious?
Anthrax is not contagious, that is, it cannot be spread from person to person. The reason it cannot be spread is because infected persons have only the actively growing bacteria and do not have the infectious spores.
How many spores does it take to get infected?
The best evidence on this suggests that it takes between 8,000 and 40,000 spores to be inhaled, perhaps fewer to cause the cutaneous form of anthrax. One would guess that it takes many more organisms to cause the gastrointestinal form, since it is so rare and since infected meat may contain millions of organisms.
What is the difference between “exposed to” and “infected with” anthrax?
One can be exposed to anthrax without getting infected with the bacteria, and, in fact, this is probably the most common occurrence. One becomes infected only when the spores grow successfully and multiply in tissues. The spores may not grow or the body’s natural defenses may kill the bacteria before they cause disease. Having the spores recovered from the nose or skin indicates exposure only – but unless the bacteria successfully grow in the skin, lungs or gastrointestinal tract, there is no infection.
How is it diagnosed?
To diagnose anthrax, your doctor will evaluate your symptoms, taking into consideration any possibility that you could have had contact with the Bacillus anthracis bacterium. He or she may take samples of any skin infections, or respiratory secretions, called sputum. However, there are no tests that can be used to reliably detect the presence of anthrax in exposed persons. This is because the bacteria are present in only small numbers on the skin or on mucous membranes of the nose or pharynx before an infection is established. Without the locus of infection on the skin or in the lungs, the usual tests are just not sensitive enough to find the organism in a high percentage of those exposed. Some of these tests are used for epidemiological studies to see if any persons within a group that may have been exposed are positive. If any are positive, then one may consider that all of those exposed have been put at risk and treatment of the entire group with prophylactic antibiotics may be considered.
How quickly must a possible exposure be treated?
The usual incubation period of anthrax is from several days to as many as 60 days from a single discrete exposure. This gives several days to assess the risks involved. Assessment by a physician or other person knowledgeable in this area should be undertaken sooner rather than later. No preventative measure needs to be given in these first few days, even for true exposure. This is especially true since all antibiotics, as well as other drugs, have the potential to cause serious side effects in some people.
What is the treatment ?
While anthrax usually kills infected animals, it can be successfully treated in humans if caught in the early stages. Penicillin has been the drug of choice for years and remains effective, even for the infections we have all read about recently. Other drugs from the penicillin family such as amoxicillin should be equally effective. Doxycycline, one of the tetracycline family of antibiotics – and most recently listed as the CDC’s drug of choice in treating anthrax, is also effective. Ciprofloxacin – more commonly known as Cipro – is one of the quinolone antibiotics and is also effective. Cipro has made news since the September 11th terrorist attack and is recommended as the first drug to use until the sensitivities of the organisms are known because the Soviet Union was known to produce anthrax bacilli that were resistant to penicillin and tetracycline in their germ warfare program. The anthrax used in the most recent incidents, however, has all been sensitive to all antibiotics listed above. Lung infections may be treated with intravenous antibiotics. It is important to take the full course of prescribed antibiotics to prevent complications. If untreated, cutaneous anthrax may result in death. Untreated inhalation anthrax always results in death.
According to the American Medical Association and other authorities, physicians should not prescribe antibiotics for patients as a preventive measure against anthrax. This may lead patients to initiate unnecessary treatment and could contribute to the development of antibiotic resistant organisms.
Is there an anthrax vaccine?
The vaccine is a cell-free filtrate vaccine, which means it contains no dead or live bacteria in the preparation. Anthrax vaccines intended for animals should not be used on humans. The vaccine is reported to be 93 percent effective in protecting against anthrax and is not recommended for the general public.
Self-care tips
People who work in professions that involve frequent contact with animals or animal products that could be infected with anthrax can get an anthrax vaccine that is highly effective against the disease. People who will be visiting countries where there is poor control of the disease should not eat meat that has not been properly prepared or cooked, and should avoid contact with animals or animal products that could be contaminated.
Anorexia Nervosa
What is it?
Anorexia nervosa is an eating disorder often marked by an unnatural fear of weight gain, compulsive exercising, self-starvation, a distorted body image, and amenorrhea, or absence of at least three consecutive menstrual cycles. There are two sub-types of anorexia nervosa – restricting and binge-purge. Restricting anorexia nervosa is characterized by strict diet and exercise. Binge-purge is marked by periods of compulsive eating with or without self-induced vomiting and the use of laxatives or enemas. Although many diagnosed with anorexia nervosa recover, the disorder can lead to death.
Who gets it?
About 90 percent of those with anorexia nervosa are young women ages 14 to 18. But men and women through their 40s are also at risk. Anorexia nervosa was once considered a disorder of the upper and middle classes. But, more recent studies show that cases of anorexia are becoming more common among young women of all races and social classes in the United States. Adolescents who aspire to be models, professional athletes or performers appear to be at higher risk for developing anorexia nervosa. Anorexia nervosa may be found in people also suffering with depression, anxiety disorders and obsessive-compulsive disorder.
What causes it?
The precise cause of anorexia is not known but is probably the result of a combination of psychological factors, social influences and occupational goals. The changes caused by puberty appear to be a strong influence. Some girls may have difficulty accepting the changes in their bodies in adolescence, especially fat accumulation. This may be coupled with teasing by peers. Other psychological contributors may include reactions to sexual abuse, a desire to appear weak and fragile to the opposite sex, family dysfunction, and an overemphasis on control and independence.
Socially, young women from an early age are conditioned by the media and other sources to believe that only very thin women are considered beautiful.
Many of the risk factors for women are the same for men, a group in which the number of cases is rising especially among homosexuals.
What are the symptoms?
One important sign that someone may be suffering from anorexia nervosa is grossly distorted body image, meaning that the person feels they are overweight and, in fact, appear thin. Other symptoms may include unnatural fear of weight gain, compulsive exercising, self-starvation, loss of energy, and, in girls who have started menstruating, amenorrhea, or absence of at least three consecutive menstrual cycles. Those with anorexia nervosa may begin to appear emaciated.
Over time, the disorder may cause serious health problems including sudden death, congestive heart failure, dental problems, growth retardation, stomach rupture, swelling of the salivary glands, anemia, abnormalities of the blood, loss of kidney function and osteoporosis.
Diagnosis
Many anorexics deny that they have a problem and are usually brought for treatment by a family member.
A physician may look for the following signs that a patient has anorexia nervosa: emaciated body, dry or yellowish skin, abnormally low blood pressure, history of amenorrhea, abdominal pin, constipation and lack of energy. The patient may also have developed lanugo, a soft, downy hair that grows on the arms and chest. If a patient has been vomiting, she may have eroded tooth enamel and Russell’s sign, or scars on the back of the hand. The physician will also assess whether a patient’s weight loss is less than 85 percent of ideal body weight.
Other health concerns that present similar symptoms will need to be ruled out through a series of tests. Those other health conditions may include metabolic disorders, brain tumors, diseases of the digestive tract and mesenteric artery syndrome.
Treatment
The disorder has different levels of severity. The most critical cases may require hospitalization with group and individual therapy and, in some cases, force-feeding. Those with less severe cases may require outpatient psychotherapy and nutrition counseling. Family counseling may also be recommended. Although treatment with medications is debated among physicians, medications including antidepressants, anti-anxiety drugs or others may be recommended.
The majority of anorexics will recover. However, some studies report that about one in 10 may die from complications of anorexia nervosa. Those causes of death include starvation, electrolyte imbalance, heart failure and suicide.
Self care tips
Families should encourage healthy attitudes towards food, body image and exercise and be mindful of the symptoms of anorexia nervosa.
Anorexia nervosa is an eating disorder often marked by an unnatural fear of weight gain, compulsive exercising, self-starvation, a distorted body image, and amenorrhea, or absence of at least three consecutive menstrual cycles. There are two sub-types of anorexia nervosa – restricting and binge-purge. Restricting anorexia nervosa is characterized by strict diet and exercise. Binge-purge is marked by periods of compulsive eating with or without self-induced vomiting and the use of laxatives or enemas. Although many diagnosed with anorexia nervosa recover, the disorder can lead to death.
Who gets it?
About 90 percent of those with anorexia nervosa are young women ages 14 to 18. But men and women through their 40s are also at risk. Anorexia nervosa was once considered a disorder of the upper and middle classes. But, more recent studies show that cases of anorexia are becoming more common among young women of all races and social classes in the United States. Adolescents who aspire to be models, professional athletes or performers appear to be at higher risk for developing anorexia nervosa. Anorexia nervosa may be found in people also suffering with depression, anxiety disorders and obsessive-compulsive disorder.
What causes it?
The precise cause of anorexia is not known but is probably the result of a combination of psychological factors, social influences and occupational goals. The changes caused by puberty appear to be a strong influence. Some girls may have difficulty accepting the changes in their bodies in adolescence, especially fat accumulation. This may be coupled with teasing by peers. Other psychological contributors may include reactions to sexual abuse, a desire to appear weak and fragile to the opposite sex, family dysfunction, and an overemphasis on control and independence.
Socially, young women from an early age are conditioned by the media and other sources to believe that only very thin women are considered beautiful.
Many of the risk factors for women are the same for men, a group in which the number of cases is rising especially among homosexuals.
What are the symptoms?
One important sign that someone may be suffering from anorexia nervosa is grossly distorted body image, meaning that the person feels they are overweight and, in fact, appear thin. Other symptoms may include unnatural fear of weight gain, compulsive exercising, self-starvation, loss of energy, and, in girls who have started menstruating, amenorrhea, or absence of at least three consecutive menstrual cycles. Those with anorexia nervosa may begin to appear emaciated.
Over time, the disorder may cause serious health problems including sudden death, congestive heart failure, dental problems, growth retardation, stomach rupture, swelling of the salivary glands, anemia, abnormalities of the blood, loss of kidney function and osteoporosis.
Diagnosis
Many anorexics deny that they have a problem and are usually brought for treatment by a family member.
A physician may look for the following signs that a patient has anorexia nervosa: emaciated body, dry or yellowish skin, abnormally low blood pressure, history of amenorrhea, abdominal pin, constipation and lack of energy. The patient may also have developed lanugo, a soft, downy hair that grows on the arms and chest. If a patient has been vomiting, she may have eroded tooth enamel and Russell’s sign, or scars on the back of the hand. The physician will also assess whether a patient’s weight loss is less than 85 percent of ideal body weight.
Other health concerns that present similar symptoms will need to be ruled out through a series of tests. Those other health conditions may include metabolic disorders, brain tumors, diseases of the digestive tract and mesenteric artery syndrome.
Treatment
The disorder has different levels of severity. The most critical cases may require hospitalization with group and individual therapy and, in some cases, force-feeding. Those with less severe cases may require outpatient psychotherapy and nutrition counseling. Family counseling may also be recommended. Although treatment with medications is debated among physicians, medications including antidepressants, anti-anxiety drugs or others may be recommended.
The majority of anorexics will recover. However, some studies report that about one in 10 may die from complications of anorexia nervosa. Those causes of death include starvation, electrolyte imbalance, heart failure and suicide.
Self care tips
Families should encourage healthy attitudes towards food, body image and exercise and be mindful of the symptoms of anorexia nervosa.
Angiogram
What is it?
An angiogram is an x-ray picture of the inside of a blood vessel. The procedure used to take an angiogram is called angiography.
Who needs this procedure?
An angiogram shows whether a blood vessel is abnormal in any way, such as blocked, bulging, inflamed, or narrowed. When a patient’s symptoms point to any of these possibilities, angiography is useful in diagnosing the cause. An angiogram can reveal heart disease, atherosclerosis, kidney disorders, brain tumors, problems with the retina, aneurysms, blood clots, and abnormal formations of arteries and veins. It helps determine whether the patient is at risk of stroke or heart attack.
How do I prepare for this procedure?
Your doctor will explain the entire process to you and tell you not to eat or drink anything for a period of time before your angiogram. If you have had an angiogram in the past and know you are allergic to the dye or have an iodine allergy, tell your doctor. Also inform your doctor if you have a history of kidney disease because the dye can make your condition worse. Angiography may not be recommended for people with blood clotting disorders.
bAngiography is usually performed as an outpatient procedure. You may receive a sedative, if necessary, and an intravenous (IV) line in case any medications are needed during the procedure. A healthcare professional called a radiologist will inject a special dye into one of your arteries or veins. The exact location of the injection and the method in which it is injected depends upon the area being studied. The area where the dye is injected will be numbed, and you should feel no more than mild to moderate discomfort. Then, x-ray pictures are bthe dye flows through the blood vessels. The angiogram will reveal anything blocking the path of the dye or other abnormalities along the way. You may feel warm or flushed as the dye spreads through your body. Some patients experience other side effects, such as headache, dizziness, or chest pain just after the dye is injected, but these should pass quickly. After the angiogram is complete, the radiologist will remove the instrument used to inject the dye and apply pressure to the site of the injection. You will need to stay for observation for a period of time after the procedure. Some patients are hospitalized overnight, depending upon the area studied.
What can I expect after the procedure?
While the injection site may feel sore for a while after the procedure, most people experience no side effects from angiography. However, if you experience a drop in blood pressure and/or breathing problems, you are having an allergic reaction to the dye and should contact your doctor immediately. Some patients may develop a hard mass, called a hematoma, around the injection site. Your doctor should monitor this condition because it could mean there is bleeding in that area. If you have had angiography on the retina of your eye, you should protect your eyes from direct sunlight for a time specified by your doctor.
Self-care tips
Give yourself a few days to rest after angiography. Call your doctor if you have any pain, swelling, or bleeding around the site where the dye was injected; or experience dizziness or chest pain.
An angiogram is an x-ray picture of the inside of a blood vessel. The procedure used to take an angiogram is called angiography.
Who needs this procedure?
An angiogram shows whether a blood vessel is abnormal in any way, such as blocked, bulging, inflamed, or narrowed. When a patient’s symptoms point to any of these possibilities, angiography is useful in diagnosing the cause. An angiogram can reveal heart disease, atherosclerosis, kidney disorders, brain tumors, problems with the retina, aneurysms, blood clots, and abnormal formations of arteries and veins. It helps determine whether the patient is at risk of stroke or heart attack.
How do I prepare for this procedure?
Your doctor will explain the entire process to you and tell you not to eat or drink anything for a period of time before your angiogram. If you have had an angiogram in the past and know you are allergic to the dye or have an iodine allergy, tell your doctor. Also inform your doctor if you have a history of kidney disease because the dye can make your condition worse. Angiography may not be recommended for people with blood clotting disorders.
bAngiography is usually performed as an outpatient procedure. You may receive a sedative, if necessary, and an intravenous (IV) line in case any medications are needed during the procedure. A healthcare professional called a radiologist will inject a special dye into one of your arteries or veins. The exact location of the injection and the method in which it is injected depends upon the area being studied. The area where the dye is injected will be numbed, and you should feel no more than mild to moderate discomfort. Then, x-ray pictures are bthe dye flows through the blood vessels. The angiogram will reveal anything blocking the path of the dye or other abnormalities along the way. You may feel warm or flushed as the dye spreads through your body. Some patients experience other side effects, such as headache, dizziness, or chest pain just after the dye is injected, but these should pass quickly. After the angiogram is complete, the radiologist will remove the instrument used to inject the dye and apply pressure to the site of the injection. You will need to stay for observation for a period of time after the procedure. Some patients are hospitalized overnight, depending upon the area studied.
What can I expect after the procedure?
While the injection site may feel sore for a while after the procedure, most people experience no side effects from angiography. However, if you experience a drop in blood pressure and/or breathing problems, you are having an allergic reaction to the dye and should contact your doctor immediately. Some patients may develop a hard mass, called a hematoma, around the injection site. Your doctor should monitor this condition because it could mean there is bleeding in that area. If you have had angiography on the retina of your eye, you should protect your eyes from direct sunlight for a time specified by your doctor.
Self-care tips
Give yourself a few days to rest after angiography. Call your doctor if you have any pain, swelling, or bleeding around the site where the dye was injected; or experience dizziness or chest pain.
Angina
What Is it?
Angina is a temporary pain or tightness that may start in the chest and will sometimes spread to other parts of your upper body. It may start suddenly and may last only a few minutes. Angina will usually occur when there are extra demands placed on the heart, such as during exercise, exposure to extreme hot or cold conditions, windy weather, or during periods of emotional stress. Some people may develop angina at rest or after eating large meals when blood flow must increase to aid in the digestion of foods.
What Are the Symptoms?
The symptoms of angina may vary from person to person. The symptoms may even vary with each episode. They can include a tightness, pressure, aching, or burning behind the breastbone. This sensation may spread or radiate to the arms, neck, jaw, back, or between the shoulder blades.
Other symptoms may include nausea, sweating, shortness of breath, or weakness.
What Causes It?
Angina is caused by a shortage of oxygen and other nutrients reaching the heart muscle. The pain of angina is produced when the heart muscle is starved for oxygen, a condition called ischemia.
Angina occurs most often when the coronary arteries of your heart become narrowed or clogged with deposits of fatty plaque-like substances. This disease is called atherosclerosis.
What Should You Do if You Experience Angina?
If you think you are having angina, you should follow these steps:
STOP what you are doing. SIT DOWN AND REST.
If the symptoms are not gone in 2 to 3 minutes, place a nitroglycerin tablet under your tongue and let it dissolve. You may feel a slight sense of stinging or burning under your tongue,this means the nitroglycerin is working to help relieve your angina.
Wait 3 to 5 minutes. If your angina is still present, take a second nitroglycerin tablet.
Again, wait 3 to 5 minutes. If the symptoms remain, take a third nitroglycerin tablet.
If your angina has not subsided after the third nitroglycerin tablet or after 15 minutes since you first began experiencing discomfort, call an ambulance or have someone drive you to the nearest emergency room.
DO NOT IGNORE THESE WARNING SYMPTOMS!!!!
Helpful Hints about Nitroglycerin tablets.The burning sensation described earlier is not always an indication that the tablet is fresh. The best way to know if your tablets are fresh is to replace them approximately every 6 months.
Another helpful hint is to "check mark" the bottle every time you open it. Once you get to six "check marks" replace the bottle.
All formations of nitroglycerin should be kept at room temperature. The sublingual (under your tongue) tablets are especially susceptible to moisture. They should NOT be kept in bathrooms or kitchens because of higher degrees of moisture there.
If carrying nitroglycerin sublingual tablets with you, you may want to check with your pharmacist for devices to aid you in carrying your nitroglycerin bottle (e.g. a metal cylinder on a chain around your neck).
When Should You Contact Your Family Physician?
Call your physician WITHIN 24 HOURS for any of the following:
· This is the first time you have ever experienced angina.
· You experience angina while resting.
· Your angina is occurring more frequently, has changed location, or is more severe than in the past.
· The nitroglycerin tablets do not work as quickly as they have in the past.
· Your angina has awakened you during the night.
· If your angina has reoccurred following a cardiac catheterization, angioplasty, or open heart surgery procedure(s).
What Can You Do to Avoid Angina?
Many people can control their angina by following their medication regimen prescribed by their physician and by making life-style changes that lower the heart's workload and reduce stress. Other things you can do may include:
Stop smoking (smoking makes the heart work harder)
Lose excess weight
Start an exercise program
Lower your blood cholesterol levels
Avoid eating heavy meals and rest after eating
AVOID outside activities on EXTREMELY HOT OR COLD DAYS
Reduce your stress.
Angina is a temporary pain or tightness that may start in the chest and will sometimes spread to other parts of your upper body. It may start suddenly and may last only a few minutes. Angina will usually occur when there are extra demands placed on the heart, such as during exercise, exposure to extreme hot or cold conditions, windy weather, or during periods of emotional stress. Some people may develop angina at rest or after eating large meals when blood flow must increase to aid in the digestion of foods.
What Are the Symptoms?
The symptoms of angina may vary from person to person. The symptoms may even vary with each episode. They can include a tightness, pressure, aching, or burning behind the breastbone. This sensation may spread or radiate to the arms, neck, jaw, back, or between the shoulder blades.
Other symptoms may include nausea, sweating, shortness of breath, or weakness.
What Causes It?
Angina is caused by a shortage of oxygen and other nutrients reaching the heart muscle. The pain of angina is produced when the heart muscle is starved for oxygen, a condition called ischemia.
Angina occurs most often when the coronary arteries of your heart become narrowed or clogged with deposits of fatty plaque-like substances. This disease is called atherosclerosis.
What Should You Do if You Experience Angina?
If you think you are having angina, you should follow these steps:
STOP what you are doing. SIT DOWN AND REST.
If the symptoms are not gone in 2 to 3 minutes, place a nitroglycerin tablet under your tongue and let it dissolve. You may feel a slight sense of stinging or burning under your tongue,this means the nitroglycerin is working to help relieve your angina.
Wait 3 to 5 minutes. If your angina is still present, take a second nitroglycerin tablet.
Again, wait 3 to 5 minutes. If the symptoms remain, take a third nitroglycerin tablet.
If your angina has not subsided after the third nitroglycerin tablet or after 15 minutes since you first began experiencing discomfort, call an ambulance or have someone drive you to the nearest emergency room.
DO NOT IGNORE THESE WARNING SYMPTOMS!!!!
Helpful Hints about Nitroglycerin tablets.The burning sensation described earlier is not always an indication that the tablet is fresh. The best way to know if your tablets are fresh is to replace them approximately every 6 months.
Another helpful hint is to "check mark" the bottle every time you open it. Once you get to six "check marks" replace the bottle.
All formations of nitroglycerin should be kept at room temperature. The sublingual (under your tongue) tablets are especially susceptible to moisture. They should NOT be kept in bathrooms or kitchens because of higher degrees of moisture there.
If carrying nitroglycerin sublingual tablets with you, you may want to check with your pharmacist for devices to aid you in carrying your nitroglycerin bottle (e.g. a metal cylinder on a chain around your neck).
When Should You Contact Your Family Physician?
Call your physician WITHIN 24 HOURS for any of the following:
· This is the first time you have ever experienced angina.
· You experience angina while resting.
· Your angina is occurring more frequently, has changed location, or is more severe than in the past.
· The nitroglycerin tablets do not work as quickly as they have in the past.
· Your angina has awakened you during the night.
· If your angina has reoccurred following a cardiac catheterization, angioplasty, or open heart surgery procedure(s).
What Can You Do to Avoid Angina?
Many people can control their angina by following their medication regimen prescribed by their physician and by making life-style changes that lower the heart's workload and reduce stress. Other things you can do may include:
Stop smoking (smoking makes the heart work harder)
Lose excess weight
Start an exercise program
Lower your blood cholesterol levels
Avoid eating heavy meals and rest after eating
AVOID outside activities on EXTREMELY HOT OR COLD DAYS
Reduce your stress.
Cerebral Aneurysm
Also known as: Brain Aneurysm; Berry Aneurysm
What is it?
Cerebral aneurysms are abnormal saccular outpouchings of blood vessels occurring on blood vessels of the brain. Aneurysms usually at artery branch points and may take a variety of shapes and sizes. According to some studies, approximately 5% of the population may harbor brain aneurysms. Twenty percent of patients with one cerebral aneurysm will have additional aneurysms. Aneurysms usually cause medical problems by bleeding (rupture) or by putting pressure on near by brain structures.
Who gets it?
Most cerebral aneurysms are sporadic, in other words they are not related to any particular disease or inherited trait. Long-standing hypertension (high blood pressure) and smoking are risk factors for the development and rupture of brain aneurysms. Less commonly, aneurysms can occur in patients with a history of blood vessel wall abnormalities seen in such diseases as Marfan’s syndrome, polycystic kidney disease, fibromuscular dysplasia, connective tissue disorders and coarctation of the aorta. can also predispose patients to intracranial aneurysms. collagen vascular disorders. Aneurysms are usually not hereditary and most do not run in families. However, if a person has a family history of two or more first-degree relatives (e.g. sibling, parent or child) with cerebral aneurysms, the risk of having an aneurysm is increased. In such people, screening for an aneurysm with an MRI/MRA is generally recommended.
What causes it?
Cerebral aneurysms have been thought to develop from weaknesses in blood vessel walls especially at branching. Smoking, high blood pressure and certain connective tissue disorders appear to promote the development of aneurysms. Less commonly, aneurysms may be traumatic in nature secondary to blood vessel injury. Rarely, infectious causes can lead to what are referred to as mycotic aneurysms.
What are the symptoms?
Many patients with cerebral aneurysms have no symptoms. However, the most common reason brain aneurysms come to medical attention is through bleeding (rupture). The typical symptoms of brain aneurysm bleeding include, severe headache (usually described as the worst headache of the patient’s life), a stiff neck, light irritating the eyes and nausea/vomiting. In the absence of aneurysm bleeding, patients may develop focal neurological problems as a growing or changing aneurysm compresses normal brain structures.
How is it diagnosed?
Cerebral aneurysms can be noted on diagnostic imaging studies such as CT scans or MRI/MRA. However, the current gold standard for evaluation of cerebral aneurysms is cerebral angiography. During a cerebral angiogram a catheter is navigated into the arteries feeding the brain and x-ray pictures are obtained while contrast dye is injected through the catheter. Cerebral angiography is usually necessary prior to treatment of an aneurysm. In some situations a CT angiogram, which uses a CT scanner and intravenously injected contrast (no catheter), may be used to assist in delineating some features of the aneurysm.
What is the treatment?
The two major methods of aneurysm treatment are microsurgery and endovascular surgery. Microsurgical treatment for aneurysms involves an open surgical procedure to expose the aneurysm by slipping under and around the brain using delicate instruments and high-powered magnification. Once the aneurysm has been located, a titanium clip is placed across the neck (base) of the aneurysm. The clip stops blood from entering the aneurysm, thereby preventing it from bleeding. In endovascular surgery, a catheter is introduced into a patient's peripheral artery and navigated, using an angiogram as a "road map" to the area where the aneurysm is located. Once found, the aneurysm is then filled from the inside with tiny platinum “coils.” The coils react with the surrounding blood causing it to clot thereby obliterating the aneurysm. Both techniques are effective and each method has certain advantages and disadvantages that vary depending on the size, configuration and location of the aneurysm.
Currently, there are no medicines available to treat brain aneurysms. However, in some instances, depending on the patient’s age and general medical health, as well as the characteristics of the aneurysm itself, it is possible that no treatment will be recommended.
What is it?
Cerebral aneurysms are abnormal saccular outpouchings of blood vessels occurring on blood vessels of the brain. Aneurysms usually at artery branch points and may take a variety of shapes and sizes. According to some studies, approximately 5% of the population may harbor brain aneurysms. Twenty percent of patients with one cerebral aneurysm will have additional aneurysms. Aneurysms usually cause medical problems by bleeding (rupture) or by putting pressure on near by brain structures.
Who gets it?
Most cerebral aneurysms are sporadic, in other words they are not related to any particular disease or inherited trait. Long-standing hypertension (high blood pressure) and smoking are risk factors for the development and rupture of brain aneurysms. Less commonly, aneurysms can occur in patients with a history of blood vessel wall abnormalities seen in such diseases as Marfan’s syndrome, polycystic kidney disease, fibromuscular dysplasia, connective tissue disorders and coarctation of the aorta. can also predispose patients to intracranial aneurysms. collagen vascular disorders. Aneurysms are usually not hereditary and most do not run in families. However, if a person has a family history of two or more first-degree relatives (e.g. sibling, parent or child) with cerebral aneurysms, the risk of having an aneurysm is increased. In such people, screening for an aneurysm with an MRI/MRA is generally recommended.
What causes it?
Cerebral aneurysms have been thought to develop from weaknesses in blood vessel walls especially at branching. Smoking, high blood pressure and certain connective tissue disorders appear to promote the development of aneurysms. Less commonly, aneurysms may be traumatic in nature secondary to blood vessel injury. Rarely, infectious causes can lead to what are referred to as mycotic aneurysms.
What are the symptoms?
Many patients with cerebral aneurysms have no symptoms. However, the most common reason brain aneurysms come to medical attention is through bleeding (rupture). The typical symptoms of brain aneurysm bleeding include, severe headache (usually described as the worst headache of the patient’s life), a stiff neck, light irritating the eyes and nausea/vomiting. In the absence of aneurysm bleeding, patients may develop focal neurological problems as a growing or changing aneurysm compresses normal brain structures.
How is it diagnosed?
Cerebral aneurysms can be noted on diagnostic imaging studies such as CT scans or MRI/MRA. However, the current gold standard for evaluation of cerebral aneurysms is cerebral angiography. During a cerebral angiogram a catheter is navigated into the arteries feeding the brain and x-ray pictures are obtained while contrast dye is injected through the catheter. Cerebral angiography is usually necessary prior to treatment of an aneurysm. In some situations a CT angiogram, which uses a CT scanner and intravenously injected contrast (no catheter), may be used to assist in delineating some features of the aneurysm.
What is the treatment?
The two major methods of aneurysm treatment are microsurgery and endovascular surgery. Microsurgical treatment for aneurysms involves an open surgical procedure to expose the aneurysm by slipping under and around the brain using delicate instruments and high-powered magnification. Once the aneurysm has been located, a titanium clip is placed across the neck (base) of the aneurysm. The clip stops blood from entering the aneurysm, thereby preventing it from bleeding. In endovascular surgery, a catheter is introduced into a patient's peripheral artery and navigated, using an angiogram as a "road map" to the area where the aneurysm is located. Once found, the aneurysm is then filled from the inside with tiny platinum “coils.” The coils react with the surrounding blood causing it to clot thereby obliterating the aneurysm. Both techniques are effective and each method has certain advantages and disadvantages that vary depending on the size, configuration and location of the aneurysm.
Currently, there are no medicines available to treat brain aneurysms. However, in some instances, depending on the patient’s age and general medical health, as well as the characteristics of the aneurysm itself, it is possible that no treatment will be recommended.
Aortic Aneurysm
What is it?
An aneurysm is an area of enlargement of a blood vessel due to the weakening of the vessel wall thus causing a bulge. If the aneurysm remains undetected, the area could rupture which is referred to as a dissection. In Cardiothoracic Surgery we specifically deal with aneurysms in the chest (thorax), not abdominal aneurysms. [These may be referred to as an ascending aortic aneurysm, or an aortic arch aneurysm] The type of aneurysm refers to its location in the chest. For example, an aortic arch aneurysm is a bulge along the arch of the aorta.
What are the symptoms?
The symptoms of an aneurysm are often vague, or nonexistent. In some instances if the aneurysm grows rapidly, the patient may experience chest or back pain.
Aneurysms are often without any definitive symptoms. However, if the patient should have a pre-existing medical condition such as Marfan's Syndrome, they should be checked regularly with chest x-ray or CT scan.
Diagnosis
Aneurysms are associated with certain medical conditions, such as Marfan's Syndrome or untreated hypertension. In the case of Marfan's, the patient should be evaluated regularly with chest x-ray or CT scan since aneurysms are very often without definitive symptoms. In most instances aneurysms are usually detected as a result of a chest x-ray done for some other medical evaluation. It will show up as a mass. A CT scan or an MRI is then used to determine the exact size and location of the aneurysm.
Treatment
If an aneurysm is diagnosed, a surveillance protocol is initiated to chart the size of the aneurysm along with medical management which may include a combination of diet, exercise, and medication aimed at reducing blood pressure. If the aneurysm continues to grow and reaches the calculated size (usually 6 cm) indicative of possible rupture, then surgery is discussed with the patient. Surgery is the only cure for an aortic aneurysm. However, the timing of surgery is based on the risk of surgery versus the risk of rupture.
Surgical repair of the aneurysm is done through an incision made along the left side of the chest, under the arm (left lateral thoracotomy) and the repair is made. Recovery from this procedure is usually 5 to 7 day stay in the hospital with a 4 to 6 week complete recovery.
An aneurysm is an area of enlargement of a blood vessel due to the weakening of the vessel wall thus causing a bulge. If the aneurysm remains undetected, the area could rupture which is referred to as a dissection. In Cardiothoracic Surgery we specifically deal with aneurysms in the chest (thorax), not abdominal aneurysms. [These may be referred to as an ascending aortic aneurysm, or an aortic arch aneurysm] The type of aneurysm refers to its location in the chest. For example, an aortic arch aneurysm is a bulge along the arch of the aorta.
What are the symptoms?
The symptoms of an aneurysm are often vague, or nonexistent. In some instances if the aneurysm grows rapidly, the patient may experience chest or back pain.
Aneurysms are often without any definitive symptoms. However, if the patient should have a pre-existing medical condition such as Marfan's Syndrome, they should be checked regularly with chest x-ray or CT scan.
Diagnosis
Aneurysms are associated with certain medical conditions, such as Marfan's Syndrome or untreated hypertension. In the case of Marfan's, the patient should be evaluated regularly with chest x-ray or CT scan since aneurysms are very often without definitive symptoms. In most instances aneurysms are usually detected as a result of a chest x-ray done for some other medical evaluation. It will show up as a mass. A CT scan or an MRI is then used to determine the exact size and location of the aneurysm.
Treatment
If an aneurysm is diagnosed, a surveillance protocol is initiated to chart the size of the aneurysm along with medical management which may include a combination of diet, exercise, and medication aimed at reducing blood pressure. If the aneurysm continues to grow and reaches the calculated size (usually 6 cm) indicative of possible rupture, then surgery is discussed with the patient. Surgery is the only cure for an aortic aneurysm. However, the timing of surgery is based on the risk of surgery versus the risk of rupture.
Surgical repair of the aneurysm is done through an incision made along the left side of the chest, under the arm (left lateral thoracotomy) and the repair is made. Recovery from this procedure is usually 5 to 7 day stay in the hospital with a 4 to 6 week complete recovery.
Sickle Cell Anemia
What is it?
Sickle cell anemia is an inherited blood disorder that causes red blood cells to be abnormally shaped. The condition can cause anemia, painful events and various complications.
Who gets it?
Sickle cell anemia primarily affects people of African, Mediterranean, Middle Eastern, and Asian Indian ancestry. In the United States, the disease occurs in one out of every 600 African-Americans.
What causes it?
Sickle cell anemia is cause by a genetic change in hemoglobin, the oxygen-carrying protein inside the red blood cells. This causes the cells to take on a sickle-shape and have a shorter life span, which can cause anemia. Sickle cells are also less flexible and stickier than normal red blood cells, and can become trapped in small blood vessels preventing blood flow and starving tissues and organs. This compromises the delivery of oxygen, which may result in damage to associated tissues and organs. The disease is often inherited.
What are the symptoms?
Symptoms of sickle cell anemia include paleness of skin as the anemia worsens, especially on the insides of eyelids, under fingernails and in the creases of the palm of the hand. The skin may also turn yellow (jaundiced). If the anemia is severe, the shortage of normal red blood cells may cause weakness, shortness of breath, or even heart failure. The symptoms of shock caused by heart failure are low blood pressure, rapid pulse, and decreasing consciousness.
How is it diagnosed?
Sickle cell anemia may be diagnosed through a test called hemoglobin electrophoresis. This blood test detects the sickle cell hemoglobin S. It can also be used to find carriers of the sickle cell trait. In addition, the doctor may order a complete blood count to confirm the effects or complications of sickle cell anemia. During this test, red blood cells are counted under a microscope and checked for abnormal shapes.
What is the treatment?
There is no cure for sickle cell anemia, so treatment focuses on lessening a patient’s symptoms and prolonging their lives. Recent studies have shown that the drug hydroxyurea may reduce pain attacks in people with sickle cell anemia. It also has been shown to prolong the lives of patients diagnosed with sickle cell anemia. Patients with sickle cell anemia are more likely to have serious infections such as the flu or pneumonia. Prevention of serious infections is an important part of treatment. The doctor may recommend immunizations are kept up-to-date, get a flu shot each year, and take antibiotics to prevent infections.
Blood transfusions are not usually given on a regular basis but may be used to treat patients who experience frequent and severe painful events, severe anemia, and other emergencies.
Self care tips
Couples who have sickle cell anemia or who are carriers of the disease may consider not having children to prevent the spread of the disease. Screening tests can be used to find carriers. Couples who find that they are carriers should seek genetic counseling.
Sickle cell anemia is an inherited blood disorder that causes red blood cells to be abnormally shaped. The condition can cause anemia, painful events and various complications.
Who gets it?
Sickle cell anemia primarily affects people of African, Mediterranean, Middle Eastern, and Asian Indian ancestry. In the United States, the disease occurs in one out of every 600 African-Americans.
What causes it?
Sickle cell anemia is cause by a genetic change in hemoglobin, the oxygen-carrying protein inside the red blood cells. This causes the cells to take on a sickle-shape and have a shorter life span, which can cause anemia. Sickle cells are also less flexible and stickier than normal red blood cells, and can become trapped in small blood vessels preventing blood flow and starving tissues and organs. This compromises the delivery of oxygen, which may result in damage to associated tissues and organs. The disease is often inherited.
What are the symptoms?
Symptoms of sickle cell anemia include paleness of skin as the anemia worsens, especially on the insides of eyelids, under fingernails and in the creases of the palm of the hand. The skin may also turn yellow (jaundiced). If the anemia is severe, the shortage of normal red blood cells may cause weakness, shortness of breath, or even heart failure. The symptoms of shock caused by heart failure are low blood pressure, rapid pulse, and decreasing consciousness.
How is it diagnosed?
Sickle cell anemia may be diagnosed through a test called hemoglobin electrophoresis. This blood test detects the sickle cell hemoglobin S. It can also be used to find carriers of the sickle cell trait. In addition, the doctor may order a complete blood count to confirm the effects or complications of sickle cell anemia. During this test, red blood cells are counted under a microscope and checked for abnormal shapes.
What is the treatment?
There is no cure for sickle cell anemia, so treatment focuses on lessening a patient’s symptoms and prolonging their lives. Recent studies have shown that the drug hydroxyurea may reduce pain attacks in people with sickle cell anemia. It also has been shown to prolong the lives of patients diagnosed with sickle cell anemia. Patients with sickle cell anemia are more likely to have serious infections such as the flu or pneumonia. Prevention of serious infections is an important part of treatment. The doctor may recommend immunizations are kept up-to-date, get a flu shot each year, and take antibiotics to prevent infections.
Blood transfusions are not usually given on a regular basis but may be used to treat patients who experience frequent and severe painful events, severe anemia, and other emergencies.
Self care tips
Couples who have sickle cell anemia or who are carriers of the disease may consider not having children to prevent the spread of the disease. Screening tests can be used to find carriers. Couples who find that they are carriers should seek genetic counseling.
Sunday, March 8, 2009
Iron-deficiency Anemia
Also known as: Hypochronic microcytic anemia
What is it?
Iron-deficiency anemia is a condition that occurs when there is not enough iron in the blood. Iron is a mineral the body needs to make hemoglobin, the part of the red blood cell that helps carry oxygen from the lungs to the rest of the body.
Who gets it?
Iron-deficiency anemia is the most common type of anemia in the world, affecting mostly women, young children, and older people. It is estimated that 15 percent of menstruating women are affected, and it is particularly common in women of Asian decent.
What causes it?
Any condition in which a person loses blood over a long period of time can cause iron-deficiency anemia. The most common cause in the United States is pregnancy and gastrointestinal bleeding. During pregnancy, a woman needs extra iron for her growing baby.
Bleeding and blood losses through gastrointestinal tract can be caused by colorectal cancer, hookworms, hemorrhoids, anal fissures, irritable bowel syndrome, aspirin-induced bleeding, blood clotting disorders, and diverticulosis (a condition caused by an abnormal opening from the intestine or bladder). Von Willebrand's disease, a genetic condition, can cause bleeding disorders which can cause gastrointestinal bleeding.
Other causes include menstruation, blood loss through the urine, donating blood more than five times per year, not eating healthy foods, chronic inflammation of the intestines, problems with iron absorption and surgery to remove part of the stomach.
What are the symptoms?
Many people who have iron-deficiency anemia don’t realize it. The most common symptoms are feeling tired and weak, paleness of skin, whites of eyes appear blue-like, shortness of breath, dizziness, abdominal pain and lack of appetite. These symptoms result because of the red blood cells are not functioning properly and cannot carry iron to exercising muscles. Other symptoms may include headache, feeling irritable, nails that break easily, burning and soreness on the tongue and in the mouth. Wanting to eat ice, paint, starch, or dirt (a condition called Pica) may be other signs of iron-deficiency anemia.
How is it diagnosed?
To diagnose iron-deficiency anemia, the doctor may look at the patient’s medical history and symptoms to determine what tests should be done. A blood test in combination with a test for oral iron absorption may confirm the diagnosis. The doctor may also want to check the patient’s stools or get x-rays of the bowel to determine if blood loss is a cause of the anemia.
What is the treatment?
The doctor may recommend the patient take oral iron supplements to treat iron-deficiency anemia. If poor iron absorption is a problem, the doctor may recommend therapy with injections of iron. The doctor may recommend a surgery, called an upper and/or lower GI endoscopy, to detect any malignancy. The doctor may also recommend the patient change his or her eating habits to be sure of a well-balanced diet.
Self-care tips
Iron-deficiency anemia is easily cured. Patients should follow their doctor’s recommendations and take their iron supplements and follow a well-balanced, varied diet.
What is it?
Iron-deficiency anemia is a condition that occurs when there is not enough iron in the blood. Iron is a mineral the body needs to make hemoglobin, the part of the red blood cell that helps carry oxygen from the lungs to the rest of the body.
Who gets it?
Iron-deficiency anemia is the most common type of anemia in the world, affecting mostly women, young children, and older people. It is estimated that 15 percent of menstruating women are affected, and it is particularly common in women of Asian decent.
What causes it?
Any condition in which a person loses blood over a long period of time can cause iron-deficiency anemia. The most common cause in the United States is pregnancy and gastrointestinal bleeding. During pregnancy, a woman needs extra iron for her growing baby.
Bleeding and blood losses through gastrointestinal tract can be caused by colorectal cancer, hookworms, hemorrhoids, anal fissures, irritable bowel syndrome, aspirin-induced bleeding, blood clotting disorders, and diverticulosis (a condition caused by an abnormal opening from the intestine or bladder). Von Willebrand's disease, a genetic condition, can cause bleeding disorders which can cause gastrointestinal bleeding.
Other causes include menstruation, blood loss through the urine, donating blood more than five times per year, not eating healthy foods, chronic inflammation of the intestines, problems with iron absorption and surgery to remove part of the stomach.
What are the symptoms?
Many people who have iron-deficiency anemia don’t realize it. The most common symptoms are feeling tired and weak, paleness of skin, whites of eyes appear blue-like, shortness of breath, dizziness, abdominal pain and lack of appetite. These symptoms result because of the red blood cells are not functioning properly and cannot carry iron to exercising muscles. Other symptoms may include headache, feeling irritable, nails that break easily, burning and soreness on the tongue and in the mouth. Wanting to eat ice, paint, starch, or dirt (a condition called Pica) may be other signs of iron-deficiency anemia.
How is it diagnosed?
To diagnose iron-deficiency anemia, the doctor may look at the patient’s medical history and symptoms to determine what tests should be done. A blood test in combination with a test for oral iron absorption may confirm the diagnosis. The doctor may also want to check the patient’s stools or get x-rays of the bowel to determine if blood loss is a cause of the anemia.
What is the treatment?
The doctor may recommend the patient take oral iron supplements to treat iron-deficiency anemia. If poor iron absorption is a problem, the doctor may recommend therapy with injections of iron. The doctor may recommend a surgery, called an upper and/or lower GI endoscopy, to detect any malignancy. The doctor may also recommend the patient change his or her eating habits to be sure of a well-balanced diet.
Self-care tips
Iron-deficiency anemia is easily cured. Patients should follow their doctor’s recommendations and take their iron supplements and follow a well-balanced, varied diet.
Anemia
What is it?
Anemia is condition caused by low levels of healthy red blood cells or hemoglobin (the part of the red blood cells that delivers oxygen from the lungs to the rest of the body). There are over 400 different types of anemia ranging from mild to severe. Many of them are rare.
Who gets it?
Anyone with certain underlying conditions can develop anemia. Those at risk include anyone with chronic blood loss due to cancer, gastrointestinal tumors, hemorrhoids, heavy menstrual flow, stomach ulcers, alcohol abuse, or other medical conditions.
What causes it?
Anemia is caused by chronic bleeding, a decrease in red blood cell production, or an increase in red blood cell destruction. A poor diet low in iron can cause anemia, as can some hereditary disorders and certain diseases. However, excessive bleeding due to cancer, childbirth, injury, gastrointestinal tumors, heavy menstrual flow, hemorrhoids, nosebleeds, stomach ulcers, alcohol abuse and surgery is the most common cause of anemia.
What are the symptoms?
Symptoms of anemia include weakness; fatigue; pale sallow skin; dizziness; lack of color in the palms of hands, gums and nail beds; chest pain; cravings for ice, paint or dirt; headache; inability to concentrate; inflammation of the mouth; insomnia; irregular heartbeat; lack of appetite; nails that are dry and brittle; swelling of the hands and feet; thirst; ringing in the ears and unexplained bleeding or bruising.
How is it diagnosed?
To diagnose anemia, the doctor may look at the patient’s medical history and symptoms to determine what tests should be done. Anemia may be diagnosed through laboratory tests that measure the percentage of red blood cells or the amount of hemoglobin in the blood. The doctor may also use the tests to determine the type of anemia responsible for the patient’s symptoms. In addition, the doctor may order x-rays and examinations of bone marrow to identify the source of the bleeding.
What is the treatment?
Treatment of anemia is usually directed at the underlying cause. The doctor may recommend anemia due to nutritional deficiencies be treated with iron supplements, injections of vitamin B12, or other vitamin supplements. If blood loss is severe, the doctor may recommend the patient undergo transfusions of red blood cells to accelerate their production. Medication or surgery may be necessary to control menstrual flow, repair a bleeding ulcer, or remove polyps (growths or nodules) from the bowels. Cancer-related anemias may be treated with blood transfusions and/or medication.
Self-care tips
While inherited anemias cannot be prevented, avoiding excessive use of alcohol, eating a balanced diet that contains plenty of iron-rich foods, and taking a daily multivitamin can help prevent many types of anemia.
Anemia is condition caused by low levels of healthy red blood cells or hemoglobin (the part of the red blood cells that delivers oxygen from the lungs to the rest of the body). There are over 400 different types of anemia ranging from mild to severe. Many of them are rare.
Who gets it?
Anyone with certain underlying conditions can develop anemia. Those at risk include anyone with chronic blood loss due to cancer, gastrointestinal tumors, hemorrhoids, heavy menstrual flow, stomach ulcers, alcohol abuse, or other medical conditions.
What causes it?
Anemia is caused by chronic bleeding, a decrease in red blood cell production, or an increase in red blood cell destruction. A poor diet low in iron can cause anemia, as can some hereditary disorders and certain diseases. However, excessive bleeding due to cancer, childbirth, injury, gastrointestinal tumors, heavy menstrual flow, hemorrhoids, nosebleeds, stomach ulcers, alcohol abuse and surgery is the most common cause of anemia.
What are the symptoms?
Symptoms of anemia include weakness; fatigue; pale sallow skin; dizziness; lack of color in the palms of hands, gums and nail beds; chest pain; cravings for ice, paint or dirt; headache; inability to concentrate; inflammation of the mouth; insomnia; irregular heartbeat; lack of appetite; nails that are dry and brittle; swelling of the hands and feet; thirst; ringing in the ears and unexplained bleeding or bruising.
How is it diagnosed?
To diagnose anemia, the doctor may look at the patient’s medical history and symptoms to determine what tests should be done. Anemia may be diagnosed through laboratory tests that measure the percentage of red blood cells or the amount of hemoglobin in the blood. The doctor may also use the tests to determine the type of anemia responsible for the patient’s symptoms. In addition, the doctor may order x-rays and examinations of bone marrow to identify the source of the bleeding.
What is the treatment?
Treatment of anemia is usually directed at the underlying cause. The doctor may recommend anemia due to nutritional deficiencies be treated with iron supplements, injections of vitamin B12, or other vitamin supplements. If blood loss is severe, the doctor may recommend the patient undergo transfusions of red blood cells to accelerate their production. Medication or surgery may be necessary to control menstrual flow, repair a bleeding ulcer, or remove polyps (growths or nodules) from the bowels. Cancer-related anemias may be treated with blood transfusions and/or medication.
Self-care tips
While inherited anemias cannot be prevented, avoiding excessive use of alcohol, eating a balanced diet that contains plenty of iron-rich foods, and taking a daily multivitamin can help prevent many types of anemia.
Andropause
Also known as: Male Menopause
What is it?
Andropause, or male menopause, is a condition associated with declining androgen levels. It may result from primary or secondary hypogonadism or from a pathologic condition.
Who gets it?
Andropause affects about half of men older than age 50.
What causes it?
Andropause is caused by lower levels of testosterone and its consequences as men age. Recent studies show that after age 30, testosterone levels generally decrease by one to two percent per year - although this decline can vary widely.
Sudden, drastic declines in testosterone levels are usually caused by hypogonadism. Classified as either primary or secondary, hypogonadism should be ruled out in patients experiencing symptoms of andropause.
What are the symptoms?
Symptoms of andropause can vary from one man to the next. Symptoms of male Andropause may include lethargy or decreased energy, decreased libido or interest in sex, erectile dysfunction with loss of erections, muscle weakness and aches, inability to sleep, hot flashes, night sweats, depression, infertility and thinning of bones or bone loss.
How is it diagnosed?
Andropause can be diagnosed by measuring the level of testosterone in the blood. Andropause occurs as a result of testosterone deficiency and a low free and bioavailable testosterone level is found in males with androgen deficiency. Total testosterone levels can be used as a screen for the Andropause but it is the decrease in the free form of testosterone that causes the symptoms.
Usually testosterone deficiency is not the most common cause of impotence; other causes include atherosclerosis, diabetes, hypertension, and use of certain medications. These factors, as well as previous genital trauma and other aspects of the patient’s medical history, are important in diagnosing andropause.
What is the treatment?
To treat andropause, the doctor may advise the patient to undergo hormone replacement therapy. Replacing testosterone can have a significant benefit particularly in older men with an improvement in well-being, improved sex drive, improved sexual function, improved muscle mass and strength and an increase in bone density. There are now several alternatives available for testosterone replacement therapy in the form of skin patches and creams that can deliver testosterone into the blood in a non-invasive way.
Men who are carefully selected for hormone replacement therapy must be monitored for signs of prostate disease, dyslipidemia, hepatotoxicity, erythrocytosis, and other side effects.
Consult your physician and ask her/him whether you should have a testosterone level determined to see if you are deficient. If you are deficient and are a candidate for testosterone replacement therapy, your physician will prescribe just the right therapy for you. Questions can be directed to the Endocrine Clinic here at Penn State Hershey Medical Center.
Self-care tips
Patients diagnosed with andropause and being treated with hormone replacement therapy should be monitored to check testosterone, lipid and hematocrit levels. That way, treatment can be adjusted according to the patient’s needs and side affects closely monitored
What is it?
Andropause, or male menopause, is a condition associated with declining androgen levels. It may result from primary or secondary hypogonadism or from a pathologic condition.
Who gets it?
Andropause affects about half of men older than age 50.
What causes it?
Andropause is caused by lower levels of testosterone and its consequences as men age. Recent studies show that after age 30, testosterone levels generally decrease by one to two percent per year - although this decline can vary widely.
Sudden, drastic declines in testosterone levels are usually caused by hypogonadism. Classified as either primary or secondary, hypogonadism should be ruled out in patients experiencing symptoms of andropause.
What are the symptoms?
Symptoms of andropause can vary from one man to the next. Symptoms of male Andropause may include lethargy or decreased energy, decreased libido or interest in sex, erectile dysfunction with loss of erections, muscle weakness and aches, inability to sleep, hot flashes, night sweats, depression, infertility and thinning of bones or bone loss.
How is it diagnosed?
Andropause can be diagnosed by measuring the level of testosterone in the blood. Andropause occurs as a result of testosterone deficiency and a low free and bioavailable testosterone level is found in males with androgen deficiency. Total testosterone levels can be used as a screen for the Andropause but it is the decrease in the free form of testosterone that causes the symptoms.
Usually testosterone deficiency is not the most common cause of impotence; other causes include atherosclerosis, diabetes, hypertension, and use of certain medications. These factors, as well as previous genital trauma and other aspects of the patient’s medical history, are important in diagnosing andropause.
What is the treatment?
To treat andropause, the doctor may advise the patient to undergo hormone replacement therapy. Replacing testosterone can have a significant benefit particularly in older men with an improvement in well-being, improved sex drive, improved sexual function, improved muscle mass and strength and an increase in bone density. There are now several alternatives available for testosterone replacement therapy in the form of skin patches and creams that can deliver testosterone into the blood in a non-invasive way.
Men who are carefully selected for hormone replacement therapy must be monitored for signs of prostate disease, dyslipidemia, hepatotoxicity, erythrocytosis, and other side effects.
Consult your physician and ask her/him whether you should have a testosterone level determined to see if you are deficient. If you are deficient and are a candidate for testosterone replacement therapy, your physician will prescribe just the right therapy for you. Questions can be directed to the Endocrine Clinic here at Penn State Hershey Medical Center.
Self-care tips
Patients diagnosed with andropause and being treated with hormone replacement therapy should be monitored to check testosterone, lipid and hematocrit levels. That way, treatment can be adjusted according to the patient’s needs and side affects closely monitored
Androgenetic Alopecia
Also known as: Male Pattern Baldness
What is it?
Male pattern baldness is a common type of hair loss.
Who gets it?
Male pattern baldness occurs in men. While it can occur during a man’s teens, it is often part of the aging process.
What causes it?
Male pattern baldness is genetically inherited, but may also be related to slightly elevated levels of male hormones. Any type of hair loss is caused by the hair entering a resting phase, in which there is no growth. The hair then falls out.
What are the symptoms?
The hair loss seen with male pattern baldness usually starts on the top of the head, toward the back; on the sides; or near the front. After the hair falls out, there is no new regrowth. In many cases, the result is a receding hairline or bald spot. However, some men become completely bald.
How is it diagnosed?
Male pattern baldness is indicated by the pattern of hair loss and a family history of hair loss. However, if your doctor suspects any other cause, he or she may perform a biopsy, in which a small sample of the hair follicle is taken, to determine if the hair follicles are normal.
What is the treatment?
Male pattern baldness does not require treatment. However, some men opt for hair transplants or take medication to promote hair growth. Some medications are applied directly to the bald spots. Others are taken orally. While some medications have been proven effective in growing new hair and preserving existing hair, they must be used daily for the hair to stay. Your doctor can help you determine which treatment is right for you.
Self-care tips
Male pattern baldness is very common and has no effect on your general health. While there is no known way to prevent it, you can help keep the hair you have in the best shape possible by maintaining a healthy lifestyle.
What is it?
Male pattern baldness is a common type of hair loss.
Who gets it?
Male pattern baldness occurs in men. While it can occur during a man’s teens, it is often part of the aging process.
What causes it?
Male pattern baldness is genetically inherited, but may also be related to slightly elevated levels of male hormones. Any type of hair loss is caused by the hair entering a resting phase, in which there is no growth. The hair then falls out.
What are the symptoms?
The hair loss seen with male pattern baldness usually starts on the top of the head, toward the back; on the sides; or near the front. After the hair falls out, there is no new regrowth. In many cases, the result is a receding hairline or bald spot. However, some men become completely bald.
How is it diagnosed?
Male pattern baldness is indicated by the pattern of hair loss and a family history of hair loss. However, if your doctor suspects any other cause, he or she may perform a biopsy, in which a small sample of the hair follicle is taken, to determine if the hair follicles are normal.
What is the treatment?
Male pattern baldness does not require treatment. However, some men opt for hair transplants or take medication to promote hair growth. Some medications are applied directly to the bald spots. Others are taken orally. While some medications have been proven effective in growing new hair and preserving existing hair, they must be used daily for the hair to stay. Your doctor can help you determine which treatment is right for you.
Self-care tips
Male pattern baldness is very common and has no effect on your general health. While there is no known way to prevent it, you can help keep the hair you have in the best shape possible by maintaining a healthy lifestyle.
Anaphylaxis
What is it?
Anaphylaxis is a life-threatening allergic reaction to a substance that is normally harmless to most people.
Who gets it?
Anyone can suffer allergic reactions, but anaphylaxis occurs in people with an extreme sensitivity to a certain substance.
What causes it?
An allergic reaction occurs when the immune system produces antibodies and other disease fighting cells in response to an allergen. An allergen is a substance, most often an insect sting, drug, or food, that causes an allergic response. The antibodies release chemicals that actually injure the surrounding cells and cause the physical symptoms of an allergic reaction. Certain antibodies release histamines, which affect the skin, mucous membrane, mucous gland, and smooth muscle cells. Life-threatening allergic reactions can occur without any previous symptoms of allergy. Exercise or exposure to cold can trigger anaphylaxis in some people.
What are the symptoms?
Symptoms of anaphylaxis occur quickly and progress rapidly. They can include sudden anxiety and weakness, itching, swelling, hives, cramps, diarrhea, vomiting, difficulty breathing, tightness in the chest, very low blood pressure, loss of consciousness, and shock. Anaphylactic shock can occur within minutes and result in death. A patient in anaphylactic shock needs immediate medical treatment.
How is it diagnosed?
Anaphylaxis is diagnosed based upon its rapidly progressing symptoms. Your doctor may order blood and skin tests to identify specific allergens.
What is the treatment?
People who have anaphylactic reactions should, of course, avoid the allergens that trigger this response. Anaphylactic shock is treated with an injection of epinephrine, a hormone that stimulates the heart and relaxes the airways. This may be combined with an injection of an antihistamine, which counteracts the histamine produced by the immune cells during an allergic reaction. Those who are known to have severe allergies should carry a self-injection kit, including antihistamine tablets, for emergency treatment. However, they should still seek medical care after any type of anaphylactic reaction. Patients with anaphylactic reactions may need to receive supplementary oxygen and intravenous (IV) fluids. In severe cases, a breathing tube may need to be inserted to open the airways. People who are severely allergic may undergo a desensitization program, in which a series of injections of the allergen are given in increasingly larger doses until the body shows that it can be tolerated. This type of program must be administered by an allergy specialist and it may take anywhere from 15 to 20 weeks to develop an immunity. These are followed up with monthly booster shots.
Self-care tips
The only way to prevent anaphylaxis is to avoid known allergens. Some of the most common include bee stings, fish and shellfish, penicillin, latex, certain vaccines, nuts and seeds, and certain food additives. If you have a history of anaphylaxis, you should wear a medical ID bracelet containing information on your allergies.
Anaphylaxis is a life-threatening allergic reaction to a substance that is normally harmless to most people.
Who gets it?
Anyone can suffer allergic reactions, but anaphylaxis occurs in people with an extreme sensitivity to a certain substance.
What causes it?
An allergic reaction occurs when the immune system produces antibodies and other disease fighting cells in response to an allergen. An allergen is a substance, most often an insect sting, drug, or food, that causes an allergic response. The antibodies release chemicals that actually injure the surrounding cells and cause the physical symptoms of an allergic reaction. Certain antibodies release histamines, which affect the skin, mucous membrane, mucous gland, and smooth muscle cells. Life-threatening allergic reactions can occur without any previous symptoms of allergy. Exercise or exposure to cold can trigger anaphylaxis in some people.
What are the symptoms?
Symptoms of anaphylaxis occur quickly and progress rapidly. They can include sudden anxiety and weakness, itching, swelling, hives, cramps, diarrhea, vomiting, difficulty breathing, tightness in the chest, very low blood pressure, loss of consciousness, and shock. Anaphylactic shock can occur within minutes and result in death. A patient in anaphylactic shock needs immediate medical treatment.
How is it diagnosed?
Anaphylaxis is diagnosed based upon its rapidly progressing symptoms. Your doctor may order blood and skin tests to identify specific allergens.
What is the treatment?
People who have anaphylactic reactions should, of course, avoid the allergens that trigger this response. Anaphylactic shock is treated with an injection of epinephrine, a hormone that stimulates the heart and relaxes the airways. This may be combined with an injection of an antihistamine, which counteracts the histamine produced by the immune cells during an allergic reaction. Those who are known to have severe allergies should carry a self-injection kit, including antihistamine tablets, for emergency treatment. However, they should still seek medical care after any type of anaphylactic reaction. Patients with anaphylactic reactions may need to receive supplementary oxygen and intravenous (IV) fluids. In severe cases, a breathing tube may need to be inserted to open the airways. People who are severely allergic may undergo a desensitization program, in which a series of injections of the allergen are given in increasingly larger doses until the body shows that it can be tolerated. This type of program must be administered by an allergy specialist and it may take anywhere from 15 to 20 weeks to develop an immunity. These are followed up with monthly booster shots.
Self-care tips
The only way to prevent anaphylaxis is to avoid known allergens. Some of the most common include bee stings, fish and shellfish, penicillin, latex, certain vaccines, nuts and seeds, and certain food additives. If you have a history of anaphylaxis, you should wear a medical ID bracelet containing information on your allergies.
Anterior Cruciate Ligament (ACL) Injury
What is it?
Anterior cruciate ligament (ACL) injury is the most common knee injuring, resulting from a stretch or tear in the ligament. Ligaments are strong bands of tissue that connect one bone to another. The ACL is one of the major ligaments in the knee, connecting the thigh bone (femur) to the shin bone (tibia). It helps to keep the knee stable and protects the femur from sliding or turning on the tibia.
Who gets it?
While anyone can injure an ACL, it is unusual in childhood. The incidence of ACL injury peaks in adults during their middle years.
What causes it?
ACL injuries most often result from sports where the foot is planted on the ground while the leg is being twisted, such as in football, soccer, basketball and skiing. The ACL may also become injured when the knee is straightened further than it normal (hyperextended). It can also occur when the thigh bone is forcefully pushed across the shin bone, such as with a sudden stop while running or a sudden transfer of weight such as in skiing.
A chronic ACL injury is often the result of an injury in which the patient either did not consult a doctor after initial injury, the diagnosis was missed, or nonoperate care of an ACL injury was unsuccessful.
What are the symptoms?
Often the patient will hear a popping sound when the ACL injury occurs and will not be able to continue the activity. Swelling of the knee within the first several hours of injury will usually follow. In the case of a chronic ACL injury, the patient will sometimes experience increasing instability of the knee during twisting and pivoting movements and muscle weakness.
How is it diagnosed?
A doctor may suspect an ACL injury after noticing the knee is loose and swelling is present upon initial examination. To confirm diagnosis, the doctor may draw blood from the knee for testing and order x-rays to be taken to see if there is an injury to the bones in the knee. An MRI test may be done to show the condition of the ACL.
The doctor may also examine the ligament, lateral ligament and posterior cruciate ligament for injury, and may make a comparison of the injured and uninjured knee to make sure that another injury is not overlooked.
In a chronic ACL injury, the longer the injury has been present the more likely it is to have an abnormal appearance on MRI examination. The doctor should also determine if there is an associated instability from other tears.
What is the Treatment?
Initial treatment for an ACL injury may including icing the knee, keeping the knee elevated whenever possible and administering anti-inflammatory medications.
Long-term treatment for ACL injuries may vary for each patient. Activity level, age, job demands, and general medical condition may be factors in the decision to recommend reconstruction. If the knee "gives way" during daily activities, this is a strong indication for surgery to prevent injuries from falls.
Since a torn ACL will not heal by itself, reconstructions by using ligaments or tendons from another part of the body (graft) are used. During ACL reconstruction, holes are drilled in the femur and tibia, and the torn ACL is removed. The graft is passed through the drill holes to replace the ACL, and is anchored in place using screws or staples. The hope is that stabilized knees will allow patients to return to pre-injury activity level and prevent further damage to the knee.
New surgical equipment has made this operation easier to perform and more precise, so that more surgeons are able to perform it. Patients with a chronic ACL injury and recurrent giving way of the knee are also candidates for ACL reconstruction.
Self-care tips
With successful ACL reconstruction, the patient may expect to return to vigorous sporting activities and degenerative changes will be prevented. Current rehabilitation after ACL reconstruction includes achieving full motion very quickly after reconstructive surgery. Exercises such as the leg press, bicycling and stair-climbing machines are usually recommended during rehabilitation.
Anterior cruciate ligament (ACL) injury is the most common knee injuring, resulting from a stretch or tear in the ligament. Ligaments are strong bands of tissue that connect one bone to another. The ACL is one of the major ligaments in the knee, connecting the thigh bone (femur) to the shin bone (tibia). It helps to keep the knee stable and protects the femur from sliding or turning on the tibia.
Who gets it?
While anyone can injure an ACL, it is unusual in childhood. The incidence of ACL injury peaks in adults during their middle years.
What causes it?
ACL injuries most often result from sports where the foot is planted on the ground while the leg is being twisted, such as in football, soccer, basketball and skiing. The ACL may also become injured when the knee is straightened further than it normal (hyperextended). It can also occur when the thigh bone is forcefully pushed across the shin bone, such as with a sudden stop while running or a sudden transfer of weight such as in skiing.
A chronic ACL injury is often the result of an injury in which the patient either did not consult a doctor after initial injury, the diagnosis was missed, or nonoperate care of an ACL injury was unsuccessful.
What are the symptoms?
Often the patient will hear a popping sound when the ACL injury occurs and will not be able to continue the activity. Swelling of the knee within the first several hours of injury will usually follow. In the case of a chronic ACL injury, the patient will sometimes experience increasing instability of the knee during twisting and pivoting movements and muscle weakness.
How is it diagnosed?
A doctor may suspect an ACL injury after noticing the knee is loose and swelling is present upon initial examination. To confirm diagnosis, the doctor may draw blood from the knee for testing and order x-rays to be taken to see if there is an injury to the bones in the knee. An MRI test may be done to show the condition of the ACL.
The doctor may also examine the ligament, lateral ligament and posterior cruciate ligament for injury, and may make a comparison of the injured and uninjured knee to make sure that another injury is not overlooked.
In a chronic ACL injury, the longer the injury has been present the more likely it is to have an abnormal appearance on MRI examination. The doctor should also determine if there is an associated instability from other tears.
What is the Treatment?
Initial treatment for an ACL injury may including icing the knee, keeping the knee elevated whenever possible and administering anti-inflammatory medications.
Long-term treatment for ACL injuries may vary for each patient. Activity level, age, job demands, and general medical condition may be factors in the decision to recommend reconstruction. If the knee "gives way" during daily activities, this is a strong indication for surgery to prevent injuries from falls.
Since a torn ACL will not heal by itself, reconstructions by using ligaments or tendons from another part of the body (graft) are used. During ACL reconstruction, holes are drilled in the femur and tibia, and the torn ACL is removed. The graft is passed through the drill holes to replace the ACL, and is anchored in place using screws or staples. The hope is that stabilized knees will allow patients to return to pre-injury activity level and prevent further damage to the knee.
New surgical equipment has made this operation easier to perform and more precise, so that more surgeons are able to perform it. Patients with a chronic ACL injury and recurrent giving way of the knee are also candidates for ACL reconstruction.
Self-care tips
With successful ACL reconstruction, the patient may expect to return to vigorous sporting activities and degenerative changes will be prevented. Current rehabilitation after ACL reconstruction includes achieving full motion very quickly after reconstructive surgery. Exercises such as the leg press, bicycling and stair-climbing machines are usually recommended during rehabilitation.
Ankylosing Spondylitis
Also known as: Rheumatoid spondylitis or Marie-Strumpell disease
What is it?
Ankylosing spondylitis (AS) is a disease of the connective tissue that results in the inflammation of the joints in the spine. The word "ankylosing" refers to a condition where the bones of a joint are fused, stiff, or rigid. "Spondylitis" is an inflammation of the spine.
Who gets it?
Ankylosing spondylitis (AS) is found in less than 1% of the population. It is three times more likely to occur in men than in women, with symptoms usually occurring for the first time between the ages of 20 and 40. People with a parent or sibling with AS are more likely to have the disorder. Afro-Americans have an approximately 25% higher incidence of AS than Caucasians.
What causes it?
The exact cause of AS is unknown. However, the fact that the disease tends to run in families makes genetics a likely factor. Researchers have identified a gene called HLA-B27 in more than 90% of patients with AS. However, the presence of this gene doesn't guarantee AS. Only around 10 to 15% of people who inherit the gene actually develop this disease.
What are the symptoms?
Like most forms of arthritis, AS flares up, so patients may have periods with no symptoms alternating with periods of mild to moderate symptoms. The most common symptom is back pain. Pain is often worse at night, and stiffness is worse upon waking in the morning. The pain and stiffness in the back can progress to the chest and neck. Patients may find that the pain is relieved by bending forward, which is why people with AS often have a stooped appearance. Eventually, the bones in the back may fuse. In some, the back ends up curved and inflexible. This condition is called "bamboo spine." In others, the back is straight and stiff. AS can also cause eye inflammation, damage to the heart valve, difficulty taking deep breaths, psoriasis, ileitis (inflammation of the small intestine), colitis (inflammation of the large intestine), fever, fatigue, and weight loss.
How is it diagnosed?
If your pattern of symptoms fits the description of AS, your doctor will order x-rays of the spine and pelvis. He or she will look for wear at the joint between the spine and the hip bone, and for abnormalities in the vertebrae. A simple blood test may also reveal the HLA-B27 gene. If AS is diagnosed, you will be referred to a rheumatologist, which is a doctor who specializes in treating arthritis.
What is the treatment?
Treatment of AS is focused on relieving pain and restoring mobility. Drugs called nonsteroidal anti-inflammatories (NSAIDs) are prescribed to relieve pain and stiffness. Your doctor may recommend corticosteroid drugs to treat severe joint and eye inflammation. Corticosteroids are only prescribed for short-term use because of potential side effects. A physical therapist can teach you exercises that will help with breathing and posture, as well as to increase and maintain flexibility. A back brace may also be needed to keep the back straight. Surgery, performed by an orthopedic surgeon, is only considered in severe cases where the hip or knee joint is completely worn away or permanently bent. Alternative treatments, such as herbal remedies and acupuncture, have brought relief to some patients. Consult your doctor before trying any alternative treatments.
Self-care tips
While there is no known way to prevent AS, most patients lead full, productive lives with treatment to control and relieve symptoms
What is it?
Ankylosing spondylitis (AS) is a disease of the connective tissue that results in the inflammation of the joints in the spine. The word "ankylosing" refers to a condition where the bones of a joint are fused, stiff, or rigid. "Spondylitis" is an inflammation of the spine.
Who gets it?
Ankylosing spondylitis (AS) is found in less than 1% of the population. It is three times more likely to occur in men than in women, with symptoms usually occurring for the first time between the ages of 20 and 40. People with a parent or sibling with AS are more likely to have the disorder. Afro-Americans have an approximately 25% higher incidence of AS than Caucasians.
What causes it?
The exact cause of AS is unknown. However, the fact that the disease tends to run in families makes genetics a likely factor. Researchers have identified a gene called HLA-B27 in more than 90% of patients with AS. However, the presence of this gene doesn't guarantee AS. Only around 10 to 15% of people who inherit the gene actually develop this disease.
What are the symptoms?
Like most forms of arthritis, AS flares up, so patients may have periods with no symptoms alternating with periods of mild to moderate symptoms. The most common symptom is back pain. Pain is often worse at night, and stiffness is worse upon waking in the morning. The pain and stiffness in the back can progress to the chest and neck. Patients may find that the pain is relieved by bending forward, which is why people with AS often have a stooped appearance. Eventually, the bones in the back may fuse. In some, the back ends up curved and inflexible. This condition is called "bamboo spine." In others, the back is straight and stiff. AS can also cause eye inflammation, damage to the heart valve, difficulty taking deep breaths, psoriasis, ileitis (inflammation of the small intestine), colitis (inflammation of the large intestine), fever, fatigue, and weight loss.
How is it diagnosed?
If your pattern of symptoms fits the description of AS, your doctor will order x-rays of the spine and pelvis. He or she will look for wear at the joint between the spine and the hip bone, and for abnormalities in the vertebrae. A simple blood test may also reveal the HLA-B27 gene. If AS is diagnosed, you will be referred to a rheumatologist, which is a doctor who specializes in treating arthritis.
What is the treatment?
Treatment of AS is focused on relieving pain and restoring mobility. Drugs called nonsteroidal anti-inflammatories (NSAIDs) are prescribed to relieve pain and stiffness. Your doctor may recommend corticosteroid drugs to treat severe joint and eye inflammation. Corticosteroids are only prescribed for short-term use because of potential side effects. A physical therapist can teach you exercises that will help with breathing and posture, as well as to increase and maintain flexibility. A back brace may also be needed to keep the back straight. Surgery, performed by an orthopedic surgeon, is only considered in severe cases where the hip or knee joint is completely worn away or permanently bent. Alternative treatments, such as herbal remedies and acupuncture, have brought relief to some patients. Consult your doctor before trying any alternative treatments.
Self-care tips
While there is no known way to prevent AS, most patients lead full, productive lives with treatment to control and relieve symptoms
Androgenetic Alopecia
Also known as: Male Pattern Baldness
What is it?
Male pattern baldness is a common type of hair loss.
Who gets it?
Male pattern baldness occurs in men. While it can occur during a man’s teens, it is often part of the aging process.
What causes it?
Male pattern baldness is genetically inherited, but may also be related to slightly elevated levels of male hormones. Any type of hair loss is caused by the hair entering a resting phase, in which there is no growth. The hair then falls out.
What are the symptoms?
The hair loss seen with male pattern baldness usually starts on the top of the head, toward the back; on the sides; or near the front. After the hair falls out, there is no new regrowth. In many cases, the result is a receding hairline or bald spot. However, some men become completely bald.
How is it diagnosed?
Male pattern baldness is indicated by the pattern of hair loss and a family history of hair loss. However, if your doctor suspects any other cause, he or she may perform a biopsy, in which a small sample of the hair follicle is taken, to determine if the hair follicles are normal.
What is the treatment?
Male pattern baldness does not require treatment. However, some men opt for hair transplants or take medication to promote hair growth. Some medications are applied directly to the bald spots. Others are taken orally. While some medications have been proven effective in growing new hair and preserving existing hair, they must be used daily for the hair to stay. Your doctor can help you determine which treatment is right for you.
Self-care tips
Male pattern baldness is very common and has no effect on your general health. While there is no known way to prevent it, you can help keep the hair you have in the best shape possible by maintaining a healthy lifestyle.
What is it?
Male pattern baldness is a common type of hair loss.
Who gets it?
Male pattern baldness occurs in men. While it can occur during a man’s teens, it is often part of the aging process.
What causes it?
Male pattern baldness is genetically inherited, but may also be related to slightly elevated levels of male hormones. Any type of hair loss is caused by the hair entering a resting phase, in which there is no growth. The hair then falls out.
What are the symptoms?
The hair loss seen with male pattern baldness usually starts on the top of the head, toward the back; on the sides; or near the front. After the hair falls out, there is no new regrowth. In many cases, the result is a receding hairline or bald spot. However, some men become completely bald.
How is it diagnosed?
Male pattern baldness is indicated by the pattern of hair loss and a family history of hair loss. However, if your doctor suspects any other cause, he or she may perform a biopsy, in which a small sample of the hair follicle is taken, to determine if the hair follicles are normal.
What is the treatment?
Male pattern baldness does not require treatment. However, some men opt for hair transplants or take medication to promote hair growth. Some medications are applied directly to the bald spots. Others are taken orally. While some medications have been proven effective in growing new hair and preserving existing hair, they must be used daily for the hair to stay. Your doctor can help you determine which treatment is right for you.
Self-care tips
Male pattern baldness is very common and has no effect on your general health. While there is no known way to prevent it, you can help keep the hair you have in the best shape possible by maintaining a healthy lifestyle.
Amyotrophic Lateral Sclerosis
Also known as: Lou Gehrig's disease
What is it?
Amyotrophic lateral sclerosis (ALS) is a progressive disease in which the nerve cells that control voluntary muscle movement gradually deteriorate, leading to muscle weakness and eventual paralysis. “Amyotrophic” means the loss of muscle bulk, “lateral” refers to the nerve tracks running down both sides of the spinal cord that are affected, and “sclerosis” refers to the thickening or hardening of the muscle tissue. Also called Lou Gehrig's disease, after the celebrated American baseball player who died of ALS. ALS is also referred to as a motor neuron disease.
Who gets it?
ALS is a rare disease, affecting approximately 30,000 Americans. It is usually diagnosed in people between the ages of 35 and 70. It is slightly more common in men than women.
What causes it?
The cause of ALS is not known. While it can run in families, called familial ALS, it is most often found in people with no family history of the disease, called sporadic ALS. There is a possibility that there is a connection between sporadic ALS and an overproduction of toxic molecular fragments called free radicals in the body, an autoimmune response, viral factors, environmental toxins, or premature aging. However, research has not been conclusive. Western Pacific ALS is a form of the disease that is seen in Guam and other Pacific islands. This form of ALS includes some symptoms of Parkinson's disease.
What are the symptoms?
The symptoms of ALS occur when the motor neurons in the brain and spinal cord begin to degenerate. The motor neurons are nerve cells responsible for sending messages from the brain to the muscles to stimulate movement. As the motor neurons degenerate and die, the muscles become weak and incapable of normal movement, which leads to a loss of muscle bulk, called wasting. The weakness usually begins in the hands, making everyday activities such as fastening buttons and tying a shoe difficult. This weakness then progresses up the arm. Weakness can also begin in the feet and progress up the leg. Weakness in the feet and ankles may first be noticed as frequent stumbling or clumsiness. It leads to a condition called foot drop, in which the feet drag when the patient walks. Over time, the patient experiences muscle cramps, spasms, and tremors. When muscles in the throat are affected, speech becomes slurred or slowed, and the patient may have difficulty swallowing. As the muscles of the diaphragm weaken, a respirator is needed to help with breathing. ALS does not affect mental function, the senses, bowel and bladder function, or the eye muscles. Because ALS progresses until it affects almost all the voluntary muscle groups in the body, patients are eventually able to move only their eyes. ALS is a fatal disease. Because the weakened respiratory and swallowing muscles make it difficult to cough and swallow food, the most likely cause of death is lung infection caused by the inhalation of food or saliva into the lungs, called aspiration.
How is it diagnosed?
ALS is diagnosed by a thorough physical examination and a study of the patient’s medical history and pattern of symptoms. While there is no specific diagnostic test for ALS, the doctor will order tests of the brain and nervous system to rule out other causes. A test called electromyography (EMG) is used to measure the electrical activity in the muscles, which will help determine if the symptoms are caused by an abnormality in the nerves or muscles. The doctor may also order blood and urine tests, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and x-rays.
What is the treatment?
There is no cure for ALS. Patients in the beginning stages of the disease should remain as active as possible. Studies have shown that taking a drug called riluzole early in the disease can slow the progression of symptoms slightly. As symptoms progress, treatment involves supporting the patient with physical therapy to prevent muscle shortening (contractures), keep the muscles as strong as possible, and maintain a good range of motion. Drugs are available to reduce muscle cramping. A speech pathologist can help with communication and swallowing difficulties. It is extremely important that ALS patients follow a special diet to prevent choking and aspiration of food. Some patients must be fed through a gastrostomy tube, which is inserted through the abdominal wall into the stomach. Patients who become unable to breathe on their own use a mechanical ventilator. Most ALS patients eventually require full-time nursing care.
Self-care tips
It is difficult to maintain a positive outlook in the face of ALS. For this reason, emotional support is extremely important. If you have been diagnosed with ALS, learn all you can about the disease and decide what type of medical treatment is acceptable to you as the disease progresses. Make sure your healthcare provider, family, and friends are aware of your choices.
What is it?
Amyotrophic lateral sclerosis (ALS) is a progressive disease in which the nerve cells that control voluntary muscle movement gradually deteriorate, leading to muscle weakness and eventual paralysis. “Amyotrophic” means the loss of muscle bulk, “lateral” refers to the nerve tracks running down both sides of the spinal cord that are affected, and “sclerosis” refers to the thickening or hardening of the muscle tissue. Also called Lou Gehrig's disease, after the celebrated American baseball player who died of ALS. ALS is also referred to as a motor neuron disease.
Who gets it?
ALS is a rare disease, affecting approximately 30,000 Americans. It is usually diagnosed in people between the ages of 35 and 70. It is slightly more common in men than women.
What causes it?
The cause of ALS is not known. While it can run in families, called familial ALS, it is most often found in people with no family history of the disease, called sporadic ALS. There is a possibility that there is a connection between sporadic ALS and an overproduction of toxic molecular fragments called free radicals in the body, an autoimmune response, viral factors, environmental toxins, or premature aging. However, research has not been conclusive. Western Pacific ALS is a form of the disease that is seen in Guam and other Pacific islands. This form of ALS includes some symptoms of Parkinson's disease.
What are the symptoms?
The symptoms of ALS occur when the motor neurons in the brain and spinal cord begin to degenerate. The motor neurons are nerve cells responsible for sending messages from the brain to the muscles to stimulate movement. As the motor neurons degenerate and die, the muscles become weak and incapable of normal movement, which leads to a loss of muscle bulk, called wasting. The weakness usually begins in the hands, making everyday activities such as fastening buttons and tying a shoe difficult. This weakness then progresses up the arm. Weakness can also begin in the feet and progress up the leg. Weakness in the feet and ankles may first be noticed as frequent stumbling or clumsiness. It leads to a condition called foot drop, in which the feet drag when the patient walks. Over time, the patient experiences muscle cramps, spasms, and tremors. When muscles in the throat are affected, speech becomes slurred or slowed, and the patient may have difficulty swallowing. As the muscles of the diaphragm weaken, a respirator is needed to help with breathing. ALS does not affect mental function, the senses, bowel and bladder function, or the eye muscles. Because ALS progresses until it affects almost all the voluntary muscle groups in the body, patients are eventually able to move only their eyes. ALS is a fatal disease. Because the weakened respiratory and swallowing muscles make it difficult to cough and swallow food, the most likely cause of death is lung infection caused by the inhalation of food or saliva into the lungs, called aspiration.
How is it diagnosed?
ALS is diagnosed by a thorough physical examination and a study of the patient’s medical history and pattern of symptoms. While there is no specific diagnostic test for ALS, the doctor will order tests of the brain and nervous system to rule out other causes. A test called electromyography (EMG) is used to measure the electrical activity in the muscles, which will help determine if the symptoms are caused by an abnormality in the nerves or muscles. The doctor may also order blood and urine tests, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and x-rays.
What is the treatment?
There is no cure for ALS. Patients in the beginning stages of the disease should remain as active as possible. Studies have shown that taking a drug called riluzole early in the disease can slow the progression of symptoms slightly. As symptoms progress, treatment involves supporting the patient with physical therapy to prevent muscle shortening (contractures), keep the muscles as strong as possible, and maintain a good range of motion. Drugs are available to reduce muscle cramping. A speech pathologist can help with communication and swallowing difficulties. It is extremely important that ALS patients follow a special diet to prevent choking and aspiration of food. Some patients must be fed through a gastrostomy tube, which is inserted through the abdominal wall into the stomach. Patients who become unable to breathe on their own use a mechanical ventilator. Most ALS patients eventually require full-time nursing care.
Self-care tips
It is difficult to maintain a positive outlook in the face of ALS. For this reason, emotional support is extremely important. If you have been diagnosed with ALS, learn all you can about the disease and decide what type of medical treatment is acceptable to you as the disease progresses. Make sure your healthcare provider, family, and friends are aware of your choices.
Amyloidosis
What is it?
Amyloidosis is a progressive disease in which deposits of a waxy, starch-like protein called amyloid accumulate in one or more organs or body systems. Amyloid proteins are not usually found in the body, but are manufactured by malfunctioning bone marrow. As the amyloid deposits build up, they begin to interfere with the normal function of the organ or body system.
Who gets it?
Amyloidosis occurs in only eight of every one million people. Symptoms usually occur after age 40. Males and females are equally affected.
What causes it?
There are at least 15 different types of amyloidosis. The major forms are primary, secondary, and hereditary. The cause of primary amyloidosis is not known. However, it is associated with abnormalities in blood cells because it often occurs in people with bone marrow cancer (multiple myeloma). Secondary amyloidosis occurs in people who have a chronic infection or inflammatory disease, such as tuberculosis, a bacterial infection called familial Mediterranean fever, bone infections (osteomyelitis), rheumatoid arthritis, inflammation of the small intestine (granulomatous ileitis), Hodgkin's disease, and leprosy. Hereditary amyloidosis occurs in most ethnic groups, and is the only inherited form of the disease. Researchers believe a child needs to receive just one copy of the defective gene to inherit amyloidosis. This pattern of inheritance is called autosomal dominance. If one parent has hereditary amyloidosis, the child will have a 50% chance of developing the disease. There is also a form of amyloidosis associated with Alzheimer's disease.
What are the symptoms?
Symptoms of amyloidosis depend upon the area of the amyloid deposits and can range from mild to severe. In some cases, amyloidosis can cause organ failure and death. The areas typically affected include the heart, gastrointestinal system, kidneys, liver and spleen, lungs, skin, thyroid and adrenal glands, lymph nodes, and blood vessels. Amyloid deposits in the heart make it difficult for the heart to function properly, resulting in shortness of breath, irregular heartbeat, and congestive heart failure. Symptoms of amyloid in the gastrointestinal system include a tongue that is thick and inflamed, signs of malnutrition caused by poor absorption of food, intestinal bleeding, abdominal pain, constipation, and diarrhea. Kidney damage is indicated by swelling in the feet and legs, protein in the urine, high cholesterol that cannot be reduced with medication, and a distaste for foods rich in protein. The liver and spleen will enlarge, and the spleen can rupture as amyloid accumulates. Amyloid deposits in the sinuses, larynx, and trachea will block the airways, making breathing difficult. Approximately half of all people with primary or secondary amyloidosis have skin symptoms. These include waxy-looking raised bumps, called papules, usually located on the face and neck; in the groin, armpits, or anal area; on the tongue; or in the ear canals. Patients may also have skin swelling, hair loss, and dry mouth. Amyloidosis can affect blood clotting, so symptoms may include abnormal bleeding or bruising. Hereditary amyloidosis almost always affects the nervous system. Symptoms may include inflammation and degeneration of the peripheral nerves (peripheral neuropathy), carpal tunnel, weakness, and abnormal sensations.
How is it diagnosed?
If your doctor suspects you have amyloidosis, either because of organ failure or unexplained bleeding, he or she may order blood and urine tests to check for the amyloid protein. A definite diagnosis is made through a tissue sample (biopsy) from the liver, kidney, skin, gums, or rectum. A bone marrow biopsy might also be performed. Other laboratory and imaging tests can confirm the exact organ or system that is affected. The affected organs are usually enlarged, and feel rubbery and firm.
What is the treatment?
Treatment for amyloidosis is determined by the type and extent of the disease. Drugs such as colchicin, prednisone, and other anti-inflammatories are commonly used to slow or stop the progression of this disease. In fact, cholchicine has been known to prevent amyloidosis in patients with familial Mediterranean fever. Chemotherapy drugs, such as melphalan, may also be used to treat this disease. Doctors have found that patients are able to tolerate higher doses of melphalan, which are more effective against amyloidosis, if they undergo bone marrow or stem cell transplants. All blood cells originate from stem cells, which are found in the bone marrow. In cases of secondary amyloidosis, where amyloid deposits are caused by another disease, treating that disease can slow down or even reverse amyloidosis. Symptoms caused by heart or kidney damage are usually treated with medication and dialysis. Heart and kidney transplants may be considered; however, there is a possibility that amyloid will again build up in the new organ. Amyloid deposits sometimes can be surgically removed from a specific area of the body. Surgery can also be performed to relieve nerve pressure in people with hereditary amyloidosis
Self-care tips
The long-term outlook for people with amyloidosis depends upon the extent of the disease. If there is a history of hereditary amyloidosis in your family, you may want to seek genetic counseling before having children.
Amyloidosis is a progressive disease in which deposits of a waxy, starch-like protein called amyloid accumulate in one or more organs or body systems. Amyloid proteins are not usually found in the body, but are manufactured by malfunctioning bone marrow. As the amyloid deposits build up, they begin to interfere with the normal function of the organ or body system.
Who gets it?
Amyloidosis occurs in only eight of every one million people. Symptoms usually occur after age 40. Males and females are equally affected.
What causes it?
There are at least 15 different types of amyloidosis. The major forms are primary, secondary, and hereditary. The cause of primary amyloidosis is not known. However, it is associated with abnormalities in blood cells because it often occurs in people with bone marrow cancer (multiple myeloma). Secondary amyloidosis occurs in people who have a chronic infection or inflammatory disease, such as tuberculosis, a bacterial infection called familial Mediterranean fever, bone infections (osteomyelitis), rheumatoid arthritis, inflammation of the small intestine (granulomatous ileitis), Hodgkin's disease, and leprosy. Hereditary amyloidosis occurs in most ethnic groups, and is the only inherited form of the disease. Researchers believe a child needs to receive just one copy of the defective gene to inherit amyloidosis. This pattern of inheritance is called autosomal dominance. If one parent has hereditary amyloidosis, the child will have a 50% chance of developing the disease. There is also a form of amyloidosis associated with Alzheimer's disease.
What are the symptoms?
Symptoms of amyloidosis depend upon the area of the amyloid deposits and can range from mild to severe. In some cases, amyloidosis can cause organ failure and death. The areas typically affected include the heart, gastrointestinal system, kidneys, liver and spleen, lungs, skin, thyroid and adrenal glands, lymph nodes, and blood vessels. Amyloid deposits in the heart make it difficult for the heart to function properly, resulting in shortness of breath, irregular heartbeat, and congestive heart failure. Symptoms of amyloid in the gastrointestinal system include a tongue that is thick and inflamed, signs of malnutrition caused by poor absorption of food, intestinal bleeding, abdominal pain, constipation, and diarrhea. Kidney damage is indicated by swelling in the feet and legs, protein in the urine, high cholesterol that cannot be reduced with medication, and a distaste for foods rich in protein. The liver and spleen will enlarge, and the spleen can rupture as amyloid accumulates. Amyloid deposits in the sinuses, larynx, and trachea will block the airways, making breathing difficult. Approximately half of all people with primary or secondary amyloidosis have skin symptoms. These include waxy-looking raised bumps, called papules, usually located on the face and neck; in the groin, armpits, or anal area; on the tongue; or in the ear canals. Patients may also have skin swelling, hair loss, and dry mouth. Amyloidosis can affect blood clotting, so symptoms may include abnormal bleeding or bruising. Hereditary amyloidosis almost always affects the nervous system. Symptoms may include inflammation and degeneration of the peripheral nerves (peripheral neuropathy), carpal tunnel, weakness, and abnormal sensations.
How is it diagnosed?
If your doctor suspects you have amyloidosis, either because of organ failure or unexplained bleeding, he or she may order blood and urine tests to check for the amyloid protein. A definite diagnosis is made through a tissue sample (biopsy) from the liver, kidney, skin, gums, or rectum. A bone marrow biopsy might also be performed. Other laboratory and imaging tests can confirm the exact organ or system that is affected. The affected organs are usually enlarged, and feel rubbery and firm.
What is the treatment?
Treatment for amyloidosis is determined by the type and extent of the disease. Drugs such as colchicin, prednisone, and other anti-inflammatories are commonly used to slow or stop the progression of this disease. In fact, cholchicine has been known to prevent amyloidosis in patients with familial Mediterranean fever. Chemotherapy drugs, such as melphalan, may also be used to treat this disease. Doctors have found that patients are able to tolerate higher doses of melphalan, which are more effective against amyloidosis, if they undergo bone marrow or stem cell transplants. All blood cells originate from stem cells, which are found in the bone marrow. In cases of secondary amyloidosis, where amyloid deposits are caused by another disease, treating that disease can slow down or even reverse amyloidosis. Symptoms caused by heart or kidney damage are usually treated with medication and dialysis. Heart and kidney transplants may be considered; however, there is a possibility that amyloid will again build up in the new organ. Amyloid deposits sometimes can be surgically removed from a specific area of the body. Surgery can also be performed to relieve nerve pressure in people with hereditary amyloidosis
Self-care tips
The long-term outlook for people with amyloidosis depends upon the extent of the disease. If there is a history of hereditary amyloidosis in your family, you may want to seek genetic counseling before having children.
Saturday, March 7, 2009
Amenorrhea
Also found under: Menstrual Disorders
What is it?
The term menstrual disorders refers to any of a number of conditions that are related to the menstrual cycle. Menstruation is the shedding of the lining of the uterus (the endometrium) each month, also referred to as the menstrual period. Menstrual periods usually last for five to seven days. Amenorrhea is the term used to describe the absence of menstrual periods. There are two types of amenorrhea. Primary amenorrhea refers to menstrual periods that have not begun by the age of 16. Secondary amenorrhea refers to the absence of three or more menstrual periods in a woman who has had regular periods up to that point. A menstrual period is considered late if it is five or more days overdue according to the woman's usual pattern of periods. A period is considered missed if there is no menstrual flow for 6 or more weeks.
Who gets it?
Any female who has begun menstruating can experience secondary amenorrhea. Girls who do not undergo puberty, the stage of sexual growth during which the breasts begin to bud and the first menstrual period begins, experience primary amenorrhea.
What causes it?
Problems with the uterus, cervix, ovaries, and hormones can cause amenorrhea. The main cause of primary amenorrhea is delayed puberty. Delayed puberty can be caused by a hormonal problem; a birth defect in which the vagina, uterus, or fallopian tubes don't develop normally; or by chromosomal disorders. Chromosomal disorders include Turner's syndrome, in which the cells contain only one X chromosome instead of the two that should be present in females. In rare cases, puberty does not occur because the child may develop as a female, but is genetically male. This may be occur in children born with both sex organs, called hermaphrodites, or with a condition called male pseudohermaphroditism. Both primary and secondary amenorrhea can be caused by high or low levels of thyroid hormones and by Cushing's syndrome, a condition in which the adrenal glands produce too much corticosteroid hormone. The most common cause of secondary amenorrhea in adult women and teenagers is pregnancy. However, many teenagers have irregular periods during the first few years. Breastfeeding, discontinuing birth control pills, physical or emotional stress, depression, malnutrition, drugs used to treat stress and depression, and sudden weight loss or gain can also cause periods to stop. Other causes of secondary amenorrhea can be related to medical conditions such as traumatic brain injury; brain, ovary, or adrenal gland tumors; ovarian cysts; overproduction of prolactin by the pituitary gland; chronic illness; and Asherman's syndrome, which is scarring of the uterine lining caused by infection or surgery. Strenuous exercise can also cause delayed onset of menstruation or missed periods, and is often seen in young female athletes. When menstrual periods stop occurring after menopause, it is called permanent secondary amenorrhea.
What are the symptoms?
Symptoms of amenorrhea vary depending upon the cause. For example, if primary amenorrhea is caused by the failure to undergo puberty, symptoms will include lack of or below normal development of breasts and pubic and underarm hair. If the cause is related to high thyroid hormones, the symptoms will include anxiety, rapid heartbeat, and warm, moist skin. Cushing's syndrome causes symptoms including a round face, enlarged abdomen, and thin arms and legs. When secondary amenorrhea is caused by pregnancy, other signs of early pregnancy may be present, such as nausea, breast swelling, or weight gain. Asherman's syndrome usually produces no symptoms.
How is it diagnosed?
To diagnose amenorrhea, your doctor will take a complete medical history and will perform a physical examination, including a pelvic, or internal, exam. This doctor would most likely be your gynecologist, a doctor who specializes in women's reproductive health. He or she will ask questions about your lifestyle, diet, sexual activity, and any medications you are taking. The doctor will first look for obvious causes of your symptoms. For example, he or she will look for signs of puberty in a teenager who has never gotten her period. If you are sexually active and have had a normal period before your symptoms began, the doctor will order a pregnancy test. A blood sample will reveal if estrogen or the hormones produced by the pituitary, adrenal, or thyroid glands are at abnormal levels. If your doctor suspects a brain tumor or other brain injury is causing your symptoms, he may order a skull x-ray. Tumors of the ovaries or adrenal glands, as well as cysts, can be detected by computed tomography (CT) or ultrasound scans of the abdomen. Your doctor may recommend genetic testing if he suspects a chromosomal disorder such as Turner's syndrome. If your doctor finds nothing abnormal in your exam or tests, irregular periods may be normal for you at this time. This is especially common in teenagers.
What is the treatment?
The treatment of amenorrhea depends on the cause of the problem. If you are pregnant, treatment involves a good program of prenatal care. If symptoms are caused by delayed puberty, the doctor will monitor your progress at regular checkups, often every three to six months. He or she may recommend hormonal supplements of progesterone and/or estrogen to induce puberty. Tumors or cysts are usually treated with surgery, as is an abnormally developed vagina. If high levels of stress are causing your symptoms, your doctor will help you develop a plan for cutting back on some activities or avoiding situations that cause you stress. A therapist may be helpful in these situations. Amenorrhea caused by extreme dieting will resolve itself, and normal periods should start, once a healthy diet is followed. If your doctor finds no cause of your symptoms and you are otherwise healthy, you may simply have an irregular cycle and do not need treatment. Some causes, such as Turner's syndrome, cannot be cured.
Self-care tips
Always check with your doctor if you miss more than one menstrual period, especially if you are sexually active and have not used birth control. If you are overweight, avoid extreme diets that deprive you of the calories you need to stay active and maintain a normal energy level. If you have an irregular cycle, try keeping a record of when your period starts and stops each month. This information will be helpful if you need to see your doctor about your symptoms. Avoid cigarette smoking, recreational drugs, and excessive use of alcohol. Also avoid situations that you know cause extreme stress. If you are involved in strenuous physical activity, you may need to cut back on your program to help your periods become regular again.
What is it?
The term menstrual disorders refers to any of a number of conditions that are related to the menstrual cycle. Menstruation is the shedding of the lining of the uterus (the endometrium) each month, also referred to as the menstrual period. Menstrual periods usually last for five to seven days. Amenorrhea is the term used to describe the absence of menstrual periods. There are two types of amenorrhea. Primary amenorrhea refers to menstrual periods that have not begun by the age of 16. Secondary amenorrhea refers to the absence of three or more menstrual periods in a woman who has had regular periods up to that point. A menstrual period is considered late if it is five or more days overdue according to the woman's usual pattern of periods. A period is considered missed if there is no menstrual flow for 6 or more weeks.
Who gets it?
Any female who has begun menstruating can experience secondary amenorrhea. Girls who do not undergo puberty, the stage of sexual growth during which the breasts begin to bud and the first menstrual period begins, experience primary amenorrhea.
What causes it?
Problems with the uterus, cervix, ovaries, and hormones can cause amenorrhea. The main cause of primary amenorrhea is delayed puberty. Delayed puberty can be caused by a hormonal problem; a birth defect in which the vagina, uterus, or fallopian tubes don't develop normally; or by chromosomal disorders. Chromosomal disorders include Turner's syndrome, in which the cells contain only one X chromosome instead of the two that should be present in females. In rare cases, puberty does not occur because the child may develop as a female, but is genetically male. This may be occur in children born with both sex organs, called hermaphrodites, or with a condition called male pseudohermaphroditism. Both primary and secondary amenorrhea can be caused by high or low levels of thyroid hormones and by Cushing's syndrome, a condition in which the adrenal glands produce too much corticosteroid hormone. The most common cause of secondary amenorrhea in adult women and teenagers is pregnancy. However, many teenagers have irregular periods during the first few years. Breastfeeding, discontinuing birth control pills, physical or emotional stress, depression, malnutrition, drugs used to treat stress and depression, and sudden weight loss or gain can also cause periods to stop. Other causes of secondary amenorrhea can be related to medical conditions such as traumatic brain injury; brain, ovary, or adrenal gland tumors; ovarian cysts; overproduction of prolactin by the pituitary gland; chronic illness; and Asherman's syndrome, which is scarring of the uterine lining caused by infection or surgery. Strenuous exercise can also cause delayed onset of menstruation or missed periods, and is often seen in young female athletes. When menstrual periods stop occurring after menopause, it is called permanent secondary amenorrhea.
What are the symptoms?
Symptoms of amenorrhea vary depending upon the cause. For example, if primary amenorrhea is caused by the failure to undergo puberty, symptoms will include lack of or below normal development of breasts and pubic and underarm hair. If the cause is related to high thyroid hormones, the symptoms will include anxiety, rapid heartbeat, and warm, moist skin. Cushing's syndrome causes symptoms including a round face, enlarged abdomen, and thin arms and legs. When secondary amenorrhea is caused by pregnancy, other signs of early pregnancy may be present, such as nausea, breast swelling, or weight gain. Asherman's syndrome usually produces no symptoms.
How is it diagnosed?
To diagnose amenorrhea, your doctor will take a complete medical history and will perform a physical examination, including a pelvic, or internal, exam. This doctor would most likely be your gynecologist, a doctor who specializes in women's reproductive health. He or she will ask questions about your lifestyle, diet, sexual activity, and any medications you are taking. The doctor will first look for obvious causes of your symptoms. For example, he or she will look for signs of puberty in a teenager who has never gotten her period. If you are sexually active and have had a normal period before your symptoms began, the doctor will order a pregnancy test. A blood sample will reveal if estrogen or the hormones produced by the pituitary, adrenal, or thyroid glands are at abnormal levels. If your doctor suspects a brain tumor or other brain injury is causing your symptoms, he may order a skull x-ray. Tumors of the ovaries or adrenal glands, as well as cysts, can be detected by computed tomography (CT) or ultrasound scans of the abdomen. Your doctor may recommend genetic testing if he suspects a chromosomal disorder such as Turner's syndrome. If your doctor finds nothing abnormal in your exam or tests, irregular periods may be normal for you at this time. This is especially common in teenagers.
What is the treatment?
The treatment of amenorrhea depends on the cause of the problem. If you are pregnant, treatment involves a good program of prenatal care. If symptoms are caused by delayed puberty, the doctor will monitor your progress at regular checkups, often every three to six months. He or she may recommend hormonal supplements of progesterone and/or estrogen to induce puberty. Tumors or cysts are usually treated with surgery, as is an abnormally developed vagina. If high levels of stress are causing your symptoms, your doctor will help you develop a plan for cutting back on some activities or avoiding situations that cause you stress. A therapist may be helpful in these situations. Amenorrhea caused by extreme dieting will resolve itself, and normal periods should start, once a healthy diet is followed. If your doctor finds no cause of your symptoms and you are otherwise healthy, you may simply have an irregular cycle and do not need treatment. Some causes, such as Turner's syndrome, cannot be cured.
Self-care tips
Always check with your doctor if you miss more than one menstrual period, especially if you are sexually active and have not used birth control. If you are overweight, avoid extreme diets that deprive you of the calories you need to stay active and maintain a normal energy level. If you have an irregular cycle, try keeping a record of when your period starts and stops each month. This information will be helpful if you need to see your doctor about your symptoms. Avoid cigarette smoking, recreational drugs, and excessive use of alcohol. Also avoid situations that you know cause extreme stress. If you are involved in strenuous physical activity, you may need to cut back on your program to help your periods become regular again.
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