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.
Sunday, March 8, 2009
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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