Bipolar Disorder

What is Bipolar Disorder?
Bipolar disorder, also known as manic depression, is an illness involving one or more episodes of serious mania and depression. The illness causes a person’s mood to swing from excessively “high” and/or irritable to sad and hopeless, with periods of a normal mood in between. More than 2 million Americans suffer from bipolar disorder.

Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as an illness and people who have it may suffer needlessly for years.

Bipolar disorder can be extremely distressing and disruptive for those who have this disease, their spouses, family members, friends and employers. Although there is no known cure, bipolar disorder is treatable, and recovery is possible. Individuals with bipolar disorder have successful relationships and meaningful jobs. The combination of medications and psychotherapy helps the vast majority of people return to productive, fulfilling lives.

“Bipolar disorder is treatable, and recovery is possible.”

What causes bipolar disorder?

Although a specific genetic link to bipolar disorder has not been found, studies show that 80 to 90 percent of those who suffer from bipolar disorder have relatives with some form of depression.

It is also possible that people may inherit a tendency to develop the illness, which can then be triggered by environmental factors such as distressing life events.

The presence of bipolar disorder indicates a biochemical imbalance which alters a person’s moods. This imbalance is thought to be caused by irregular hormone production or to a problem with certain chemicals in the brain, called neurotransmitters, that act as messengers to our nerve cells.

What are the symptoms of bipolar disorder?

Bipolar disorder is often difficult to recognize and diagnose. It causes a person to have a high level of energy, unrealistically expansive thoughts or ideas, and impulsive or reckless behavior. These symptoms may feel good to a person, which may lead to denial that there is a problem.

Another reason bipolar disorder is difficult to diagnose is that its symptoms may appear to be part of another illness or attributed to other problems such as substance abuse, poor school performance, or trouble in the workplace.

Symptoms of mania

The symptoms of mania, which can last up to three months if untreated, include:

• Excessive energy, activity, restlessness, racing thoughts and rapid talking
• Denial that anything is wrong
• Extreme “high” or euphoric feelings -- a person may feel “on top of the world” and nothing, including bad news or tragic events, can change this “happiness.”
• Easily irritated or distracted.
• Decreased need for sleep – an individual may last for days with little or no sleep without feeling tired.
• Unrealistic beliefs in one’s ability and powers -- a person may experience feelings of exaggerated confidence or unwarranted optimism. This can lead to over ambitious work plans and the belief that nothing can stop him or her from accomplishing any task.
• Uncharacteristically poor judgment -- a person may make poor decisions which may lead to unrealistic involvement in activities, meetings and deadlines, reckless driving, spending sprees and foolish business ventures.
• Sustained period of behavior that is different from usual-- a person may dress and/or act differently than he or she usually does, become a collector of various items, become indifferent to personal grooming, become obsessed with writing, or experience delusions.
• Unusual sexual drive
• Abuse of drugs, particularly cocaine, alcohol or sleeping medications
• Provocative, intrusive, or aggressive behavior -- a person may become enraged or paranoid if his or her grand ideas are stopped or excessive social plans are refused.

Symptoms of Depression

Some people experience periods of normal mood and behavior following a manic phase, however, the depressive phase will eventually appear. Symptoms of depression include:

• Persistent sad, anxious, or empty mood
• Sleeping too much or too little, middle-of-the-night or early morning waking
• Reduced appetite and weight loss or increased appetite and weight gain
• Loss of interest or pleasure in activities, including sex
• Irritability or restlessness
• Difficulty concentrating, remembering or making decisions.
• Fatigue or loss of energy
• Persistent physical symptoms that don’t respond to treatment (such as chronic pain or digestive disorders)
• Thoughts of death or suicide, including suicide attempts
• Feeling guilty, hopeless or worthless

TREATMENT

Treatment is critical for recovery. A combination of medication, professional help and support from family, friends and peers help individuals with bipolar disorder stabilize their emotions and behavior.

Most people with bipolar disorder can be treated with medication. A common medication, Lithium, is effective in controlling mania in 60% of individuals with bipolar disorder. Olanzapine (Zyprexa), an antipsychotic, is a new treatment for bipolar disorder, Carbomazepine (Tegratol) and divalproex sodium (Depakote), which are mood-stabilizers and anticonvulsants, are some of the other medications used. In addition, benzodiazepines are sometimes prescribed for insomnia and thyroid medication can also be helpful.

It is suggested that those with bipolar disorder receive guidance, education and support from a mental health professional to help deal with personal relationships, maintain a healthy self-image and ensure compliance with his or her treatment.

Support and self-help groups are also an invaluable resource for learning coping skills, feeling acceptance and avoiding social isolation. Friends and family should join a support group to better understand the illness so that they can continue to offer encouragement and support to their loves ones.

Eating disorders (Anorexia Nervosa)

Eating disorders are a broad group of serious conditions in which you're so preoccupied with food and weight that you can often focus on little else. The main types of eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder, and there are also many subtypes.

Most people with eating disorders are females, but males also have eating disorders. The exception is binge-eating disorder, which appears to affect almost as many males as females.

Treatments for eating disorders usually involve psychotherapy, nutrition education, family counseling, medications and hospitalization.

Symptoms

The signs and symptoms of eating disorders vary with the particular type of eating disorder.

Anorexia nervosa
When you have anorexia nervosa (an-o-REK-se-uh nur-VOH-suh), you're obsessed with food and being thin, sometimes to the point of deadly self-starvation. You may exercise excessively or simply not eat enough calories.

Anorexia symptoms may include:

• Thin appearance
• Abnormal blood counts
• Fatigue
• Dizziness or fainting
• Brittle nails
• Hair that thins, breaks or falls out
• Soft, downy hair covering the body
• Menstrual irregularities or loss of menstruation (amenorrhea)
• Constipation
• Dry skin
• Frequently being cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration
• Bone loss

Emotional and behavioral symptoms of anorexia may include:

• Refusal to eat
• Denial of hunger
• E xcessive exercise
• Flat mood or lack of emotion
• Difficulty concentrating
• Preoccupation with food

Red flags that family and friends may notice include:

• Skipping meals
• Making excuses for not eating
• Eating only a few certain "safe" foods, usually those low in fat and calories
• Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing
• Weighing food
• Cooking elaborate meals for others but refusing to eat them themselves
• Repeated weighing of themselves
• Frequent checking in the mirror for perceived flaws
• Wearing baggy or layered clothing
• C o mplaining about being fat

Bulimia nervosa

When you have bulimia, you have episodes of bingeing and purging. During these episodes, you typi

cally eat a large amount of food in a short amount of time and then try to rid yourself of the extra calories by vomiting or excessive exercise. In between these binge-purge episodes, you may eat very little or skip meals altogether. You may be a normal weight or even a bit overweigh

t.

Bulimia symptoms may include:

• Abnormal bowel functioning
• Damaged teeth and gums
• Swollen salivary glands in the cheeks
• Sores in the throat and mouth
• Bloating
• Dehydration
• Fatigu e
• Dry skin
• Irregular heartbeat
• Sores, scars or calluses on the knuckles or hands
• Menstrual irregularities or loss of menstruation (amenorrhea)

Emotional and behavioral symptoms of bulimia may include:

• Constant dieting
• Feeling that you can't control your eating behavior
• Eating until the point of discomfort or pain
• Self-induced vomiting
• Laxative use
• Excessive exercise
• Unhealthy focus on body shape and weight
• Having a distorted, excessively negative body image
• Going to the bathroom after eating or during meals
• Hoarding food
• Depression or anxiety

Binge-eating

When you have binge-eating disorder, you regularly eat excessive amounts of food (binge), sometimes for hours on end. You may eat when you're not hungry and continue eating even long after you're uncomfortably full. After a binge, you may try to diet or eat normal meals, triggering a new round of bingeing. You may be a normal weight, overweight or obese.

Emotional and behavioral symptoms of binge-eating disorder may include:

• Eating to the point of discomfort or pain
• Eating much more food during a binge episode than during a normal meal or snack
• Eating faster during binge episodes
• Feeling that your eating behavior is out of control
• Frequent dieting without weight loss
• Frequently eating alone
• Hoarding food
• Hiding empty food containers
• Feeling depressed, disgusted or upset over the amount eaten
• Depression or anxiety

In youngsters Eating disorders can affect people of any age. In children, it's sometimes hard to tell what's an eating disorder and what's simply a whim, a new fad, or experimentation with a vegetarian diet or other eating styles. In addition, many girls and sometimes boys go on diets to lose weight, but stop dieting after a short time. If you're a parent or guardian, be careful not to mistake occasional dieting with an eating disorder. On the other hand, be alert for eating patterns and beliefs that may signal unhealthy behavior, as well as peer pressure that may trigger eating disorders.

Causes

It's not known with certainty what causes eating disorders. As with other mental illnesses, the possible causes are complex and may result from an interaction of biological, psychological, family, genetic, environmental and social factors. Possible causes of eating disorders include:

• Biology. Some people may be genetically vulnerable to developing eating disorders. Some studies show that people with biological siblings or parents with an eating disorder may develop one too, suggesting a possible genetic link. In addition, there's some evidence that serotonin, a naturally occurring brain chemical, may influence eating behaviors because of its connection to the regulation of food intake.
• Psychological and emotional health. People with eating disorders may have psychological and emotional characteristics that contribute to the disorder. They may have low self-esteem, perfectionism, impulsive behavior, anger management difficulties, family conflicts and troubled relationships, for instance.
• Sociocultural issues. The modern Western cultural environment often cultivates and reinforces a desire for thinness. Success and worth are often equated with being thin. The media and entertainment industries often focus on appearance and body shape. Peer pressure may fuel this desire to be thin, particularly among young girls.

Risks

Certain situations and events might increase the risk of developing an eating disorder. These risk factors may include:

• Gender. Teenage girls and young women are more likely than teenage boys and young men to have eating disorders.
• Age. Although eating disorders can occur across a broad age range — from preadolescents to older adults — they are much more common during the teens and early 20s.
• Family influences. People who feel less secure in their families, whose parents and siblings may be overly critical, or whose families tease them about their appearance are at higher risk of eating disorders.
• Emotional disorders. People with depression, anxiety disorders and obsessive-compulsive disorder are more likely to have an eating disorder.
• Dieting. People who lose weight are often reinforced by positive comments from others and by their changing appearance. This dieting may be taken too far and lead to an eating disorder.
• Transitions. Whether it's heading off to college, moving, landing a new job or a relationship breakup, change can bring emotional distress. One way to cope, especially in situations that may be out of someone's control, is to latch on to something that they can control, such as their eating patterns, which can eventually lead to an eating disorder if taken to an extreme.
• Sports, work and artistic activities. Athletes, actors and television personalities, dancers, and models are at higher risk of eating disorders. Eating disorders are particularly common among ballerinas, gymnasts, runners and wrestlers. Coaches and parents may unwittingly contribute to eating disorders by encouraging young athletes to lose weight.
• Media and society. The media, such as television and fashion magazines, frequently focus on body shape and size. Exposure to these images may lead some people to believe that thinness equates to success and popularity.

Tests

Eating disorders are diagnosed based on signs, symptoms and eating habits. When doctors suspect someone has an eating disorder, they typically run a battery of tests and exams. These can help pinpoint a diagnosis and also check for related complications. You may see both a medical doctor and a mental health provider for a diagnosis.

Physical evaluations
These exams and tests generally include:

• Physical exam. This may include such things as measuring height and weight; assessing body mass index; checking vital signs, such as heart rate, blood pressure and temperature; checking the skin for dryness or other problems; listening to the heart and lungs; and examining your abdomen.
• Laboratory tests. These may include a complete blood count (CBC), as well as more specialized blood tests to check electrolytes and protein, as well as liver, kidney and thyroid function. A urinalysis also may be done.
• Other studies. X-rays may be taken to check for broken bones, pneumonia or heart problems. Electrocardiograms may be done to look for heart irregularities. You may also have a bone density test.

Psychological evaluations
In addition to a physical exam, you'll have a thorough psychological evaluation. Your doctor or mental health provider may ask you a number of questions about your eating habits, beliefs and behavior. The questions may focus on your history of dieting, bingeing, purging and exercise. You'll explore how you perceive your body image and how you think others perceive your body image. You may also fill out psychological self-assessments and questionnaires.

Diagnostic criteria
To be diagnosed with an eating disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. Each eating disorder has its own set of diagnostic criteria. Your mental health provider will review your signs and symptoms to see if you meet the necessary diagnostic criteria for a particular eating disorder. Some people may not meet all of the criteria but still have an eating disorder and need professional help to overcome or manage it.

Complications

Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long lasting the eating disorder, the more likely you are to experience serious complications. Complications may include:

• Death
• Heart disease
• Depression
• Suicidal thoughts or behavior
• Absence of menstruation (amenorrhea)
• Bone loss
• Stunted growth
• Nerve damage
• Seizures
• Digestive problems
• Bowel irregularities
• Tooth decay
• Ruptured esophagus
• High blood pressure
• Type 2 diabetes
• Gallbladder disease

Prevention

Although there's no sure way to prevent eating disorders, some steps may help. Pediatricians may be in a good position to identify early indicators of an eating disorder and prevent the development of full-blown illness. They can ask children questions about their eating habits and satisfaction with their appearance during routine medical appointments, for instance. Make sure children attend well-child doctor visits. These visits should include checks of body mass index and weight percentiles. Those checks can provide an early warning about overeating or undereating.

Family dining habits may also influence the relationships children develop with food. Try to eat at least some meals together as a family. Teach children about the pitfalls of dieting, and encourage healthy eating. If your child has symptoms of anxiety, depression or other mood disorders, seek medical care.

Parents and other adults also can cultivate and reinforce a healthy body image in children of any shape or size. Talk to children about their self-image and offer reassurance that body shapes can vary. Don't allow children to be teased about their appearance. And encourage your own children or family members to refrain from joking about other children or adults who are overweight or have a large body frame. These messages of acceptance and respect can help build healthy self-esteem and resilience that will carry children through the rocky periods of adolescence.

In addition, if you notice a family member or friend with low self-esteem, severe dieting, frequent overeating, hoarding of food or dissatisfaction with appearance, consider talking to him or her about these issues. Although you may not be able to prevent an eating disorder from developing, reaching out with compassion may encourage him or her to seek treatment.

Home remedies

When you have an eating disorder, taking care of your health needs often isn't one of your priorities. But proper self-care can help you feel better during and after treatment and help maintain your overall health.

Try to make these steps a part of your routine. But don't beat yourself up if you aren't able to do so every day:

• Stick to your treatment plan. Don't skip therapy sessions and try not to stray from meal plans.
• Talk to your doctor about appropriate vitamin and mineral supplements to make sure you're getting all the essential nutrients.
• Don't isolate yourself from caring family members and friends who want to see you get healthy and have your best interests at heart.
• Talk to your health care providers about what kind of exercise, if any, is appropriate for you.
• Read self-help books that offer sound, practical advice. Consider discussing the books with your health care providers.
• Resist urges to weigh yourself or check yourself in the mirror frequently. Otherwise, you may simply fuel your drive to maintain unhealthy habits.

Allergy

What Is an Allergy?

Allergies are an abnormal response of the immune system. People who have allergies have an immune system that reacts to a usually harmless substance in the environment. This substance (pollen, mold, animal dander, etc.) is called an allergen.

Allergies are a very common problem, affecting at least two out of every 10 Americans.
What Happens During an Allergic Reaction?

First, a person is exposed to an allergen by inhaling it, swallowing it, or getting it on or under their skin. After a person is exposed to the allergen, a series of events create the allergic reaction:

1. The body starts to produce a specific type of antibody, called IgE, to bind the allergen.
2. The antibodies attach to a form of blood cell called a mast cell. Mast cells can be found in the airways, in the intestines, and elsewhere. The presence of mast cells in the airways and GI tract makes these areas more susceptible to allergen exposure.
3. The allergens bind to the IgE, which is attached to the mast cell. This causes the mast cells to release a variety of chemicals into the blood. Histamine, the main chemical, causes most of the symptoms of an allergic reaction.

What Are the Symptoms of an Allergic Reaction?

Common symptoms of an allergic reaction to inhaled or skin allergens include:

• Itchy, watery eyes

• Sneezing

• Itchy, runny nose

• Rashes

• Feeling tired or ill

• Hives (a rash with raised red patches)

Other exposures can cause different allergic reactions:

• Food allergies. An allergic reaction to food allergens can also cause stomach cramps, vomiting, or diarrhea.

• Insect stings. The allergic reaction to a sting from a bee or other insect causes local swelling, redness, and pain.

The severity of an allergic reaction’s symptoms can vary widely:

• Mild symptoms may be almost unnoticeable, just making you feel a little “off.”

• Moderate symptoms can make you feel ill, as if you’ve got a cold or even the flu.

• Severe allergic reactions are extremely uncomfortable, even incapacitating.

Most symptoms of an allergic reaction go away shortly after the exposure stops.

The most severe allergic reaction is called anaphylaxis. In anaphylaxis, allergens cause a whole-body allergic reaction that can include:

• Hives and itching all over (not just in the exposed area)



• Wheezing or shortness of breath





• Hoarseness or tightness in the throat

• Tingling in the hands, feet, lips, or scalp

Anaphylaxis is life-threatening and requires immediate medical attention. Symptoms can progress rapidly, so head for the emergency room if there’s any suspicion of anaphylaxis.
Does Everyone Have Allergies?

No, not everyone has allergies. People inherit a tendency to be allergic, although not to any specific allergen. When one parent is allergic, their child has a 50% chance of having allergies. That risk jumps to 75% if both parents have allergies.

Symptoms & Types

Sneezing, difficulty breathing, cramps, and vomiting–all are allergy symptoms. Learn the types of allergies, specific allergy symptoms, and emergency warning signs.

Symptoms

What Are Typical Allergy Symptoms?

Learn the difference between mild and severe allergy symptoms.

Related Web Site: Severe Allergy Symptoms - Know What to Watch For

The reaction will depend on the body part involved and the severity of the reaction. Here’s what to look for.

Types

Hay Fever (Allergic Rhinitis)

Alllergic rhinitis, also known as hay fever, is an allergic response to pollen or other microscopic substances.

Hives (Urticaria)

Find out what causes hives and how to treat them.

Poison Ivy & Plant Allergies

Many people think poison ivy is contagious. Find out if that’s true and the best way to prevent poison ivy and other plant allergies.

Bee Sting Allergy

A normal reaction to a bee sting is different from a bee sting allergy. Do you know the difference?

Pet Allergies: What You Can Do

An allergy specialist shares her tips on dealing with pet allergies. And she should know. She has a cat, a dog, and many family members who have dog and cat allergies.

Latex Allergy

Learn about latex allergy symptoms and what to do in case of a severe reaction.

Mold Allergy

Mold is present in most indoor and outdoor spaces, and in many foods. Find out more about mold allergy symptoms and common food sources of mold.

Cosmetic Allergies

Drug Allergies

How do you tell the difference between a normal side effect a drug allergy? Find out here.

Eczema (Atopic Dermatitis)

This itchy skin rash, common in children and infants, affects some people all their lives. Find out more about eczema treatment and symptoms in WebMD's Eczema Health Center.

Eye Allergies (Allergic Conjunctivitis)

How can you tell the difference between pink eye and eye allergies?

Get started here.

Understanding Food Allergies

Do you get a reaction when you eat nuts, shellfish, or other foods? Learn what’s causing those food allergy symptoms.

Milk Allergy

Many unsuspecting products contain milk or milk products. Check our list.

Egg Allergy

If you have an egg allergy, check this food list for potential problems.

Nut Allergy
A nut allergy can become very serious, even fatal, rapidly. This food list will help you identify potential problems.

Fish Allergy

Some unexpected foods contain fish. If you’ve got a fish allergy, these tips will help keep you safe.

Shellfish Allergy

For most people with shellfish allergies, all shellfish must be avoided. Check out this list to learn which foods to avoid.

Soy Allergy

This allergy is most common among infants. By age two, the majority of children outgrow it. Find out more about the symptoms and how to avoid soy products.

Sun Allergy

Learn more about photosensitivity – an allergic response to sunlight.

Wheat Allergy

Knowing which ingredients to look for is key to avoiding a wheat allergy. Check this list for unsuspected products that contain wheat.

Aspirin Allergy (Salicylate Allergy)

Sulfite Allergy

About 1% of people have a sulfite allergy. This article has a list of foods that may contain sulfites.

Fall Allergies

Learn more about what triggers allergies in the fall season.

Warning Signs

Severe Allergies

A severe allergic reaction can be life-threatening. Learn more about the reaction called anaphylaxis so you can be prepared.

Complications

Allergies & Asthma

Allergies are a main trigger for asthma attacks. See what an asthma attack looks like in the lungs and learn the early warning signs.

Related Guide: Children, Allergies & Asthma

How can you tell if your child’s allergies are causing asthma? Find out how to spot the symptoms and learn how asthma is treated in children.

Sinus Infection (Sinusitis)

Hay fever allergies can cause sinus blockage and infection. Learn how to spot sinus infection symptoms and how to treat the problem.

Assess Your Allergy Symptoms

How bad are your allergy problems? Find out with WebMD's Allergy and Sinus Health Check.

Diagnosis & Tests

To pinpoint the allergy problem -- and determine the treatment – your doctor will ask questions about your symptoms and habits. You’ll also need various tests.

Diagnosis

Allergy Testing: The Physical Exam

Diagnosing allergies starts with a doctor’s exam. Learn which questions your doctor may ask so you can be prepared.

Food Allergy Testing

Proper testing can make it much easier to live with a food allergy. See a list of the most common food allergies and learn how testing can make your life easier.

Allergy Symptom Diary

If you have a food allergy, you may need to keep a food diary – and remove certain foods from your diet – to determine exactly what you’re allergic to.

Tests

Allergy Skin Test

An allergy skin test is used to identify the substances that are causing your allergy reactions. Learn more about allergy skin tests, including what happens during the test.

Blood Test for Allergies

See how blood tests are used to diagnose allergies and learn what can interfere with the test.

Treatment & Care

There are lots of allergy treatment options. Over-the-counter and prescription medications can ease annoying symptoms. Allergy shots also help.

Treatment

Allergy Medications: An Overview

Learn all about the different over-the-counter and prescription medicines that can help ease annoying symptoms.

Natural Allergy Relief

Mother Nature may be able to provide natural allergy relief. Find out what may help – and what may cause harm.

Antihistamines

Find out how antihistamines work, who should not take them, and which foods or drugs may interact with them.

Decongestants

Learn how decongestants work – and who should not use them.

Anticholinergic Nasal Allergy Sprays

Atrovent nasal spray can help with certain allergy symptoms. Find out if it’s right for you.

Steroid Nasal Sprays

Steroid nasal sprays are one of the strongest allergy medications. Find out how they work and how to use them.

Allergy Eye Drops

Find out when allergy eye drops can help and who should not use them.

Leukotriene Inhibitors

These medications are fairly new to the allergy world. Find out if they’re right for you.

Mast Cell Inhibitors

This type of medication can help but it’s all in the timing. Find out how to use it for best results.

Allergy Shots

For some people, allergy shots can mean the end to allergy medication. Find out all you need to know.

Skin Allergies

Advanced Reading: This article, written for doctors, provides in-depth information on skin allergy treatments.

Understanding Hay Fever - Treatment

Get the basics on hay fever treatment.

Food Allergy Treatments

Advanced Reading: This article, written for doctors, provides in-depth information on food allergy treatments.

Latex Allergy Treatments

Advanced Reading: For in-depth information on latex allergies, read this article written for doctors.

Care

Natural Allergy Relief

These tips will help you reduce exposure to allergens – at home, work, in the car, outdoors.

Should I Take Allergy Shots?

These discussion points will help you decide if you’re ready for allergy shots.

EpiPen: It Could Save Your Child’s Life

If your child has severe allergies, an EpiPen could save his/her life. Learn what you need to know.

Giving an Adult an Epinephrine Injection

If you’ve had a severe allergic reaction in the past, you need to carry an EpiPen. Learn how to use it. It could save your life.

Home Treatment

For tips to help relieve symptoms of an allergic reaction, see home treatment for:

• A severe allergic reaction. If you have symptoms of a severe allergic reaction, call911or other emergency services immediately.
• Itching or hives. Avoid further contact with whatever you think is causing the hives.
• A sore throat caused by postnasal drip. Gargle with warm salt water to help ease throat soreness.
• Hay fever symptoms. Take an antihistamine to reduce symptoms of itchy, watery eyes; sneezing; or a runny, itchy nose. Be sure to read and follow any warnings on the label. Don't give antihistamines to your child unless you've checked with the doctor first.
• Allergies that are worse in damp weather. Mold may be the cause of allergies that get worse in damp weather. Mold produces spores that move, like pollen, in outdoor air during warmer months. During winter months, indoor molds can also be a problem.
• Indoor allergies. Newer, energy-saving homes that are built with double- or triple-paned windows and more insulation keep heat as well as allergens indoors.
• Allergies to a pet or other animal. When allergies are worse around pets, symptoms may be caused by your pet's dead skin (dander), urine, dried saliva, or hair.
• Seasonal allergies. These are often caused by exposure to pollen.

For tips on how to treat dry and irritated skin, see the topic Dry Skin and Itching.

For information on how to treat an insect bite or sting, see the topic Insect Bites and Stings and Spider Bites.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Difficulty breathing, wheezing, or tightness in the chest develops.
• Swelling of the throat, tongue, lips or face develops.
• Hives develop or get worse.
• Swelling gets worse.
• A skin infection develops.
• Symptoms have not improved after 1 to 2 weeks of home treatment.
• Symptoms become more severe or more frequent.

Bronchopulmonary Dysplasia

What Is Bronchopulmonary Dysplasia?

Bronchopulmonary dysplasia, or BPD, is a serious lung condition that affects mostly babies who:

• Are born more than 10 weeks before their due dates



• Weigh less than 2½ pounds, or 1,000 grams, at birth



• Have breathing problems at birth



• Need long-term breathing support and oxygen

Many of these babies are born with serious respiratory distress syndrome (RDS). Their lungs haven't yet developed enough to make surfactant (sur-FAK-tant). Surfactant is a liquid that coats the inside of the lungs and keeps them open so that the baby can breathe in air once he or she is born.

As a result, these babies are usually put on oxygen and a breathing machine at birth—either a ventilator (also known as a respirator) or a nasal continuous positive airway pressure (NCPAP) machine. This can prevent damage to their brains and other body organs from lack of oxygen. They also are given surfactant.

Most babies with RDS begin to get better within the next 2 to 4 weeks. But some get worse and need more oxygen and/or breathing assistance from a machine. These babies have developed BPD.

The lungs of the babies who are born with RDS and go on to develop BPD are less developed than those of babies with RDS who recover. They usually have fewer and larger alveoli, or air sacs, than other newborns. They also may have fewer tiny blood vessels in the alveoli. The blood vessels are needed to move oxygen from the alveoli into the bloodstream.

These babies also are more likely than other infants to have problems in other parts of their bodies that aren't yet fully developed. These include the heart, kidneys, brain, stomach, intestines, and eyes.

With new and better treatments now available, most babies with BPD get better over time, and many go on to live normal, active lives.

What Causes Bronchopulmonary Dysplasia?

The lungs of babies born more than 10 weeks before they are due are fragile and easily irritated or injured by things in the outside environment during the first hours or days after birth.

Doctors now believe that a baby gets bronchopulmonary dysplasia (BPD) as a result of the way his or her lungs respond to some of these things, including:

• High levels of oxygen. Doctors usually give oxygen to newborns with breathing problems. This is to make sure that their brains, hearts, livers, and kidneys receive enough oxygen to do their jobs. But high levels of oxygen can cause inflammation in the lungs. This can result in injury to the breathing passages. High levels of oxygen also can slow the normal development of the lungs in babies born very early.



• Pressure caused by mechanical ventilation. In the past, doctors usually put newborns who couldn't breathe on their own on mechanical ventilators. These machines apply pressure to push air into the babies' lungs. This pressure can irritate the lungs and cause them to become more inflamed. Mechanical ventilation is a factor in most cases of BPD.



• Doctors try to minimize the injury by using ventilation only when absolutely needed. Today, more and more doctors are putting these babies on nasal continuous positive airway pressure (NCPAP) machines, which don't put the same kind of pressure on the babies' lungs.



• Infections. Infections in babies born early can cause inflammation in their underdeveloped lungs. This narrows the breathing passages and makes it harder for the baby to breathe. Lung infections also increase the baby's need for extra oxygen and help with breathing.

Some doctors think that heredity may be a factor in the development of BPD.

What Are the Signs and Symptoms of Bronchopulmonary Dysplasia?

Most babies who get bronchopulmonary dysplasia (BPD) are born with respiratory distress syndrome (RDS). The signs and symptoms of RDS at birth are:

• Rapid, shallow breathing



• Sharp pulling in of the chest below the ribs with each breath taken in



• Grunting sounds during exhalation



• Flaring of the nostrils during breathing

As a result, these babies usually are put on a breathing machine right away. This is to prevent damage to their brains, hearts, and other body organs from lack of oxygen. These babies also are given surfactant to coat the tiny air sacs and to help prevent their lungs from collapsing.

Doctors can usually diagnose BPD after about 2 weeks. At this point, the baby hasn't started getting better, and he or she needs more oxygen.

Babies with severe BPD may also develop:

• Pulmonary arterial hypertension, continuous high blood pressure in the blood vessels that carry oxygen-poor blood from the right ventricle in the heart to the small arteries in the lungs



• Cor pulmonale, failure of the right side of the heart caused by ongoing high blood pressure in the pulmonary artery and right ventricle

How Is Bronchopulmonary Dysplasia Diagnosed?

It's hard to tell whether a baby with breathing problems has bronchopulmonary dysplasia (BPD) before he or she is about 14 to 30 days old. At this point, the baby should be showing improvement in the breathing problems. Instead, the baby's condition seems to be getting worse and he or she needs more oxygen or help from a breathing machine.

Doctors usually conduct a number of tests on newborns with breathing problems to make sure they diagnose their condition correctly. These tests include:

• Blood tests. Blood samples are checked to see whether the baby has enough oxygen in his or her blood.



• Chest x ray. A chest x ray takes a picture of the heart and lungs. It shows larger areas of air and changes from inflammation or infection. It also shows areas of the lung that have collapsed and may help confirm that the lungs aren't developing normally.



• Echocardiogram. This test uses sound waves to create a moving picture of the heart. Echocardiogram is used to rule out congenital heart defects orpulmonary arterial hypertension as the cause of the breathing problems.

Doctors grade BPD as mild, moderate, or severe, depending on how much extra oxygen the baby needs and how long he or she needs it.

How Can Bronchopulmonary Dysplasia Be Prevented?

You can do certain things to help ensure that your baby isn't born before his or her lungs have developed completely.

They include:

• Seeing your doctor regularly during your pregnancy



• Eating right



• Avoiding tobacco smoke, alcohol, and illegal drugs



• Controlling any ongoing medical conditions you have



• Preventing infection

Your doctor may also recommend that you take progesterone if you had a prior preterm birth. This is a hormone that may help delay delivery.

Your doctor may give you injections of a corticosteroid medicine if it looks as though you may give birth too early. This medicine can speed up surfactant production and development of the lungs, brain, and kidneys in the fetus. Usually, within about 24 hours after you start taking the medicine, the fetus' lungs will work better. They also will respond better to surfactant treatment so that respiratory distress syndrome will not develop after delivery, or it will be relatively mild.

How Is Bronchopulmonary Dysplasia Treated?

The goals of treatment for babies with bronchopulmonary dysplasia (BPD) are to:

• Reduce further injury to the lungs



• Provide nutrition and other support to help the lungs grow and recover

Treatment is done in three stages. They are:

• Treatment for respiratory distress at birth and before doctors know whether the baby has BPD



• Treatment after doctors know the baby has BPD



• Home care after the baby leaves the hospital

Treatment of respiratory distress usually begins as soon as the baby is born, sometimes in the delivery room. Most infants who show signs and symptoms ofrespiratory distress syndrome (RDS) are quickly moved to a special intensive care unit called a neonatal intensive care unit (NICU). There they receive around-the-clock treatment from a group of health care professionals who specialize in treating premature infants.

The most important treatments for RDS are:

• Breathing support



• Surfactant replacement therapy

Breathing Support

These babies usually are put on a breathing machine to help them breathe—either a mechanical ventilator or a nasal continuous positive airway pressure (NCPAP) machine. The ventilator is connected to a breathing tube that runs through the baby's mouth or nose into the windpipe. The ventilator can be set to help a baby breathe or to completely control a baby's breathing. It also is set to give the amount of oxygen the baby needs.

Today, more and more babies are receiving breathing support from an NCPAP machine, which pushes air into the baby's lungs through prongs in the nostrils.

With breathing help, the baby's lungs have a chance to develop. Breathing machines today don't cause as much injury to the airways and lungs as those used in the past.

Surfactant Replacement Therapy

The baby is given surfactant to open his or her lungs until the lungs have developed enough to start making their own surfactant. Surfactant is given through a tube that is attached to the breathing machine, which pushes the surfactant directly into the baby's lungs.

Other Types of Treatment

Other treatments for babies who show signs and symptoms of RDS and haven't yet been diagnosed with BPD include:

• Medicines



• Supportive therapy



• Treatment for patent ductus arteriosus, a condition that affects some premature infants

Medicines

Doctors usually give the baby medicines to reduce swelling in the airways and improve the flow of air in and out of the lungs. These medicines include:

• Bronchodilators to improve the flow of air in and out of the lungs



• Diuretics to help remove extra fluid from the lungs



• Antibiotics to control infections

Supportive Therapy

Treatment in the NICU is designed to limit stress on the baby and meet his or her basic needs of warmth, nutrition, and protection. Such treatment usually includes:

• Using a radiant warmer or incubator to keep your baby warm and reduce the chances of infection.



• Ongoing monitoring of blood pressure, heart rate, breathing, and temperature through sensors taped to the baby's body.



• Using a sensor on a finger or toe to monitor the amount of oxygen in the baby's blood.



• Giving fluids and nutrients through a needle or tube inserted into a vein to prevent malnutrition and promote growth. Nutrition is critical to the growth and development of the lungs. Later, your baby may be given milk through a tube that is passed through his or her nose into the mouth.



• Monitoring fluid intake to make sure that fluid doesn't build up in the baby's lungs.

Once doctors know that the baby has BPD, some or all of these treatments are continued in the NICU:

• Babies with BPD are usually taken off the breathing machine slowly over time. They are often moved from the ventilator to an NCPAP machine until they can breathe on their own. This machine pushes air into the baby's lungs through prongs in the nostrils.



• The baby is likely to continue to need extra oxygen for some time. Once the baby no longer needs help breathing, he or she may get additional oxygen through prongs in the nostrils.



• Babies with moderate to severe BPD have an echocardiogram every 2 to 3 months to check their pulmonary artery pressure.

These babies also may need physical therapy to strengthen their muscles and help their lungs clear out mucus.

Today, most babies with BPD recover. They may spend several weeks or months in the hospital. But the best place for the baby's growth and development is at home with the family where he or she can be in a loving and familiar environment.

After the baby goes home:

• It's important for the parents to know about the symptoms and treatments for BPD. Parents and family members play an important role by being loving and involved with their babies and giving care.



• The baby may continue to have some breathing symptoms and may remain in poor health.



• He or she may still need extra oxygen and a breathing machine.



• He or she needs good nutrition and extra calories because of the extra work involved with breathing.



• Regular checkups and timely vaccinations from a pediatrician (a doctor who specializes in treating children) are important. A pediatrician also can treat any other illnesses that the baby may develop.



• The family also may need social services to help them take care of the baby's medical and nonmedical needs.

What Is Sudden Cardiac Arrest (SCA)?

Sudden cardiac arrest (SCA) is acondition in which the heart suddenly and unexpectedly stops beating. When this happens, blood stops flowing to the brain and other vital organs.

SCA usually causes death if it's not treated within minutes.

Outlook

Ninety-five percent of people who have SCA die from it—most within minutes. Rapid treatment of SCA with a defibrillator can be lifesaving. A defibrillator is a device that sends an electric shock to the heart to try to restore its normal rhythm.

Automated external defibrillators (AEDs), which often are found in public places like airports and office buildings, can be used by bystanders to save the lives of people who are having SCA.

Causes

Most cases of sudden cardiac arrest (SCA) are due to ventricular fibrillation (v-fib). V-fib is a type of arrhythmia (for this please see my article on Wolff-Parkinson-White Syndrome (Arrhythmia). In v-fib, the ventricles (the heart's lower chambers) don't beat normally. Instead, they quiver very rapidly and irregularly.

When this happens, the heart pumps little or no blood to the body. V-fib is fatal if not treated within a few minutes.

Other electrical problems in the heart also can cause SCA. For example, SCA can occur if the rate of the heart's electrical signals becomes very slow and stops. SCA also can occur if the heart muscle doesn't respond to the heart's electrical signals.

Several factors can cause the electrical problems that lead to SCA. These factors include:

• Coronary artery disease (CAD), which reduces blood flow to the heart muscle
• Severe physical stress, which raises the risk for abnormal electrical activity in the heart
• Inherited disorders that disrupt the heart's electrical activity
• Structural changes in the heart that cause electrical signals to spread abnormally

Several research studies are under way to try to find the exact causes of SCA and how to prevent them.

Who Is At Risk?

Each year, between 250,000 and 450,000 Americans have sudden cardiac arrest (SCA). SCA occurs most often in people in their mid-thirties to mid-forties. It appears to affect men twice as often as women.

SCA rarely occurs in children unless they have inherited problems that make them likely to have SCA. Only a very small number of children have SCA each year.

Other Risk Factors

Other risk factors for SCA include:

• A personal or family history of SCA or of inherited disorders that make you prone to arrhythmias
• A history of having arrhythmias
• Heart attack
• Heart failure
• Drug abuse or excessive alcohol intake

How Is Sudden Cardiac Arrest Diagnosed?

Sudden cardiac arrest (SCA) happens without warning. It requires immediate emergency treatment. Doctors rarely can diagnose SCA with medical tests as it's happening.

Instead, SCA often is diagnosed after it happens. Doctors do this by ruling out other causes of a person's sudden collapse.

How Is Sudden Cardiac Arrest Treated?

Emergency Treatment

Sudden cardiac arrest (SCA) requires immediate treatment with a defibrillator. This device sends an electric shock to the heart. The electric shock may restore a normal rhythm to a heart that's stopped beating.

To work well, defibrillation must be done within minutes of SCA. With every minute that passes, the chances of surviving SCA drop rapidly.

Police, emergency medical technicians, and other first responders usually are trained and equipped to use a defibrillator. Call 9–1–1 right away if someone has signs or symptoms of SCA. The sooner help is called, the sooner potentially lifesaving treatment can be done.

How Can Death Due to Sudden Cardiac Arrest Be Prevented?

Ways to prevent death due to sudden cardiac arrest (SCA) differ depending on whether:

• You've already had SCA
• You've never had SCA but are at high risk for the condition
• You've never had SCA and have no known risk factors for the condition

For People Who Have Survived Sudden Cardiac Arrest

If you've already had SCA, you're at high risk of having it again. Research shows that an implantable cardioverter defibrillator (ICD) reduces the chances of dying from a second SCA.

An ICD is surgically placed under the skin in your chest or abdomen. The device has wires with electrodes on the ends that connect to your heart's chambers. The ICD monitors your heartbeat.

If the ICD detects a dangerous heart rhythm, it gives an electric shock to restore the heart's normal rhythm. Your doctor may give you medicine to limit irregular heartbeats that can trigger the ICD.

Implantable Cardioverter Defibrillator

The illustration shows the location of an implantable cardioverter defibrillator in the upper chest. The electrodes are inserted into the heart through a vein.

An ICD isn't the same as a pacemaker. The devices are similar, but have some differences. Pacemakers only give off low-energy electrical pulses. They're often used to treat less dangerous heart rhythms, such as those that occur in the upper chambers of the heart. Most new ICDs work as both pacemakers and ICDs.

For People at High Risk for a First Sudden Cardiac Arrest

If you have severe coronary artery disease (CAD), you're at increased risk for SCA. This is especially true if you've recently had a heart attack.

Your doctor may prescribe a type of medicine called a beta blocker to help lower your risk for SCA. Other treatments for CAD, such as angioplasty or coronary artery bypass grafting, also may lower your risk for SCA.

Your doctor also may recommend an ICD if your risk for SCA is very high.

For People Who Have No Known Risk Factors for Sudden Cardiac Arrest

CAD seems to be the cause of most cases of SCA in adults. CAD also is a major risk factor for angina (chest pain or discomfort) and heart attack, and it contributes to other heart problems.

Following a healthy lifestyle can help you lower your risk for CAD, SCA, and other heart problems.

Healthy Diet and Physical Activity

A healthy diet is an important part of a heart healthy lifestyle. Choose a variety of fruits, vegetables, and grains; half of your grains should come from whole-grain products.

Choose foods that are low in saturated fat, trans fat, and cholesterol. Healthy choices include lean meats, poultry without skin, fish, beans, and fat-free or low-fat milk and milk products.

Choose and prepare foods with little sodium (salt). Too much salt can raise your risk for high blood pressure. Recent studies show that following the Dietary Approaches to Stop Hypertension (DASH) eating plan can lower blood pressure.

Choose foods and beverages that are low in added sugar. If you drink alcoholic beverages, do so in moderation.

Aim for a healthy weight by staying within your daily calorie needs. Balance the calories you take in with the calories you use while doing physical activity. Be as physically active as you can.

Some people should get medical advice before starting or increasing physical activity. For example, talk to your doctor if you have a chronic (ongoing) health problem, are on medicine, or have symptoms such as chest pain, shortness of breath, or dizziness. Your doctor can suggest types and amounts of physical activity that are safe for you.

For more information on following a healthy diet, see the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site, "Your Guide to a Healthy Heart," and "Your Guide to Lowering Your Blood Pressure With DASH." All of these resources provide general information about healthy eating.

For more information about physical activity, see NHLBI's "Your Guide to Physical Activity and Your Heart."

Other Lifestyle Changes

Other lifestyle changes also can help lower your risk for SCA. Examples include:

• Quitting smoking. Talk to your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.
• Losing weight if you're overweight or obese.
• Treating other health problems, such as high blood pressure, high blood cholesterol, and diabetes.