General Health

Natural treatments for stretch marks

2010-04-14T12:54:00.005+05:00

Pregnant women or those who suddenly lose or gain weight are more likely to have stretch marks. So, we found 4 natural remedies for stretch marks.

Unfortunately, this problem although doesn’t affect our health, makes us anxious and frustrated because of skins bad appearance, especially when we struggle with all the power to remove them from our skin.

Although on the market are dozens treatments, each more expensive and more demanding than other, specially designed to remove stretch marks, you should not have high expectations. Any money you invest in these products, will not make stretch marks disappeared, the only method of complete removal is the surgical, laser or ultrasound way.

However, instead of using expensive creams, you can turn to natural treatments, much cheaper, and you might be surprised that they will work, even better than the luxury products.

Here are some of the best natural treatments:

Aloe Vera
On the market you can see a wide variety of creams and ointments that contain Aloe Vera. Acquire a cream and massage the areas affected by stretch marks daily, about three times a day. Also it would be great to have an aloe plant, you can massage the skin with the juice obtained from squeezing the plant.

Olive Oil
Olive oil is a powerful ally in fighting with stretch marks, especially if used regularly. Heat a little olive oil (as much as your skin supports), massage the skin, and wrap up with foil and wait for 20 minutes. After that, get in the shower to get rid of dead skin cells.

Balm with Swedish Bitter

Swedish balsam role is to heal wounds, but also to restore skin elasticity. Therefore it can be successfully used to significantly reduce stretch marks. Affected skin has to be massaged daily for at least a month, twice per day. In a short time, results will appear.

Marigold Cream

Although it is very oily, calendula cream helps reduce stretch marks. For visible results you can mix calendula cream, collagen and vitamin A. These ampules offer skin elasticity, treat stretch marks and prevent the emergence of new ones, are therefore they are especially recommended for massage during pregnancy.

VITAMIN D

2010-04-14T12:32:00.004+05:00

Vitamin D helps the immune system to defend against viruses. It is a real natural health defender. Researchers at Oregon State University have published a major study showing that vitamin D has a crucial role for the immune system: stimulates immune function and destroys invading microorganisms (including viruses). Vitamin D prompts innate immune response by activating an antimicrobial protein.

This study shows that without sufficient vitamin D in their blood, viruses grow freely in your body. If you lack vitamin D, your immune system is weakened and does not work effectively. A simple example is: the people with lack of vitamin D get the flu more often in the winter.

Specific immune system genes are activated by vitamin D. Thus, it will protect the initial infection with the virus, in addition it will prevent the body to react in excess by swelling (bacterial pneumonia, an infection of the lungs). If your body maintains a sufficient level of vitamin D, the flu viruses are rapidly neutralized.

Sources of vitamin D

The main source of vitamin D is the skin. In the skin is found a fat, called pro-vitamin D. Under the influence of light, pro-vitamin turns into vitamin D which is then absorbed into the body through vessels located in the deep layer of skin.

What to do to protect our health?

Although you probably thought of supplementation with vitamins, it is much easier to follow a healthy diet and to have the correct alimentation.
High doses of vitamin D are found in natural pollen collected by bees, seeds, wheat (attention: not in germinated wheat), unrefined vegetable oils (sunflower, olive, rape, etc.. – the first extraction). Because this vitamin is very sensitive to heat, light, oxygen and acidic environments, fire-cooked food is very poor in vitamin D.

Although fish liver, fatty fish, egg yolks, whole milk and milk products are rich in vitamin D, by cooking them you diminish their amount of vitamin D (even pasteurized milk is the factory – at UHT is completely useless).

The recommendation is to eat foods rich in vitamin D – raw use, without heat treatment. This treatment (dietary) is absolutely safe, inexpensive, natural, and – most importantly – easy to follow.

In addition, it is very pleasant! Sufficient vitamin D in the blood will help your immune system to protect you against the swine flu, bird flu, human flu, and many other viruses. Vitamin D is a true support for the immune system, a guarantee of its well functioning and efficiency for a sustainable health.

have you gone bananas ?

2010-04-13T18:39:00.002+05:00

it is ok to be a banana...

Never, put your banana in the refrigerator! !!
This is interesting.
After reading this, you'll never look at a banana in the same way again .

Bananas contain three natural sugars - sucrose, fructose and glucose combined with fiber. A banana gives an instant, sustained and substantial boost of energy.

Research has proven that just two bananas provide enough energy for a strenuous 90-minute workout. No wonder the banana is the number one fruit with the world's leading athletes.

But energy isn't the only way a banana can help us keep fit.

It can also help overcome or prevent a substantial number of illnesses and conditions, making it a must to add to our daily diet.

Depression: According to a recent survey undertaken by MIND amongst people suffering from depression, many felt much better after eating a banana. This is because bananas contain tryptophan, a type of protein that the body converts into serotonin, known to make you relax, improve your mood and generally make you feel happier.

PMS: Forget the pills - eat a banana. The vitamin B6 it contains regulates blood glucose levels, which can affect your mood.

Anemia: High in iron, bananas can stimulate the production of hemoglobin in the blood and so helps in cases of anemia.

Blood Pressure: This unique tropical fruit is extremely high in potassium yet low in salt, making it perfect to beat blood pressure. So much so, the US Food and Drug Administration has just allowed the banana industry to make official claims for the fruit's ability to reduce the risk of blood pressure and stroke.

Brain Power: 200 students at a Twickenham (Middlesex) school were helped through their exams this year by eating bananas at breakfast, break, and lunch in a bid to boost their brain power. Research has shown that the potassium-packed fruit can assist learning by making pupils more alert.

Constipation: High in fiber, including bananas in the diet can help restore normal bowel action, helping to overcome the problem without resorting to laxatives.

Hangovers: One of the quickest
ways of curing a hangover is to make a banana milkshake, sweetened with honey. The banana calms the stomach and, with the help of the honey, builds up depleted blood sugar levels, while the milk soothes and re-hydrates your system.

Heartburn: Bananas have a natural antacid effect in the body, so if you suffer from heartburn, try eating a banana for soothing relief.

Morning Sickness: Snacking on bananas between meals helps to keep blood sugar levels up and avoid morning sickness.

Mosquito bites: Before reaching for the insect bite cream, try rubbing the affected area with the inside of a banana skin. Many people find it amazingly successful at reducing swelling and irritation.

Nerves: Bananas are high in B vitamins that help calm the nervous system.

Overweight and at work? Studies at the Institute of Psychology in Austria found pressure at work leads to gorging on comfort food like chocolate and crisps. Looking at 5,000 hospital patients, researchers found the most obese were more likely to be in high-pressure jobs. The report concluded that, to avoid panic-induced food cravings, we need to control our blood sugar levels by snacking on high carbohydrate foods every two hours to keep levels steady.
Ulcers: The banana is used as the dietary food against intestinal disorders because of its soft texture and smoothness. It is the only raw fruit that can be eaten without distress in over-chronicler cases. It also neutralizes over-acidity and reduces irritation by coating the lining of the stomach.

Temperature control: Many other cultures see bananas as a 'cooling' fruit that can lower both the physical and emotional temperature of expectant mothers. In Thailand , for example, pregnant women eat bananas to ensure their baby is born with a cool temperature.

Seasonal Affective Disorder (SAD): Bananas can help SAD sufferers because they contain the natural mood enhancer tryptophan.

Smoking & Tobacco Use: Bananas can also help people trying to give up smoking. The B6, B12 they contain, as well as the potassium and ma gnesium found in them, help the body recover from the effects of nicotine withdrawal.

Stress: Potassium is a vital mineral, which helps normalize the heartbeat, sends oxygen to the brain and regulates your body's water balance. When we are stressed, our metabolic rate rises, thereby reducing our potassium levels. These can be rebalanced with the help of a high-potassium banana snack.

Strokes: According to research in 'The New England Journal of Medicine, 'eating bananas as part of a regular diet can cut the risk of death by strokes by as much as 40%!

Warts: Those keen on natural alternatives swear that if you want to kill off a wart, take a piece of banana skin and place it on the wart, with the yellow side out. Carefully hold the skin in place with a plaster or surgical tape!

So, a banana really is a natural remedy for many ills. When you compare it to an apple, it has four times the protein, twice the carbohydrate, three times the phosphorus, five times the vitamin A and iron, and twice the other vitamins and minerals. It is also rich in potassium and is one of the best value foods around So maybe its time to change that well-known phrase so that we say, 'A banana a day keeps the doctor away!'

How & When to eat FRUIT

2010-04-13T16:22:00.002+05:00

EATING FRUIT

We all think eating fruit means just buying fruit, cutting it up and popping it into our mouths. It's not that easy. It's important to know how and when to eat fruit.

What's the correct way to eat fruit?

IT MEANS NOT EATING FRUIT AFTER MEAL! FRUIT SHOULD BE EATEN ON AN EMPTY STOMACH.

Eating fruit like that plays a major role in detoxifying your system, supplying you with a great deal of energy for weight loss and other life activities..

FRUIT IS THE MOST IMPORTANT FOOD.

Let's say you eat two slices of bread, then a slice of fruit. The slice of fruit is ready to go straight through the stomach into the intestines, but it's prevented from doing so.

In the meantime, the whole meal rots and ferments, and turns to acid. The minute the fruit comes into contact with the food in the stomach, and digestive juices, the entire mass of food begins to spoil
Eat your fruit on an empty stomach, or before your meal! You've heard people complain: Every time I eat watermelon I burp, when I eat durian my stomach bloats, when I eat a banana I feel like running to the toilet, etc. This will not happen if you eat the fruit on an empty stomach. Fruit mixes with the putrefying other food and produces gas. Hence, you bloat!

Graying Hair

Balding

Nervous Outburst

Dark Circles under the Eyes

Graying hair, balding, nervous outburst, and dark circles under the eyes - all of these will NOT happen if you eat fruit on an empty stomach.

There's no such thing as some fruits, like orange and lemon are acidic, because all fruit becomes alkaline in our body, according to Dr. Herbert Shelton who did research on this matter. If you have mastered the correct way of eating fruit, you have the Secret of Beauty, Longevity, Health, Energy, Happiness and normal weight.
When you need to drink fruit juice drink only fresh fruit juice, NOT from the cans. Don't drink juice that has been heated. Don't eat cooked fruit; you don't get the nutrients at all. You get only the taste... Cooking destroys all of the vitamins

Eating a whole fruit is better than drinking the juice. If you should drink the juice, drink it mouthful by mouthful slowly, because you must let it mix with your saliva before swallowing it. You can go on a 3-day fruit-fast to cleanse your body. Eat fruit and drink fruit juice for just 3 days, and you will be surprised when your friends say how radiant you look!

KIWI:

Tiny but mighty, and a good source of potassium, magnesium, vitamin E & fiber. Its vitamin C content is twice that of an orange!

APPLE

An APPLE a day keeps the doctor away? Although an apple has a low vitamin C content, it has antioxidants & flavonoids which enhances the activity of vitamin C, thereby helping to lower the risk of colon cancer, heart attack & stroke.

STRAWBERRY:

Protective Fruit. Strawberries have the highest total antioxidant power among major fruits & protect the body from cancer-causing, blood vessel-clogging free radicals.

ORANGES:

Eating 2-4 Oranges a day may help keep colds away, lower cholesterol, prevent & dissolve kidney stones, and reduce the risk of colon cancer.

WATERMELON:

Coolest thirst quencher. Composed of 92% water, it is also packed with a giant dose of glutathione, which helps boost our immune system. Also a key source of lycopene, the cancer-fighting oxidant. Also found in watermelon: Vitamin C & Potassium..

GUAVA & PAPAYA:

Top awards for vitamin C. They are the clear winners for their high vitamin C content. Guava is also rich in fiber, which helps prevent constipation. Papaya is rich in carotene, good for your eyes..

Drinking Cold water after a meal = Cancer!

Can u believe this? For those who like to drink cold water, this applies to you. It's nice to have a cold drink after a meal, however, the cold water will solidify the oily stuff that you've just consumed, which slows digestion. Once this 'sludge' reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food. It will line the intestine. Very soon, this will turn into fats and lead to cancer.. It is best to drink hot soup or warm water after a meal.

A serious note about heart attacks.

HEART ATTACK PROCEDURE

Women should know that not every heart attack symptom is going to be the left arm hurting. Be aware of intense pain in the jaw. You may never have the first chest pain during the course of a heart attack. Nausea and intense sweating are also common symptoms. Sixty percent of people who have a heart attack while they're asleep do not wake up. Pain in the jaw can wake you from a sound sleep. Be careful, and be aware. The more we know, the better our chance to survive.

Bipolar Disorder

2009-10-27T10:39:00.001+06:00

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)

2009-10-18T16:10:00.004+06:00

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

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

2009-07-22T14:25:00.004+06:00

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.

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.

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

2009-06-23T15:02:00.003+06:00

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)?

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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.

Bronchitis

2009-06-10T15:03:00.002+06:00

What Is Bronchitis?

Bronchitis (bron-KI-tis) is a condition in which the bronchial tubes, the tubes that carry air to your lungs, become inflamed. (For more information on the bronchial tubes and the airways, see the Diseases and Conditions Index How the Lungs Work article.)

People who have bronchitis often have a cough that brings up mucus. Mucus is a slimy substance made by the lining of the bronchial tubes. Bronchitis also may cause wheezing (a whistling or squeaky sound when you breathe), chest pain or discomfort, a low fever, and shortness of breath.

Acute Bronchitis

Infections or other factors that irritate the lungs cause acute bronchitis. The same viruses that cause colds and the flu often cause acute bronchitis. These viruses are spread through the air when people cough. They also are spread through physical contact (for example, on hands that have not been washed). Sometimes bacteria cause acute bronchitis.

Acute bronchitis lasts from a few days to 10 days. However, the cough that occurs may last for several weeks after the infection is gone.

Several factors increase the risk for acute bronchitis. Examples include tobacco smoke (including secondhand smoke), air pollution, dust, and fumes. Avoiding these lung irritants as much as possible can help lower your risk for acute bronchitis.

Most cases of acute bronchitis go away within a few days. If you think you have acute bronchitis, see your doctor. He or she will want to rule out other, more serious health conditions that need medical care.

Chronic Bronchitis

Chronic bronchitis is an ongoing, serious condition. It occurs when the lining of the bronchial tubes is constantly irritated and inflamed.

Bronchitis is "chronic" if you have a cough with mucus on most days for at least 3 months a year and 2 years in a row (without another apparent cause). Smoking is the main cause of chronic bronchitis.

Viruses or bacteria can easily infect the irritated bronchial tubes. When this happens, the condition worsens and lasts longer. As a result, people who have chronic bronchitis also have periods when symptoms get much worse than usual.

Chronic bronchitis is a serious, long-term medical condition. Early diagnosis and treatment, combined with quitting cigarette smoking and avoiding secondhand cigarette smoke, can help people live better with this condition. The chance of complete recovery is low for people who have severe chronic bronchitis.

Symptoms of Bronchitis?

Acute Bronchitis

Acute bronchitis caused by an infection usually develops after you already have a cold or the flu. Symptoms of a cold or the flu include sore throat, fatigue (tiredness), fever, body aches, stuffy or runny nose, vomiting, and diarrhea.

The main symptom of acute bronchitis is a cough. The cough may produce clear mucus (a slimy substance). If the mucus is yellow or green, you may have a bacterial infection as well. Even after the infection clears up, you may still have a dry cough for days or weeks.

Other symptoms of acute bronchitis include wheezing (a whistling or squeaky sound when you breathe), low fever, and chest tightness or pain.

If your acute bronchitis is severe, you also may have shortness of breath, especially with physical activity.

Chronic Bronchitis

The signs and symptoms of chronic bronchitis include coughing, wheezing, and chest discomfort. The coughing may produce large amounts of mucus. This type of cough is often called "smoker's cough."

Diagnosis

Your doctor usually will diagnose bronchitis based on your signs and symptoms. He or she may ask questions about your cough, such as how long you’ve had it, what you’re coughing up, and how much you cough.

Your doctor also will likely ask:

About your medical history
Whether you’ve recently had a cold or the flu
Whether you smoke or spend time around others who smoke
Whether you’ve been exposed to air pollution, dust, or fumes

Your doctor will use a stethoscope to listen for wheezing (a whistling or squeaky sound when you breathe) or other abnormal sounds in your lungs. He or she also may:

Look at your mucus to see whether you have a bacterial infection
Test the oxygen levels in your blood using a sensor attached to your fingertip or toe
Order a chest x ray, lung function tests, or blood tests

What Causes Bronchitis?

Acute Bronchitis

Infections or other factors that irritate your lungs cause acute bronchitis. The same viruses that cause colds and the flu are the most common cause of acute bronchitis. Sometimes bacteria can cause the condition.

Certain substances can irritate your lungs and airways and raise your risk for acute bronchitis. For example, inhaling or being exposed to cigarette or cigar smoke, air pollution, dusts, vapors, or fumes raises your risk. These lung irritants also can make symptoms worse.

Being exposed to a high level of dust or fumes, such as from an explosion or a big fire, also may lead to acute bronchitis.

Chronic Bronchitis

Repeatedly breathing in fumes that irritate and damage lung and airway tissues causes chronic bronchitis. Smoking is the major cause of this condition.

Breathing in air pollution and dust or fumes from the environment or the workplace also can lead to chronic bronchitis.

People who have chronic bronchitis go through periods when symptoms become much worse than usual. During these times, they also may have acute viral or bacterial bronchitis.

Treatment

The main goals of treating acute and chronic bronchitis are to relieve symptoms and help make breathing easier.

If you have acute bronchitis, your doctor may recommend rest, plenty of fluids, and aspirin (for adults) or acetaminophen to treat fever.

Antibiotics usually aren't prescribed for acute bronchitis. This is because they don't work against viruses—the most common cause of acute bronchitis. However, if your doctor thinks you have a bacterial infection, he or she may prescribe antibiotics.

A humidifier or steam can help loosen mucus and relieve wheezing and limited air flow. If your bronchitis causes wheezing, you may need an inhaled medicine to open your airways. You take this medicine using an inhaler. This device allows the medicine to go right to your lungs.

Your doctor also may prescribe medicines to relieve or reduce your cough and treat your inflamed airways (especially if your cough persists).

To lower your risk of getting bronchitis, your doctor also may suggest a flu shot and/or a pneumonia vaccine (if you're aged 60 or older).

If you have chronic bronchitis and have also been diagnosed with COPD (chronic obstructive pulmonary disease), you may need medicines to open your airways and help clear away mucus. These medicines include bronchodilators (inhaled) and steroids (inhaled or pill form).

Sometimes people who have chronic bronchitis need oxygen therapy to help them breathe better and get enough oxygen to their bodies.

One of the best ways to treat acute and chronic bronchitis is to remove the source of irritation and damage to the lungs. If you smoke cigarettes, it's very important to quit. Talk to your doctor about programs and products that can help you quit smoking. Try to avoid secondhand smoke. Also, try to avoid places with a lot of dusts, fumes, vapors, or air pollutants.

Links to Other Information About Bronchitis

Bronchitis (MedlinePlus)

Kawasaki Disease

2009-06-10T14:59:00.001+06:00

What Is Kawasaki Disease?

Kawasaki (KAH-wah-SAH-ke) disease is a rare childhood disease. It's a form of a disease called vasculitis (vas-kyu-LI-tis).

In Kawasaki disease, the walls of the blood vessels throughout the body become inflamed. The disease can affect any type of blood vessel in the body, including the arteries, veins, and capillaries.

Overview

The cause of Kawasaki disease isn't known. The body's response to a virus or infection combined with genetic factors may cause the disease. However, no specific virus or infection has been found, and the role of genetics isn't known.

The disease can't be passed from one child to another. Your child won't get it from close contact with a child who has the disease. Also, if your child has the disease, he or she can't pass it on to another child.

Kawasaki disease affects children of all races and both genders. It occurs most often in children of Asian and Pacific Island descent. It's more likely to affect males, and most cases occur in children younger than 5 years.

One of the main symptoms of this disease is a fever that lasts longer than 5 days. The fever remains high even after treatment with standard childhood fever medicines. Children with the disease also may have red eyes, red lips, and redness on the palms of their hands and soles of their feet. These are all signs of inflamed blood vessels.

Early treatment is important. It helps reduce the risk that Kawasaki disease will affect the coronary arteries and cause more serious problems.

Outlook

Kawasaki disease can't be prevented. However, most children who develop Kawasaki disease fully recover—usually within weeks of getting symptoms. Further problems are rare.

In some children, the disease affects the coronary arteries. This can cause serious problems. These children need long-term care and treatment.

How Is Kawasaki Disease Treated?

Kawasaki disease is mainly treated with medicines. Rarely, medical procedures and surgery may be used for children whose coronary arteries are affected.

The goals of treatment are to:

Lower fever and reduce inflammation to improve symptoms
Prevent the disease from affecting the coronary arteries

Initial Treatment

Kawasaki disease can cause serious complications. Therefore, your child will likely be treated in a hospital, at least for the early part of the treatment.

The standard treatment during the disease's acute phase is high-dose aspirin and immune globulin. Immune globulin is a medicine given intravenously (injected into a vein).

Most children who receive these treatments improve greatly within 24 hours. For a small number of children, fever remains. In these cases, a second round of immune globulin may be given.

At the start of treatment, high doses of aspirin are given. As soon as your child's fever goes away, a low dose of aspirin is given. The low dose helps prevent blood clots, which can form in the inflamed small arteries.

Most children treated for Kawasaki disease fully recover from the acute phase and don't need any further treatment. They should, however, follow a healthy diet and adopt healthy lifestyle habits to lower their risk for future heart disease (this is advised for all children, not just those who have the disease).

Children who have had immune globulin should wait 11 months before having the measles and chicken pox vaccines. Immune globulin can prevent those vaccines from working properly.

Long-Term Care and Treatment

If Kawasaki disease has affected your child's coronary arteries, he or she will need ongoing care and treatment. It's best if a pediatric cardiologist provides this care to reduce the risk of severe heart problems. A pediatric cardiologist is a doctor who treats children who have heart problems.

Medicines and Tests

When Kawasaki disease affects the coronary arteries, they may expand and twist. If this happens, your child's doctor may prescribe anticoagulants (like warfarin) to prevent blood clots from forming in the affected coronary arteries.

Anticoagulants usually are stopped after the coronary arteries heal. Healing may occur about 18 months after the acute phase of the disease.

For the small number of children whose coronary arteries don't heal, routine tests are needed. These include:

Echocardiography. This test uses sound waves to create images of the heart.
EKG (electrocardiogram). This test detects and records the heart's electrical activity.
Stress test. This test gives the doctor information about how the heart works during physical activity or stress.

Medical Procedures and Surgery

Rarely, a child may need cardiac catheterization (KATH-e-ter-i-ZA-shun). This procedure is used to diagnose and treat some heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in the arm, groin (upper thigh), or neck and threaded to the heart. Through the catheter, doctors can perform diagnostic tests and treatments on the heart.

Very rarely, a child may need to have other procedures, or even surgery, if inflammation narrows his or her coronary arteries and blocks blood flow to the heart. Coronary angioplasty (AN-jee-oh-plas-tee), stent placement, or coronary artery bypass grafting(CABG) may be used.

Coronary angioplasty restores blood flow through a narrowed or blocked coronary artery. A thin tube with a balloon on the end is threaded through a blood vessel in the arm or groin (upper thigh) to the narrowed or blocked coronary artery. The balloon is then inflated to widen the artery and restore blood flow.

A stent may be placed in the coronary artery during angioplasty. Stents are small mesh tubes. They're used to keep narrowed or weakened arteries open. Stents can help improve blood flow and prevent the artery from bursting.

Rarely, a child may need to have CABG. This surgery is used when a coronary artery is severely blocked. During CABG, a healthy artery or vein from another part of the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, it goes around) the blocked part of the coronary artery. This improves blood flow to the heart.

Wolff-Parkinson-White Syndrome (Arrhythmia)

2009-05-20T16:23:00.000+06:00

Arrhythmia An arrhythmia (ah-RITH-me-ah) is a problem with the speed or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. A heartbeat that is too fast is called tachycardia. A heartbeat that is too slow is called bradycardia.Most arrhythmias are harmless, but some can be serious or even life threatening. When the heart rate is too slow, too fast, or irregular, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs.

Understanding the Heart’s Electrical System The heart has an internal electrical system that controls the speed and rhythm of the heartbeat. With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As it travels, the electrical signal causes the heart to contract and pump blood. The process repeats with each new heartbeat.

Each electrical signal begins in a group of cells called the sinus node, or sinoatrial (SA) node. The SA node is located in the right atrium (AY-tree-um), which is the upper right chamber of the heart. In a healthy adult heart at rest, the SA node fires off an electrical signal to begin a new heartbeat 60 to 100 times a minute.

From the SA node, the electrical signal travels through special pathways to the right and left atria. This causes the atria to contract and pump blood into the heart’s two lower chambers, the ventricles (VEN-trih-kuls). The electrical signal then moves down to a group of cells called the atrioventricular (AV) node, located between the atria and the ventricles. Here, the signal slows down just a little, allowing the ventricles time to finish filling with blood. The electrical signal then leaves the AV node and travels along a pathway called the bundle of His. This pathway divides into a right bundle branch and a left bundle branch. The signal goes down these branches to the ventricles, causing them to contract and pump blood out to the lungs and the rest of the body. The ventricles then relax, and the heartbeat process starts all over again in the SA node.

A problem with any part of this process can cause an arrhythmia. For example, in atrial fibrillation, a common type of arrhythmia, electrical signals travel through the atria in a fast and disorganized way. This causes the atria to quiver instead of contract.

Overview There are many different types of arrhythmia. Most arrhythmias are harmless but some are not. The outlook for a person with an arrhythmia depends on the type and severity of the arrhythmia. Even serious arrhythmias can often be successfully treated. Most people with arrhythmias are able to live normal, healthy lives.

How the Heart Works The heart is a muscle about the size of your fist. The heart works like a pump and beats about 100,000 times a day.

A healthy adult heart generally beats 60 to 100 times a minute, but it can beat faster or slower at times. For example, physical activity, strong emotion, certain medicines, fever, or infection can make the heart beat faster. A person’s heart rate generally slows down during sleep. Some very fit athletes always have heart rates below 60 beats a minute because their hearts work so well.

The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. Then, oxygen-rich blood returns from the lungs to the left side of the heart, and the left side pumps it to the body.

The heart has four chambers and four valves and is connected to various blood vessels. Veins are the blood vessels that carry blood from the body to the heart. Arteries are the vessels that carry blood away from the heart to the body.

Heart Chambers The heart has four chambers or “rooms”—two on the left side of the heart and two on the right.

The atria are the two upper chambers that collect blood as it comes into the heart.
The ventricles are the two lower chambers that pump blood out of the heart to the lungs or other parts of the body.

Heart Valves Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.

The tricuspid (tri-CUSS-pid) valve is in the right side of the heart, between the right atrium and the right ventricle.
The pulmonary (PULL-mun-ary) valve is in the right side of the heart, between the right ventricle and the entrance to the pulmonary artery that carries blood to the lungs.
The mitral (MI-tral) valve is in the left side of the heart, between the left atrium and the left ventricle.
The aortic (ay-OR-tik) valve is in the left side of the heart, between the left ventricle and the entrance to the aorta, the artery that carries blood to the body.

Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries, and then they shut to keep blood from flowing backward.

When the heart’s valves open and close, they make a “lub-DUB” sound that a doctor can hear using a stethoscope.

The first sound—the “lub”—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the ventricles contract, or squeeze, and pump blood out of the heart.
The second sound—the “DUB”—is made by the aortic and pulmonary valves closing at beginning of diastole (di-AS-toe-lee). Diastole is when the ventricles relax and fill with blood pumped into them by the atria.

Arteries

The arteries are major blood vessels connected to your heart.

The pulmonary artery carries blood pumped from the right side of the heart to the lungs to pick up a fresh supply of oxygen.
The aorta is the main artery that carries oxygen-rich blood pumped from the left side of the heart out to the body.
The coronary arteries are the other important arteries attached to the heart. They carry oxygen-rich blood from the aorta to the heart muscle, which must have its own blood supply to function.

Veins

The veins are also major blood vessels connected to your heart.The pulmonary veins carry oxygen-rich blood from the lungs to the left side of the heart so it can be pumped out to the body.The vena cava is a large vein that carries oxygen-poor blood from the body back to the heart.

Types of Arrhythmia There are four main types of arrhythmia: premature (extra) beats, supraventricular arrhythmias, ventricular arrhythmias, and bradyarrhythmias.

Premature (Extra) Beats Premature beats are the most common type of arrhythmia. They are harmless most of the time and often don’t cause any symptoms. When symptoms do occur, they usually feel like a fluttering in the chest or a sensation of a skipped beat. Most of the time, premature beats need no treatment, especially in healthy people.

Premature beats that occur in the atria are called premature atrial contractions, or PACs. Premature beats that occur in the ventricles are called premature ventricular contractions, or PVCs.

In most cases, premature beats occur naturally, not due to any heart disease. But certain heart diseases can cause premature beats. They also can happen because of stress, too much exercise, or too much caffeine or nicotine.

Supraventricular Arrhythmias Supraventricular arrhythmias are tachycardias (fast heart rates) that start in the atria or the atrioventricular node (cells located between the atria and the ventricles). Types of supraventricular arrhythmias include atrial fibrillation (AF), atrial flutter, paroxysmal supraventricular tachycardia (PSVT), and Wolff-Parkinson-White (WPW) syndrome.

Atrial Fibrillation AF is the most common type of serious arrhythmia. It’s a very fast and irregular contraction of the atria. AF occurs when the heart’s electrical signal begins in a different part of the atrium than the sinoatrial (SA) node or when the signal is conducted abnormally. When this happens, the electrical signal doesn’t travel through the normal pathways in the atria, but instead may spread throughout the atria in a fast and disorganized manner. This causes the walls of the atria to quiver very fast (fibrillate) instead of beating normally. As a result, the atria aren’t able to pump blood into the ventricles the way they should.

In AF, electrical signals can travel through the atria at a rate of more than 300 per minute. Some of these abnormal electrical signals can travel to the ventricles, causing them to beat too fast and with an irregular rhythm. AF is not usually life threatening, although it can be dangerous when it causes the ventricles to beat very fast.

The two most serious complications of chronic (long-term) AF are stroke and heart failure. Stroke can happen when a blood clot travels to an artery in the brain, blocking off blood flow. In AF, blood clots can form in the atria because some of the blood “pools” in the fibrillating atria instead of flowing into the ventricles. If a piece of a blood clot in the left atrium breaks off, it can travel to the brain, causing a stroke. People with AF are often treated with blood-thinning medicines to reduce the chances of developing blood clots.

Heart failure is when the heart can’t pump enough blood to meet the needs of the body. AF can cause heart failure when the ventricles beat too fast and don’t have enough time to fill with blood to pump out to the body. Heart failure causes tiredness, leg swelling, and shortness of breath.

AF and other supraventricular arrhythmias can occur for no apparent reason. Most of the time, however, they are caused by an underlying condition that damages the heart muscle and its ability to conduct electrical impulses. These conditions include high blood pressure (hypertension), coronary artery disease, heart failure, or rheumatic heart disease.

Other conditions also can lead to AF, including overactive thyroid gland (too much thyroid hormone produced) and heavy alcohol use. AF also becomes more common as people get older.

Atrial Flutter

Atrial flutter is similar to atrial fibrillation, but instead of the electrical signals spreading through the atria in a fast and irregular rhythm, they travel in a fast and regular rhythm. Atrial flutter is much less common than atrial fibrillation, but has similar symptoms and complications.

Paroxysmal Supraventricular Tachycardia

PSVT is a very fast heart rate that begins and ends suddenly. PSVT occurs due to problems with the electrical connection between the atria and the ventricles. In PSVT, electrical signals that begin in the atria and travel to the ventricles can reenter the atria, causing extra heartbeats. This type of arrhythmia is not usually dangerous and tends to occur in young people. It can happen during vigorous exercise.

A special type of PSVT is called Wolff-Parkinson-White syndrome. WPW syndrome is a condition in which the heart’s electrical signals travel along an extra pathway from the atria to the ventricles. This extra pathway disrupts the timing of the heart’s electrical signals and can cause the ventricles to beat very fast. This type of arrhythmia can be life threatening.

Ventricular Arrhythmias

These are arrhythmias that start in the ventricles. They can be very dangerous and usually need immediate medical attention. Ventricular arrhythmias include ventricular tachycardia and ventricular fibrillation (v-fib). Coronary artery disease, heart attack, weakened heart muscle, and other problems can cause ventricular arrhythmias.

Ventricular Tachycardia

Ventricular tachycardia is a fast, regular beating of the ventricles that may last for only a few seconds or for much longer. A few beats of ventricular tachycardia often don’t cause problems, but ventricular tachycardia episodes that last for more than just a few seconds can be dangerous. Ventricular tachycardia can turn into other, more dangerous arrhythmias, such as v-fib.

Ventricular Fibrillation

V-fib occurs when disorganized electrical signals make the ventricles quiver instead of pump normally. Without the ventricles pumping blood out to the body, a person will lose consciousness within seconds and will die within minutes if not treated. To prevent death, the condition must be treated immediately with defibrillation, an electric shock to the heart. V-fib may happen during or after a heart attack, or in a heart that is already weak because of another condition. Health experts think that most of the sudden cardiac deaths that occur every year (about 335,000) are due to v-fib.

Torsades de pointes (torsades) is a specific form of v-fib with a unique pattern on anEKG (electrocardiogram). Certain medicines and imbalanced amounts of potassium, calcium, or magnesium in the bloodstream can cause this condition. People with a particular finding on an EKG test, called prolonged QT interval, are at increased risk of developing torsades. People with prolonged QT interval need to be careful about taking certain antibiotics, heart medicines, and over-the-counter medicines.

Bradyarrhythmias

Bradyarrhythmias are arrhythmias in which the heart rate is slower than normal. If the heart rate is too slow, not enough blood reaches the brain, and the person can lose consciousness. In adults, a heart rate slower than 60 beats per minute is considered a bradyarrhythmia. Some people normally have slow heart rates, especially people who are very physically fit. For them, a heartbeat slower than 60 beats per minute is not dangerous and doesn’t cause symptoms. But in other people, bradyarrhythmia can be due to a serious disease or other condition.

Bradyarrhythmias can be caused by heart attack, conditions that harm or change the heart’s electrical system (such as underactive thyroid gland or aging), an imbalance of chemicals or other substances (such as potassium) in the blood, or even some medicines (such as beta blockers).

Bradyarrhythmias also can happen as a result of severe bundle branch block. Bundle branch block is a condition in which the electrical signal traveling down either or both of the bundle branches is delayed or blocked. When this happens, the ventricles don’t contract at exactly the same time, as they should, and the heart has to work harder to pump blood to the body. The cause of bundle branch block is often an existing heart condition.

Arrhythmias in Children

Normally, a child’s heart beats between 70 and 100 times a minute. A newborn’s heart beats about 140 times a minute. A baby or child’s heart can beat faster or slower than normal for many reasons. As is true for adults, when children are active, their hearts will beat faster. When they are sleeping, their heart will beats slower. Their heart rates can speed up and slow down as they breathe in and out. All of these changes are normal.

Some children are born with heart defects that cause arrhythmias. In other children, arrhythmias can develop later in childhood. Doctors do the same kinds of tests in children and adults to diagnose arrhythmias.

Treatments for children with arrhythmias include medicines, electric shock (defibrillation), surgically implanted devices that control the heartbeat, and other procedures that fix distorted electrical signals in the heart.

What Causes an Arrhythmia?

An arrhythmia can occur when the electrical signals that control the heartbeat are delayed or blocked. This can happen when the special nerve cells that produce the electrical signal don't work properly or when the electrical signal doesn't travel normally through the heart. An arrhythmia also can occur when another part of the heart starts to produce electrical signals, adding to the signals from the special nerve cells and disrupting the normal heartbeat.

Stress, smoking, heavy alcohol use, heavy exercise, use of certain drugs (such as cocaine or amphetamines), use of certain prescription or over-the-counter medicines, and too much caffeine or nicotine can lead to arrhythmia in some people.

A heart attack or an underlying condition that damages the heart's electrical system also can cause an arrhythmia. These conditions include high blood pressure(hypertension), coronary artery disease, heart failure, overactive or underactive thyroid gland (too much or too little thyroid hormone produced), and rheumatic heart disease.

For some arrhythmias, such as Wolff-Parkinson-White syndrome, the underlying heart defect that causes the arrhythmia is present at birth (congenital). Sometimes, the cause of an arrhythmia can't be found.

What Are the Signs and Symptoms of Arrhythmias?

Many arrhythmias cause no signs or symptoms. When signs or symptoms are present, the most common ones are:

Palpitations (a feeling that your heart has skipped a beat or is beating too hard)
A slow heartbeat
An irregular heartbeat
Feeling of pauses between heartbeats

More serious signs and symptoms include:

Anxiety
Weakness
Dizziness and light-headedness
Fainting or nearly fainting
Sweating
Shortness of breath
Chest pain

How Are Arrhythmias Treated?

Common arrhythmia treatments include medicines, medical procedures, and surgery. Treatment is needed when an arrhythmia causes serious symptoms, such as dizziness, chest pain, or fainting, or when it increases your chances of developing complications, such as heart failure, stroke, or sudden cardiac death.

Medicines

Medicines can be used to speed up a heart that's beating too slow, or slow down a heart that's beating too fast. They also can be used to convert an abnormal heart rhythm to a normal steady rhythm. Medicines can be used to control an underlying medical condition, such as heart disease or a thyroid condition, that might be causing an arrhythmia. Medicines used to convert an abnormal rhythm are called antiarrhythmics.

Some of the medicines used to slow a fast heart rate are beta blockers (such as metoprolol and atenolol), calcium channel blockers (such as diltiazem and verapamil), and digoxin (digitalis). These medicines are often used to slow the heart rate in people with atrial fibrillation.

Some of the medicines used to restore an abnormal heartbeat to a normal rhythm are amiodarone, sotalol, flecainide, propafenone, dofetilide, ibutilide, quinidine, procainamide, and disopyramide. These medicines often have side effects. Some of the side effects can make an arrhythmia worse or even cause a different kind of arrhythmia.

People with atrial fibrillation and some other arrhythmias are often treated with blood-thinning medicines (anticoagulants) to reduce the chances of developing blood clots. Aspirin, warfarin (Coumadin®), and heparin are commonly used blood thinners.

Medical Procedures Some arrhythmias are treated with a device called a pacemaker. The pacemaker is a small device that's surgically placed under the skin at the collarbone; wires lead from it to the atrium and ventricle(s). The pacemaker sends small electric signals through the wires to control the speed of the heartbeat. Most pacemakers contain a sensor that activates the device only when the heartbeat is abnormal.

Some arrhythmias are treated with a jolt of electricity delivered to the heart. This type of treatment is called cardioversion or defibrillation, depending on which type of arrhythmia is being treated.

Some people who are at risk for ventricular fibrillation are treated with a device called an implantable cardioverter defibrillator (ICD). This device is surgically implanted in the chest and connected to the heart with wires. It continuously monitors the heartbeat. If it senses a dangerous ventricular arrhythmia, it sends an electric shock to the heart to restore a normal heartbeat.

A procedure called radiofrequency ablation is sometimes used to treat certain types of arrhythmias when medicines don't work. In this treatment, a special wire is inserted through a vein in the arm or leg and threaded up to the heart. Radiowave energy is sent through the wire to destroy abnormal tissue in the heart that's interrupting the normal flow of electric signals. Radiofrequency ablation is usually done in the hospital as part of an electrophysiologic study.

Surgery Sometimes, surgery is used to treat arrhythmia. Often this is done when surgery is already being performed for another reason, such as repair of a heart valve. One type of surgery for atrial fibrillation is called "maze" surgery. In this operation, the surgeon makes small cuts or burns in the atria, which prevent the spread of disorganized electrical signals.

Coronary artery bypass surgery may be needed for arrhythmias caused by coronary artery disease. The operation improves blood supply to the heart muscle.

Other Treatments Vagal maneuvers are another arrhythmia treatment. These are simple exercises that sometimes can stop or slow down certain types of supraventricular arrhythmias. They stop the arrhythmia by affecting the vagus nerve, which is one factor that controls the heart rate. Some vagal maneuvers include:

Gagging
Holding your breath and bearing down (Valsalva maneuver)
Immersing your face in ice-cold water
Coughing
Putting your fingers on your eyelids and pressing down gently

Vagal maneuvers aren't an appropriate treatment for everyone. Discuss with your doctor whether vagal maneuvers are safe and effective for you to try.

Who Is At Risk for an Arrhythmia? Populations Affected Millions of Americans have arrhythmias. They are very common in older adults. About 2.2 million Americans have atrial fibrillation (a common type of arrhythmia that can cause problems).

Most serious arrhythmias happen in adults older than 60. This is because older adults are more likely to have heart disease and other health problems that can lead to arrhythmias. Older adults also tend to be more sensitive to the side effects of medicines, some of which can cause arrhythmias. Some medicines used to treat arrhythmias can cause arrhythmias as a side effect.

Some types of arrhythmia happen more often in children and young adults. Paroxysmal supraventricular tachycardias (a fast heart rate that begins and ends suddenly), including Wolff-Parkinson-White syndrome, are more common in young people.

Major Risk Factors Arrhythmias are more common in people who have a disease or condition that weakens the heart, such as:

Heart attack
Heart failure or cardiomyopathy, which weakens the heart and changes the way electrical signals move around the heart
Heart tissue that is too thick or stiff or that hasn't formed normally
Leaking or narrowed heart valves, which make the heart work too hard and can lead to heart failure
Congenital problems (problems that are present at birth) with the heart's structure or function

Other conditions also can increase the chances of arrhythmia, such as:

High blood pressure
Infections that damage the heart muscle or the sac around the heart
Diabetes, which increases the risk of high blood pressure and coronary artery disease
Sleep apnea (when breathing becomes shallow or stops during sleep), which can stress the heart because it doesn't get enough oxygen
Overactive or underactive thyroid gland (too much or too little thyroid hormone in the body)

In addition to certain diseases and conditions, several other risk factors increase a person's chance of having an arrhythmia. Heart surgery, certain drugs (such as cocaine or amphetamines), or an imbalance of chemicals or other substances (such as potassium) in the bloodstream can increase a person's chance of having an arrhythmia.

SLEEP APNEA

2009-05-20T15:15:00.000+06:00

What is Sleep Apnea?

Obstructive sleep apnea, OSA, is a breathing related sleep disorder which can cause people to snore, as well as pose serious health threats. OSA is a condition that occurs when a person regularly stops breathing (apnea) for 10 seconds or longer during sleep. It is usually caused by either the tongue or the soft palate falling back against the back of the throat when the muscles in the neck and throat relax during sleep.

There are three vital things that you need to know about sleep apnea:

Not only does sleep apnea result in sleep deprivation, but it can also threaten your life.
Sleep apnea is a progressive sleep disorder (it gets worse as you age).
Treatment for sleep apnea is necessary and usually successful

Are Snoring and Sleep Apnea the Same Thing?

Snoring and sleep apnea are not the same thing. Snoring is simply a loud sound that you make during breathing while asleep. Snoring may accompany sleep apnea, but snoring by itself does not mean that breathing has stopped.

Warning signs and symptoms of sleep apnea are:

Frequent cessation of breathing (apnea) during sleep. Your sleep partner may notice repeated silences from your side of the bed.
Choking or gasping during sleep to get air into the lungs
Loud snoring
Sudden awakenings to restart breathing
Waking up in a sweat during the night
Feeling unrefreshed in the morning after a night’s sleep
Headaches, sore throat, or dry mouth in the mornings after waking up
Daytime sleepiness, including falling asleep at inappropriate times, such as during driving or at work
Lethargy
Rapid weight gain
Memory loss and learning difficulties
Short attention span

Diagnosis of Sleep Apnea:

A sleep study is the only way to positively diagnose sleep apnea.. The polysomnography (sleep study) is a standard lab test that measures and records specific body functions during sleep. The test is painless and usually performed overnight in a comfortably appointed suite.

Types of Sleep Apnea

Obstructive Sleep Apnea (OSA)
The most common type of sleep apnea. Caused by a breathing obstruction, which stops the air flow in the nose and mouth.

Central Sleep Apnea (CSA)
A much less common type of sleep apnea. The brain signal that instructs the body to breathe is delayed. This central nervous system disorder can be caused by disease or injury involving the brain stem, such as a stroke, a brain tumor, a viral brain infection, or a chronic respiratory disease.

Mixed sleep apnea
A combination of the two other types of sleep apnea, Obstructive Sleep Apnea and Central Sleep Apnea.

Causes of Sleep Apnea

Sleep apnea is caused by the throat being blocked during sleep. The soft tissues of the upper airway collapse and the tongue falls back, blocking the flow of air during sleep. These periods can last from 10 to 90 seconds during which the body receives no oxygen. While there is no cure for sleep apnea, certain factors can contribute to the disorder. Making some lifestyle changes and seeking medical treatment can alleviate most or all of the symptoms.

Risk Factors

Various risk factors can predispose you to have an obstructed airway and therefore cause sleep apnea. If you have a number of the risk factors below, and you are not sleeping well, you might consult a doctor for a diagnosis of sleep apnea. The risk factors for sleep apnea are:

Obesity or excessive fat in the neck and throat
However, note that almost half of people with sleep apnea are not obese.

Age

Male gender

Irregular sleep hours
An irregular sleep schedule can throw off your sleep cycles. Disruptions include work days vs. non-work days; a snoring bed partner; a new baby; aggravation from the day’s events; not following a natural preference for sleep during unconventional hours; and overuse of caffeinated products. Particularly affected are Stage 1 sleep (when you first fall asleep) and REM sleep (when you dream). The result of disruption can be unstable breathing and sleep apnea during these phases of sleep.

Anatomical anomalies that narrow your airway
For example, a deviated septum, an enlarged tongue, or a receding chin.

Snoring
Snoring itself is not only a result of sleep apnea, but also a cause. The repeated vibrations of the soft palate during snoring can cause the soft palate to lengthen, which can obstruct the airway.

Enlarged tonsils or adenoids
Especially can cause sleep apnea in children.

Use of alcohol and sedatives before bedtime

Smoking or exposure to secondhand smoke

Nasal congestion, nasal blockages, and nasal irritants
For example, household dust and dander can inhibit breathing through the nose and force breathing through the throat, which may also be blocked.

Family history of sleep apnea
No specific genetic marker for sleep apnea has been discovered, but obstructive sleep apnea seems to run in families. This may be a result of facial and neck characteristics or anatomic abnormalities that are passed along to succeeding generations.

Other disorders and syndromes
Hypothyroidism, acromegaly, amyloidosis, vocal cord paralysis, post-polio syndrome, neuromuscular disorders, Marfan's syndrome, and Down Syndrome.

Effects of Sleep Apnea

Periods of not breathing cause an alarming drop in the blood oxygen level and can lead to high blood pressure, cardiovascular disease, and stroke. Sleep apnea episodes can happen from 5 to more than 100 times an hour, and sometimes breathing stops hundreds of times each night. Additionally, from the interrupted loss of sleep, excessive daytime sleepiness can occur. This may put a person experiencing obstructive sleep apnea symptoms at even greater risk by causing them to fall asleep while driving or working.

Treatment of Sleep Apnea

Once diagnosed, there are several types of sleep apnea aids and treatment that can offer patients a clear and open airway during sleep. For some people, developing good sleeping habits, losing weight, and avoiding sleep medications and alcohol may cure the sleep apnea syndrome. Other people may need to use a breathing device called aCPAP machine (Continuous Positive Airway Pressure). Worn while the patient sleeps the CPAP uses air pressure to keep the upper airway from collapsing. For patients that cannot wear a CPAP machine, a dental appliance is the most common prevention & relief for sleep apnea. Dentists use a small appliance much like an orthodontic retainer to prevents the tongue from falling back and blocking the airway.

Classifications

Apnea severity is usually categorized by the frequency of apnea episodes:

mild 5 to 19 episodes per hour
moderate 20 to 39 episodes per hour
severe more than 40 episodes per hour

These episodes can last anywhere between 10 to 90 seconds each, terminating with at least a partial awakening. A severe apnea patient may have more than 300 episodes per night!

Common Blood Test

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What Are Blood Tests?

Blood tests help doctors check for certain diseases and conditions. They also help check the function of your organs and show how well treatments are working.

Specifically, blood tests can help doctors:

Evaluate how well organs, like the kidneys, liver, and heart, are working
Diagnose diseases like cancer, HIV/AIDS, diabetes, anemia(uh-NEE-me-eh), and heart disease
Learn whether you have risk factors for heart disease
Check whether medicines you’re taking are working

Overview

Blood tests are very common. When you have routine checkups, your doctor often orders blood tests to see how your body is working.

Many blood tests don’t require any special preparations. For some, you may need to fast (not eat any food) for 8 to 12 hours before the test. Your doctor will let you know whether this is necessary.

During a blood test, a small amount of blood is taken from your body. It’s usually drawn from a vein in your arm using a thin needle. A finger prick also may be used. The procedure is usually quick and easy, although it may cause some short-term discomfort. Most people don’t have serious reactions to having blood drawn.

Lab workers draw the blood and analyze it. They use either whole blood to count blood cells, or they separate the blood cells from the fluid that contains them. This fluid is called plasma or serum.

The fluid is used to measure different substances in the blood. The results can help detect health problems in early stages, when treatments or lifestyle changes may work best.

However, blood tests alone can’t be used to diagnose or treat many diseases or medical problems. Your doctor may consider other factors, such as your signs and symptoms, your medical history, and results from other tests and procedures, to confirm a diagnosis.

Outlook

Blood tests have few risks. Most complications are minor and go away shortly after the tests are done.

Types of Blood Tests

Some of the most common blood tests that doctors order are:

Complete blood count (CBC)
Blood chemistry tests
Blood enzyme tests
Blood tests to assess heart disease risk

Complete Blood Count

The CBC is one of the most common types of blood test. It's often done as part of a routine checkup.

A CBC measures many different parts of your blood (as described below). This test can help detect blood diseases and disorders. These include anemia, infection, clotting problems, blood cancers, and immune system disorders.

Red Blood Cells

Red blood cells carry oxygen from your lungs to the rest of your body. Abnormal red blood cell levels may be a sign of anemia, dehydration (too little fluid in the body), bleeding, or another disorder.

White Blood Cells

White blood cells are part of your immune system, which fights infections and disease. Abnormal white blood cell levels may be a sign of infection, blood cancer, or an immune system disorder.

A CBC measures the overall number of white blood cells in your blood. A differential count looks at the amounts of different types of white blood cells in your blood.

Platelets

Platelets (PLATE-lets) are blood cells that help your blood clot. They stick together to seal cuts or breaks and stop bleeding. Abnormal platelet levels may be a sign of a bleeding disorder (not enough clotting) or a thrombotic disorder (too much clotting).

Hemoglobin

Hemoglobin (HEE-muh-glow-bin) is an iron-rich protein in red blood cells that carries oxygen. Abnormal hemoglobin levels may be a sign of anemia, sickle cell anemia,thalassemia (thal-a-SE-me-ah), or other blood disorders.

If you have diabetes, excess glucose in your blood can attach to hemoglobin and raise the level of hemoglobin A1c.

Hematocrit

Hematocrit (hee-MAT-oh-crit) is a measure of how much space red blood cells take up in your blood. A high hematocrit level might mean you're dehydrated. A low hematocrit level might mean you have anemia. Abnormal hematocrit levels also may be a sign of a blood or bone marrow disorder.

Mean Corpuscular Volume

Mean corpuscular (kor-PUS-kyu-lar) volume (MCV) is a measure of the average size of your red blood cells. Abnormal MCV levels may be a sign of anemia or thalassemia.

Blood Chemistry Tests/Basic Metabolic Panel

The basic metabolic panel (BMP) is a group of tests that measure different chemicals in the blood. These tests usually are done on the fluid (plasma) part of blood. The tests can give doctors information about your muscles, including the heart; bones; and organs, such as the kidneys and liver.

The BMP includes blood glucose, calcium, electrolyte, and kidney tests. Some of these tests require you to fast (not eat any food) before the test, and others don't.

Blood Glucose

Glucose is a type of sugar that the body uses for energy. Abnormal glucose levels in your blood may be a sign of diabetes.

For some blood glucose tests, you have to fast before your blood is drawn. Other blood glucose tests are done after a meal or at any time with no preparation.

Calcium

Calcium is one of the most important minerals in the body. Abnormal calcium levels in the blood may be a sign of kidney problems, bone disease, thyroid disease, cancer, malnutrition, or another disorder.

Electrolytes

Electrolytes are minerals that help maintain fluid levels and acid-base balance in the body. They include sodium, potassium, bicarbonate, and chloride.

Abnormal electrolyte levels may be a sign of dehydration, kidney disease, liver disease, heart failure, high blood pressure, or other disorders.

Kidneys

Kidney tests measure levels of blood urea nitrogen (BUN) and creatinine. Both of these are waste products that the kidneys filter out of the body. Abnormal BUN and creatinine levels may be signs of a kidney disease or disorder.

Blood Enzyme Tests

Enzymes are chemicals that help control different reactions in your body. There are many blood enzyme tests. This section focuses on blood enzyme tests used to check for heart attack.

These include creatine kinase (CK) and troponin tests.

Creatine Kinase

When muscle or heart cells are injured, CK (a blood product) leaks out, and its levels in your blood rise. There are different types of CK. CK-MB is released when the heart muscle is damaged.

High CK levels can mean that you've had muscle damage in your body. High levels of CK-MB can mean that you've had a heart attack.

Doctors order CK tests (such as CK-MB) when patients have chest pain or other heart attack signs and symptoms.

Troponin

This is a muscle protein that helps your muscles contract. Blood levels of troponin rise when you have a heart attack. For this reason, doctors often order troponin tests along with CK-MB tests when patients have chest pain or other heart attack signs and symptoms.

Blood Tests To Assess Heart Disease Risk

Abnormal levels of certain chemicals in the blood may mean that you’re at higher risk for heart disease. Your doctor may want to test the levels of these chemicals to assess your risk and to suggest ways to reduce it.

Lipoprotein Panel

This test can help show how high your risk is for coronary heart disease. A lipoprotein panel looks at substances in your blood that carry cholesterol.

The test gives information about your:

Total cholesterol.
LDL ("bad") cholesterol. This is the main source of cholesterol buildup and blockages in the arteries.
HDL ("good") cholesterol. This type of cholesterol helps decrease blockages in the arteries.
Triglycerides. These are another form of fat in your blood.

A lipoprotein panel measures the levels of HDL and LDL cholesterol and triglycerides in your blood. Abnormal cholesterol and triglyceride levels may be signs of increased risk for coronary heart disease.

Most people will need to fast for 9 to 12 hours before a lipoprotein panel.

High-Sensitivity C-Reactive Protein

This is a fairly new test for heart disease risk. It looks at blood levels of C-reactive protein (CRP). High CRP blood levels can be a sign of inflammation.

Doctors use standard CRP tests to check for inflammation and autoimmune diseases. Your doctor may order an hs-CRP test, along with other tests, to see whether you’re at increased risk for heart disease.

However, CRP tests aren’t routinely done, because it’s still unclear how useful they are for showing heart disease risk.

Homocysteine

High levels of this chemical in the blood can mean that you’re at higher risk for heart attack or stroke. This isn’t a routine test for heart disease risk. But some doctors may use it, a long with other tests, if they think you’re at increased risk.

What To Expect With Blood Tests

What To Expect Before Blood Tests

Many blood tests don’t require any special preparation and take only a few minutes.

Other blood tests require fasting (not eating any food) anywhere from 8 to 12 hours before the test. Your doctor will let you know whether you need to fast for your blood test(s).

What To Expect During Blood Tests

Blood usually is drawn from a vein in your arm or other part of your body using a thin needle. It also can be drawn using a finger prick.

The person who draws your blood might tie a band around the upper part of your arm or ask you to make a fist. These things can make the veins in your arm stick out more. This makes it easier to insert the needle.

The needle that goes into your vein is attached to a small test tube. The person who draws your blood removes the tube when it's full, and the tube seals on its own. The needle is then removed from your vein. If you're getting a few different blood tests, more than one test tube may be attached to the needle before it’s withdrawn.

Some people get nervous about blood tests because they’re afraid of the needle. Others may not want to see blood leaving their bodies.

If you’re nervous or scared, it can help to look away or talk to someone to distract yourself. You might feel a slight sting when the needle goes in or comes out.

Drawing blood usually takes less than 3 minutes.

What To Expect After Blood Tests

Once the needle is withdrawn, you’ll be asked to apply gentle pressure with a piece of gauze or bandage to the place where the needle went in. This helps stop bleeding. It also helps prevent swelling and bruising.

After a minute or two, you can remove the pressure. You may want to keep a bandage on for a few hours.

Usually, you don’t need to do anything else after a blood test, except wait for the results. They can take anywhere from a few minutes to a few weeks to come back. Your doctor should get the results. It’s important that you follow up with your doctor to discuss your test results.

What Do Blood Tests Show?

Blood tests show whether the levels of different substances in your blood fall within a normal range.

For many blood substances, the normal range is the range of levels seen in 95 percent of healthy people in a particular group. For many tests, normal ranges are different depending on your age, gender, race, and other factors.

Many factors can cause your blood test levels to fall outside the normal range. Abnormal levels may be a sign of a disorder or disease. Other factors—such as diet, menstrual cycle, how much physical activity you do, how much alcohol you drink, and the medicines you take (both prescription and over-the-counter)—also can cause abnormal levels.

Your doctor should discuss any unusual or abnormal blood tests results with you. These results may or may not suggest a health problem.

Many diseases or medical problems can’t be diagnosed with blood tests alone. However, they can help you and your doctor learn more about your health. Blood tests also can help find potential problems early, when treatments or lifestyle changes may work best.

Result Ranges for Common Blood Tests

This section presents the result ranges for some of the most common blood tests.

NOTE: All values in this section are for adults only. They don’t apply to children. Talk to your child’s doctor about values on blood tests for children.

Complete Blood Count

The table below shows some normal ranges for different components of the complete blood count (CBC). Some of the normal ranges are different for men and women. Other factors, such as age and race, also may affect normal ranges.

Your doctor should discuss your results with you. He or she will advise you further if your results are outside the normal range for your group.

Test	Normal Range Results*
Red blood cell (varies with altitude)	Male: 5 to 6 million cells/mcL Female: 4 to 5 million cells/mcL
White blood cell	4,500 to 10,000 cells/mcL
Platelets	140,000 to 450,000 cells/mcL
Hemoglobin (varies with altitude)	Male: 14 to 17 gm/dL Female: 12 to 15 gm/dL
Hematocrit (varies with altitude)	Male: 41 to 50% Female: 36 to 44%
Mean corpuscular volume	80 to 95 femtoliter

* Cells/mcL = cells per microliter; gm/dL = grams per deciliter

Blood Glucose

This table shows the ranges for blood glucose levels after 8 to 12 hours of fasting (not eating). It shows the normal range and also the abnormal ranges that are a sign of prediabetes or diabetes.

Plasma Glucose Results (mg/dL)*	Diagnosis
99 and below	Normal
100 to 125	Prediabetes
126 and above	Diabetes^†

* mg/dL = milligrams per deciliter.
† The test is repeated on another day to confirm the results.

Lipoprotein Panel

The table below shows ranges for total cholesterol, LDL ("bad") cholesterol, and HDL ("good") cholesterol levels after 9 to 12 hours of fasting. High blood cholesterol is a risk factor for coronary heart disease.

Your doctor should discuss your results with you. He or she will advise you further if your results are outside the desirable range.

Total Cholesterol Level	Total Cholesterol Category
Less than 200 mg/dL	Desirable
200–239 mg/dL	Borderline high
240 mg/dL and above	High

LDL Cholesterol Level	LDL Cholesterol Category
Less than 100 mg/dL	Optimal
100–129 mg/dL	Near optimal/above optimal
130–159 mg/dL	Borderline high
160–189 mg/dL	High
190 mg/dL and above	Very high

HDL Cholesterol Level	HDL Cholesterol Category
Less than 40 mg/dL	A major risk factor for heart disease
40–59 mg/dL	The higher, the better
60 mg/dL and above	Considered protective against heart disease

What Is Pulmonary Embolism?

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A pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE, is a sudden blockage in a lung artery, usually due to a blood clot that traveled to the lung from a vein in the leg. A clot that forms in one part of the body and travels in the bloodstream to another part of the body is called an embolus.

PE is a serious condition that can cause:
Permanent damage to part of your lung from lack of blood flow to lung tissue
Low oxygen levels in your blood
Damage to other organs in your body from not getting enough oxygen

If the blood clot is large, or if there are many clots, PE can cause death.

Overview

In most cases, PE is a complication of a condition called deep vein thrombosis (DVT). In DVT, blood clots form in the deep veins of the body—most often in the legs. These clots can break free, travel through the bloodstream to the lungs, and block an artery. This is unlike clots in the veins close the skin's surface, which remain in place and do not cause PE.

Outlook

At least 100,000 cases of PE occur each year in the United States. PE is the third most common cause of death in hospitalized patients. If left untreated, about 30 percent of patients with PE will die. Most of those who die do so within the first few hours of the event

Other Names for Pulmonary Embolism

Venous thromboembolism (VTE). This term is used for both pulmonary embolism and deep vein thrombosis.

Who Is At Risk for Pulmonary Embolism?

Populations Affected

Pulmonary embolism (PE) occurs equally in men and women. Risk increases with age: For each 10 years after age 60, the risk of PE doubles. Certain inherited conditions, such as factor V Leiden, increase the risk of blood clotting, and, therefore, the risk of PE.

Major Risk Factors

People at high risk for a blood clot that travels to the lungs are those who:

Have deep vein thrombosis (DVT, a blood clot in the leg) or a history of DVT
Have had PE before

Other Risk Factors

People who recently have been treated for cancer or who have a central venous catheter (a tube placed in a vein to allow easy access to the bloodstream for medical treatment) are more likely to develop DVT. The same is true for people who have been bedridden or have had surgery or suffered a broken bone in the past few weeks. Other risk factors for DVT, which can lead to PE, include sitting for long periods of time (such as on long car or airplane rides), pregnancy and the 6-week period after pregnancy, and being overweight or obese. Women who take hormone therapy or birth control pills also are at increased risk for DVT. People with more than one risk factor are at higher risk for blood clots.

What Causes Pulmonary Embolism?

Major Causes

In 9 out of 10 cases, pulmonary embolism (PE) begins as a blood clot in the deep veins of the leg (a condition known as deep vein thrombosis). The clot breaks free from the vein and travels through the bloodstream to the lungs, where it can block an artery.

Other Causes

Rarely, an air bubble, part of a tumor, or other tissue travels to the lungs and causes PE. Also, when a large bone in the body (such as the thigh bone) breaks, fat from the marrow inside the bone can travel through the blood to the lungs and cause PE.

Signs and Symptoms of Pulmonary Embolism?

Major Signs and Symptoms

Signs and symptoms of pulmonary embolism (PE) include unexplained shortness of breath, difficulty breathing, chest pain, coughing, or coughing up blood. An arrhythmia(a rapid or irregular heartbeat) also may indicate PE. In some cases, the only signs and symptoms are related to deep vein thrombosis(DVT). These include swelling of the leg or along the vein in the leg, pain or tenderness in the leg, a feeling of increased warmth in the area of the leg that's swollen or tender, and red or discolored skin on the affected leg. See your doctor at once if you have any symptoms of PE or DVT. It's possible to have a PE and not have any signs or symptoms of PE or DVT.

Other Signs and Symptoms

Sometimes people who have PE experience feelings of anxiety or dread, lightheadedness or fainting, rapid breathing, sweating, or an increased heart rate.

Treatment

Goals of Treatment The main goals of treating pulmonary embolism (PE) are to:

Stop the blood clot from getting bigger
Keep new clots from forming

Treatment may include medicines to thin the blood and slow its ability to clot. If your symptoms are life threatening, the doctor may give you medicine to dissolve the clot more quickly. Rarely, the doctor may use surgery or another procedure to remove the clot.

Specific Types of Treatment Medicines

Anticoagulants (AN-te-ko-AG-u-lants), which are blood-thinning medicines, decrease your blood's ability to clot. They're used to stop blood clots from getting bigger and to prevent clots from forming. They don't break up blood clots that have already formed. (The body dissolves most clots with time.)

Anticoagulants can be taken as either a pill, an injection, or through a needle or tube inserted into a vein (called intravenous, or IV, injection). Warfarin is given in a pill form. (Coumadin® is a common brand name for warfarin.) Heparin is given as an injection or through an IV tube.

Your doctor may treat you with both heparin and warfarin at the same time. Heparin acts quickly. Warfarin takes 2 to 3 days before it starts to work. Once warfarin starts to work, usually the heparin will be stopped.

Pregnant women usually are treated with heparin only, because warfarin is dangerous for the pregnancy.

If you have deep vein thrombosis, treatment with anticoagulants usually lasts for 3 to 6 months.

If you have had blood clots before, you may need a longer period of treatment. If you're being treated for another illness, such as cancer, you may need to take anticoagulants as long as risk factors for PE are present.

The most common side effect of anticoagulants is bleeding. This happens if the medicine thins your blood too much. This side effect can be life threatening. Sometimes, the bleeding can be internal. This is why people treated with anticoagulants usually receive regular blood tests. These tests are called PT and PTT tests, and they measure the blood's ability to clot. These tests also help the doctor make sure you're taking the right amount of medicine. Call your doctor right away if you have easy bruising or bleeding.

Thrombin inhibitors are a newer type of anticoagulant medicine. They're used to treat some types of blood clots for patients who can't take heparin.

Emergency Treatment

When PE is life threatening, doctors may use treatments that remove or break up clots in the blood vessels of the lungs. These treatments are given in the emergency room or in the hospital.

Thrombolytics are medicines given to quickly dissolve a blood clot. They're used to treat large clots that cause severe symptoms. Because thrombolytics can cause sudden bleeding, they're used only in life-threatening situations.

In some cases, the doctor may use a catheter to reach the blood clot. A catheter is a flexible tube placed in a vein to allow easy access to the bloodstream for medical treatment. The catheter is inserted into the groin (upper thigh) or arm and threaded through a vein to the clot in the lung. The catheter may be used to extract the clot or deliver medicine to dissolve it.

Rarely, surgery may be needed to remove the blood clot.

Other Types of Treatment

When you can't take medicines to thin your blood, or when you're taking blood thinners but continue to develop clots anyway, the doctor may use a device called a vena cava filter to keep clots from traveling to your lungs. The filter is inserted inside a large vein called the inferior vena cava (the vein that carries blood from the body back to the heart). The filter catches clots before they travel to the lungs. This prevents PE, but it doesn't stop other blood clots from forming.

Graduated compression stockings can reduce the chronic (ongoing) swelling that may occur after a blood clot has developed in a leg. The leg swelling is due to damage to the valves in the leg veins. Graduated compression stockings are worn on the legs from the arch of the foot to just above or below the knee. These stockings are tight at the ankle and become looser as they go up the leg. This causes a gentle compression (or pressure) up the leg. The pressure keeps blood from pooling and clotting.

Prevention

Preventing pulmonary embolism (PE) begins with preventing deep vein thrombosis(DVT). Knowing whether you're at risk for DVT and taking steps to lower your risk are important.

If you've never had a deep vein clot, but are at risk for it, these are steps you can take to decrease your risk.

Exercise your lower leg muscles during long car trips and airplane rides.
Get out of bed and move around as soon as you're able after having surgery or being ill. The sooner you move around, the lower your chance of developing a clot.
Take medicines to prevent clots after some types of surgery (as directed by your doctor).
Follow up with your doctor.

If you already have had DVT or PE, you can take additional steps to help keep new blood clots from forming:

Visit your doctor for regular checkups.
Use compression stockings to prevent chronic swelling in your legs after DVT (as directed by your doctor).

Contact your doctor at once if you have any signs or symptoms of DVT or PE.

Living With Pulmonary Embolism

Treatment for PE usually takes place in the hospital. After leaving the hospital you may need to take medicine at home for 6 months or longer. It's important to:

Take medicines as prescribed.
Have blood tests done as directed by your doctor.
Talk to your doctor before taking anticoagulants with any other medicines, including over-the-counter medicines. Over-the-counter aspirin, for example, can thin your blood. Taking two medicines that thin your blood (even if one is over-the-counter) may increase your risk for bleeding.
Ask your doctor about your diet. Foods that contain vitamin K can affect how well warfarin (Coumadin®) works. Vitamin K is found in green leafy vegetables and some oils, such as canola and soybean oil. It's best to eat a well-balanced, healthy diet.
Discuss with your doctor what amount of alcohol is safe for you to drink if you're taking medicine.

Medicines used to treat PE can thin your blood too much. This can cause bleeding in the digestive system or the brain. If you have signs or symptoms of bleeding in the digestive system or the brain, get treatment at once.

Signs and symptoms of bleeding in the digestive system include:

Bright red vomit or vomit that looks like coffee grounds
Bright red blood in your stool or black, tarry stools
Pain in your abdomen

Signs and symptoms of bleeding in the brain include:

Severe pain in your head
Sudden changes in your vision
Sudden loss of movement in your legs or arms
Memory loss or confusion

Excessive bleeding from a fall or injury also may mean that your PE medicines have thinned your blood too much. Excessive bleeding is bleeding that will not stop after you apply pressure to a wound for 10 minutes. If you have excessive bleeding from a fall or injury, get treatment at once.

Once you have had PE (with or without deep vein thrombosis (DVT)), you have a greater chance of having another one. During treatment and after, continue to:

Take steps to prevent DVT
Check your legs for any signs or symptoms of DVT, such as swollen areas, pain or tenderness, increased warmth in swollen or painful areas, or red or discolored skin

If you think that you have DVT or are having symptoms of PE, contact your doctor at once.

Hypotension (Low Blood Pressure)

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What Is Hypotension?

Hypotension (HI-po-TEN-shun) is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood.

Blood pressure is measured as systolic (sis-TOL-ik) and diastolic (di-a-STOL-ik) pressures. Systolic blood pressure is the pressure when the heart beats while pumping blood. Diastolic blood pressure is the pressure when the heart is at rest between beats.

You will most often see blood pressure numbers written with the systolic number above or before the diastolic, such as 120/80 mmHg. (The mmHg is millimeters of mercury-the units used to measure blood pressure.)

Normal blood pressure in adults is lower than 120/80 mmHg. Hypotension is blood pressure that's lower than 90/60 mmHg.
General idea

Blood pressure changes during the day. It lowers as you sleep and rises when you wake up. It also can rise when you're excited, nervous, or active.

Your body is very sensitive to changes in blood pressure. Special cells in the arteries can sense if your blood pressure begins to rise or fall. When this happens, the cells trigger your body to try to bring blood pressure back to normal.

For example, if you stand up quickly, your blood pressure may drop. The cells will sense the drop and will quickly take action to make sure that blood continues to flow to your brain, kidneys, and other important organs.

Most forms of hypotension happen because your body can't bring blood pressure back to normal or can't do it fast enough.

Some people have low blood pressure all of the time. They have no signs or symptoms, and their low blood pressure is normal for them. In other people, certain conditions or factors cause blood pressure to drop below normal.

Hypotension is a medical concern only if it causes signs or symptoms, such as dizziness, fainting, or, in extreme cases, shock.
Point of View

In a healthy person, low blood pressure without signs or symptoms usually isn't a problem and needs no treatment. If low blood pressure causes signs or symptoms, your doctor will try to find and treat the underlying condition that's causing it.
Hypotension can be dangerous. It can make a person fall because of dizziness or fainting. Shock, a severe form of hypotension, is a condition that's often fatal if not treated right away. With prompt and proper treatment, shock can be successfully treated.

Types of Hypotension

There are several types of hypotension. People who always have low blood pressure have chronic asymptomatic hypotension. They have no signs or symptoms and need no treatment. Their low blood pressure is normal for them.

Other types of hypotension occur only sometimes, when blood pressure suddenly drops too low. The symptoms and effects on the body range from mild to severe.

The three main types of this kind of hypotension are orthostatic (OR-tho-STAT-ik) hypotension, neurally mediated hypotension (NMH), and severe hypotension linked to shock.

Orthostatic Hypotension

This type of low blood pressure occurs when standing up from a sitting or lying down position. It can make you feel dizzy or lightheaded, or even make you faint.

Orthostatic hypotension occurs if your body isn't able to adjust blood pressure and blood flow fast enough for the change in position. This type of low blood pressure usually lasts for only a few seconds or minutes after you stand up. You may need to sit or lie down for a short time while your blood pressure returns to normal.

Orthostatic hypotension can occur in all age groups. However, it's more common in older adults, especially those who are frail or in poor health. It can be a symptom of other medical conditions, and treatment often focuses on treating the underlying condition(s).

Some people have orthostatic hypotension, but also have high blood pressure when lying down.

A form of orthostatic hypotension called postprandial hypotension is a sudden drop in blood pressure after a meal. This type of low blood pressure mostly affects older adults. It's also more likely to affect people who have high blood pressure or a central nervous system disorder, such as Parkinson's disease.
Neurally Mediated Hypotension

With NMH, blood pressure drops after you've been standing for a long time. You may feel dizzy, faint, or sick to the stomach as a result. This type of low blood pressure also can occur if you have an unpleasant, upsetting, or scary experience.

NMH affects children and young adults more often than people in other age groups. Children often outgrow NMH.
Severe Hypotension Linked to Shock

People may say a person has "gone into shock" as a result of an upsetting event. But to doctors, the word "shock" has a different meaning.

Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can't get enough blood to work properly. Blood pressure drops much lower in shock than in other types of hypotension.

Many factors can cause shock, such as major blood loss, certain severe infections, severe burns and allergic reactions, and poisoning. Shock can be fatal if it's not treated right away.

Other Names for Hypotension

Low blood pressure
Neurally mediated hypotension
Neurogenic orthostatic hypotension
Orthostatic hypotension
Postprandial hypotension
Postural hypotension
Shock

What Causes Hypotension?

Factors or conditions that disrupt the body's ability to control blood pressure cause hypotension. The different types of hypotension have different causes.

Orthostatic Hypotension

Orthostatic hypotension has many causes. Sometimes two or more factors combine to cause this type of low blood pressure.

Dehydration (de-hi-DRA-shun) is the most common cause of orthostatic hypotension. Dehydration occurs when the body loses more water than it takes in. You may become dehydrated if you don't drink enough fluids or if you sweat a lot during physical activity. Fever, vomiting, and severe diarrhea also can lead to dehydration.

Orthostatic hypotension may occur during pregnancy, but it generally goes away after the birth.

Because an older body doesn't manage changes in blood pressure as well as a younger body, getting older also can lead to this type of hypotension.

Postprandial hypotension (a type of orthostatic hypotension) mostly affects older adults. Postprandial hypotension is a sudden drop in blood pressure after a meal.

Certain medical conditions can raise your risk for orthostatic hypotension, including:

Heart conditions, such as heart attack, heart valve disease, bradycardia (a very low heart rate), and heart failure. These conditions prevent the heart from pumping enough blood to the body.
Anemia (uh-NEE-me-eh).
Severe infections.
Endocrine conditions, such as thyroid disorders, Addison's disease, low blood sugar, and diabetes.
Disorders of the central nervous system, such as Parkinson's disease.
Pulmonary embolism.

Some medicines used to treat high blood pressure and heart disease can raise your risk for orthostatic hypotension. These medicines include:

Diuretics, or "water pills"
Calcium channel blockers
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Nitrates
Beta blockers

Medicines used to treat conditions such as anxiety, depression, erectile dysfunction, and central nervous system disorders (like Parkinson's disease) also can increase your risk for orthostatic hypotension.

Other substances, when taken with high blood pressure medicines, also can lead to orthostatic hypotension. These substances include alcohol, barbiturates, and some prescription and over-the-counter medicines.

Finally, other factors or conditions that can trigger orthostatic hypotension include being out in the heat or being immobile (not being able to move around very much) for a long time.

Neurally Mediated Hypotension

Neurally mediated hypotension (NMH) occurs when the brain and heart don't communicate with each other properly.

For example, when you stand for a long time, blood begins to pool in your legs. This causes your blood pressure to drop. In NHM, the body mistakenly tells the brain that blood pressure is high. In response, the brain slows the heart rate. This makes blood pressure drop even more, causing dizziness and other symptoms.

Severe Hypotension Linked to Shock.

Many factors and conditions can cause severe hypotension linked to shock. Some of these factors also can cause orthostatic hypotension. In shock, though, blood pressure drops very low and doesn't return to normal on its own.

Shock is an emergency and must be treated right away. If a person has signs or symptoms of shock.

Certain severe infections can cause shock. This is known as septic shock. It can occur when bacteria enter the bloodstream. The bacteria release a toxin (a poison) that leads to a dangerous drop in blood pressure.

A severe loss of blood or fluids from the body also can cause shock. This is known as hypovolemic (HI-po-vo-LE-mik) shock. Hypovolemic shock can happen as a result of:

Major external bleeding (for example, from a severe cut or injury)
Major internal bleeding (for example, from a ruptured blood vessel or injury that causes bleeding inside the body)
Major loss of body fluids from severe burns
Severe swelling of the pancreas (an organ that produces enzymes and hormones, such as insulin)
Severe diarrhea
Severe kidney disease
Overuse of diuretics

A major decrease in the heart's ability to pump blood also can cause shock. This is known as cardiogenic (KAR-de-o-JEN-ik) shock. Heart attack, pulmonary embolism, or arrhythmia (an irregular heartbeat) can cause this type of shock.

A sudden and extreme widening of the arteries and drop in blood pressure also can cause shock. This is known as vasodilatory (VA-so-DI-la-tory) shock. It can occur due to:

A severe head injury
A reaction to certain medicines
Liver failure
Poisoning
A severe allergic reaction (called anaphylactic (AN-a-fi-LAK-tik) shock)

Who Is At Risk for Hypotension?

Hypotension can affect people of all ages. However, people in certain age groups are more likely to have certain types of low blood pressure.

Older adults are more likely to have orthostatic and postprandial hypotension. Children and young adults are more likely to have neurally mediated hypotension.

People who take certain medicines, such as high blood pressure medicines, are at higher risk for low blood pressure. People who have central nervous system disorders (such as Parkinson's disease) or some heart conditions also are at higher risk for low blood pressure.

Other risk factors for hypotension include being immobile (not being able to move around very much) for long periods and pregnancy. Hypotension during pregnancy is normal and goes away after birth.

What Are the Signs and Symptoms of Hypotension?

Orthostatic Hypotension

The signs and symptoms of orthostatic hypotension may happen within a few seconds or minutes of standing up after you've been sitting or lying down. You may feel that you're going to faint, or you may actually faint. Signs and symptoms include:

Dizziness or feeling lightheaded
Blurry vision
Confusion
Weakness
Nausea (feeling sick to your stomach)

These signs and symptoms go away if you sit or lie down for a few minutes until your blood pressure adjusts to normal.

Neurally Mediated Hypotension

The signs and symptoms of neurally mediated hypotension (NMH) are similar to those of orthostatic hypotension. They occur after standing for a long time or in response to an unpleasant, upsetting, or scary experience.

The drop in blood pressure with NMH doesn't last long and often goes away after sitting down.

Severe Hypotension Linked to Shock

In shock, not enough blood flows to the major organs, including the brain.

The early signs and symptoms of reduced blood flow to the brain include lightheadedness, sleepiness, and confusion. In the earliest stages of shock, it may be hard to detect any signs or symptoms. In older people, the first symptom may only be confusion.

Over time, as shock worsens, a person won't be able to sit up without passing out. If the shock continues, the person will lose consciousness. Shock is often fatal if not treated right away.

Other signs and symptoms of shock vary, depending on what's causing the shock. When low blood volume (from major blood loss, for example) or poor pumping action in the heart (from heart failure, for example) causes shock:

The skin becomes cold and sweaty. It often looks blue or pale. If pressed, the color returns to normal more slowly than usual. A bluish network of lines appears under the skin.
The pulse becomes weak and rapid.
The person begins to breathe very quickly.

When extreme widening or stretching of blood vessels (such as in septic shock) causes shock, a person feels warm and flushed at first. Later, the skin becomes cold and clammy, and the person feels very sleepy.

How Is Hypotension Diagnosed?

Hypotension is diagnosed based on your medical history, a physical exam, and results from tests. Your doctor will want to know:

The type of low blood pressure you have and how severe it is
Whether an underlying condition is causing the low blood pressure

Specialists Involved

A primary care doctor or specialist may diagnose and treat hypotension. The type of specialist most commonly involved is a cardiologist (heart specialist).

Other specialists also may be involved, such as surgeons, nephrologists (kidney specialists), neurologists (brain and nerve specialists), or others.

Diagnostic Tests

When a person is in shock, someone should call 9-1-1 right away because emergency treatment is needed.

For other types of hypotension, your doctor may order tests to find out how your blood pressure responds in certain situations. The results will help your doctor understand why you're fainting or having other symptoms.

Blood Tests

During a blood test, a small amount of blood is taken from your body. It's usually drawn from a vein in your arm using a thin needle. The procedure is quick and easy, although it may cause some short-term discomfort.

Blood tests can show whether anemia or low blood sugar is causing your hypotension.

EKG (Electrocardiogram)

An EKG is a simple test that detects and records the heart's electrical activity. It shows how fast the heart is beating and the heart's rhythm (steady or irregular). An EKG also shows the strength and timing of electrical signals as they pass through each part of the heart.

Holter and Event Monitors

Holter and event monitors are medical devices that record the heart's electrical activity. These monitors are similar to an EKG. However, a standard EKG only records the heartbeat for a few seconds. It won't detect heart rhythm problems that don't occur during the test.

Holter and event monitors are small, portable devices. You can wear one while you do your normal daily activities. This allows the monitor to record your heart longer than an EKG can.

Echocardiography

Echocardiography is a test that uses sound waves to create a moving picture of your heart. The picture shows how well your heart is working and its size and shape.

There are several different types of echocardiography, including a stress echocardiogram, or "stress echo." This test is done as part of a stress test (see below). A stress echo usually is done to find out whether you have decreased blood flow to your heart, a sign of coronary artery disease.

Stress Test

Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise (or are given medicine if you're unable to exercise) to make your heart work hard and beat fast while heart tests are done.

These tests may include nuclear heart scanning, echocardiography, and magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning of the heart.

Valsalva Maneuver

This is a simple test of the part of your nervous system that controls functions such as your heartbeat and the narrowing and widening of your blood vessels. If something goes wrong with this part of the nervous system, blood pressure problems may occur.

During this test you take a deep breath and then force the air out through your lips. You will do this several times. Your heart rate and blood pressure will be checked during the test.

Tilt Table Test

This test is used if you have fainting spells for no known reason. For the test, you lie on a table that moves from a lying down to an upright position. Your doctor checks your reaction to the change in position.

Doctors use a tilt table test to diagnose orthostatic hypotension and neurally mediated hypotension (NMH). People who have NMH usually faint during this test. The test can help your doctor find any underlying brain or nerve condition.

How Is Hypotension Treated?

Treatment depends on the type of hypotension you have and how severe your signs and symptoms are. The goals of treatment are to relieve signs and symptoms and manage any underlying condition(s) causing the hypotension.

Your response to treatment depends on your age, overall health, and strength. It also depends on how easily you can stop, start, or change medicines.

In a healthy person, low blood pressure without signs or symptoms usually needs no treatment.

If you have signs or symptoms of low blood pressure, you should sit or lie down right away. Put your feet above the level of your heart. If your symptoms don't go away quickly, you should seek medical care right away.

Orthostatic Hypotension

There are a number of treatments for orthostatic hypotension. If you have this type of low blood pressure, your doctor may advise making lifestyle changes such as:

Drinking plenty of fluids, like water
Drinking little or no alcohol
Standing up slowly
Not crossing your legs while sitting
Gradually sitting up for longer periods if you've been immobile (not able to move around much) for a long time due to a medical condition
Eating small, low-carbohydrate meals if you have postprandial hypotension (a form of orthostatic hypotension)

Talk to your doctor about using compression stockings. These stockings apply pressure to your lower legs. They help move blood throughout your body.

If medicine is causing your low blood pressure, your doctor may change the medicine or adjust the dose you take.

Several medicines also are used to treat orthostatic hypotension. These medicines, which raise blood pressure, include fludrocortisone and midodrine.

Neurally Mediated Hypotension

If you have neurally mediated hypotension (NMH), you may need to make lifestyle changes. These may include:

Avoiding situations that trigger symptoms. For example, don't stand for long periods. Try to avoid unpleasant, upsetting, or scary situations.
Drinking plenty of fluids, like water.
Increasing your salt intake (as your doctor advises).
Learning to recognize symptoms that occur before fainting and taking action to raise blood pressure. For example, sitting down and putting your head between your knees can help raise blood pressure.

If medicine is causing your low blood pressure, your doctor may change the medicine or adjust the dose you take. He or she also may prescribe a medicine to treat NMH.

Children who have NHM often outgrow it.

Treating Severe Hypotension Linked to Shock

Shock is a life-threatening emergency. People who have shock usually need to be treated in a hospital or by emergency medical personnel.

The goals of treating shock are to:

Restore blood flow to the organs as quickly as possible to prevent organ damage
Find and reverse the cause of shock

Special fluid or blood injected into the bloodstream is often used to restore blood flow to the organs. Medicines can be used to raise blood pressure or make the heartbeat stronger. Depending on the cause of the shock, other treatments, such as antibiotics or surgery, may be needed.

Key Points

Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood.
Normal blood pressure in adults is lower than 120/80 mmHg. Hypotension is blood pressure that's lower than 90/60 mmHg.
Some people have low blood pressure all the time. They have no signs or symptoms and their low readings are normal for them. In other people, certain conditions or factors cause blood pressure to drop below normal.
In a healthy person, low blood pressure without signs or symptoms usually isn't a problem and needs no treatment.
The three main types of hypotension that causes signs and symptoms are orthostatic hypotension, neurally mediated hypotension (NMH), and severe hypotension linked to shock.
Orthostatic hypotension is low blood pressure that occurs after standing up from a sitting or lying down position. With NMH, blood pressure drops after you've been standing for a long time or due to severe emotional stress. Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can't get enough blood to work properly. Many factors can cause shock, such as major blood loss, certain severe infections, severe burns and allergic reactions, and poisoning. Shock can be fatal if not treated right away.
Factors or conditions that disrupt the body's ability to control blood pressure cause hypotension. The different types of hypotension have different causes.
Hypotension can affect people of all ages. Older adults are more likely to have orthostatic and postprandial hypotension. Children and young adults are more likely to have NMH.
The signs and symptoms of orthostatic hypotension and NMH include dizziness or feeling lightheaded, blurry vision, confusion, weakness, and nausea (feeling sick to your stomach). You may feel as though you're going to faint, or you may actually faint. Both of these types of hypotension can be dangerous if a person falls because of the dizziness or fainting.
Signs and symptoms of shock include lightheadedness, sleepiness, and confusion. Over time, if shock worsens, a person won't be able to sit up without passing out. If the shock continues, the person can lose consciousness. Other signs and symptoms of shock include cold and sweaty skin, a weak and rapid pulse, and rapid breathing. If a person has signs or symptoms of shock, someone should call 9-1-1 right away.
Hypotension is diagnosed based on your medical history, a physical exam, and results from tests.
Treatment depends on the type of hypotension you have and how severe your signs and symptoms are. The goals of treatment are to relieve signs and symptoms and manage any underlying condition causing the hypotension. Treatments may include lifestyle changes, compression stockings, procedures, and medicines.
Doctors often can successfully treat hypotension. Many people who have the disorder live normal, healthy lives.

(RLS) Restless Legs Syndrome

2009-05-19T17:38:00.000+06:00

What Is Restless Legs Syndrome?

Restless legs syndrome (RLS) is a disorder that causes a strong urge to move your legs. This urge to move often occurs with strange and unpleasant feelings in your legs. Moving your legs relieves the urge and the unpleasant feelings.People who have RLS describe the unpleasant feelings as creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. Sometimes, the feelings also occur in the arms.

The urge to move and unpleasant feelings occur when you're resting and inactive. They tend to be worse in the evening and at night and are temporarily relieved in the morning.Overview
RLS can make it hard to fall asleep and stay asleep. It may make you feel tired and sleepy during the day. This can make it hard to learn, work, and do your normal routine. Not getting enough sleep also can cause depression, mood swings, or other health problems.RLS can range from mild to severe based on:

The strength of your symptoms and how often they occurHow easily moving around relieves your symptomsHow much your symptoms disturb your sleepOne type of RLS usually starts early in life (before age 45) and tends to run in families. It may even start in childhood. Once this type of RLS starts, it usually lasts for the rest of your life. Over time, symptoms slowly get worse and occur more often. If you have a mild case, you may have long periods with no symptoms.Another type of RLS usually starts later in life (after age 45). It generally doesn't run in families. This type tends to have a more abrupt onset. The symptoms usually don't get worse with age.

Some diseases, conditions, and medicines also may trigger RLS. For example, it has been associated with kidney failure, Parkinson disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency. When a disease, condition, or medicine causes RLS, the symptoms usually start suddenly.Medical conditions or medicines often cause or worsen the type of RLS that starts later in life.

Outlook

RLS symptoms often get worse over time. However, some people's symptoms go away for weeks to months.

If a condition or medicine triggers RLS, it may go away if the trigger is relieved or stopped. For example, RLS that occurs due to pregnancy tends to go away after giving birth. Kidney transplants (but not dialysis) relieve RLS linked to kidney failure.Treatments for RLS include lifestyle changes and medicines. Some simple lifestyle changes often help relieve mild cases of RLS. Medicines usually can relieve or prevent the symptoms of more severe RLS. Research is ongoing to better understand the causes of RLS and to find better treatments.

What Causes Restless Legs Syndrome?

Faulty Use or Lack of Iron

Research suggests that restless legs syndrome (RLS) is mainly due to the faulty use or lack of iron in the brain. The brain uses iron to make the chemical dopamine and to control other brain activities. Dopamine works in the parts of the brain that control movement.A number of conditions can affect how much iron is in the brain or how it's used. These conditions include kidney failure, Parkinson disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency. All of these conditions increase the risk of having RLS.

People whose family members have RLS also are more likely to develop the disorder. This suggests that genetics may contribute to the faulty use or lack of iron in the brain that triggers RLS.

Nerve Damage

Nerve damage in the legs or feet and sometimes in the arms or hands may cause or worsen RLS. Several conditions can cause such nerve damage, including diabetes.Medicines and Substances
Certain medicines may trigger RLS. These include some:

Anti-nausea medicines (used to treat upset stomach)
Antidepressants (used to treat depression)
Anti-psychotics (used to treat certain mental health disorders)
Cold and allergy medicines that contain antihistamines
Calcium channel blockers (used to treat heart problems and high blood pressure)

RLS symptoms usually get better or may even go away if the medicine is stopped.

Certain substances, such as alcohol and tobacco, also can trigger or worsen RLS symptoms. Symptoms may get better or go away if the substances are stopped.

Who Is At Risk for Restless Legs Syndrome?

Restless legs syndrome (RLS) may affect as many as 12 million people in the United States. More than half of the people who have RLS have family members with the condition.
RLS can affect people of any race or ethnic group, but the disorder is more common in people of Northern European descent. RLS affects both genders, but women are more likely to have it than men.The number of cases of RLS rises with age. Many people who have RLS are diagnosed in middle age. However, in about 40 percent of RLS cases, symptoms start before age 20. People who develop RLS early in life usually have a family history of it.

People who have certain diseases or conditions or who take certain medicines are more likely to develop RLS. (For more information, see "What Causes Restless Legs Syndrome?")
For example, RLS is common in pregnant women. It usually occurs during the last 3 months of pregnancy. The disorder usually improves or goes away after giving birth. Some women may continue to have symptoms after giving birth. Other women may develop RLS again later in life.

What Are the Signs and Symptoms of Restless Legs Syndrome?

The four key signs of restless legs syndrome (RLS) are:

A strong urge to move your legs. This urge often, but not always, occurs with unpleasant feelings in your legs. When the disorder is severe, you also may have the urge to move your arms.
Symptoms that start or get worse when you're inactive. The urge to move increases when you're sitting still or lying down and resting.
Relief from moving. Movement, especially walking, helps relieve the unpleasant feelings.
Symptoms that start or get worse in the evening or at night.

You must have all four of these signs to be diagnosed with RLS.

The Urge To Move

RLS gets its name from the urge to move the legs when sitting or lying down. This movement relieves the unpleasant feelings that RLS sometimes causes.

Typical movements are:

Pacing and walking
Jiggling the legs
Stretching and flexing
Tossing and turning
Rubbing the legs

Unpleasant Feelings

People who have RLS describe the unpleasant feelings in their limbs as creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. More severe RLS symptoms may cause painful feelings. However, the pain usually is more of an ache than a sharp, stabbing pain.

Children may describe RLS symptoms differently than adults. Sometimes children with RLS are misdiagnosed as having ADHD.

The unpleasant feelings from RLS often occur in the lower legs (calves). But the feelings can occur at any place in the legs or feet. They also can occur in the arms.

The feelings seem to come from deep within the limbs, rather than from the surface. You usually will have the feelings in both legs. However, the feelings can occur in one leg, move from one leg to the other, or affect one leg more than the other.

People who have mild symptoms may only notice them when they're still or awake for a long time, such as on a long airplane trip or when watching TV. If they fall asleep quickly, they may not have symptoms when lying down at night.

The unpleasant feelings from RLS aren't the same as the leg cramps many people get at night. Leg cramps often are limited to certain muscle groups in the leg, which you can feel tightening. Leg cramps cause more severe pain and require stretching the affected muscle for relief.

Sometimes arthritis or peripheral arterial disease (PAD) can cause pain or discomfort in the legs. Moving the limbs usually worsens the discomfort instead of relieving it.

Periodic Limb Movement in Sleep

Most people who have RLS also have a condition called periodic limb movement in sleep (PLMS). PLMS causes your legs or arms to twitch or jerk about every 10 to 60 seconds during sleep. These movements cause you to wake up often and get less sleep.
PLMS usually affects the legs, but it also can affect the arms.
Not everyone who has PLMS also has RLS.

Related Sleep Problems

The symptoms of RLS can make it hard to fall or stay asleep. If RLS disturbs your sleep, you may feel very tired during the day.Lack of sleep may make it hard for you to concentrate at school or work. Not enough sleep also can cause depression, mood swings, or other health problems such as diabetes or high blood pressure.

How Is Restless Legs Syndrome Diagnosed?

Your doctor will diagnose restless legs syndrome (RLS) based on your symptoms, your medical and family histories, and the results from a physical exam and tests.
Your doctor will use this information to rule out other conditions that have symptoms similar to those of RLS.

Specialists Involved

Your primary care doctor usually can diagnose and treat RLS. However, he or she also may suggest that you see a sleep specialist or neurologist.

Symptoms

You must have the four key signs of RLS to be diagnosed with the condition.

Your doctor also will want to know how your symptoms are affecting your sleep and how alert you are during the day.

To help your doctor, you may want to keep a sleep diary. Use the diary to keep a daily record of how easy it is to fall and stay asleep, how much sleep you get at night, and how alert you feel during the day.
For a sample sleep diary, see the National Heart, Lung, and Blood Institute's "Your Guide to Healthy Sleep."

Medical and Family Histories

Your doctor may ask whether you have any of the diseases or conditions that can trigger RLS. These include kidney failure, Parkinson disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency.

Your doctor also may want to know what medicines you take. Some medicines can trigger or worsen RLS.

Because the most common type of RLS tends to run in families, your doctor may ask whether any of your relatives have the disorder.

Physical Exam

Your doctor will do a physical exam to check for underlying conditions that may trigger RLS. He or she also will check for other conditions that have symptoms similar to those of RLS.

Tests

Currently, no test can diagnose RLS. Still, your doctor will likely order blood tests to measure your iron levels. He or she also may order muscle or nerve tests. These tests can show whether you have a condition that may worsen RLS or that has symptoms similar to those of RLS.

Rarely, sleep studies are used to diagnose RLS. A sleep study measures how much and how well you sleep. Although RLS can cause a lack of sleep, this sign isn't specific enough to diagnose RLS.

Researchers continue to study new tests to diagnose RLS.

Drug Therapy Trial

If your doctor thinks you have RLS, he or she may prescribe certain medicines to relieve your symptoms. These medicines, which are used to treat people who have Parkinson disease, also can relieve RLS symptoms. If the medicines relieve your symptoms, your doctor can confirm that you have RLS.

How Is Restless Legs Syndrome Treated?

Restless legs syndrome (RLS) has no cure. If a condition or medicine triggers RLS, it may go away or get better if the trigger is relieved or stopped.
RLS can be treated.

The goals of treatment are to:

Prevent or relieve symptoms
Increase the amount and improve the quality of your sleep
Treat or correct any underlying condition that may trigger or worsen RLS

Mild cases of RLS often are treated with lifestyle changes and sometimes with periodic use of medicines. More severe RLS usually is treated with daily medicines.

Lifestyle Changes

Lifestyle changes can prevent or relieve the symptoms of RLS. For mild RLS, lifestyle changes may be the only treatment needed.

Preventing Symptoms

Many common substances, such as alcohol and tobacco, can trigger RLS symptoms. Avoiding these substances can limit or prevent symptoms.

Some prescription and over-the-counter medicines can cause or worsen RLS symptoms. Tell your doctor about all of the medicines you're taking. He or she can tell you whether you should stop or change certain medicines.

Adopting good sleep habits can help you fall asleep and stay asleep-a problem for many people who have RLS. Good sleep habits include:

Keeping the area where you sleep cool, quiet, comfortable, and as dark as possible.

Making your bedroom sleep-friendly. Remove things that can interfere with sleep, such as a TV, computer, or phone.
Going to bed and waking up at the same time every day. Some people who have RLS find it helpful to go to bed later in the evening and get up later in the morning.
Avoiding staying in bed awake for any long period in the evening or during the night.

Regular, moderate physical activity also may help limit or prevent RLS symptoms. Often, people who have RLS find that if they increase their activity during the day, they have fewer symptoms.

Relieving Symptoms

Certain activities can relieve RLS symptoms.
These include:

Walking or stretching
Taking a hot or cold bath
Massaging the affected limb(s)
Using heat or ice packs on the affected limb(s)
Doing mentally challenging tasks

Choose an aisle seat at the movies or on airplanes and trains so you can move around, if necessary.

Medicines

You may need medicines to treat RLS if lifestyle changes can't control symptoms. Many medicines can relieve or prevent RLS symptoms, including many new medicines.

No single medicine works for all people who have RLS. It may take several changes in medicines and dosages to find the best approach. Sometimes, a medicine will work for a while and then stop working.

Some of the effective medicines used to treat RLS also are used to treat Parkinson disease. These medicines make dopamine or act like it in the parts of the brain that control movement. (Dopamine is a chemical that helps you move properly.)

If medicines for Parkinson disease don't prevent or relieve your symptoms, your doctor may prescribe other medicines. You may have to take more than one medicine to treat your RLS.

Always talk with your doctor before taking any medicines. He or she can tell you the side effects of each RLS medicine. Side effects may include nausea, headache, and daytime sleepiness.

In some cases, RLS medicines may worsen problems controlling excessive gambling, shopping, or sexual activity. Sometimes, continued use of RLS medicines may make your RLS symptoms worse.

Contact your doctor if you have any of these problems. He or she can adjust your medicines to prevent these side effects.

VON Willebrand Disease

2009-05-19T15:30:00.000+06:00

What Is von Willebrand Disease?

Von Willebrand disease (VWD) is a bleeding disorder. It affects your blood's ability to clot. If your blood doesn't clot, you can have heavy, hard-to-stop bleeding after an injury. The bleeding can damage your internal organs or even cause death, although this is rare.

In VWD, you either have low levels of a certain protein in your blood, or the protein doesn't work the way it should. The protein is called von Willebrand factor, and it helps the blood clot.

Normally, when one of your blood vessels is injured, you start to bleed. Small blood cell fragments called platelets (PLATE-lets) clump together to plug the hole in the blood vessel and stop the bleeding. Von Willebrand factor acts like glue to help the platelets stick together and form a blood clot.

Von Willebrand factor also carries clotting factor VIII (8), another important protein that helps your blood clot. Factor VIII is the protein that's inactive or missing in people who have hemophilia, another clotting disorder.

VWD is more common and usually milder than hemophilia. In fact, VWD is the most common of all the inherited bleeding disorders. It occurs in about 1 out of every 100 to 1,000 people. VWD affects both males and females, while hemophilia mainly affects males.

Types of von Willebrand Disease

There are three major types of VWD.

Type 1

In type 1 VWD, you have a low level of von Willebrand factor, and you may have lower than normal levels of factor VIII. This is the mildest and most common form of VWD. About 3 out of 4 people who have VWD have type 1.

Type 2
In type 2 VWD, the von Willebrand factor doesn't work the way it should. Type 2 is divided into subtypes: 2A, 2B, 2M, and 2N. Different gene mutations (changes) cause each type, and each is treated differently. So it's important to know the exact type of VWD that you have.

Type 3
In type 3 VWD, you usually have no von Willebrand factor and low levels of factor VIII. Type 3 is the most serious form of VWD, but it's very rare.

Overview

Most people who have VWD have type 1, a mild form. This type usually doesn't cause life-threatening bleeding. You may need treatment only if you have surgery, tooth extraction, or trauma. If you need treatment, medicines and medical therapies are used.

Some people who have severe forms of VWD need emergency treatment to stop bleeding before it becomes life threatening.

Early diagnosis is important. With the right treatment plan, even people who have type 3 VWD can live normal, active lives.

What Causes von Willebrand Disease?

Von Willebrand disease (VWD) is almost always inherited. "Inherited" means that parents pass the gene for the disorder on to their children.

You can inherit type 1 or type 2 VWD if only one of your parents passes the gene on to you. You usually inherit type 3 VWD only if both of your parents pass the gene on to you. Your symptoms may be different from your parents' symptoms.

Some people have the genes for the disorder but don't have symptoms. However, they still can pass the genes on to their children.

Some people develop a form of VWD later in life as a result of other medical conditions. This form of VWD is called acquired von Willebrand syndrome.

What Are the Signs and Symptoms of von Willebrand Disease?

The signs and symptoms of von Willebrand disease (VWD) depend on the type and severity of the disorder. Many people have such mild symptoms that they don't know they have the disorder.

If you have type 1 or type 2 VWD, you may have the following mild-to-moderate bleeding symptoms:

Frequent, large bruises from minor bumps or injuries
Frequent or hard-to-stop nosebleeds
Extended bleeding from the gums after a dental procedure
Heavy or extended menstrual bleeding in women
Blood in your stools from bleeding in your intestines or stomach
Blood in your urine from bleeding in your kidneys or bladder
Heavy bleeding after a cut or other accident
Heavy bleeding after surgery

People who have type 3 VWD may have all of the symptoms listed above, as well as severe bleeding episodes for no reason. These bleeding episodes can be fatal if not treated right away. People who have type 3 VWD also may have bleeding into soft tissues or joints, causing severe pain and swelling.

Heavy menstrual bleeding is often the main symptom of VWD in women. Doctors call this menorrhagia (men-o-RA-je-a).

They define it as:

Bleeding with clots larger than about 1-inch in diameter
Anemia or low blood iron
The need to change pads or tampons more than every hour

However, just because a woman has heavy menstrual bleeding doesn't mean she has VWD.

How Is von Willebrand Disease Diagnosed?

Early diagnosis of von Willebrand disease (VWD) is important to make sure that you're treated and can live a normal, active life.

Sometimes VWD is hard to diagnose. People who have type 1 or type 2 VWD may not have major bleeding problems. As a result, they may not be diagnosed until they have heavy bleeding after surgery or some other trauma.

On the other hand, type 3 VWD can cause major bleeding problems during infancy and childhood. As a result, children who have type 3 VWD usually are diagnosed during their first year of life.

To find out whether you have VWD, your doctor will review your medical history and the results from a physical exam and tests.

Medical History

Your doctor will likely ask questions about your medical history and your family's medical history. He or she may ask about:

Any bleeding from a small wound that lasted more than 15 minutes or started up again within the first 7 days following the injury.
Any extended, heavy, or repeated bleeding that required medical attention after surgery or dental extractions.
Any bruising with little or no apparent trauma, especially if you could feel a lump under the bruise.
Any nosebleeds that occurred for no known reason and lasted more than 10 minutes despite pressure on the nose, or any nosebleeds that needed medical attention.
Any blood in your stools for no known reason.
Any heavy menstrual bleeding (for women). This bleeding usually involves clots or lasts longer than 7 to 10 days.
Any history of muscle or joint bleeding.
Any medicines you've taken that might cause bleeding or increase the risk of bleeding. Examples include aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), clopidogrel, warfarin, or heparin.
Any history of liver or kidney disease, blood or bone marrow disease, or high or low blood platelet counts.

Physical Exam

Your doctor will do a physical exam to look for unusual bruising or other signs of recent bleeding. He or she also will look for evidence of liver disease or anemia (a low red blood cell count).

Diagnostic Tests

No single test can diagnose VWD. Your doctor may recommend a combination ofblood tests to diagnose the disorder. These tests may include:

Von Willebrand factor antigen. This test measures the amount of von Willebrand factor in your blood.
Von Willebrand factor ristocetin (ris-to-SEE-tin) cofactor activity. This test shows how well your von Willebrand factor works.
Factor VIII clotting activity. Some people who have VWD have low levels of factor VIII activity, while others have normal levels.
Von Willebrand factor multimers. This test is done if one or more of the first three tests are abnormal. It shows the structure of your von Willebrand factor. The test helps your doctor diagnose what type of VWD you have.
Platelet function test. This test measures how well your platelets are working.

You may have these tests more than once to confirm a diagnosis. Your doctor also may refer you to a hematologist (a blood disease specialist) to confirm the diagnosis and for followup care.

How Is von Willebrand Disease Treated?

Treatment for von Willebrand disease (VWD) is based on the type of VWD you have and how severe it is. Most cases of VWD are mild, and you may need treatment only if you have surgery, tooth extraction, or an accident.

Medicines are used to:

Increase the release of von Willebrand factor and factor VIII into the bloodstream
Replace von Willebrand factor
Prevent the breakdown of blood clots
Control heavy menstrual bleeding in women

Specific Treatments

Desmopressin (DDAVP) is a synthetic hormone that you usually take by injection or nasal spray. It makes your body release more von Willebrand factor and factor VIII into your bloodstream. DDAVP works for most people who have type 1 VWD and for some who have type 2 VWD.

Von Willebrand factor replacement therapy is an infusion of a concentrate of von Willebrand factor and factor VIII into a vein in your arm. This treatment may be used if you:

Can't take DDAVP or need extended treatment
Have type 1 VWD that doesn't respond to DDAVP
Have type 2 or type 3 VWD

Antifibrinolytic medicines help prevent the breakdown of blood clots. They're mostly used to stop bleeding after minor surgery, tooth extraction, or an injury. These medicines may be used alone or together with DDAVP and replacement therapy.

Fibrin glue is medicine that's placed directly on a wound to stop bleeding.

Treatments for Women

Treatments for women who have VWD with heavy menstrual bleeding include:

Combined oral contraceptives (birth control pills). The hormones in these pills can increase the amount of von Willebrand factor and factor VIII in your bloodstream and reduce menstrual blood loss. Birth control pills are the most recommended birth control method for women who have VWD.
A levonorgestrel intrauterine device. This is a contraceptive device that contains the hormone progestin. The device is placed in the uterus (womb).
Aminocaproic acid or tranexamic acid. These antifibrinolytic medicines can reduce bleeding by slowing the breakdown of blood clots.
DDAVP.

For some women who are done having children or don't want children, endometrial ablation is done. This procedure destroys the lining of the uterus. It has been shown to reduce menstrual blood loss in women who have VWD.

If you need a hysterectomy (surgical removal of the uterus) for another reason, this procedure will stop menstrual bleeding and possibly improve your quality of life. However, hysterectomy carries its own risk of bleeding complications.

Living With von Willebrand Disease

If you have von Willebrand disease (VWD), you can take steps to prevent bleeding and stay healthy. You should:

Avoid over-the-counter medicines that can affect blood clotting, including aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs).
Always check with your doctor before taking any medicines.
Tell your doctor, dentist, and pharmacist that you have VWD. Your dentist can talk to your doctor about whether you need medicine before dental work to reduce bleeding. You also may want to tell people like your employee health nurse, gym trainer, and sports coach about your condition.
Consider wearing a medical ID bracelet or necklace if you have a serious form of VWD (for example, type 3). In case of a serious accident or injury, the health care team treating you will know that you have VWD.
Exercise regularly and maintain a healthy weight. Exercise helps keep muscles flexible. It also helps prevent damage to muscles and joints. Always stretch before exercising.

Some safe exercises and activities are swimming, biking, and walking. Football, hockey, wrestling, and lifting heavy weights are not safe activities if you have bleeding problems. Always check with your doctor before starting any exercise program.

Your parents, brothers and sisters, and children also may have VWD. Consider telling them about your diagnosis and suggesting that they get tested too.

Pregnancy and von Willebrand Disease

Pregnancy can be a challenge for women who have VWD. Although blood levels of von Willebrand factor and factor VIII tend to increase during pregnancy, women who have VWD can have bleeding complications during delivery. They also are likely to have heavy bleeding for an extended time after delivery.

However, you can take steps to lower the risk of complications during pregnancy. Consult a hematologist and an obstetrician who specialize in high-risk pregnancies before you become pregnant.

A hematologist is a doctor who specializes in treating blood diseases and disorders. An obstetrician is a doctor who treats and provides care for pregnant women.

Consider using a medical center that specializes in high-risk obstetrics and has a hematologist on staff for prenatal care and delivery.

Before you have any invasive procedure, such as amniocentesis (AM-ne-o-sen-TE-sis), discuss with your doctor whether anything needs to be done to prevent serious blood loss.

During your third trimester, you should have blood tests to measure von Willebrand factor and factor VIII to help plan for delivery.

You also should meet with an anesthesiologist to review your choices for anesthesia (AN-es-THE-ze-a) and to discuss taking medicine to reduce your bleeding risk. The term "anesthesia" refers to a loss of feeling and awareness. Some types of anesthesia temporarily put you to sleep, while others only numb certain areas of your body.

With these precautions, most women who have VWD can have successful pregnancies.

Children and von Willebrand Disease

If your child has VWD that's severe enough to pose a major risk of bleeding, anyone who is responsible for him or her should be told about the condition.

For example, the school nurse, teacher, daycare provider, coach, or any leader of afterschool activities should know, especially if your child has one of the more severe forms of VWD. This information will help them handle the situation if your child has an injury.

Links to Other Information About von Willebrand Disease

NHLBI Resources

Blood Diseases and Resources Information

"In Brief: Your Guide to von Willebrand Disease"

Non-NHLBI Resources

Bleeding Disorders (MedlinePlus)

Von Willebrand Disease (MedlinePlus)

Clinical Trials

Current Research (ClinicalTrials.gov)

NHLBI Pediatric Clinical Trials

What is Cirrhosis of the Liver?

2009-05-19T13:41:00.000+06:00

Cirrhosis of the liver is a liver disease characterized by a gradual annihilation of the liver cells. These cells are progressively replaced with fibrous tissue, which then leads to hardening. Cirrhosis is irreversible chronic injury of the liver. It often has no symptoms. Your health care provider will diagnose cirrhosis based on your medical history, a physical examination, and laboratory tests.

Signs

The signs and symptoms of cirrhosis can range from an absence of symptoms (in 10 to 20 percent of patients) to liver failure. Cirrhosis can also have symptoms such as jaundice (yellowing of the skin), weight loss, abdominal pain, testicular atrophy (in men), menstrual irregularity (in women), swelling and fluid in the abdomen, and enlarged veins.

Usually no symptoms appear until the disease has entered the late stages as the disease tends to come on gradually. When they occur, symptoms can include:

· nausea, vomiting, and loss of appetite.

· unusual gain or loss of weight.

· yellow coloration of the skin and eyes (see Jaundice).

· dark urine.

· bloody, black stools, or unusually light-colored stools.

· vomiting of blood.

· thinning hair

· abdominal swelling.

· itching.

· swollen feet or legs.

· red palms.

· sleep disturbances and confusion.

· fatigue or loss of stamina.

· enlarged breasts in men.

· loss of sex drive and menstrual problems in women.

· spider like blood vessels on chest and shoulders.

· in severe cases, mental disturbances

Causes

The most common cause of cirrhosis is alcoholism. Consuming a lot of alcohol daily (32 to 48 oz. of beer, 4 to 8 oz. of liquor, 16 to 32 oz. of wine) for 10 years or more increases your chances of developing cirrhosis. How much alcohol you drink and for how long are more important than the type of alcohol ingested. Between 5 and 10 percent of people in the United States are alcoholics. Of these, 10 to 15 percent will develop liver disease. Cirrhosis can also be caused by the ingestion of drugs and toxins, infections, inherited medical conditions, and cardiovascular diseases. About 10 percent of cases have no known cause.

Herbs

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

Due to the high doses required and the need to avoid alcohol, the preferred form of these herbs is powdered.

Milk thistle (Silybum marianum): 100 mg three times per day prevents free radical damage in the liver.
Barberry (Berberis vulgaris): 250 to 500 mg per day corrects metabolic abnormalities in liver cirrhosis.
Catechin (Uncaria gambir): 400 mg three times per day, is antioxidant, antiviral, and helps regenerate liver tissue.

What is primary biliary cirrhosis?

Primary biliary cirrhosis is a chronic disease that causes the bile ducts in the liver to become inflamed and damaged and, ultimately, disappear. Bile is a liquid produced in the liver that travels through the bile ducts to the gallbladder and then the small intestine, where it helps digest fats and fat-soluble vitamins A, D, E, and K. When the bile ducts become damaged from chronic inflammation, bile builds up in the liver, injuring liver tissue.

Normal liver and biliary system.

Injured liver tissue from chronic inflammation and the buildup of bile leads to cirrhosis, a condition in which the liver slowly deteriorates and malfunctions. Scar tissue replaces healthy liver tissue, partially blocking the flow of blood through the liver. Scarring also impairs the liver’s ability to

control infections
remove bacteria and toxins from the blood
process nutrients, hormones, and drugs
make proteins that regulate blood clotting
produce bile to help absorb fats—including cholesterol—and fat-soluble vitamins
effectively replace its own cells when they become damaged

Primary biliary cirrhosis develops over time and may ultimately cause the liver to stop working completely. Most people are diagnosed early, before the disease progresses. Early treatment delays—but does not stop—the eventual onset of cirrhosis and liver failure. When a person has end-stage liver disease, a liver transplant is necessary for survival.

Primary biliary cirrhosis usually occurs between the ages of 40 and 60 and affects women more often than men.

What causes primary biliary cirrhosis?

The cause of primary biliary cirrhosis is unknown. Most research suggests the disease is an autoimmune condition. The immune system usually protects the body from harmful substances such as bacteria and viruses by attacking and destroying them. In autoimmune diseases, the immune system instead attacks the body’s own tissues. In primary biliary cirrhosis, the immune system attacks the bile ducts.

Genetic factors may make a person prone to develop primary biliary cirrhosis. Primary biliary cirrhosis is more common in people who have a parent or sibling—particularly an identical twin—with the disease.

Genetic factors may also make some people prone to develop other autoimmune diseases. People with primary biliary cirrhosis may have other autoimmune conditions such as rheumatoid arthritis or autoimmune thyroiditis.

A person who has genetic factors for primary biliary cirrhosis may be more likely to develop the disease after exposure to chemicals or infections, such as urinary tract infections.

What are the symptoms of primary biliary cirrhosis?

Most people with primary biliary cirrhosis are diagnosed before symptoms begin. The first and most common symptoms people with this condition experience are

a general feeling of tiredness, or fatigue
pruritus—itchy skin—and darkened skin in itchy areas due to scratching

Other symptoms may develop, including

dry eyes and mouth
jaundice—darkening of the urine and yellowing of the skin and whites of the eyes—which occurs when the diseased liver does not remove enough bilirubin from the blood. Bilirubin is the pigment that gives bile its reddish-yellow color.

How is primary biliary cirrhosis diagnosed?

The first indication of primary biliary cirrhosis may occur when results of routine blood tests to check liver function are abnormal. The doctor will then order one or more tests to confirm the disease:

Anti-mitochondrial antibody (AMA) blood test. The presence of AMA is detected in 90 percent of people with primary biliary cirrhosis.
Alkaline phosphatase blood test. Primary biliary cirrhosis is likely if two blood tests performed at least 6 months apart reveal alkaline phosphatase—a liver enzyme—to be abnormally high.
Liver biopsy. A liver biopsy can confirm the diagnosis but is not always necessary. A biopsy may help determine the extent of liver damage. The biopsy is performed with a needle inserted between the ribs or into a vein in the neck. Precautions are taken to minimize discomfort. A tiny sample of liver tissue is examined with a microscope for scarring or other signs of cirrhosis. Sometimes a cause of liver damage other than cirrhosis is found during biopsy.

The doctor may also order the following tests:

Cholesterol blood test. People with primary biliary cirrhosis may have abnormally high levels of cholesterol in the blood. However, these high cholesterol levels are usually less harmful to people with primary biliary cirrhosis than to those without the disease.
Abdominal ultrasound. An ultrasound shows whether the liver and bile ducts are inflamed. A handheld device, which a technician glides over the abdomen, sends sound waves toward the abdomen. The sound waves bounce off the liver and other organs, and their echoes create a picture of the liver and biliary system on a video monitor.

What are the complications of primary biliary cirrhosis?

Some people develop one or more complications of primary biliary cirrhosis when the disease progresses to cirrhosis.

Osteoporosis. The disease may cause bones to become fragile and more likely to break. Osteoporosis can also result from steroid use as a treatment of primary biliary cirrhosis.

Maldigestion. When a person with primary biliary cirrhosis has jaundice, the small intestine cannot easily absorb fats and fat-soluble vitamins. Maldigestion may result in diarrhea and fatty stools and can lead to weight loss in the late stages of the disease.

Portal hypertension. Normally, blood from the intestines and spleen is carried to the liver through the portal vein. But primary biliary cirrhosis may cause inflammation in the portal tract, leading to increased pressure in the portal vein. This condition is called portal hypertension.

Esophageal varices and gastropathy. When portal hypertension occurs, it may cause enlarged blood vessels in the esophagus, called varices, or in the stomach, called gastropathy, or both. Enlarged blood vessels are more likely to burst due to thin walls and increased pressure. If they burst, serious bleeding can occur in the esophagus or upper stomach, requiring immediate medical attention.

Splenomegaly. When portal hypertension occurs, the spleen frequently enlarges and sequesters or holds white blood cells and platelets, reducing the numbers of these cells in the blood. A low platelet count in the blood may be the first evidence that a patient has developed cirrhosis.

Edema and ascites. When the liver dam-age progresses to an advanced stage, fluid collects in the legs, called edema, and in the abdomen, called ascites. Ascites can lead to bacterial peritonitis, a serious infection.

Bruising and bleeding. When the liver slows or stops producing the proteins needed for blood clotting, a person will bruise or bleed easily.

Sensitivity to medications. Cirrhosis slows the liver’s ability to filter medications from the blood. When this occurs, medications act longer than expected and build up in the body. This causes a person to be more sensi-tive to medications and their side effects.

Hepatic encephalopathy. A failing liver cannot remove toxins from the blood, and they eventually accumulate in the brain. The buildup of toxins in the brain—called hepatic encephalopathy—can decrease mental function and cause coma. Signs of decreased mental function include confusion, personality changes, memory loss, trouble concentrating, and a change in sleep habits.

Insulin resistance and type 2 diabetes. Cirrhosis causes resistance to insulin—a hormone produced by the pancreas that enables the body to use glucose as energy. With insulin resistance, the body’s muscle, fat, and liver cells do not use insulin prop-erly. The pancreas tries to keep up with the demand for insulin by producing more, but excess glucose builds up in the bloodstream causing type 2 diabetes.

Liver cancer. Hepatocellular carcinoma is a type of liver cancer that can occur in patients with cirrhosis. Hepatocellular carcinoma has a high mortality rate, but several treatment options are available.

Other problems. Cirrhosis can cause immune system dysfunction, leading to the risk of infection. Cirrhosis can also cause kidney and lung failure, known as hepato-renal and hepatopulmonary syndromes.

How is primary biliary cirrhosis treated?

Early Treatment

Initial treatment for primary biliary cirrhosis is aimed at relieving symptoms. Vitamin replacement therapy, calcium supplements, and drugs to treat itching are usually prescribed.

A specific treatment that stops or reverses the progression of primary biliary cirrhosis has not been found. However, medication prescribed during the early stage of the disease may slow liver damage.

Ursodiol (Actigall). Ursodiol is the only drug approved by the U.S. Food and Drug Administration for the treatment of primary biliary cirrhosis. Ursodiol assists the liver in moving bile through the ducts to the gallbladder and small intestine. Studies have shown that ursodiol prescribed early in the disease improves liver function, slowing the time it takes to progress to liver failure and the need for a liver transplant.

Researchers are studying the effects of sev-eral other medications on the progression of primary biliary cirrhosis. To date, none have shown the positive effects of ursodiol.

Treatment for Cirrhosis and Its Complications

When the disease progresses to cirrhosis, the goals of treatment are to slow the progression of scar tissue in the liver and prevent or treat the complications of the disease. Hospitalization may be necessary for people who have cirrhosis with complications.

Eating a nutritious diet. Because malnutrition is common in people with cirrhosis, a healthy diet is important in all stages of the disease. Health care providers recommend a meal plan that is well balanced. If fluid overload develops, a sodium-restricted diet is recommended. A person with cirrhosis should not eat raw shellfish, which can contain a bacterium that causes serious infection. To improve nutrition, the doctor may add a liquid supplement either for drinking or administration with a nasogastric tube—a tiny tube inserted through the nose and throat that reaches into the stomach.

Avoiding alcohol and other substances. People with primary biliary cirrhosis are encouraged not to consume alcohol or illicit substances, as both will cause more liver damage. Because many vitamins and medications—prescription and over-the-counter—can affect liver function, a doctor should be consulted before taking them.

Treatment for cirrhosis also addresses specific complications. For edema and ascites, the doctor may recommend diuretics—medications that remove fluid from the body. Large amounts of ascitic fluid may be removed from the abdomen and checked for bacterial peritonitis. Oral antibiotics may be prescribed to prevent infection. Severe infection with ascites requires intravenous (IV) antibiotics.

The doctor may prescribe a beta-blocker or nitrate for portal hypertension, which can lower the pressure in the varices and reduce the risk of bleeding. Gastrointestinal bleed-ing requires an immediate upper endoscopy to look for esophageal varices. The doctor may perform a band-ligation using a special device to compress the varices and stop the bleeding. People who have had varices in the past may need to take medicine to prevent future episodes.

Hepatic encephalopathy is treated by cleans-ing the bowel with lactulose—a laxative given orally or in enemas. Antibiotics are added to the treatment if necessary. Patients may be asked to reduce dietary protein intake. The condition may improve as other complications of cirrhosis are controlled.

People with cirrhosis who develop hepatorenal syndrome must undergo regular hemodialysis treatment, which uses a machine to clean wastes from the blood. Medications are also given to improve blood flow through the kidneys.

Liver Transplantation

A liver transplant is the only treatment that will cure primary biliary cirrhosis. A liver transplant is considered when complications cannot be controlled by treatment. A liver transplant is a major operation in which the diseased liver is removed and replaced with a healthy one from an organ donor. A team of health professionals determines the risks and benefits of the procedure for each patient. Survival rates have improved over the past several years because of drugs that suppress the immune system and keep it from attack-ing and damaging the new liver.

The number of people who need a liver transplant far exceeds the number of available organs. A person needing a transplant must go through a complicated evaluation process before being added to a long transplant waiting list. Generally, organs are given to people with the best chance of living the longest after a transplant. Survival after a transplant requires intensive follow-up and cooperation on the part of the patient and caregiver.

Points to Remember

Primary biliary cirrhosis is a chronic disease that causes the bile ducts in the liver to become inflamed and damaged and, ultimately, disappear.
Injured liver tissue from chronic inflammation and the buildup of bile leads to cirrhosis, a condition in which the liver slowly deteriorates and malfunctions.
The cause of primary biliary cirrhosis is unknown. Most research suggests the disease is an autoimmune condition.
Primary biliary cirrhosis is more common in people who have a parent or sibling—articularly an identical twin—with the disease.
Most people are diagnosed early, before the disease progresses. The disease is often discovered when routine blood tests to check liver function are abnormal.
Many people with primary biliary cirrhosis do not have symptoms until after the disease is diagnosed.
The first and most common symptoms of the disease are itching, called pruritus, and fatigue. Other symptoms include dry eyes and mouth and jaundice.
The anti-mitochondrial antibody (AMA) blood test, the alkaline phosphatase blood test, and a liver biopsy may be necessary to confirm a diagnosis of primary biliary cirrhosis.
Some of the complications of primary biliary cirrhosis are osteoporosis and maldigestion.
Early treatment delays—but does not stop—the eventual onset of cirrhosis and liver failure.
Ursodiol (Actigall) is the only drug approved by the U.S. Food and Drug Administration for the treatment of primary biliary cirrhosis.
Liver transplantation is the only treatment that will cure primary biliary cirrhosis. A liver transplant is considered when complications cannot be controlled by treatment.

Hope

The National Institute of Diabetes and Digestive and Kidney Diseases’ Division of Digestive Diseases and Nutrition supports basic and clinical research into liver diseases—including primary biliary cirrhosis—and liver transplantation. Researchers are studying

· the mechanisms of liver injury and regeneration

· ways to improve outcomes of liver transplantation

· how autoimmune liver diseases develop in the body

Is Swine Flu a Real Threat to the World?

2009-05-05T13:53:00.000+06:00

What are "swine flu" and "bird flu"?

Flu is a disease caused by the influenza virus. Humans, pigs, birds, and other animals all can be infected by influenza viruses. Typically, influenza viruses can infect only one species, so the influenza viruses of humans are different from those of pigs and birds. However, sometimes a virus can infect more than one species. For example, pigs sometimes can be infected not only with pig influenza viruses, but also with human and bird

influenza viruses. Then these

viruses can sidle up to one another and swap genes, creating new viruses that have a mix of genes — from human, pig, and bird viruses. That is what has happened with this new swine flu virus.

Sometimes this swapping of genes allows a virus that was originally able to infect only pigs or only birds to also infect humans. When that happens, we refer to the illness as "swine f

lu" or "bird flu." This current virus could actually be called "swine/bird flu," since it has some genes from pig flu viruses and other genes from bird flu viruses. However, for simplicity's sake, it is just being referred to as "swine flu."

Are swine flu or bird flu viruses dangerous?

Most viruses that cause swine flu or bird flu are very hard to pass from one human to another: they don't cause epidemics. Sometimes, however, further changes in genes create a virus that can spread rapidly among humans, and can produce a more severe illness. One reason this illness is more severe is that the virus is so new. The regular flu that comes each year is caused by a regular human influenza virus that often has similarities to the viruses that have caused the flu in years past, so people have some degree of immunity to the latest virus. The unusual swine flu or bird flu viruses that develop the ability for person-to-person spread are so different that people have little or no immunity to them. That is what some experts worry may be happening with swine flu.

How bad can a global pandemic be?

The worst global pandemic in modern times was the influenza pandemic of 1918 to 1919. It affected about a third of the human race, and killed at least 40 million people in less than a year — more than have been killed by AIDS in three decades. The world economy went into a deep recession. The average length of life dropped for 10 years. In other words, global pandemics can be a really big deal. On the other hand, other pandemics have been considerably less serious than the 1918 to1919 influenza pandemic.

Can this new swine flu virus be easily transmitted from person to person?

Unfortunately, the new swine flu virus can be transmitted between humans. It is not clear yet how easily it is transmitted, nor how it is transmitted. Almost surely it is transmitted by sneezing and coughing and by skin-to-skin contact (like shaking hands or kissing) with an infected person.

How sick do people get from this virus?

Most people infected with the virus have recovered from the illness.

However, in Mexico, some people have kept getting sicker, and eventually died. The regular flu viruses that come each winter can occasionally cause severe illness and death. Most often, this happens in very young children or frail elderly people. What worries some experts is that many of the deaths in Mexico have been in young, healthy adults. In past pandemics, like the influenza pandemic of 1918 to 1919, it was also young, healthy people who were most likely to die. Experts are puzzled as to why the infection currently appears to be worse in Mexico than in the United States.

Are there treatments for swine flu?

As of now, the new virus is killed by two antiviral medicines — Tami flu (oseltamivir) and Relenza (zanamivir). Based on experience with other flu viruses, treatment would be most effective if given within two days of the onset of symptoms. As long as this current swine flu virus is infecting people, it is likely that health authorities will recommend that people with more severe illness take these medicines.

On the other hand, there is no proven benefit from using the medicines before symptoms develop, and there is proven harm: Unnecessary widespread use of these drugs could produce drug-resistant viruses.

There is no vaccine yet for the new virus, and the Centers for Disease Control and Prevention (CDC) has expressed doubt that this year's regular flu vaccine will offer protection.

How do I know if I've caught swine flu?

The initial symptoms of this flu virus are like those of the regular, annual flu viruses: fever, muscle aches, runny nose, and sore throat. Nausea, vomiting, and diarrhea may be more common with this swine flu than with the regular flu. If this epidemic hits your community and you develop flu-like symptoms, it is likely your doctor will take samples from your throat or material you cough up and send them to the state public health laboratory for testing.

How do I protect myself?

To protect yourself from catching swine flu, take the same steps you would to prevent getting any cold or flu:

Wash your hands or use alcohol-based hand cleaners frequently.
When you greet people, don't shake hands or exchange kisses.
Avoid contact with people with flu symptoms.

And to protect others, if you develop sneezing and coughing, be sure to use tissues to wipe your nose and cover your mouth, and to throw the tissues in the trash or toilet bowl.

How long are people contagious?

Adults should be considered contagious until at least seven days after the start of symptoms; with children, it may be 10 to14 days.

Can you get swine flu from eating pork?

A: Absolutely not. But, as you probably know, you need to cook pork thoroughly to avoid getting other illnesses that can be spread by undercooked meat.

Will there be unusual restrictions on our lives if there is a global pandemic?

If there is a global pandemic, for some period of time, governments may well restrict travel (indeed, some governments already have). Governments also may close schools and public places, require as many people as possible to work from home, tell any people who develop symptoms to isolate themselves at home, and tell people to seek medical attention immediately if more serious symptoms develop. What are those symptoms?

For adults, teens, and kids aged 3 to12, the most worrisome symptoms are:

Shortness of breath
Persistent vomiting
Confusion
Dizziness

For children younger than 2, the most worrisome symptoms are:

Very rapid breathing
Not interacting normally, not eating or drinking normally, being unusually
irritable, or appearing unusually sleepy
High fever and rash
A bluish color of the lips and skin

Misconception about ADHD

2009-05-05T13:42:00.000+06:00

It is a myth that poor parenting causes ADHD. However, it is highly probable that poor parenting greatly contributes to the severity of ADHD symptoms. Setting a family schedule, setting clear expectations and consequences, and being consistent are some of the parenting skills necessary for the ADHD child.

While much research has been done on the subject of food additives, diet, and ADHD, this subject remains highly controversial. The National Institutes of Health (NIH) consensus conference (NIH 1982) concluded that controlled studies "did indicate a limited positive association between defined [Feingold-type] diets and a decrease in hyperactivity."

The Center for Science in the Public Interest (CSPI) has found more than 20 controlled studies of diet and behavior. Most of the studies found that food dyes and, in some cases, other additives, and foods provoked symptoms of ADHD or other behavior problems in some children. It is often difficult for a family to follow a restricted diet. Support groups dedicated to ADHD and diet can be found on the Internet.

Not all video games are created equal. Some video games encourage higher order brain functions and reasoning while some video games require only the ability to point and shoot. While too much TV or video game play does not appear to cause ADHD they may exacerbate the condition. Several studies have shown that chronic play of violent, high stimulation video games actually lowers metabolic rate in the brain's frontal lobes.The frontal lobes control attention, impulsive control, and other executive functions.

Carefully monitoring what your child is playing and limiting the amount of time your child plays are good practices. ADHD doesn't necessarily diminish as one grows older. Concentration and impulsive difficulties often persist into adolescence, causing significant difficulties. Instead of being hyperactive, teachers may notice restlessness, inattentiveness, or excessive talking.

Approximately 60% to 70% of children with ADHD have symptoms into adulthood and can be diagnosed in adults.

Since ADHD has no identifiable location in the brain, it is usually diagnosed by a clinician who uses a series of tests.

Exposing the enemy. (Anger)

2009-05-05T13:37:00.000+06:00

We live in a world which often seems more violent with every passing day. Terrorist bombings, school-yard massacres, war, and atrocities fill news headlines. At times it even seems that humanity has a collective death wish.

Human aggression has been blamed on many things, including broken homes, poverty, racism, inequality, chemical imbalances in the brain, toy guns, TV violence, sexual repression, sexual freedom, overpopulation, alienation, bad genes, and original sin. However, virtually all of these potential causes have one thing in common which is
Unfulfilled Human Needs and Desires:
Human needs and desires are endless. Virtually all of us would like to have fancy homes, social status in our community, the ability to eat all we want without getting fat, sex whenever we want it, perpetual health, unconditional love, and the ability to live until we're 200. Most of us will enjoy few of these things.

Fortunately, most people are realistic and sane enough not to turn to violence to deal with their frustrations. However, self-control sometimes breaks down - resulting in aggressions ranging from petty theft - to the Columbine massacre - to the mass killing fields of Cambodia.
What causes people and societies to turn to aggression? Throughout history there have been five key factors: neurosis, desperation, envy, greed, and collectivism.

Aggressive behavior is often the result of a brain gone wrong. When these brain abnormalities are properly treated there is often significant improvement. There is substantial imaging research on violence.

Violence is not one thing. Research has shown that there are at least three different types of violence that all require different treatments: impulsive violence (low prefrontal cortex), compulsive violence (high anterior cingulate) and random or senseless violence (temporal lobe). Knowing which type or combination of types is essential to getting the right help'

Let’s face it—anger is a fact of life. Our world is filled with violence, hatred, war, and aggression. Psychologically, many theories of human development focus on the infant’s struggle with anger and frustration and the primitive fantasies of aggression, guilt, and reparation that result from these feelings.In essence, we grow up with anger right from the beginning of life.

The brilliant French psychoanalyst, Jacques Lacan, taught that aggression results as a psychological defense Jacques Lacan against threats of fragmentation. That is, as infants, we are just a jumble of diverse biological processes over which we have no authority, and our first task in life is to develop a coherent identity which “pulls together” this fragmented confusion. This identity may give the appearance of a unified personality, but it really is just a psychological illusion that hides our essential human vulnerability and weakness. And so, when anything or anyone threatens us with the truth of our essential fragmentation, the quickest, easiest, and most common defense available—to hide the truth of our weakness and to give the illusion that we possess some sort of power—is aggression.

Even though this might seem like an obviously simple point, many persons still have a deep reluctance to grasp it: Anger is a common human emotion. We all feel it. And we feel it more often than we like to admit.

But before going any further, we need to make a clear distinction between anger and feeling hurt or irritated.

We all feel hurt or irritated when someone or something obstructs our needs or desires. Anger, though, in its technical sense refers to the desire to “get even with”—that is, to take revenge on—the cause of the hurt.

But then, as a psychological reaction to these immediate physical responses, indignation and animosity toward the other driver overrun your mind.

So the psychological process is clear and simple. If a person hurts you, then, in your anger, you want to hurt him back, just as you have been hurt.

Anger can also be expressed indirectly. If something like a traffic jam, for example, leaves you feeling tense and frustrated, then what do you do? Maybe you go home and find some petty thing out of order and then blow up, just to take out your frustration on your family. Or maybe you go to a bar, maneuver someone into offending you, and get into a fight. Either way you vent your frustrations at the traffic jam by hurting innocent persons—after first manipulating circumstances so that you can believe in your own mind that these persons have somehow hurt you and deserve to suffer for it.

Still, there is more to the story than this, because there is more to anger than meets the eye.

The truth is, anger may be a “natural”—that is, a commonly occurring—social reaction to hurt and insult, but being natural doesn’t make it good for us. Sure, “natural” foods are commonly advertised as being healthy and good for us. But poisons, for example, are also natural, and poisons, by definition, are deadly.

And so there are far better ways to cope with hurt and insult than with anger, because anger itself acts like a poison in your own heart that ultimately degrades the quality of your own life as much as it hurts the life of another person.

So the FIRST STEP in learning a healthy response to feelings of hurt and insult is simply to acknowledge that you’re hurt.

This is not as easy as it sounds.

For example, when you get angry you don’t really allow yourself to feel your inner vulnerability and hurt. All you can think about in the moment is your desire to get revenge, to defend your pride, to do something—anything—to create the feeling that you have power and importance. In essence, your outbursts of rage paradoxically hide your inner feelings of vulnerability, so you never recognize the hurt you’re feeling that triggers your hostile reaction. All the bitterness and hostility is a big puff of smoke, an emotional fraud. It hardens your heart toward others so that you can seal off your own emotional pain.

Or you might feel hurt by someone emotionally close to you, and, out of fear that your immediate impulse to hurt that person in return will cause you to lose that person’s “love,” you suppress the awareness of your honest inner experiences. If you do this often enough you can end up convincing yourself that everything is fine and peaceful. In this case the hurt becomes anger anyway, only it becomes unconscious anger: you remain hurt while the desire to hurt the other person gets pushed into your unconscious where it stews in bitter resentment. And so, in reality, you are just deceiving yourself and defiling your relationships when you deny that you have anything to feel hurt about. And before you know it you’re wondering why you’re so depressed. Depression, after all, is often “anger turned inwards”—that is, you end up despising yourself because you feel guilty for unconsciously wanting to hurt someone else.

In Western psychology, acceptance of every person’s unique emotional experiences is commonplace, but many non-Western cultures place a high value on social conformity. As a way to ensure a child’s survival in such a culture, families teach children that all expressions of anger are forbidden and shameful. And to accomplish this, parents, along with the rest of society in general, tend to suppress all recognition of individual emotions.

Hurt feelings in response to slight or insult, however, are universally human. If these feelings are suppressed in any culture to the point that they never become recognized or named, they can fuel the ugly cultural darknesses of prejudice, hatred, paranoia, child abuse, domestic violence, drug addictions—and all other dark psychological poisons that defile real love—as well as depression itself, which, sadly, can also feel shameful.

It’s ironic, then, that a healthy response to feelings of hurt and insult actually leads to compassion and peace, while the suppression of emotions, in trying to protect the surface peace, only leads to a psychological undercurrent of suspicion and cruelty. That’s why people who become social “doormats” and let others walk all over them, rather than admit that they feel hurt about anything, usually have quite a lot of resentment and “dirt” underneath their appearance of welcome.

So the SECOND STEP in learning a healthy response to feelings of hurt and insult is to follow the hurt back into its roots in the past to all those times and circumstances when you felt the same way.

You need to do this because any insult in the present is magnified by similar insults from the past. Failure to recognize old insults only makes the current insult seem far larger than it really is.

This entire process is a bit like what happens when an insect stings you and you feel a pain way out of proportion to the size of the stinger. First you simply recognize that it hurts. Then you have to explore the wound to find the stinger. The stinger represents the insult that hurts you, digging out the stinger represents the psychological task of realizing how this one insult pierces deep into your self-esteem, and the venom which spreads into the surrounding tissues represents the way unconscious resentment about all sorts of old emotional injuries from the past continues to poison you even in the present.

aving acknowledged the wound and explored it, you will be ready for the healing process to begin. But, for healing to take place, you must be careful to avoid anything that irritates, rather than soothes, the wound.

Therefore, the THIRD STEP in learning a healthy response to feelings of hurt and insult is to avoid the popular response to feelings of hurt and insult.

So let’s move on to discover just what this popular response to feelings of hurt and insult might be.

So we all suffer insult, and we all feel hurt, and we all tend to sink into fantasies of revenge. Some of us then “get angry” and violently act out the fantasies in real life. And some of us just push everything out of awareness and pretend we are “nice” persons. So what honest alternative is there?

Well, you can get up the courage to explore the human psyche a bit more deeply than most persons want to go and discover something about human nature. Something ugly.

You will discover a concept about human psychology that theology and religion have for ages called sin. But a secular, philosophical understanding of the concept could describe it as a sort of infatuation with the vanity of your personal desires and a reliance on social prestige or power to defeat or destroy anyone or anything that stands in the way of your getting what you want. Or, to say it more simply, most people are narcissistically preoccupied with their immediate desires and have little, if any, altruistic awareness of anyone or anything else around them. Psychologically, this behavior allows you to feel good about yourself (that is, to feel strong and “in control”) by using, hurting, or neglecting someone else. Sin therefore leads you away from true love and compassion, and it sends you right into all the predicaments of self-indulgence. Sin really does hurt others because sin defiles love.

Narcissistic Personality Disorder refers to a pervasive pattern of grandiosity (in fantasy or behavior), a need for admiration, and a lack of empathy.

But, in its more universal sense, narcissism can be found at the core of almost all psychological dysfunction, for it represents the way we all, like the Greek god Narcissus himself, can “fall in love” with ourselves to hide our own inadequacy and consequently treat others like objects to make ourselves feel strong and competent.

Now, if you understand this psychological fact about human nature—that everyone is drawn away from essential human goodness by a need to avoid feeling weak or foolish—then you have a new way to cope with your feelings of hurt and to overcome your “natural,” hostile slide into anger.
Instead of taking all insults personally, you can realize that every insult derives from that universal tendency in human nature toward selfish, inconsiderate behavior. Given this ugly reality, no cache of guns or bombs or witty insults or curses can be sufficient to eradicate its evil effects from the world, so revenge becomes futile. The only sane response to insult is deep sorrow for all of humanity and compassion for the misguided person who gets caught up in the “popular” way of behaving.

Therefore, the FOURTH STEP in learning a healthy response to feelings of hurt and insult is forgiveness.
To forgive someone means that you consciously make the decision to set aside any desire to see a person hurt because of the hurt he or she caused you, and instead you wish that the person will recognize his or her hurtful behavior, feel sorrow for it, and learn to be a more considerate person.

This, too, like the first step, is not as easy as it sounds.

For the truth of the matter is that you cannot forgive someone until you have fully felt the pain he or she has caused you.

Pushing the pain into your unconscious, as described earlier, only makes forgiveness impossible because, as unconscious anger, the dark wish to harm the person who hurt you remains alive but out of sight.

And, with your animosity kept out of sight, it’s all too easy to present yourself as a “nice” person

There are also many persons who deny the concept of “sin.” Psychologically, this denial serves the defense of protecting these persons from the recognition of the ugly parts of their own unconscious. They just refuse to admit that they are fully capable of inflicting their own harmful wishes on another person.

Beware. There is no escaping the psychological effects of injury and anger; either you can face up to all of your unconscious anger and learn real forgiveness, or you can let the deadly poison of revenge become your ugly destiny.

Remember that anger, being an emotion, is not something you can ever “get rid of.” As long as you are alive there will be times when you are insulted and feel hurt. And, as long as there are times when you feel hurt, you will be pulled down into unconscious fantasies of revenge.

But once you notice that you feel hurt you have a choice. You don’t have to accept blindly the unconscious slide into revenge.

On the one hand, you don’t have to “get angry.” That is, you don’t have to become abusive or violent. If you tell yourself, “Yes, I hurt. But it is not so much another person as human nature itself hurting me, and there’s nothing I can do about it, except refuse to return hurt for hurt, sin for sin,” then you can feel compassion for the person who hurt you, and you can be forgiving.

On the other hand, all of this does not preclude the possibility that there may be times when you have to stand up—to defend yourself or to defend others—and say something about the ugliness that everyone wants to ignore or deny. To be quiet—to stifle your feeling offended—is also a fear of love and a slide into revenge.

In these situations—whether in your family, among friends, or at work—when you experience feelings about anything, you need only express those feelings openly.
The key to all this, however, is that you speak up as soon as you feel the first inkling of injury—and this means that you have to be very good at recognizing the feeling of hurt in the first place. You must speak up well before the hurt turns to anger and has a chance to build into anything destructive. You don’t have to understand why you’re feeling what you’re feeling in the moment; just communicate what you’re feeling in the moment.

Venting anger does not work. Even though it might give some immediate satisfaction, venting anger (called catharsis)—whether by yelling obscenities, making obscene gestures, honking the horn of your car, throwing or breaking things, or screaming insults—does nothing to dispel anger. More often than not, it actually pumps up your emotional arousal and may even prolong it.

The Ultimate Remedy:

So, recognize the feeling of anger, but don’t act on it. Instead, do the following.

Cool down. Remember the old, stereotypical advice about counting to ten before saying or doing anything when you first feel hurt? Well, it’s still good advice. That’s because the first reaction to hurt is purely physiological: you receive a rush of adrenaline to prepare you to take action in real danger. But when the hurt comes from an event that poses only a short-term threat—such as when a car cuts in front of you—or threatens your pride far more than your life and safety, then all that adrenaline surging through your body isn’t serving any meaningful purpose.

If you’re prone to violence, then walk away from the provocation as soon as you feel the pressure building.

In most cases, simply taking a few moments to practice some simple relaxation exercises, such as deep breathing, can allow your sympathetic nervous system’s arousal to calm down and dissipate by itself. Deep, slow breathing is an automatic physiological effect of being at peace, so when you deliberately take slow, deep breaths you are indirectly telling your body that all danger has now passed; as a consequence, your body will stop producing adrenaline and your arousal will cease.

Just don’t use this cooling off period to dwell on negative thoughts or you will make matters even worse. In fact, this leads to the next step.

Challenge your negative thoughts. The way we think has a lot to do with the way we feel, so changing your thoughts from a hateful, negative orientation to a calm, positive orientation becomes essential in managing feelings of hurt and insult.
NEGATIVE: “[Expletive!] What a piece of [expletive] junk! Now we’re going to be [expletive] late!”

POSITIVE: “OK. It’s a flat tire. There was nothing we could have done to prevent it. Let’s forget about being on time and just see about getting the tire changed. One thing at a time.”

Or look for a rational explanation:

IRRATIONAL: “[Expletive!] What a [expletive] jerk! He knew this was an important [expletive] meeting! So why is he [expletive] late?”

RATIONAL: “Maybe there was a traffic accident. Maybe they had a flat tire. Who knows? We’ll find out in due time.”

Ask yourself what you’re really feeling. Many persons have such a limited knowledge of their emotional life that they tend to lump everything together into anger. But, if you look closely, you might find that behind the anger are more pertinent feelings, such as disappointment, sadness, fear, and so on.

References:
http://seegod.org/anger.htm
http://www.guidetopsychology.com/anger.htm

Attention Deficit Hyperactivity Disorder (ADHD)

2009-05-05T01:25:00.000+06:00

Parenting is exhausting and challenging, but parenting a child with ADHD presents unique challenges. Less than 10% of the population has ADHD, but ADHD is a family, school and community affair. A 2 year old child should be able to attend to a task for 6 minutes, and a child entering kindergarten should be able to concentrate for 15 minutes. People with ADHD are impulsive, hyperactive and have a limited attention span.

Symptoms

Symptoms could include:

Impulsivity

Easily Distracted

Fidgeting

Fidgeting is moving about restlessly or the behavior of being continually in motion.

Alternative Names : Fidgets, fidgety.

Synopsis : Fidgeting is usually used to describe someone who is seen as not being able to sit still. Fidgety people move in their seats constantly, move their hands and feet and appear to be in perpetual motion. While fidgeting in children is sometimes a sign of hyperactivity, it is not always a bad thing. Recent studies indicate that people who fidget burn more calories – as many a 400 a day - than people who are still. Scientists have discovered that some people have a genetic predisposition to fidget – they are restless and move around constantly, burning up energy. Some obese people have a genetic predisposition to be energy efficient and are naturally inclined to conserve energy by not "wasting" calories.

Forgetful

Problem Behavior

Problem behavior is troublesome, risk taking, or disruptive behavior that is more extreme than occasional errors in judgment and requires professional intervention to avoid legal difficulties.

Alternative Names : Behavior problem, behavioral problem, behavior problems.

Synopsis

Problem behavior is often associated with adolescence but may manifest in the very young or in adults. Delinquency, drug use, academic failure, risky sexual behavior, violence, property damage, vandalism and disregard of the rights of others are all problem behaviors. Because of changes within the brain and social issues that contribute to lack of control, problem behavior rises dramatically in early adolescence. The rate of problem behavior tends to fall after age 23 years.

Talkative

Unable to Concentrate

Problems at Work

Interrupts Others

Behavioral Problems at School

Disturbance of Attention

Unable to Play Quietly

Runs About Inappropriately

Difficulty Managing Behavior

Makes Impulsive Remarks

Tends to Abandon Tasks

Unable to Conform to A Position

Anxiety

Lying

Impatient

Memory Impairment

Loses Things

Academic Underachievement

Attention Seeking Behavior

Aggressive Outburst

Tends to Be Disorganized

Careless Character

Tests

Tests could include:

History and Physical Exam

Psychologic Evaluation and Testing

Developmental Assessment Test

Treatments

Treatments could include:

Behavior Therapy Behavioral therapy, or behavioral modification, is a psychological technique based on the premise that specific, observable, maladaptive, badly adjusted, or self-destructing behaviors can be modified by learning new, more appropriate behaviors to replace them.

Social Skills Training Social skills training (SST) is a form of behavior therapy used by teachers, therapists, and trainers to help persons who have difficulties relating to other people.

Individual Psychotherapy The treatment of mental or emotional disorders and adjustment problems through the use of psychological techniques rather than through physical or biological means.

Psychotherapy

Supplements

1. Zinc
2. Iron
3. melatonin
4. flaxseed
5. pycnogenol
6. pyridoxine
7. Pantothenic Acid
8. gamma-Linolenic Acid
9. s-adenosylmethionine
10. Acetylcarnitine
11. levocarnitine
12. evening primrose

Complications

Complications could include:

Problems at Work

Definition

Problems at work describes troublesome, disruptive, interpersonal behaviors at work that are more extreme than occasional errors in judgment.

Alternative Names

Job difficulties, problem working conditions, trouble at work.

Synopsis

Problems at work are carelessness, excessive absenteeism, being accident prone, being unable to follow through on assigned tasks, frequent anger or other problems that may be attributable to a medical or psychiatric problem. People with stormy or unpredictable ways of relating to others in social situations may have problems in a work environment.

Social Communication Disorder

Communication Skills and Disorders

The skills needed to use language (spoken, written, signed, or otherwise communicated) to interact with others, and problems related to the development of these skills.

Experts in child development generally agree that all babies develop skills for spoken and written language according to a specific developmental schedule, regardless of the language being learned. Although the milestones follow one another in roughly the same sequence, there is significant variability from child to child as to when the first word is spoken and the first sentence is composed.

The accompanying table illustrates the developmental milestones for communication.

Language employs symbols—words, gestures, or spoken sounds—to represent objects and ideas. Communication of language begins with spoken sounds combined with gestures, relying on two different types of skills. Children first acquire the skills to receive communications, that is, listening to and understanding what they hear (supported by accompanying gestures); next,

Age Milestone
0-12 months

* Responds to speech by looking at the speaker; responds differently to aspects of speaker's voice (such as friendly or angry, male or female).
* Turns head in direction of sound.
* Responds with gestures to greetings such as "hi," "bye-bye," and "up" when these words are accompanied by appropriate gesture by speaker.
* Stops ongoing activity when told "no" when speaker uses appropriate gesture and tone.
* May say two or three words by around 12 months of age, although probably not clearly.
* Repeats some vowel and consonant sounds (babbles) when alone or spoken to; attempts to imitate sounds.

12-24 months

* Responds correctly when asked "where?"
* Understands prepositions on, in, and under; understands simple phrases (such as "Get the ball.").
* Says 8-10 words by around age 18 months; by age two, vocabulary will include 20-50 words, mostly describing people, common objects, and events (such as "more" and "all gone").
* Uses single word plus a gesture to ask for objects.
* Refers to self by name; uses "my" or "mine."

24-36 months

* Points to pictures of common objects when they are named.
* Can identify objects when told their use
* Understands questions with "what" and "where" and negatives "no," "not," "can't," and "don't."
* Responds to simple directions.
* Selects and looks at picture books; enjoys listening to simple stories, and asks for them to be read aloud again.
* Joins two vocabulary words together to make a phrase.
* Can say first and last name.
* Shows frustration at not being understood.

36-48 months

* Begins to understand time concepts, such as "today," "later," "tomorrow," and "yesterday."
* Understands comparisons, such as "big" and "bigger."
* Forms sentences with three or more words.
* Speech is understandable to most strangers, but some sound errors may persists (such as "t" sound for "k" sound).

48-60 months

* By 48 months, has a vocabulary of over 200 words.
* Follows two or three unrelated commands in proper order.
* Understands sequencing of events ("First we have to go to the grocery store, and then we can go to the playground").
* Asks questions using "when," "how," and "why." Talks about causes for things using "because".

Source: U.S. Department of Health and Human Services.
60-72 months

* By 60 months, can identify rhyming words.
* There are few obvious differences between child's grammar and adult grammar.
* Still needs to learn subject-verb agreement, and may not have mastered all irregular verbs.
* Can carry on a conversation.
* Communicates with family, friends, and strangers, and responds with information appropriately.

they will begin experimenting with expressing themselves through speaking and gesturing. Speaking will begin as repetitive syllables, followed by words, phrases, and sentences. Later, children will acquire the skills of reading and writing, the written forms of communication. Although milestones are discussed for the development of these skills of communication, many children begin speaking significantly earlier or later than the milestone date. Parents should refrain from attaching too much significance to either deviation from the average. When a child's deviation from the average milestones of development cause the parents concern, a pediatrician or other professional may be contacted for advice.

Spoken language problems are referred to by a number of labels, including language delay, language disability, or a specific type of language disability. In general, experts distinguish between those children who seem to be slow in developing spoken language (language delay)
and those who seem to have difficulty achieving a milestone of spoken language (language disorders).

Language disorders include stuttering; articulation disorders, such as substituting one sound for another (tandy for candy), omitting a sound (canny for candy), or distorting a sound (shlip for sip); and voice disorders, such as inappropriate pitch, volume, or quality. Causes can be related to hearing, nerve/muscle disorders, head injury, viral diseases, mental retardation, drug abuse, cleft lip or palate.

In the past, most parents, pediatricians, and educators recommended giving the child time to outgrow a difficulty with spoken language. As of the late 1990s, research had shown that early speech and language disorders could lead to later difficulties in learning to read, write, and spell. Thus, many professionals recommended evaluation by a speech-language pathologist for toddlers who demonstrated language delay. However, not all speech-language specialists agree on early evaluation and therapy. Those who feel early intervention is unnecessary cite the results of research by Rhea Paul at Portland (Oregon) State University. She found that about two-thirds of children who were not talking at age two showed continued delays until age three, and one-half were still behind the typical language development schedule at age four. But by kindergarten, only one-fourth of those children had not caught up with their peers.

Parents and their pediatrician should communicate frequently about a child's spoken language development, and should consider all factors related to spoken language delay when considering whether to have a specialist evaluate and treat the delay. Such factors as the possible stigma attached to labeling a child with language difficulties versus whether intervention will prevent social and educational difficulties should be considered in making the decision.