Other Problems – Lucky clinic

[vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Acne” use_theme_fonts=”yes”][vc_column_text]Acne lesions include comedones (whiteheads, blackheads), papules and pustules (small bumps, often with scarring), nodules, and cysts, often followed by scarring. Common sites for acne are the face, chest, shoulders, and back—the sites of oil glands.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”c21137c3-826b-4″][vc_row_inner][vc_column_inner width=”1/2″][vc_column_text]

What is acne?

Acne is the most common skin condition that people experience. Most people develop acne to some degree during their lifetime. Though it primarily affects teenagers undergoing hormonal changes, many people will develop acne as adults. Acne might be mild (few, occasional pimples), moderate (inflammatory papules), or severe (nodules and cysts). Scarring can occur. Treatment depends on the severity of the condition.

What is the cause of acne?

Acne is primarily a hormonal condition driven by male hormones, which typically become active during the teenage years. Sensitivity to such hormones — combined with surface (skin) bacteria and lipids (fatty acids) within sebaceous (oil) glands — yields acne. Common sites for acne are the face, chest, shoulders, and back — the sites of oil glands.

The first lesion in acne is a comedone or clogged pore (whiteheads, blackheads). These can become inflamed and progress to papules and pustules (small bumps), nodules, and cysts. Larger nodules and cysts and popping of pimples often lead to scarring.

Certain conditions can aggravate acne.

Fluctuating hormone levels around the time of menses (menstruation)
Manipulating (picking/prodding) acne lesions
Blocking clothing and headgear, such as hats and sports helmets
Air pollution and certain weather conditions, especially high humidity

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What is the treatment for acne?

Only three medicines have proven to be effective for the treatment of acne: benzoyl peroxide, retinoids, and antibiotics. These medications target the different factors that contribute to acne. Most patients require at least one or two agents, depending on disease severity.

Benzoyl peroxide is available as an over-the-counter product (such as Clearasil®, Stridex®, PanOxyl®) available as a leave-on gel or wash. It targets surface bacteria, which often aggravate acne. Irritation (dryness) is a common side effect. Lower concentrations and wash formulations are less irritating.
Retinoids (vitamin A derivatives): such as Retin-A®, Tazorac®, and Differin® ,which is available over the counter — “break up” comedones (blackheads and whiteheads) and help to prevent clogged pores, the first lesions of acne. Most patients are candidates for retinoid therapy. These medications are not spot treatments and must be used on the entire area of skin affected by acne to prevent the formation of new acne bumps. The most common side effect is irritation which usually improves with moisturization and time on the medication.
Antibiotics, either topically applied to the skin (clindamycin, erythromycin) or taken by mouth (tetracycline and its derivatives) control surface bacteria that aggravate and often foster inflammation in acne. Antibiotics are more effective when combined with benzoyl peroxide which prevents antibiotic resistance, or retinoids.

The oral retinoid isotretinoin (Accutane®) is reserved for those patients with severe (nodular or cystic) disease or those with scarring. Accutane shrinks the size of oil glands, the anatomic origin of acne. Without active, plump oil glands, acne actively diminishes.

Because it is a medication taken by mouth, there are more possible side effects than with topical treatments. All patients will experience skin dryness. Less commonly, patients can have elevated blood lipids or liver enzymes.

Women of childbearing age must practice birth control before and during treatment with Accutane®, and for several months afterward because of the risk of devastating birth defects. Because of these risks, the use of Accutane® requires regular lab testing (lipids, pregnancy tests) and follow-up during the medication course, which usually lasts 5 or six months.

Hormone therapy is helpful for some women with acne, especially for those that flare with their menses or those with signs and symptoms (irregular periods, thinning hair) of androgen (male hormone) excess. The hormone therapy consists of low-dose estrogen and progesterone (birth control pills) or a medication called spironolactone that blocks the effect of male hormones at the level of the hair follicle and oil gland.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Anemia” use_theme_fonts=”yes”][vc_column_text]Anemia is a blood disorder that happens when there is not enough oxygen-transporting hemoglobin in the blood. Symptoms may include feeling cold, tired or dizzy. Adding iron to the diet is one aspect of treatment.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”a8ce59f9-c60c-8″][vc_column_text]

What is anemia?

Anemia happens when a person’s blood is low on hemoglobin and does not have enough red blood cells. Hemoglobin is a protein that helps carry oxygen through the body. When a person develops anemia, he or she is said to be “anemic.”

There are several different types of anemia. Each type is caused by one of these factors:

The body cannot make enough hemoglobin.
The body makes hemoglobin, but the hemoglobin doesn’t work correctly.
The body does not make enough red blood cells.
The body breaks down red blood cells too fast.

Who is most likely to develop iron-deficiency anemia?

Anyone can develop iron-deficiency anemia, although the following groups have a higher risk:

Women: Blood loss during monthly periods and childbirth can lead to anemia.
Children, ages 1 to 2: The body needs more iron during growth spurts.
Infants: Infants may get less iron when they are weaned from breast milk or formula to solid food. Iron from solid food is not as easily taken up by the body.
People over 65: People over 65 are more likely to have iron-poor diets.
People on blood thinners: These include aspirin, Plavix®, Coumadin®, or heparin.

If I am pregnant, should I be concerned about anemia?

Yes. If you are pregnant, you are more likely to develop iron-deficiency anemia. Your unborn baby relies on you for iron and other nutrients. Many women who are pregnant take iron pills to prevent anemia.

To make sure that you have enough iron for you and your baby, eat well-balanced meals and follow your healthcare provider’s instructions for taking vitamins and adding iron to your diet.

Are there different types of anemia?

Yes. Iron-deficiency anemia is just one type of anemia. Other types are caused by:

Diets lacking in vitamin B12 (the body is unable to use, or absorb Vitamin B12)
Diets lacking in folic acid (or, the body is unable to use folic acid)
Inherited blood disorders (sickle cell anemia, thalassemia)
Conditions that cause red blood cells to break down too fast

This chart describes some of the different types of anemia, their causes and the related blood factors:

Iron-deficiency anemia

Causes: Blood loss, not enough iron in the diet
Factors: Body cannot make enough red blood cells.

Pernicious anemia

Causes: Body is unable to absorb vitamin B12.
Factors: Body cannot make enough red blood cells.

Folic acid-deficiency anemia

Causes: Not enough folic acid in the diet; body is unable to use folic acid; or caused by an illness
Factors: Body cannot make enough red blood cells.

Hemolytic anemia

Causes: Inherited or acquired diseases that cause the red blood cells to be deformed; harmful substances; reaction to certain drugs
Factors: Body breaks down red blood cells too fast.

Causes: Inherited disease that is most common among African-Americans; red blood cells become sickle-shaped
Factors: Hemoglobin doesn’t work right; the shape of the red blood cells causes them to clog blood vessels and break down easily.

What causes anemia?

The most common cause of anemia is low levels of iron in the body. This type of anemia is called iron-deficiency anemia. Your body needs iron to make hemoglobin; without the needed amount of iron, your body cannot make hemoglobin.

Causes of low iron in the body:

Bleeding, either from losing a large amount of blood quickly (for instance, in a serious accident) or losing small amounts of blood over a long period of time. The body loses more iron with blood loss than it is able to replace with food. This can happen to women having heavy menstrual periods or in people who have inflammatory bowel disease.
Not enough iron in the diet
An increase in the body’s need for iron (during pregnancy)

What are the symptoms of anemia?

Several symptoms occur in all types of anemia, including:

Feeling tired
Shortness of breath
Dizziness
Headache
Feeling cold
Weakness
Pale skin

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How can I know if I have anemia?

Your healthcare provider can perform blood tests to tell if you have anemia. The type and number of blood tests will depend on what type of anemia is suspected. Your healthcare provider will also determine the proper treatment, depending on the type of anemia and its cause.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567788692784-2-2″][vc_column_text]

Can iron-deficiency anemia be treated?

Yes. This type of anemia can be treated and cured. First, your healthcare provider will determine if the anemia is being caused by a poor diet or a more serious health problem. Then, you can be treated for both the anemia and its cause. Iron-deficiency anemia is treated with:

Iron supplements taken by the mouth
Foods high in iron
Iron given through an intravenous (IV) infusion

How do I manage anemia?

While some types of anemia are short-term and mild, others can last throughout a lifetime. There are several ways to help manage anemia, including:

Following a healthy diet
Exercising regularly
Avoiding exposure to chemicals that set off anemia
Washing your hands often to avoid infection
Talking to your doctor about any changing symptoms

If you have asthma, you need to take precautions during flu season.

People with asthma are no more likely to catch the flu, or influenza, than people without asthma. But when people with asthma get the flu, it can literally take their breath away.

“Infection with influenza can trigger an asthma exacerbation. People with asthma are at substantially elevated risk for a serious flare needing ER management or hospitalization,” says Cleveland Clinic allergist David Lang, MD.

This makes people with asthma good candidates for flu shots every year. “Flares can be prevented by influenza vaccination,” says Dr. Lang.

Flu Shots Won’t Worsen Asthma

There is a misconception that flu shots will make you sick or make your asthma worse. Not the case, says Dr. Lang.

“Flu vaccine contains material made to resemble the virus, so it makes the body produce antibodies that protect against the virus,” he explains. “If you experience fever, aches and feel out of sorts for 24 to 36 hours after a flu shot, it’s your immune system revving up in response to the vaccine. It’s not the flu.”

If you are allergic to eggs, don’t schedule a flu shot without consulting your allergist.

Dr. Lang adds that people with lung diseases, including asthma, might also consider receiving the pneumonia vaccine (Pneumovax®).

Practical Protective Measures

Common-sense avoidance measures are also important. Flu is spread through droplets, so wash your hands often, and keep them away from your face.

By the way, maintaining control of your asthma will help your lungs cope better with flu if you get it. Well-controlled asthma does not awaken you at night, restrict your activities, or cause you to need your rescue inhaler more than twice a week.

What to Do If You Get the Flu

Despite your best efforts, the flu may be unavoidable. “If you develop symptoms of flu, get a prescription for a medication such as Tamiflu® (oseltamivir) within 48 hours,” Dr. Lang advises.

What’s the Flu and What’s Not?

The following are symptoms of flu:

Fever (100° F or higher)
Chills
Dry (nonproductive) cough
Muscle aches and pains
Severe fatigue
Headache

However, flu rarely causes:

Stuffy or runny nose
Itchy eyes
Abdominal distress, nausea or diarrhea (the exception is H1N1 flu).

[/vc_column_text][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Arthritis” use_theme_fonts=”yes”][vc_column_text]Arthritis is a general term for a group of more than 100 diseases. The word “arthritis” means “joint inflammation.” Arthritis is inflammation in and around the body’s joints. Some types of arthritis include but are not limited to osteoarthritis, rheumatoid arthritis, psoriatic arthritis and gout. However, arthritis affects people in all age groups, including almost 300,000 children. The goals of treatment are to increase joint mobility and strength and help patients learn to manage pain.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”b62fdca4-85f6-0″][vc_column_text]

What is arthritis?

Arthritis, or “joint inflammation,” is a general term for a group of more than 100 diseases. Arthritis is inflammation (swelling) in and around the body’s joints. (A joint is a point at which two or more bones come together, such as the hip or the knee.)

Inflammation is one of the body’s natural responses to disease or injury. Inflammation can cause pain, stiffness, and swelling, as well as loss of movement in some patients. Some types of arthritis include osteoarthritis, rheumatoid arthritis, psoriatic arthritis, and gout.

Download a Free Guide on Arthritis Pain Treatment

Arthritis limits everyday activities such as walking, dressing, and bathing. In the United States, one in five adults (52.5 million) reports having arthritis that has been diagnosed by a doctor.

Arthritis is the leading cause of disability among Americans aged 15 and older. However, arthritis affects people in all age groups, including almost 300,000 children.

Other statistics about arthritis:

More than 27 million people in the United States have osteoarthritis.
An estimated 1.3 million have rheumatoid arthritis.
More than half of those with arthritis are under 65 years of age.
Nearly 60% of Americans with arthritis are women.

What causes arthritis?

The causes of most types of arthritis are not known. Scientists are studying how three major factors may play a role in certain types of arthritis:

Genetic (inherited) factors (“runs in the family”)
What happened during a person’s lifetime
The person’s current lifestyle

Although the exact causes of arthritis might not be known, there are several risk factors. A risk factor is a something that increases a person’s chance of developing a disease or condition. Risk factors for arthritis include:

Age — The risk of developing arthritis, especially osteoarthritis, increases with age.
Gender — In general, arthritis occurs more often in women than in men.
Weight — Being overweight puts extra stress on the joints that support a person’s weight. This increases wear and tear, and the risk of arthritis.
Work factors — Jobs in which the worker has to keep doing the same movements over and over, or does a great deal of heavy lifting, can cause stress in the joints and/or an injury, which can lead to arthritis.

The pain of arthritis might be caused by different things, including inflammation of the synovial membrane (tissue that lines the joints), tendons, or ligaments; muscle strain; and fatigue. A combination of these factors can have an effect on how strong the pain is.

The pain of arthritis can be very different for each person. Things that contribute to the pain include the amount of damage and swelling within the joint.

What are the symptoms of arthritis?

Different types of arthritis have different symptoms, which can be mild in some people and very strong in others. Osteoarthritis usually does not cause any symptoms outside the joint.

Symptoms of other types of arthritis might include fatigue (feeling tired), fever, a rash, and the signs of joint inflammation, including:

Pain
Swelling
Stiffness
Tenderness
Redness
Warmth

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How is arthritis diagnosed?

To diagnose arthritis, a doctor will take a medical history and ask questions about the patient’s pain. The doctor will do a physical examination to find the causes of pain and how this pain is affecting the patient’s ability to function.

The patient might have X-rays or other imaging procedures such as a CT scan (computerized tomography) or MRI (magnetic resonance imaging) to see how much joint damage there is. The patient may also see several different specialists.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567839653147-2-5″][vc_separator style=”dashed” border_width=”2″][vc_column_text]

How is arthritis treated?

Treatment of arthritis will depend on the type of arthritis, how strong the pain is, and the patient’s overall health. The goal is to treat all aspects of arthritis pain, increase joint mobility (movement) and strength, and help patients learn to manage pain.

Treatment options include medicine, exercise, heat/cold, use of joint protection, and surgery. Treatment plans might include more than one of these treatments.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Back Pain Basics” use_theme_fonts=”yes”][vc_column_text]Eighty-five to 90 percent of people in the US will suffer from back pain at some time during their lives. Learn more about this condition, including its causes and treatment.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”4f3b3dcc-e4ce-3″][vc_column_text]

Who is affected by back pain?

In the United States 85 to 90% of people experience back pain at some time during their lives. Back pain is the second most common reason people visit their family doctors (just after upper respiratory infections).

On any given day, almost 2% of the entire US work force is disabled by back pain. In people under 40 years of age, back pain is the most common reason for the inability to perform daily tasks. It also is the direct cause of enormous healthcare expenses, with estimates as high as $60 billion annually.

Pain that primarily affects the back is different from a spinal condition that results in mostly leg pain, a condition commonly called sciatica. Typically, sciatica is the result of a “pinched nerve” in the spinal column.

In most cases the cause of the sciatica is clear — for example, a disc problem or arthritis. The cause of an episode of back pain, on the other hand, often is more difficult to pinpoint and may be related to the discs, joints, or soft tissue supports (muscles, ligaments, and tendons).

What is acute back pain?

Acute back pain refers to a brief episode of pain that comes on suddenly. Most people recover from acute back pain within two weeks with minimal treatment. Using over-the-counter pain relievers — such as acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) — and getting back to normal activities as the pain permits are simple and effective treatments for most people with acute back pain.

What is chronic, persistent back pain?

Most back pain is relieved within a few days to a couple of weeks with simple treatment. When back pain persists beyond 2 to 4 weeks — which is chronic, persistent back pain — further medical evaluation is required. This evaluation focuses on a careful assessment of the patient’s medical history and a thorough physical examination to identify, if possible, a precise cause of the pain. In rare cases, cancer or an infection is found. More commonly, the pain is related to the spinal joints, discs, or supporting muscles of the back.

What causes back pain?

Back strain is the leading cause (85% of cases) of back pain in the US. Other causes of back pain include:

Disc herniation: A herniated disc is a rupture or tear of the cartilage that surrounds the vertebral discs. Pressure from the vertebrae above and below the affected disc squeezes the cushioning substance (nucleus pulposus) out of the disc. The nucleus pulposus can press against spinal nerve roots. This can cause severe leg pain and may cause nerve damage if not treated properly.
Osteoarthritis/spinal stenosis: The constriction or narrowing of the vertebral canal, the space that surrounds the spinal column.
Ankylosing spondylitis: A chronic inflammatory disease that first affects the spine and nearby structures. As the disease progresses, vertebrae will fuse together. This disease has a strong hereditary (runs in the family) tendency and primarily affects men under 30 years of age.
Spondylolisthesis: Spondylolisthesis is the partial forward movement (dislocation) of one vertebra over the one below it. Usually, the fifth lumbar (low back) vertebra is dislocated over the first sacral (tail bone) vertebra.
Infection (less than 1% of cases).
Cancer (less than 1% of cases).
Fracture.
Trauma: An injury due to an accident or fall may cause a fracture or muscle strain.
Non-spinal causes: Non-spinal causes of low back pain include abdominal aortic aneurysms, kidney stones, infection, or perforating stomach ulcer.

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How is back pain diagnosed?

Evaluating the patient’s medical history often is the doctor’s most powerful diagnostic tool. The doctor asks a series of questions to help identify possible causes of the back pain.

The questions may focus on:

Lifestyle factors, such as where you live, what type of work you do, and what activities or hobbies you enjoy
When your pain began
Where your pain is located and what effect it has had on your daily activities
Whether your pain has responded to any treatment
Your medical, surgical, family, and social history

Extensive testing — including X-rays, MRI/CT scans, EMGs (electromyography, to test electrical activity of skeletal muscles), and lab tests — are necessary in only a small number of cases.

For example, the MRI (magnetic resonance imaging) gives little information about the condition of the ligaments, muscles, and tendons. However, it may show common degenerative, or “wear and tear,” changes in the discs or joints in the spine.

One or more of these diagnostic tests may be done immediately if the pain is caused by trauma or a neurological change, persistent fever, weight loss, numbness, weakness, or loss of bowel or bladder control.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567840208136-2-9″][vc_column_text]

How is back pain treated?

Most back pain can be successfully treated with conservative (non-surgical) measures. Conservative treatment includes:

As much activity (standing, walking, working) as can be tolerated
Acetaminophen (non-aspirin over-the-counter pain reliever) and/or an anti-inflammatory medication
Cold packs to diminish swelling and pain

Usually, the pain will subside within 4 to 7 days. If there is no improvement after 4 to 7 days, contact your doctor.

When back pain is chronic, persistent and disabling, a complete treatment approach addressing all aspects of the problem, including psychological as well as physical, offers the best hope for rehabilitation and recovery. A multi-disciplinary treatment team — consisting of a medical physician, physical therapist, psychologist or psychiatrist, and pain management specialist — offers the best hope for return to an active, productive life.

Medication

The role of medication in the management of back pain is to relieve symptoms and facilitate an active, exercise-oriented rehabilitation program. An array of new medications is now available to assist in achieving this goal.

The newer anti-inflammatory pain relievers, such as celecoxib, are less likely to cause gastrointestinal side effects, such as nausea or diarrhea.

Some older medications also have been found to help in the treatment of back pain. For example, disruption of sleep by chronic back pain is common. Poor sleep may, in fact, magnify pain. Low doses of traditional anti-depressant medicines, such as doxepin, may reduce pain and improve the quality of sleep.

Anti-convulsants, such as gabapentin, often are helpful for nerve irritation symptoms, such as burning or numbness.

In rare instances, careful use of long-acting opioid pain relievers may improve function and quality of life.

Exercise

Active, exercise-oriented physical therapy is the cornerstone of treatment for people with chronic back pain. Heat, ice, massage, and ultrasound may provide temporary relief, but rarely provide long-term benefits.

Exercise programs should be individualized by a spine-oriented physical therapist. Typically, the exercise program can be performed at home without special equipment. Follow-up visits with the therapist are necessary to “fine tune” the program. Returning to work in any capacity is strongly recommended.[/vc_column_text][/vc_tab][vc_tab title=”Living With” tab_id=”1567840210029-3-3″][vc_column_text]

When should I call my healthcare provider?

See your healthcare provider if:

You have a fever
The pain worsens
The pain progressively moves from your back into your leg(s)
Pain is unrelieved at rest or disturbs sleep

These are warning signs or “red flags” that require prompt, urgent medical attention.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Back Pain in Athletes” use_theme_fonts=”yes”][vc_column_text]

Common Causes of Back Pain Including Athletic Injuries

Back pain and related symptoms rank among the second most frequent medical complaints. Disability from low back pain is second only to the common cold as a cause of lost work time and is the most common cause of disability in people under 45 years of age.

In the United States, the lifetime prevalence of back pain is approximately 80%, with one-year prevalence rate of 15% to 20%, the highest prevalence is in the 45 to 64 age group.

Natural History

In reality, the natural history of acute low back pain is very favorable and the same is true for sciatica (an inflammation of the sciatic nerve, characterized by pain and tenderness through the thigh and leg):

60% recover in 1 to 3 weeks;
90% recover in 6 to 8 weeks; and
95% recover in 12 weeks.
Serious causes of low back pain (e.g. cancer) are uncommon (less than 1%).

Mechanisms

The onset of acute low back pain most often is the result of mechanical damage due to excessive and prolonged poor posture and mechanics, a sedentary lifestyle and inadequate conditioning. Seemingly trivial stress such as bending over, sneezing or coughing can produce a herniated disc when superimposed on chronic wear and tear. People in sedentary occupation have a high risk of herniating a disc.

During the flexion that occurs with sitting, intradiscal pressure is greatest and the disc exerts pressure on the thinnest, least supported area of the supporting ligament known as the annulus fibrosus. As a result, the disc can herniate.

Mechanical low back pain may be defined as pain secondary to overuse of a normal structure (muscle strain) or pain secondary to injury or deformity of an anatomic structure (herniated nucleus pulporus). Mechanical low back pain is usually aggravated by static loading of the spine (prolonged sitting or standing), long levered activities (e.g. vacuuming) or levered postures (bending forward). It is eased when the spine is balanced by multidirectional forces (e.g. walking) or when the spine is unloaded (e.g. reclining).

Mechanical conditions of the spine including back strain, disc herniation, disc disease, osteoarthritis and spinal stenosis account for up to 98% of cases of back pain.

Management

The history and physical examination is the first step in the evaluation and management of low back pain. Based on this information and specific guidelines, x-rays may be ordered; however, not every patient with low back pain requires x-rays.

Since the natural history of low back pain is favorable, most patients can start initial and usually successful therapy without the benefit of x-rays, a CT scan or MRI scan. Though radiographic evaluation may identify anatomic alterations in the lumbar spine, studies have shown that these may correlate poorly with the presence of severity of low back pain. The physician must take all the clinical data together and formulate a diagnosis and treatment plan based upon all the collected information. The physician does not want to intervene with inappropriate surgery nor overlook the possibility of a serious complication associated with a mechanical disorder (cauda equina syndrome) or a secondary cause of back pain (malignancy); the latter can be identified in the history and physical by certain “red flags.”

The majority of patients will improve with controlled physical activity, physical therapy, nonaddictive non-steroidal anti-inflammatory drugs, and, in appropriate patients, muscle relaxants. Surgical invention is reserved for the patient who has not shown improvement on conservative therapy and has undeniable symptoms and signs (sciatica) associated with mechanical disorder (herniated disc) that can be corrected by surgical intervention.

Chronic low back pain is a complex disorder that must be managed with a multi-disciplinary approach that addresses the physical, psychologic and socioeconomic aspects of the illness. Fortunately, chronic low back pain affects only a small percentage of patients.

Prevention

Obesity and smoking correlate unfavorably with low back pain and may adversely affect the progression of this disorder. Overall physical fitness will correlate favorably with recovery from low back pain and return to work. Training, education and ergonomic intervention may reduce the incidence of back disorders.

Sports

The competitive athlete and most individual who exercise regularly maintaining a level of fitness, are less prone to lumbar spine injury and problems due to the strength and flexibility of supporting structures. These structures include strong abdominal and lumbar paraspinal muscle support, and flexible gluteal and hamstring muscles.

Problems involving the lumbar spine are rare in athletes and account for less than10% of sports-related injuries. Sports such as gymnastics, football and racquet sports have a higher incidence of associated lumbar spine problems related to repetitive twisting and bending motions. Most injuries are minor, self-limited and respond quickly to conservative treatment. The incidence of lumbar spine problems with the through proper conditioning and technique is important.[/vc_column_text][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_custom_heading stripe_pos=”hide” text=”Blood Pressure” use_theme_fonts=”yes”][vc_tabs][vc_tab title=”Overview” tab_id=”ed434f21-d48b-7″][vc_column_text]

What is blood pressure?

Your blood pressure is a measurement of the pressure/force inside your arteries with each heartbeat. Each time your heart beats, blood is pumped out of the heart into arteries that carry the blood throughout your body.

How is blood pressure measured?

A special cuff is used to measure your blood pressure. The cuff inflates and deflates, and during the process, your pressures are measured. Many times, a stethoscope is also used.

Blood pressure readings

Blood pressure is recorded as two measurements: systolic and diastolic blood pressure. Systolic blood pressure is the top/first number, and diastolic blood pressure is the bottom/second number. The numbers are expressed as millimeter of mercury (mmHg)

Systolic blood pressure
The pressure in the arteries when the heart is beating and the arteries are filled with blood

Diastolic blood pressure
The pressure in the arteries when the heart is resting between beats

What do the numbers mean?
Your blood pressure can be normal, elevated, or you may have Stage 1 or 2 hypertension (high blood pressure).
Normal blood pressure is <120/<80 mmHg
Elevated blood pressure is 120-129/<80 mmHg
Stage 1 hypertension is 130-139 (top number) OR 80-89 (bottom number)
Stage 2 hypertension is 140 or higher (top number) OR 90 or higher (bottom number)

Two or more readings are needed to determine if you have high blood pressure.

GET IMMEDIATE MEDICAL ATTENTION!
IF YOUR TOP NUMBER IS EVER 180 OR HIGHER AND/OR YOUR BOTTOM NUMBER IS EVER 110 OR HIGHER, GET EMERGENCY MEDICAL TREATMENT OR HAVE SOMEONE TAKE YOU TO THE HOSPITAL RIGHT AWAY!

Your blood pressure does not stay the same at all times. When you are exercising or excited, your blood pressure goes up. When you are resting, your blood pressure is lower. Your blood pressure can also change due to age, medications you take, and changes in position.

Tips for measuring your blood pressure

Sit for at least 5 minutes before your blood pressure is measured.
Do not smoke or drink caffeine 30 minutes before you measure your blood pressure.
If you are nervous when you go to the doctor, you could have a false high blood pressure reading. This is called “white coat syndrome.” If this happens, your doctor may ask you to: Use a blood pressure monitor to check your blood pressure throughout the day. You can bring a record of your readings to your appointments.

Some people are asked to wear a blood pressure monitor for 24 hours. The monitor is usually set to take blood pressure every 15 to 30 minutes as you go about your normal activities.

What are the symptoms of high blood pressure?

High blood pressure usually has no symptoms. It is often called the “silent killer” because it can damage your heart, kidneys and brain without you even knowing anything is wrong.

Who is at risk of getting high blood pressure?

Your risk of high blood pressure is higher if:

You have a family history of high blood pressure, cardiovascular disease or diabetes
You are African American
You are age 60 or older
You take oral contraceptives
You are overweight

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What treatments are available for patients with high blood pressure?

High blood pressure is a major risk factor for cardiovascular disease. Without treatment, you can have a transient ischemic attack (TIA) or stroke, heart attack, enlarged heart, heart failure, peripheral vascular disease (such as poor circulation and pain in your legs), aneurysms, kidney disease, and broken blood vessels in your eyes. Treatment includes making changes recommended by your healthcare provider.

Diet and lifestyle changes:

Reach and stay at your ideal body weight
Get regular exercise
Eat a well-balanced, heart healthy diet that is low in salt, fat and cholesterol, and contains lots of fresh fruits and vegetables*
- *Your diet is an important part of blood pressure control. The Dietary Approaches to Stop Hypertension (DASH) eating plan and limiting sodium (salt) help control blood pressure. Ask your doctor to refer you to a dietitian for a more personalized eating plan.
Having no more than two alcoholic drinks per day (for most men) and no more than one drink per day for women and lighter-weight men. One drink is considered to be 12 ounces of beer or wine cooler, 5 ounces of wine or 1.5 ounces of 80-proof liquor
Control stress and anger
Avoid all tobacco and nicotine products
Other lifestyle changes, such as controlling lipid levels (LDL, cholesterol, triglycerides) and managing other health conditions, such as diabetes

Medications and follow-up care:

Take all medications as prescribed. Do not stop or start taking any medication without talking to your doctor. Blood pressure medication does not keep working after you stop taking it
Some over-the-counter medications, such as decongestants, can change the way your blood pressure medication works
Keep all follow-up appointments so your doctor can monitor your blood pressure, make any needed changes to your medications and help control your risk of cardiovascular disease

Your doctor may ask you to record your blood pressure at home. Follow your doctor’s instructions for recording your blood pressure.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Bladder Stones (Bladder Calculi)” use_theme_fonts=”yes”][vc_column_text]Bladder stones are hard crystal masses formed by minerals and protein that are found in urine. The causes, symptoms, and treatment of bladder stones are discussed.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”77a69888-cdec-7″][vc_column_text]

What are bladder stones?

Bladder stones are hard crystal masses formed by minerals and protein that are found in urine. The stones are also called bladder calculi. Stones can form in any of the organs that make up the urinary system. Bladder stones form in the bladder, which holds urine. Bladder stones may be related to stones that have formed in other parts of the urinary tract, such as the kidneys.

Who gets bladder stones?

Both men and women can develop bladder stones. Children can get stones, but this is rare in developed countries. The risk is higher for people who are paralyzed, who have had bladder augmentation, or who have bladder outlet obstruction.

What causes bladder stones?

Bladder stones are caused by concentrated urine that stays in the bladder for too long. Certain minerals form crystals that stick together into stones. Being unable to empty the bladder completely can lead to the formation of stones.

Causes of inability to empty the bladder can include:

Enlarged prostate (men): The prostate is an organ that surrounds the urethra, the tube that lets urine pass out of the body. When the prostate is enlarged, it may cause pressure that keeps urine in the body.
Cystocele (women): This condition happens when the bladder wall, weakened from straining or childbirth, falls into the vagina. The flow of urine is blocked.
Neurogenic bladder: This condition happens when the nerves of the bladder are damaged. Damage can happen because of nerve or spinal cord injury. Many people with neurogenic bladder have to use catheters (thin, flexible tubes) that are inserted into the ureter to remove urine. Sometimes, the catheter is unable to remove all of the urine. In addition, the catheter might be a place where crystals collect, forming stones.
Bladder diverticula: This condition means that there are pouches within the bladder that may become big enough to interfere with urine leaving the body.
Bladder augmentation: This is an operation to make the bladder bigger by adding tissue from the bowel. People who need this surgery often develop bladder stones.
Diet: A diet that does not include enough fluid can lead to stones. Some stones are related to limited protein in the diet. Calcium levels in the urine may also be an issue.

What are the symptoms of bladder stones?

Constant need to urinate, especially at night
Pain or other problems when urinating
Pain in or near the penis
Blood in the urine
Pain in the lower part of the abdomen
Dark or cloudy urine
Frequent infections in the urinary tract

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How are bladder stones diagnosed?

In addition to an examination by a healthcare provider, tests to diagnose bladder stones include:

Urine tests
X-ray
Ultrasonography (ultrasound)
Computed tomography (CT) scans, especially spiral CT scans which combine many images to provide better information
Cystoscopy (looking in the bladder with a small scope)

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How are bladder stones treated?

Small bladder stones might pass through your system naturally. If they do not pass on their own, bladder stones should be removed. Your healthcare provider may also recommend treating the cause if one is known. Bladder stone removal may be done by:

Cystolitholapaxy: This technique uses an instrument called a cystoscope to go into the bladder from the urethra. Ultrasound, laser, or an instrument crushes the stones and flushes them out of the bladder.
Cystotomy: This surgery involves cutting into the bladder through the abdomen to remove the stones.

What are complications of bladder stones?

If not treated, bladder stones can cause frequent infections in the urinary tract and chronic (long-term) problems with urinating, such as pain. Some stones can block urine from leaving the body, a problem that requires medical aid.

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How can bladder stones be prevented?

It is best to drink plenty of fluids, especially if you are at risk of stones forming.
If you have an infection or feel like your bladder is not completely empty, try urinating 10 to 20 seconds after you urinate the first time. This is called double voiding.
If diet is related to stones, follow directions on how to eat.
Get medical help at the first sign of urinary problems.
Some studies have shown that men with enlarged prostates might be able to empty their bladders more completely if they sit when they urinate.

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What is the outlook for someone with bladder stones?

Treatment of bladder stones generally solves the problem. Some people might be more liable to get bladder stones and should take action to prevent them.

[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Bronchitis” use_theme_fonts=”yes”][vc_column_text]The condition that falls in between the common cold and pneumonia in severity is called bronchitis. Symptoms include a frequent cough that produces mucus, fatigue, fever, and a wheezing sound when breathing. Find out how to treat, or better yet, prevent bronchitis.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”d1a84979-f78b-6″][vc_column_text]

What is bronchitis?

Bronchitis occurs when the bronchioles (air-carrying tubes in the lungs) are inflamed and make too much mucus. There are two basic types of bronchitis:

Chronic bronchitis is defined as cough productive of sputum that persists for three months out of the year for at least two consecutive years. The cough and inflammation may be caused by initial respiratory infection or illness, exposure to tobacco smoke or other irritating substances in the air. Chronic bronchitis can cause airflow obstruction and then is grouped under the term chronic obstructive pulmonary disease (COPD).
Acute or short-term bronchitis is more common and usually is caused by a viral infection. Episodes of acute bronchitis can be related to and made worse by smoking. Acute bronchitis could last for 10 to 14 days, possibly causing symptoms for three weeks.

What is the difference between bronchitis and pneumonia?

In terms of symptoms, these two diseases may seem very similar. Both cause cough, fever, fatigue, and a heavy feeling in your chest. Bronchitis can sometimes progress to pneumonia.

Despite similarities, the conditions are different. First, bronchitis involves the bronchial tubes, while pneumonia affects the alveoli, or the air sacs in the lungs. Second, pneumonia symptoms are usually much worse. In addition, pneumonia can be life-threatening, especially in older people and other vulnerable groups.

If your symptoms do not get better in a week or so, it is best to contact your doctor.

What causes bronchitis?

Usually, acute bronchitis is brought on by a viral infection, though it may also be caused by a bacterial infection. The flu and colds are examples of viral infections.

Chronic bronchitis is usually, but not always, caused by smoking tobacco. It can also be caused by exposure to secondhand cigarette smoke, air pollution, dust, or toxic gases. Your risk can be increased by family history of bronchitis, having asthma and allergies, and having gastroesophageal reflux disease (GERD).

What are the symptoms of bronchitis?

Symptoms of bronchitis include:

A cough that is frequent and produces mucus.
A lack of energy.
A wheezing sound when breathing (may or may not be present).
A fever (may or may not be present).
Shortness of breath.

Is bronchitis contagious?

Acute bronchitis can be contagious because it is usually caused by infection with a virus or bacteria. Chronic bronchitis is not likely to be contagious because it is a condition usually caused by long-term irritation of airways.

How long are you contagious if you have acute bronchitis?

If you have begun taking antibiotics for bronchitis, you usually stop being contagious 24 hours after starting the medication. If you have a viral form of bronchitis, antibiotics will not work. You will be contagious for at least a few days and possibly for as long as a week.

How is acute bronchitis spread?

If bronchitis is caused by a viral or bacterial infection, it is spread the same ways that colds are spread—by germs traveling through the air when someone coughs or sneezes. You can breathe the germs in if you are close enough. You could also touch something that has germs on it, like a door, and then transfer the germs by touching your nose, mouth or eyes. That is why good hand washing practices are important for adults and children.[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”8ed729b0-4c67-2″][vc_column_text]

How is bronchitis diagnosed?

Your healthcare provider will do a physical examination and take a medical history. They may ask if you have had a cold recently, how long your cough has lasted, and if you produce mucus when you cough. In addition, they may order a chest X-ray, tests for viruses in your upper respiratory secretions or blood tests.

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How is bronchitis treated?

The treatment for bronchitis depends on what type you have. If you have acute bronchitis, you might not need any treatment. Or you might use over-the-counter drugs that break up mucus or that treat fever or pain. If you have a bacterial infection, your doctor might prescribe antibiotics.

If you have chronic bronchitis, treatment will be different. Chronic bronchitis, considered to be chronic obstructive pulmonary disease (COPD), is not curable. Symptoms can be treated using a variety of methods, including drugs, oxygen therapy, pulmonary rehabilitation, surgery, or a combination of these. Your doctor might prescribe a mucus clearing device, also called an airway clearance device, to help you bring up mucus easily.

What medications are used to treat chronic bronchitis/COPD?

Drug classes that may be used to treat chronic bronchitis/COPD include:

Antibiotics to treat worsening coughs, breathlessness, and mucus production caused by infections.
Anti-inflammatory drugs, such as corticosteroids (also called steroids), to reduce swelling and mucus output. Steroids can have many different types of side effects, including swelling in feet and hands, mood changes, increased appetite and weight gain, trouble sleeping, and more serious ones such as diabetes, higher risk of infections, osteoporosis, and cataracts.
Bronchodilators to keep muscles around the airways relaxed so that airways stay open. There are long-acting and short-acting bronchodilators. Short-acting products are often called rescue drugs because they act quickly, but wear off in a couple of hours.
Combination drugs that contain a mix of steroids and long- or short-acting bronchodilators

How can I take care of myself?

If you have bronchitis, you might consider these home remedies:

Drink fluids every one to two hours, unless your doctor has restricted your fluid intake.
Rest.
Don’t smoke. Stay away from all kinds of smoke.
Relieve body aches by taking aspirin or acetaminophen.
Follow your doctor’s instructions on ways to help you clear your mucus.
If you have a cough that is severe or keeps you from sleeping, your doctor may prescribe a cough medicine to suppress (or quiet) your cough. If you have a dry cough or difficulty coughing out the mucus, your doctor may also prescribe an expectorant to help loosen and cough out the mucus.
If you have a moist, productive cough (with mucus), note how often you cough, as well as the color and amount of the sputum (mucus). Report this to your doctor.
Use a humidifier.
Try herbal teas or lemon water with 1-2 tablespoons of honey to provide comfort.

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What can I do to reduce my risk of getting bronchitis?

Don’t smoke.
Insist that others do not smoke in your home.
Stay away from or try to reduce your time around things that irritate your airway (nose, throat, and lungs). Irritants can include dust, mold, pet dander, air pollution, smoke, and cleaners.
If you catch a cold, get plenty of rest.
Take your medicine exactly the way your doctor tells you.
Eat a healthy diet.
Wash your hands often. Use soap and water. If you are not able to use soap and water, use a hand sanitizer that contains alcohol.
Make sure you are up-to-date on the flu and pneumonia vaccines.

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What is the outlook for people with bronchitis?

People who have acute bronchitis generally have very few problems with their recovery as long as they get the treatment they need. You can expect to stay home from work or school for a few days while you are recovering.

Although chronic bronchitis/COPD cannot be cured, its symptoms can be treated and your quality of life can be improved. Your prognosis, or outlook, for the future will depend on how well your lungs are functioning and your symptoms. It will also depend on how well you respond to and follow your treatment plan.[/vc_column_text][/vc_tab][vc_tab title=”Living With” tab_id=”1567842124912-5-10″][vc_column_text]

When should I see my healthcare provider?

It is often difficult to know whether you have a cold, bronchitis, or pneumonia because symptoms are similar. See your healthcare provider if you have:

A cold that lasts more than two to three weeks.
A fever greater than 102° F.
A fever that lasts more than five days.
A cough that produces blood.
Any shortness of breath or wheezing.
A change in the color of mucus.

If you have chronic bronchitis/COPD, choose lifestyle and activity changes that promote mental and physical health. Tips include:

Working as long as you are able to do so.
Managing your emotional health. Talk to a counselor if you need to do so. Make positive changes, like going outside, staying involved with friends and hobbies, getting a good night’s sleep and following suggestions of your healthcare provider.
Being a partner in your healthcare plan.
Asking for support from family and friends.
Managing stress by exercising and practicing relaxation methods.
Eating well.

[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Chickenpox” use_theme_fonts=”yes”][vc_column_text]Chickenpox is a disease caused by the varicella zoster virus and is often associated with childhood. Symptoms include an itchy rash, fever, and stomachache. Shingles is a condition of adulthood that happens when the virus becomes active again. Vaccines are available.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”71ba793c-f5e7-9″][vc_column_text]

What is chickenpox?

Chickenpox is a common illness caused by a virus (germ) called varicella zoster. People often get the virus as young children if they have not been vaccinated against it. A child with chickenpox can easily give the virus to other children. Almost all children catch chickenpox but few develop any serious problems. Chickenpox today is much less common because most children are vaccinated when they are young.

Once you have had chickenpox, you will not catch it again from another person. Adults who get chickenpox may become very sick, so it’s better to have chickenpox when you are a child, or prevent getting it by being vaccinated.

How is chickenpox spread?

Children can get chickenpox at any age. After being exposed to chickenpox, your child may appear to be fine for one to three weeks before feeling sick. Children can spread the virus from one day before they show signs of illness to about five days after a skin rash appears.

The virus is spread by:

Coming in contact with someone who has chickenpox
Breathing air from an infected person who sneezes or coughs
Coming in contact with fluids from an infected child’s eyes, nose or mouth

What are the symptoms of chickenpox?

Signs of chickenpox are easy to see. Healthcare providers often can look at a child’s skin and know if he or she has chickenpox. Signs of chickenpox usually happen in the following order:

Fever, feeling tired, headache
A stomachache that lasts for one or two days
A skin rash that is very itchy and looks like many small blisters
Bumps filled with a liquid that looks like milky water
Scabs after the blisters break
Skin that looks blotchy
Spots that fade away

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How is chickenpox diagnosed?

Signs of chickenpox are easy to see. Healthcare providers often can look at a child’s skin and know if he or she has chickenpox.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567844390155-2-0″][vc_column_text]

How can I help my child get well?

Make sure your child gets plenty of rest and fluids. Chickenpox will go away on its own in a week or two. To help your child feel less itchy, you can:

Press a cool, moist rag on the rash.
Keep your child cool.
Encourage your child not to scratch. Trim the fingernails so he or she can’t scratch.
Put a lotion with antihistamines on the rash. These lotions can be bought at the drugstore. If you don’t know what to buy, ask the pharmacist for help.
Give your child an over-the-counter pill form of antihistamine. Benadryl® is one example.
Give your child a cool bath or shower every day. You can also give your child an oatmeal bath.

Don’t give your child aspirin. Aspirin can harm children who have fevers. If you must give your child a pain killer, use acetaminophen (such as Tylenol®). If you are not sure what pain killer to use, ask your healthcare provider or pharmacist.

To prevent dehydration, give your child fluids. Cold fluids and a soft bland diet will help if he or she has mouth sores.

What if my baby gets chickenpox?

If your newborn baby (up to age 3 months) gets chickenpox, let your healthcare provider know right away.

What complications are possible with chickenpox?

Bacterial infections of the skin, blood, and soft tissues
Encephalitis
Pneumonia
Becoming dehydrated
Blood clotting or healing issues
Liver problems

Who is more likely to have complications from chickenpox?

Healthy people who get chickenpox do not usually have complications. However, having a severe case of chickenpox could be more dangerous for very young babies, teenagers, pregnant women and people with immunity issues, such as transplant patients. This group also includes people with cancer or HIV or people being treated with chemotherapy or steroids.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1567844391679-3-10″][vc_column_text]

Can my child get a shot to prevent chickenpox?

A vaccine for chickenpox is available and recommended. Ask your healthcare provider about the vaccine.

What should I know about the chickenpox vaccine?

Two doses are recommended. In children under the age of 13, one dose should be given between the ages of 12 and15 months, while the other is given at the age of 4-6 years.

If you are 13 or older and never got the vaccine, you should get two doses at least 28 days apart.

There is a vaccine that is only for chickenpox called Varivax®. There is another called ProQuad® that protects against measles, mumps, rubella and varicella (MMRV).

Who should not get the chickenpox vaccine?

People who are allergic to the vaccine or to any part of the vaccine
Pregnant women or women who think they might be pregnant
People with immune system problems
People with tuberculosis
People who do not feel well (Get the vaccine when you feel better.)
People who have recently had a blood transfusion or any other live vaccines

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Can adults get chickenpox?

When children get chickenpox, their bodies fight the illness by making a substance called antibodies. The antibodies fight the virus and help the body get well. These antibodies stay in the body throughout an adult’s life. If an adult comes in contact with the virus, the antibodies are there to fight the germ.

Rarely, adults get chickenpox even though they’ve already had it. When the chickenpox virus in an adult becomes active again, the illness that results is called “shingles.” People “catch” shingles from their own chickenpox virus. People with shingles can spread chickenpox to people who have not had chickenpox.

What are shingles?

Shingles also looks like a rash of small bumps. It can be painful and can take longer to heal. Shingles will usually go away on its own in a week or two.

shingles rash

Is there a vaccine for shingles?

A new shingles vaccine is now available. This product is called Shingrix® (recombinant zoster vaccine. Shingrix is given as a shot in the arm. You should have two shots that are given 2-6 months apart. The vaccine is only a preventive therapy and is not a treatment for those who have already developed shingles. However, if you have had shingles, you can still get the vaccine to prevent further outbreaks.

Due to high levels of demand for GSK’s Shingrix vaccine, providers should anticipate ordering limits and intermittent shipping delays for Shingrix. It is anticipated order limits and shipping delays will continue throughout 2019. GSK increased the US supply available for 2018 and plans to make even more doses available in the US in 2019. Additionally, GSK will continue to release doses to all customer types on a consistent and predictable schedule during 2019.

Who should be vaccinated with Shingrix?

This vaccine is recommended for those 50 years of age and older who are in decent health.

You should get the Shingrix vaccine even if:

You have had shingles already
You have been vaccinated with an older vaccine called Zostavax® (zoster vaccine live), but you should wait at least 8 weeks after having Zostavax.
You do not know for sure if you have ever had chickenpox

Who should not be vaccinated with Shingrix?

People who have ever had a severe allergy to this vaccine or any part of this vaccine
Women who are breastfeeding or pregnant
People who are somewhat ill or very ill

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When should you call your healthcare provider if your child has chickenpox?

Call your healthcare provider if your child:

Is acting ill, with a severe headache
Has sores in the eyes
Has sores that get bigger or have pus in them
Has difficulty breathing or is breathing very fast

When can my child go back to school?

Your child can go back to school seven days after the rash appears. It is not necessary to wait for the scabs to heal.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Constipation” use_theme_fonts=”yes”][vc_column_text]Constipation occurs when bowel movements become less frequent and stools become difficult to pass. It happens most often due to changes in diet or routine, or due to inadequate intake of fiber. You should call the doctor if you have severe pain, blood in your stools, or constipation that lasts longer than three weeks.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”c65c6cc7-a4aa-1″][vc_column_text]

What is constipation?

Constipation occurs when bowel movements become difficult or less frequent than normal. The frequency or time between bowel movements ranges widely from person to person. Some people have bowel movements several times a day while others only one to two times a week. Going longer than three days without a bowel movement is too long. After three days, the stool becomes harder and more difficult to pass.

What causes constipation?

Constipation is most commonly caused by inadequate fiber in the diet or a disruption of the regular diet or routine. Chronic constipation may be due to a poor diet, dehydration, certain medications (such as antidepressants, strong pain medications), stress, or the pressure of other activities that force you to ignore the urge to empty the bowel.

Various medical conditions can also cause or aggravate constipation. Some of the more common medical conditions that cause constipation include endocrine problems, such as decreased function of the thyroid gland or diabetes. Colorectal cancer is another medical condition that can cause constipation but it usually also accompanied by other symptoms including blood in the stool and weight loss. Common causes of constipation include the following:

A diet low in fiber
Not drinking enough water
Lack of exercise
Travel or another change in routine
Eating large amounts of milk or cheese
Stress or resisting the urge to have a bowel movement
Medications
- Strong pain medicines such as narcotics
- Antidepressants
- Antacids containing calcium or aluminum such as TUMS
- Iron pills
- Allergy medications such as antihistamines
- Certain blood pressure medicines
- Psychiatric medications
- Herbal supplements
Irritable bowel syndrome (IBS)
Pregnancy
Neurologic disorders including spinal cord injury and multiple sclerosis (MS)
Slow transit of the colon

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How is constipation evaluated?

Most people do not need extensive testing to evaluate constipation. Only a small number of patients with constipation have a serious underlying medical problem (such as poor function of the thyroid gland, diabetes, or colorectal cancer).

If you have constipation that has persisted for more than two weeks, you should see a doctor to determine if you need further evaluation. For a patient who has colorectal cancer, early detection and treatment may be life-saving.

Standard evaluation for constipation includes performing blood tests and examining the colon by colonoscopy, particularly for patients older than 50 years.. Other tests include colonic transit studies (time it takes for stools to move through the colon) and anal manometry (measures pressure and muscle function in the rectum and anus).

Most patients with serious constipation, and without any obvious illness to explain their symptoms, suffer from one of two problems:

Colonic inertia (also called lazy colon): a condition in which the colon contracts poorly and retains stool. This can be determined by colon transit studies.
Obstructed defecation: a condition in which the colon contracts normally, but the patient is unable to expel stool from the rectum. This condition can be confirmed by a test called anal manometry.

When should I call my healthcare provider?

Call your healthcare provider if:

Constipation is a new problem for you.
You have blood in your stool.
You are losing weight unintentionally.
You have severe pain with bowel movements.
Your constipation has lasted more than three weeks.

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How is constipation treated?

Drink two to four extra glasses of water a day.
Try warm liquids, especially in the morning.
Add fruits and vegetables to your diet.
Eat prunes and/or bran cereal.
Add supplemental fiber to your diet (there are several types, such as Metamucil, Citrucel, and Benefiber).
If needed, use a very mild stool softener or laxative (such as colace [docusate] or Milk of Magnesia). Do not use laxatives for more than two weeks without calling your healthcare provider, as laxative overuse can aggravate your symptoms.

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How can I prevent constipation?

Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain breads and cereals. Fiber and water help the colon pass stool. Most of the fiber in fruits is found in the skins, such as in apples. Fruits with seeds you can eat, like strawberries, have the most fiber. Bran is a great source of fiber: eat bran cereal or add bran cereal to other foods, like soup and yogurt.
Drink eight 8-ounce glasses of water a day. (Note: Milk can cause constipation in some people.) Liquids that contain caffeine, such as coffee and soft drinks, have a dehydrating effect and may need to be avoided until your bowel habits return to normal.
Exercise regularly.
Move your bowels when you feel the urge.

[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Depression” use_theme_fonts=”yes”][vc_column_text]Major depression is characterized by a profound and constant sense of hopelessness and despair. In the U.S., approximately 10 percent of people suffer from major depression at any one. Find out about common symptoms and available treatments.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”a077319b-4ebc-3″][vc_column_text]

What is depression?

Nearly everyone has felt depressed, sad, or blue at one time or another. A depressed mood is a normal reaction to loss, life’s struggles, or injured self-esteem. Sometimes, however, depression becomes intense, lasts for long periods, and prevents a person from leading a normal life. If left untreated, depression can get worse, sometimes lasting for years. It can even result in suicide. It is important to recognize the signs of depression and seek help if you see signs of depression in you or a loved one. It is important to know that depression CAN be treated successfully.

What are the types of depression?

Major depressive disorder (or major depression): A person with this type of depression feels a profound and constant sense of hopelessness and despair. The symptoms of major depression interfere with the person’s ability to work, sleep, study, eat, and enjoy themselves, even activities which had previously been pleasurable. This disabling type of depression may occur only once in a lifetime, or more commonly, occurs several times in a lifetime.

Minor depression: A person with this type of depression has symptoms for longer than two weeks at a time, but does not meet the criteria for major depression.

Dysthymic disorder (or dysthymia or chronic depression): In dysthymia, the main symptom is a low mood on most days for a long period of time. Other depression symptoms may be present, but are not as severe as in major depression.

What causes depression?

Depression may result from various factors in a person’s life, including:

High levels of stress
Life transitions
Loss
Physical illness
Family history of depression
Imbalances in the chemicals that the body uses to control mood
Certain medicines
Lack of social support
Lack of good coping skills
History of traumatic experiences

What are the symptoms of depression?

The major symptoms of depression include the following:

Feeling extremely sad, anxious, or “empty”
Feeling hopeless
Feeling worthless
Sleeping too much or too little
Loss of enjoyment from things that were once pleasurable
Loss of energy
Difficulty concentrating, thinking, or making decisions
Changes in appetite that lead to weight loss or gain
Uncontrollable crying
Headache
Stomach ache
Digestive problems
Problems with sexual function
Thoughts of death or suicide
Attempting suicide

If you or someone you know is demonstrating any of the following warning signs, contact a primary care doctor, a mental health professional, or a community mental health center. If you feel unsafe, go to the nearest emergency room for evaluation and treatment.[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”da36d529-d880-10″][vc_column_text]

How is depression diagnosed?

Your healthcare provider will ask you to describe your symptoms and medical history. He or she likely will ask if you or anyone in your family has had depression or other mental health problems. You also may need to complete a depression screening questionnaire. Symptoms of depression sometimes are caused by a physical disorder or illness. Your health care provider also may perform a physical exam or laboratory tests to determine if there is a physical cause for the depression.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567931438023-2-1″][vc_column_text]

How is depression treated?

The two most common treatments for depression are psychotherapy and antidepressant medications. However, other options are also available, including electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation and alternative therapies like biofeedback.

Psychotherapy. Psychotherapy is sometimes called “talk therapy.” It is used to treat mild and moderate forms of depression. A licensed mental health professional helps people with depression focus on behaviors, emotions, and ideas that contribute to depression. They also help the depressed person identify and understand life problems that contribute to their illness in order to enable them to regain a sense of control. Psychotherapists help patients learn coping techniques and problem-solving skills. Psychotherapy can be done on an individual or group basis and can include spouses and family members. It is most often the first line of treatment for depression.

Medicines. Medicines are commonly used to treat depression. Your family doctor can prescribe the medications or refer you to a psychiatrist. Currently, five different types of medications are approved to treat depression. These are:

Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®), and fluoxetine (Prozac®)
Serotonin and noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine (Effexor®) and duloxetine (Cymbalta®)
Tricyclic antidepressants (TCAs), such as nortriptyline (Pamelor®), amitriptyline (Elavil®), and imipramine (Tofranil®)
Monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil®), and tranylcypromine (Parnate®)
Norepinephrine and dopamine reuptake inhibitors (NDRIs), such as bupropion (Wellbutrin®)
Non-competitive N-methyl-D-aspartate receptor antagonist, called esketamine (Ketanest®, Spravato®)

The type of drug initially prescribed for you will depend on your symptoms, the presence of other medical conditions, other medicines you are currently taking, the cost of the prescribed treatments, and potential side effects.

Electroconvulsive therapy (ECT). Electroconvulsive therapy is a procedure that uses a brief application of electric current to the scalp to produce a seizure in the patient. It is believed that ECT results in the release of chemicals in the brain that aid in reversing the symptoms of depression. It is used for severe forms of depression, suicidal patients, and for other mental illnesses. ECT is performed while the patient is asleep under general anesthesia.

Transcranial magnetic stimulation (TMS). Transcranial magnetic stimulation uses magnetic energy to help control mood. The treatment consists of the use of a magnetic device that creates an electric current. When the device is pressed against the scalp near the forehead, the electric current causes nerve cells in that area of the brain to send impulses that triggers a chemical reaction that, over time, helps relieve symptoms of depression. TMS is approved for the treatment of severe depression in patients who have not been helped by at least one antidepressant medication.

Vagus nerve stimulation (VNS). Traditionally used for epilepsy, this treatment uses electrical pulses to stimulate the vagus nerve, a nerve thought to affect the area of the brain that controls depression. A tiny pacemaker-like device implanted in the chest sends electrical pulses to an electrode in the neck to stimulate the nerve and provide symptom relief. VNS is only approved for patients with treatment-resistant depression. The specific Food and Drug Administration approval is for patients with chronic (ongoing) or recurring depression in whom at least four other antidepressant treatment methods have been tried and failed to relieve symptoms of depression.

Alternative treatments. Alternative treatments, by providing forms of relaxation and relief from stress, have a place in healing and general health and well-being. Examples of alternative therapies include acupuncture, guided imagery, chiropractic treatments, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage, and many others. In general, alternative therapies by themselves are effective for mild, but not more severe, forms of depression.

What is the typical approach to treating depression?

The earlier treatment is started, the more effective it is. Antidepressant medications, psychotherapy or a combination of both are the usual first steps in treating depression.

The good news is that are many options available to treat depression. Don’t be discouraged if you start taking an antidepressant and it doesn’t appear to be working. Antidepressant therapy can take 4 to 8 weeks or longer before becoming fully effective. If the initial dose of antidepressant is not fully effective, your doctor may increase the dose of the drug, change to a different antidepressant drug, add a second antidepressant to your drug regimen, or try other drugs that are sometimes used to treat other conditions but have been shown to be useful in patients with depression (such as anti-anxiety medications, anti-psychotics, or mood stabilizers).

Other treatment options, such as psychotherapy and alternative treatments, can also be part of the initial treatment for mild to moderate depression. ECT, TMS, and VNS are reserved for more severe forms of depression.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1567931781520-3-1″][vc_column_text]

Can depression be prevented?

Some individuals who have had an episode of depression are prone to have another one. The best way to prevent another episode is to be aware of the triggers of depression, know your own symptoms, and seek help early if you need it.[/vc_column_text][/vc_tab][vc_tab title=”Outlook / Prognosis” tab_id=”1567931830399-4-4″][vc_column_text]

Why seek help if I have coped with depression before?

You may have recognized periods of depression in your life. Perhaps these periods lasted for several months and you learned to cope. But early treatment is important because:

Without treatment, depression can become worse.
Depression can lead to suicide.
Without treatment, people who suffer from episodes of depression often do not fully recover.
Treatment can prevent depression from coming back.
Your depression may be the sign of another illness, which can worsen without treatment.
Depression can increase your risk of developing other diseases, including dementia.

[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Dermatomyositis” use_theme_fonts=”yes”][vc_column_text]Dermatomyositis occurs when polymyositis (an inflammatory muscle disease) affects the skin, causing a scaly rash and/or purple spots. Steroids are usually the first treatment tried.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”a077319b-4ebc-3″][vc_column_text]

What is depression?

What are the types of depression?

Minor depression: A person with this type of depression has symptoms for longer than two weeks at a time, but does not meet the criteria for major depression.

What causes depression?

Depression may result from various factors in a person’s life, including:

High levels of stress
Life transitions
Loss
Physical illness
Family history of depression
Imbalances in the chemicals that the body uses to control mood
Certain medicines
Lack of social support
Lack of good coping skills
History of traumatic experiences

What are the symptoms of depression?

The major symptoms of depression include the following:

Feeling extremely sad, anxious, or “empty”
Feeling hopeless
Feeling worthless
Sleeping too much or too little
Loss of enjoyment from things that were once pleasurable
Loss of energy
Difficulty concentrating, thinking, or making decisions
Changes in appetite that lead to weight loss or gain
Uncontrollable crying
Headache
Stomach ache
Digestive problems
Problems with sexual function
Thoughts of death or suicide
Attempting suicide

How is dermatomyositis diagnosed?

The diagnosis of dermatomyositis is usually confirmed by the following tests:

Blood tests to detect increased amounts of muscle enzymes such as creatine kinase (CK) and sometimes lactic dehydrogenase (LDH).
Blood tests to detect autoantibodies (antibodies that react with cells, tissues, or native proteins of the individual in which the antibodies are produced).
Skin biopsy of the rash.
Biopsy of an affected muscle.
Electromyography (EMG) testing.
Magnetic resonance imaging (MRI) scan of muscles.

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How is dermatomyositis treated?

Doctors usually begin treatment of dermatomyositis with steroid drugs such as prednisone. Immunosuppressants may be helpful for patients who are not helped by prednisone. These include:

Methotrexate (brand names Rheumatrex® and Trexall®)
Azathioprine (brand name Imuran® and Azasan®)
Cyclophosphamide (brand name Cytoxan®)
Chlorambucil (brand name Leukeran®)
Cyclosporine (brand name Sandimmune®, Gengraf®, and Neoral®)
Tacrolimus (brand name Astagraf XL®, Hecoria®, Prograf®)
Mycophenolate (brand name CellCept®, Myfortic®)
Rituximab (brand name Rituxan®)

Further treatment with intravenous immunoglobulin (IVIG), used to slow down the autoimmune process, has been shown to be effective and safe. Physical therapy can preserve muscle function and prevent muscle wasting.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Diabetes Management Checklist” use_theme_fonts=”yes”][vc_column_text]Drug addiction is a chronic disease. It is characterized by a need to seek out and misuse drugs despite negative consequences. Drug addiction is a life-threatening condition.[/vc_column_text][vc_column_text]

Here is a summary of the guidelines that will help you manage your diabetes for a lifetime of good health:

Plan what you eat and follow a balanced meal plan. See your dietitian at least once a year.
Exercise at least five times a week for 30 minutes each session. Talk to your doctor before starting any exercise program. Tell your doctor what kind of exercise you want to do so adjustments can be made to your medicine schedule or meal plan, if necessary.
Follow your medicine schedule as prescribed by your doctor.
Know what medicines (brand and generic names) you are taking and how they work. Keep a list of your medicines with you at all times.
Test your blood glucose regularly, as recommended by your health care provider. Test your blood glucose more often when you’re sick.
Try to continuously keep your blood glucose level at the recommended range. If your blood glucose is less than 70 mg/dl and you have more than one unexplained low blood glucose reaction a week, call your doctor. If your blood glucose is greater than 160 mg/dl for more than a week or if you have two consecutive readings greater than 300 mg/dl, call your doctor.
Contact your doctor when your blood glucose is over 300 mg/dl. Test your urine for ketones if recommended by your doctor.
Record your blood glucose and urine ketone test results in a recordkeeping log. Bring your log book with you to all of your doctor’s visits.
Keep your scheduled appointments with your health care providers. See your doctor at least every three to four months for regular check-ups if you are treated with insulin. See your doctor every four to six months if you are treated with other diabetes medicines or if you are managing diabetes with diet and exercise alone. More frequent visits might be necessary if your blood glucose is not controlled or if complications of diabetes are progressing. Make sure your health care provider checks your blood pressure and weight, and examines your feet and insulin injection sites.
Have a glycosylated hemoglobin test (HbA1c) at least two times a year or more frequently as recommended by your doctor.
Have an eye exam (including a retinopathy screening test) and urinalysis test once a year, or as recommended by your doctor. (Your doctor might request that you have these tests more frequently.)
Have your cholesterol and triglyceride levels checked (lipid profile test) once a year.
Have a dental exam every six months.
If you have any signs of infection, call your doctor or health care provider.
Practice good foot and skin care.
DO NOT SMOKE.
Try to manage stress as best as you can. You might think about attending a stress management workshop to help you learn better coping methods.
Discuss your travel plans with your doctor. Make sure to bring enough medicine and supplies with you on your trip. Keep medicines, syringes, and blood glucose testing supplies in your carry-on bag. Do not check these supplies in case your luggage is lost.
Continue learning about your diabetes to maintain and improve your health. Attend a diabetes class or schedule visits with your diabetes educator at least once a year.

What is drug addiction?

Drug addiction is a long-term condition of compulsive drug seeking that is not stopped by negative consequences. Addictions, in general, are compulsions to use and abuse things to an excessive and destructive extent. This need to use and misuse substances can be very powerful and can be life-threatening. It often extends to not only harm the user, but family and friends as well.

Commonly abused drugs include:

Alcohol
Club drugs (GHB, ketamine, MDMA (Ecstasy/Molly), Rohypnol)
Cocaine
Hallucinogens (ayahuasca, D-lysergic acid diethylamide (LSD), peyote (mescaline) phencyclidine (PCP), DMT)
Inhalants (solvents, aerosol sprays, gases, nitrites)
Marijuana
Methamphetamine
Opioids (heroin, fentanyl, oxycodone, hydrocodone, codeine, morphine)
Prescription Drugs & Cold Medicines
Steroids (Anabolic)
Synthetic Cannabinoids (K2/Spice)
Synthetic Cathinones (Bath Salts)
Tobacco/Nicotine & E-cigarettes

Why are more and more drugs needed to maintain a high over time?

Over time, your body adapts to the drug. It no longer releases the chemicals that provide the “high” feeling (euphoria). This is called tolerance. When this happens, you will need more and more of the drug to feel the same high that was experienced the first time. As more of the drug is consumed, you may enjoy other aspects of life less. Social, family, and work obligations may also fall to the side. The need for the drug to recapture that original high can become all-consuming.

Who is most likely to become addicted to drugs?

Anyone can become addicted to drugs. Some people may be more prone to use drugs based on family history (genetic predisposition), social factors, their gender, or ethnicity.

What are the causes of drug addiction?

Addiction causes changes to the brain over time. It is actually considered a brain disease because of the way the drugs can impact the brain over a long period of time. Continued use of drugs can shift the way the brain works and the structure of the organ. Even though the first use of a drug is by choice, addiction creates a need for the drug after continued use. The ability to make decisions, like stopping drug use, can be decreased because of the impact of the drug on the brain.

What are the symptoms of drug addiction?

The symptoms of drug addiction include:

Craving the drug
Trying, or failing, to cut down or control drug use
Struggling to complete tasks at work, in school, or at home
Partaking in risky behaviors (driving while impaired or unprotected sex)
Continuing to take risks despite knowing the negative results
Building up a tolerance
Experiencing withdrawal symptoms when stopping the drug

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How is drug addiction diagnosed?

Drug addiction is diagnosed in several steps, including:

Recognizing a problem and wanting help (often starts with an intervention from friends)
Getting an examination from a healthcare professional
Beginning a treatment plan that works with the specific type of addiction (in-patient or out-patient)

Unfortunately, many people who suffer from drug misuse don’t go through these steps to seek treatment.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567931438023-2-1″][vc_column_text]

How are different types of addiction treated?

Drug addiction can be treated through detoxification (the process of the drug leaving the body), behavioral therapies and drug-assisted therapies. In many cases a combination of therapies is used. Behavioral therapy is used to help change attitudes about drug misuse and advocate a healthy lifestyle.

Medications can be given to help with withdrawal and other symptoms of addiction during treatment. The method of treatment is not one-size-fits-all. There are different options for different types of addiction. A few drug-assisted treatment options include:

Opioids: there are several drug-assisted treatment options for opioid addiction. They include methadone, buprenorphine, and naltrexone.
Alcohol: the FDA has approved three drugs for use in alcohol addiction treatment. These include naltrexone, acamprosate, and disulfiram.
Tobacco: addiction to tobacco can be treated with Nicotine (as a patch, spray, gum, or lozenge). The FDA has also approved the medications bupropion and varenicline.

In-patient and out-patient therapies are also available treatment options. These often involve group therapies and can occur weekly (out-patient) or for as long as 6-12 months (in-patient).

Can you cure drug addiction?

No. Similar to other long-lasting diseases, addiction cannot be cured in the traditional sense. It can be managed and treated. The risk of falling back into an addiction may be present for the rest of the person’s life.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1567934635992-3-8″][vc_column_text]

Can drug addiction be prevented?

Drug addiction is preventable. Educational programs in schools, communities and on the family level can help prevent the first usage of a substance. Not taking illegal drugs and following the instructions for prescription medications can also prevent addiction.[/vc_column_text][/vc_tab][vc_tab title=”Outlook / Prognosis” tab_id=”1567934674421-4-6″][vc_column_text]

Are there long-term effects to drug addiction?

After extended misuse of drugs, the structure and functions of the brain can change. This is considered a brain disease. A few ways the brain changes include how it:

Learns
Makes judgments and decisions
Deals with stress
Stores memory
Processes behavior

[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Eczema” use_theme_fonts=”yes”][vc_column_text]Eczema is a general term for a group of conditions that cause the skin to become inflamed, red, dry, and itchy. In some cases, a rash might develop in one area or over the entire body. The exact cause of eczema is not known.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”a077319b-4ebc-3″][vc_column_text]

What is eczema?

Eczema is a general term for a group of conditions that cause the skin to become inflamed, red, dry, bumpy, and itchy. However, this term is most often used to refer to a condition called atopic dermatitis. In atopic dermatitis, skin barrier function (the “glue” of the skin) is damaged. This loss of barrier function makes the skin more sensitive and more prone to infection and to becoming dry.

How common is eczema?

Eczema is a common skin condition, affecting as many as 15 million Americans. It most often occurs in very young children. Ten percent to 20 percent of all infants have eczema, according to the National Institutes of Health. However, nearly half outgrow the condition or have significant improvement as they get older. Eczema affects males and females equally, and is more common in people who have a personal or family history of asthma and allergies.

What are the symptoms of eczema?

Common symptoms of eczema include:

Itching
Skin redness
Dry, scaly, or crusted skin that might become thick and leathery from scratching
Formation of bumps or small, fluid-filled blisters that might ooze when scratched

In adults, eczema most often affects the hands. In children, eczema is more common in “bending” areas such as the insides of the elbows and backs of the knees. In babies, eczema is usually worst on the face, neck, and scalp.

What causes eczema?

The exact cause of eczema is not known. However, it appears to run in families and occurs more often in people who have a personal or family history of asthma, hay fever, and other allergies. This suggests that there is a genetic (hereditary) factor in the development of eczema (runs in the family).

In addition, eczema symptoms tend to flare up or get worse when the person is exposed to certain substances and situations, called triggers. Eczema triggers might include:

Skin irritants: Irritants are substances that cause burning, itching, or redness. They include harsh soaps, chemicals, perfumes, and skin care products that contain fragrance or alcohol. Some fabrics, such as wool, and tight clothing can also irritate the skin.
Allergens: Allergens are substances that trigger an allergic reaction, which may include sneezing, itching, watery eyes, and a stuffed or runny nose. Some allergens such as pollens, pet hair, or foods (in rare cases) can also trigger or worsen eczema symptoms.
Climate and environment: Low humidity (dry air) can cause the skin to become dry and itchy. Heat and high humidity cause sweating, which can make itching worse.
Stress: Stress has been shown to trigger flare-ups in some people with eczema. In addition, it may be more difficult to avoid scratching irritated skin when under stress.

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How is eczema diagnosed?

In most cases, eczema is diagnosed from the person’s history of symptoms and by examining the skin. The doctor might test an area of scaly or crusted skin to rule out other skin diseases or infections.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567931438023-2-1″][vc_column_text]

How is eczema treated?

Treatment of eczema depends on the symptoms (for example, dry skin is treated differently than oozing blisters) and the factors that trigger or worsen symptoms. No one treatment is best for all people. The goal of treatment is to reduce itching and discomfort and to prevent infection and additional flare-ups.

Treatment options include:

Prevention: Preventing flare-ups is the best way to manage eczema. For that reason, it is important to try to identify and avoid symptom triggers, such as certain detergents or food allergens, and to moisturize the skin.
Skin care: Keeping your skin moist is important, because itching increases when the skin is dry. Use a moisturizing cream or ointment. Lotions are less effective. It is important to keep skin moisturized by applying creams or ointments several times a day — including after bathing/showering while skin is still damp — to keep your skin moist. Use mild soaps and products that are free of perfumes, dyes, and alcohol. Look for products that are “fragrance-free,” “hypoallergenic,” and “for sensitive skin.” New products containing “ceramide” actually replace some of the “glue” that is missing in the skin of eczema patients and are the most effective moisturizers.
Medications: Over-the-counter creams and ointments containing the steroid cortisone — such as hydrocortisone (Cortisone 10®) and hydrocortisone acetate (Cort-Aid®) — may be used to help control the itching, swelling, and redness associated with eczema. Stronger, prescription-strength steroid creams are also available. Steroid pills and shots may be used in the short term to get control of severe eczema, but long-term use of these is not recommended because of the possible side effects, which include high blood pressure, weight gain, and thinning of the skin.

Newer medications, called topical immunomodulators (TIMs), are showing progress in treating patients with moderate to severe eczema, particularly those patients who do not respond to traditional treatment. TIMs — such as tacrolimus (Protopic®) and pimecrolimus (Elidel) — work by modulating (changing) the body’s immune response to allergens. TIMs also have fewer side effects than steroids. The most common side effect reported with tacrolimus is a temporary stinging or burning sensation that generally improves after a few days of use.

Other medications that might be used for patients with eczema include antibiotics if the skin becomes infected, and antihistamines to help control itching. Some patients with severe eczema may require oral immunomodulatory or immunosuppressant medications to control their skin disease.

Phototherapy: The ultraviolet light waves found in sunlight have been shown to help certain skin disorders, including eczema. Phototherapy uses ultraviolet light, usually ultraviolet B (UVB), from special lamps to treat people who have severe eczema.

What complications are associated with eczema?

Scratching or rubbing itchy areas can break the skin, allowing bacteria to enter and cause infection.
Scars can form when the skin is damaged from continued scratching.
Very itchy eczema can disturb sleep.
Some people with eczema avoid social activities because they are uncomfortable and/or self-conscious.
In persons with darker skin, inflammation from eczema may leave dark marks that linger for months.

Can eczema be cured?

Currently, there is no cure for eczema. However, proper treatment and good skin care can often control or minimize symptoms.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1567934635992-3-8″][vc_column_text]

Can eczema be prevented?

There are steps you can take to prevent eczema outbreaks:

Establish a skin care routine, and follow your doctor’s recommendations for keeping your skin healthy.
Wear gloves for jobs in which you have to put your hands in water. Wear cotton gloves under plastic gloves to absorb sweat, and wear gloves outside, especially during the winter months.
Use mild soap for your bath or shower, and pat your skin dry instead of rubbing. Apply a moisturizing cream or ointment immediately after drying your skin to help seal in the moisture. Reapply cream or ointment two to three times a day.
Take baths or showers with tepid (lukewarm) rather than hot water temperature.
Drink at least eight glasses of water each day. Water helps to keep your skin moist.
Try to avoid getting too hot and sweaty.
Wear loose clothes made of cotton and other natural materials. Wash new clothing before wearing. Avoid wool.
Avoid sudden changes in temperature and humidity.
Learn to recognize stress in your life and how to manage it. Regular aerobic exercise, hobbies, and stress-management techniques, such as meditation or yoga, might help.
Limit your exposure to known irritants and allergens.
Avoid scratching or rubbing itchy areas of skin.

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What is the outlook for people with eczema?

Nearly half of children with eczema will outgrow the condition or experience great improvement by the time they reach puberty. Others will continue to have some form of the disease. For adults with eczema, the disease can be generally well-managed with good skin care and treatment, although flare-ups of symptoms can occur throughout life.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Fatty Liver Disease” use_theme_fonts=”yes”][vc_column_text]Fatty liver disease is a common problem caused by the buildup of certain fats in the liver. In most cases, it does not cause any serious problems, but it can lead to liver damage. Symptoms and treatments are discussed.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”a077319b-4ebc-3″][vc_column_text]

What is fatty liver disease?

Fatty liver disease (steatosis) is a common problem caused by the buildup of certain fats in the liver. The liver normally contains a small amount of fat. However, if more than 5 to 15 percent of the liver’s weight consists of fat, the patient has fatty liver disease.

What are the forms of fatty liver disease?

There are two main forms of fatty liver disease:

Non-alcoholic fatty liver: Fat buildup in the liver that is not linked to drinking alcohol.
Alcoholic fatty liver: Fat buildup in the liver due to drinking large amounts of alcohol (more than one drink per day on average for women and more than two drinks per day on average for men).

What are the effects of fatty liver disease?

In most cases, fatty liver disease does not cause any serious problems or prevent the liver from functioning normally. However, it may lead to liver damage under certain circumstances.

Non-alcoholic fatty liver disease affects up to 25 percent of people in the United States and is one of the country’s leading causes of cirrhosis of the liver. Non-alcoholic steatohepatitis (NASH) with fibrosis or cirrhosis is the most severe condition resulting from non-alcoholic fatty liver disease. NASH is more likely to occur in people who are overweight or obese, or who have diabetes.

What are the risk factors for fatty liver disease?

A risk factor makes a person more likely to have a condition or disease. There are many risk factors for non-alcoholic fatty liver disease, including:

Being obese or overweight
Having type 2 diabetes or insulin resistance
Having metabolic syndrome (excess body weight, insulin resistance, high blood pressure and high triglyceride levels)

Some genetic metabolic conditions or prescription medications, including amiodarone (Cordarone®), diltiazem (Cardizem®), steroids, and tamoxifen (Nolvadex®) also may increase the risk of non-alcoholic fatty liver disease. If you are taking one of these medications and are diagnosed with fatty liver, your doctor might substitute another drug.

What are the symptoms of fatty liver disease?

People with fatty liver disease usually do not have any symptoms. If symptoms do appear, they may include:

A feeling of fullness in the middle or upper right side of the abdomen
Abdominal pain
Loss of appetite or weight loss
Nausea
Weakness
Jaundice (yellowing of the skin and the whites of the eyes)
Swelling of the abdomen and legs (edema)
Mental confusion
Extreme fatigue or tiredness

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How is fatty liver disease diagnosed?

If your doctor thinks you may have fatty liver disease, he or she may order the following tests:

Blood tests to check for higher levels of certain liver enzymes.
An ultrasound or computed tomography (CT) scan of the liver to check for abnormalities and confirm the diagnosis of fatty liver disease.
A liver biopsy (tissue sample) if your doctor suspects that you have severe liver disease.

Elastography is a newer technique that uses waves transmitted by ultrasound, magnetic resonance imaging (MRI) or vibration (Fibroscan) to estimate the amount of steatosis (fat) and fibrosis (stiffness) of the liver without taking a biopsy.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567931438023-2-1″][vc_column_text]

How is fatty liver disease treated?

There is no single treatment for fatty liver disease. In most cases, no treatment is required. If it is needed, treatment will depend on the underlying cause:

For fatty liver disease caused by alcohol abuse, alcohol should be strictly avoided.
For non-alcoholic fatty liver disease, your doctor may recommend that you go on a diet, since losing weight can reduce the amount of fat in the liver. Even losing 1 or 2 pounds per week might help. Your doctor or nutritionist can give you advice on healthy weight loss techniques.
The anti-inflammatory drugs pentoxifylline (Trental®) and obeticholic acid (Ocaliva®) may improve fibrosis (liver stiffness), while vitamin E, thiazolidinediones (drugs used to treat diabetes) and obeticholic acid may improve inflammation associated with non-alcoholic fatty liver disease.

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How can fatty liver disease be prevented?

Maintain a healthy weight. If you are overweight or obese, lose weight gradually.
Eat a balanced diet. The Mediterranean diet, which is high in vegetables, fruits and good fats, may help lower bad cholesterol and triglyceride levels.
Exercise regularly.
Limit your alcohol consumption, or do not drink.
Take medications as prescribed. Your doctor may prescribe statins to lower triglyceride levels or anti-diabetic drugs if you are diabetic or insulin-resistant.

[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Food Allergies & Asthma” use_theme_fonts=”yes”][vc_column_text]Did you ever eat something and then get hives, rash, nausea, vomiting, or diarrhea? Any reaction to a food that is abnormal is considered an adverse reaction; the reaction can be a food intolerance or food allergy.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”a077319b-4ebc-3″][vc_column_text]

What is a food allergy?

Any reaction to a food that is abnormal is considered an adverse reaction. Adverse reactions are classified either as food intolerance or food allergy.

Food allergy is defined as an over-reaction by the body’s immune system to proteins in foods that are usually safe or harmless. The over-reaction is caused by IgE, the allergy antibody in humans. Your doctor can perform specific testing of your skin or blood to determine any foods to which you might be sensitive. Testing foods can be done to confirm food allergy.

What is food intolerance?

Food intolerance is an abnormal response of the body to an ingested food that is not an allergy. Examples of this are food poisoning and reactions to chemicals in food or drinks such as caffeine.

Which foods may trigger asthma?

Asthma might be triggered by foods, but this is rare. The most common symptoms of food allergy are hives, rash, nausea, vomiting, and diarrhea. Asthma might be triggered by foods, but this is rare. The most common foods associated with allergic symptoms are:

Eggs
Milk
Peanuts
Tree nuts (cashews, almonds, filberts, etc.)
Soy
Wheat
Fish
Shellfish
Shrimp

Which food additives may trigger asthma?

Although also rare, food additives (sodium bisulfite, potassium bisulfite, sodium metabisulfite, potassium metabisulfite, and sodium sulfite) can also trigger asthma. These additives are used as preservatives in food processing or preparation, and can be found in the following foods:

Dried fruits or vegetables
Potatoes (packaged and some prepared)
Wine and beer
Bottled lime or lemon juice
Shrimp (fresh, frozen, or prepared)
Pickled foods

Some sources state that other food additives (food colorings or dyes, preservatives such as nitrites and nitrates, and the artificial sweetener aspartame) can also trigger asthma, but there is no scientific evidence that proves this is true.

If you suspect that certain foods might be triggering your asthma, discuss this with your doctor. Allergy skin testing can be done to determine if you are allergic to these foods. Avoiding the food is the best way to prevent asthma reactions. It is important to read food labels. When dining out, ask how foods are prepared.[/vc_column_text][/vc_tab][vc_tab title=”Resources” tab_id=”da36d529-d880-10″][vc_column_text]

Where can I find more information about food allergies?

For more information on food allergies, contact:[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Fungal Rhinosinusitis” use_theme_fonts=”yes”][vc_column_text]Fungal rhinosinusitis refers to a broad group of conditions caused by fungal infections of the paranasal sinuses.[/vc_column_text][vc_column_text]

Fungus Ball

In this condition, an isolated paranasal sinus is completed filled with a ball of fungal debris, most frequently in the maxillary sinuses. Patient symptoms include fullness, pressure and discharge. Treatment for a fungus ball requires surgery for complete removal of all fungal elements. The prognosis is good.

Allergic Fungal Rhinosinusitis

Allergic fungal rhinosinusitis (AFRS) is characterized by it the sinus secretions, which have a characteristic golden-yellow color and have a consistency like rubber cement. These secretions contain proteins from degranulated eosinophils (a type of inflammatory cell) plus some fungal elements. Patients often will have received multiple treatments (including steroids) for chronic rhinosinusitis before the diagnosis of AFRS is confirmed. Many AFRS patients also have asthma. Endoscopic sinus surgery is required for diagnosis and mechanical cleansing of the sinuses, but surgery must be combined with long-term medical management. Medical sinus infection treatments include systemic and topical corticosteroids and antifungals as well as antibiotics for bacterial infection.

Acute Fulminant Fungal Rhinosinusitis

Acute fulminant invasive rhinosinusitis (also know as rhinocerebral mucormycosis or simply “mucor”) occurs when fungal organisms invade the sinus tissues in patients who are immunosuppressed. Classically, these patients have suppressed immune systems due to chemotherapy administered for cancer treatment, or they have diabetes which leads to immune suppression. In the early stages, patients have an area of necrotic tissue (i.e., dead tissue due to invasion by the fungus) within the sinuses, but within hours, it can rapidly progress to eye and brain involvement. Prognosis is poor. Emergency surgery is necessary to confirm the diagnosis and to mechanically remove all dead tissue. Systemic antifungal treatment is also provided. If possible, the efforts to reverse the underlying immune suppression should be initiated.

Chronic Invasive Fungal Rhinosinusitis

In chronic invasive fungal rhinosinusitis, the process of invasion of the sinus tissues occurs over a period of weeks or months, rather than hours. Many patients with this relatively rare condition have subtle abnormalities in their immune system due to diabetes or chronic steroid use. Patients can present with eye swelling and blindness. Urgent surgery is necessary to confirm the diagnosis and to remove all involved tissues. Again, systemic antifungal treatments are also critically important.

Granulomatous Fungal Rhinosinusitis

The onset of granulomatous fungal rhinosinusitis is also gradual. This condition is characterized by a specific long-term inflammatory response, known as granulomatous inflammation to fungal organisms that have invaded the sinus tissues. Almost all cases occur in the Sudan and neighboring countries.[/vc_column_text][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Gallstones” use_theme_fonts=”yes”][vc_column_text]The gallbladder stores and releases bile which helps digest fats. Sometimes gallstones form in the gallbladder or bile ducts. Gallstones may cause pain. Treatment options include medication or surgical removal of the stones or the gallbladder itself.[/vc_column_text][vc_tabs][vc_tab title=”Management and Treatment” tab_id=”1567938585072-2-10″][vc_column_text]

How are gallstones treated?

In most cases, if you have gallstones in the gallbladder but no symptoms (silent stones), you probably do not need treatment.

If you have symptoms such as pain, you will probably need to be treated. The treatment that is used most often for gallstones is surgery to remove the gallbladder, which is known as a cholecystectomy. In the vast majority (90%) of cases, this surgery is performed laparoscopically.

Laparoscopic cholecystectomy is known as a “minimally invasive” procedure because it uses several small incisions instead of one large one. A laparoscope, a narrow tube with a camera, is inserted through one incision. The camera allows your doctor to see your gallbladder on a TV screen. Your gallbladder is then removed through another small incision.

If the patient has certain complications associated with gallstones – such as inflammation, infection, major scarring from a previous surgery, a bleeding disorder, or a condition that would make it difficult to see through the laparoscope – the surgeon may have to remove the gallbladder with an open cholecystectomy through an incision in the abdomen.This procedure requires a longer hospital stay (3-5 days).

If there are gallstones in the bile duct, they need to be removed in most cases even if you do not have any symptoms. This is done most commonly with the endoscopic retrograde cholangiopancreatography (ERCP) procedure.

Can I digest food without a gallbladder?

You don’t need a gallbladder in order to digest food properly. If your gallbladder is removed, bile will flow directly from your liver through the hepatic duct and the common bile duct to the small intestine. After the surgery, you will probably have to go to the bathroom more frequently, and you may have softer stools for a short time.

Non-surgical treatment

If a patient is unable to undergo surgery, the doctor can prescribe certain drugs to dissolve the gallstones. The drugs are made from bile acid and are used to treat cholesterol stones only.

The 2 drugs used for treatment are ursodiol (Actigall®) and chenodiol (Chenix®). Patients usually have to take these drugs for months or even years in order to dissolve the gallstones. In many cases, gallstones may recur within 5 years in people who take these drugs.

What are the complications of gallstones?

Gallstones can block the ducts and hinder the flow of bile from the liver or gallbladder to the intestine. This blockage can cause bloating, nausea, vomiting, and pain in your abdomen, shoulder, back, or chest.

Gallstones can also cause the gallbladder or bile ducts to become infected. A blockage in the common bile duct can cause jaundice (yellowing of your skin or eyes) or can irritate the pancreas.[/vc_column_text][/vc_tab][vc_tab title=”Overview” tab_id=”a077319b-4ebc-3″][vc_column_text]

What are gallstones?

Gallstones are stone-like objects that form in the gallbladder or bile ducts. Gallstones can be tiny (the size of a grain of sand), or may be as large as a golf ball. Depending on the symptoms, people who have gallstones may not need treatment, or they may need to take medication or have surgery to remove their gallbladder. If the stones are in the bile ducts, they usually need to be removed by endoscopy.

What is the gallbladder?

The gallbladder is an organ that resembles a small pear. It is located under the liver on the right side of the abdomen. The function of the gallbladder is to store and dispense bile, a fluid that is produced by the liver and helps digest fats in the foods you eat. Bile is made up of several substances, including bilirubin and cholesterol.

The gallbladder is connected to the liver and the intestine by a group of ducts, including the hepatic duct, the cystic duct, and the common bile duct. When you eat, the gallbladder sends bile through the common bile duct into the intestine to help you digest food, particularly fatty foods.

Who is at risk for gallstones?

The following have an increased risk for developing gallstones:

Women.
People over the age of 40.
People who have a family history of gallstones (relatives who have the disease).
People who are overweight or obese.
People who lose a great deal of weight in a short period of time.
People who have diabetes.
People with Crohn’s disease.
People whose diet is high in fat and cholesterol.
People who take drugs that lower cholesterol.
American Indians and people of Mexican descent.

How do gallstones form?

There are 2 types of gallstones: pigment stones (made up of bilirubin) and cholesterol stones (made up of cholesterol). Most gallstones are cholesterol stones.

Cholesterol gallstones can form when there is too much cholesterol or bilirubin in the bile. Gallstones can also develop if the gallbladder does not completely empty itself of bile.

Pigment gallstones may form in people who have certain conditions, such as cirrhosis of the liver or blood disorders.

What are the symptoms of gallstones?

In many cases, people who have gallstones do not have any symptoms. These gallstones are known as “silent stones.”

The main symptom of gallstones is pain, which can last from several minutes to several hours. Pain can occur when gallstones move from the gallbladder into one of the ducts (the hepatic duct, the cystic duct, and the common bile duct). Gallstones that migrate can cause conditions such as acute cholecystitis (inflammation of the gallbladder), cholangitis (infection and inflammation of the bile ducts), and pancreatitis (inflammation of the pancreas).

The pain may be located in the upper part of the abdomen, between the shoulder blades, or under the right shoulder.

Other symptoms of gallstones include:

Sweating
Vomiting
Fever
A yellow tint to the skin (jaundice)

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How are gallstones diagnosed?

The most commonly used test to detect gallstones is ultrasound. Ultrasound is a procedure that transmits high-frequency sound waves through body tissues. The echoes are recorded and transformed into video or photographic images of the internal structures of the body.

Other tests that may help in the diagnosis of gallstones include the following:

Computed tomography (CAT scan)
Endoscopic retrograde cholangiopancreatography (ERCP): In this test, an endoscope—a flexible tube with a light and a camera attached—is inserted into the patient’s mouth, down the throat, and into the stomach and small intestine. A dye is injected to allow the bile ducts to stand out. If there are gallstones in the bile duct, they can be removed by the endoscope.
Magnetic resonance cholangiopancreatography (MRCP): In MRCP, the bile ducts are examined with magnetic resonance imaging (MRI), a test that uses a large magnet, radio waves, and a computer to produce very clear images of parts of the body. Unlike ERCP, MRCP can only diagnose gallstones; it cannot be used to treat gallstones.
Endoscopic ultrasound (EUS): This procedure combines endoscopy with ultrasound. In EUS, a small ultrasound transducer is installed on the tip of an endoscope and inserted into the patient’s mouth. Because the EUS transducer can get close to the gallbladder and bile ducts, the images obtained with EUS can be more accurate and detailed than images provided by traditional ultrasound.

[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Gastroenteritis” use_theme_fonts=”yes”][vc_column_text]If you have watery stools, chills, and stomach cramping, you might have gastroenteritis. This is commonly called the stomach flu, but is not influenza.[/vc_column_text][vc_tabs][vc_tab title=”Prevention” tab_id=”1567938997017-3-10″][vc_column_text]

How can gastroenteritis be prevented?

There are several steps that you can take to reduce your risk of getting gastroenteritis, including:

Washing your hands frequently, especially after going to the bathroom and when you are working with food.
Cleaning and disinfecting kitchen surfaces, especially when working with raw meat or eggs.
Keeping raw meat, eggs, and poultry away from foods that are eaten raw.
Drinking bottled water and avoiding ice cubes when traveling, especially in developing countries.

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What is gastroenteritis?

Gastroenteritis is an inflammation of the gastrointestinal tract (the pathway responsible for digestion that includes the mouth, esophagus, stomach, and intestines). Gastroenteritis is also sometimes referred to as “stomach flu,” even though it may not be related to influenza.

How common is gastroenteritis?

Because gastroenteritis is so similar to diarrhea, and because so many cases do not require hospitalization, it is difficult to determine how many cases of gastroenteritis occur per year. Worldwide, it is estimated that 3 to 5 billion cases of acute diarrhea (which can be caused by many other diseases besides gastroenteritis) occur per year, with about 100 million cases in the United States (roughly one to 2.5 cases of diarrhea per child). Severe gastroenteritis is estimated to cause about 5 to 10 million deaths per year worldwide, and about 10,000 deaths per year in the United States.

Who is at risk for gastroenteritis?

Anyone can get the disease. People who are at a higher risk include:

Children in daycare
Students living in dormitories
Military personnel
Travelers

People with immune systems that are weakened by disease or medications or not fully developed (i.e., infants) are usually affected most severely

What causes gastroenteritis?

Gastroenteritis can be caused by viral, bacterial, or parasitic infections. Viral gastroenteritis is contagious and is responsible for the majority of outbreaks in developed countries.

Common routes of infection include:

Food (especially seafood)
Contaminated water
Contact with an infected person
Unwashed hands
Dirty utensils

In less developed countries, gastroenteritis is more often spread through contaminated food or water.

What are the symptoms of gastroenteritis?

The main symptom of gastroenteritis is diarrhea. When the colon (large intestine) becomes infected during gastroenteritis, it loses its ability to retain fluids, which causes the person’s feces to become loose or watery. Other symptoms include:

Abdominal pain or cramping
Nausea
Vomiting
Fever
Poor feeding (in infants)
Unintentional weight loss (may be a sign of dehydration)
Excessive sweating
Clammy skin
Muscle pain or joint stiffness
Incontinence (loss of stool control)

Because of the symptoms of vomiting and diarrhea, people who have gastroenteritis can become dehydrated quickly. It is very important to watch for signs of dehydration, which include:

Extreme thirst
Urine that is darker in color, or less in amount
Dry skin
Dry mouth
Sunken cheeks or eyes
In infants, dry diapers (for more than 4-6 hours)

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How is gastroenteritis diagnosed?

The doctor will take a medical history to make sure that nothing else is causing the symptoms. Also, the doctor might perform a sigmoidoscopy or radiologic examination to exclude the possibilities of inflammatory bowel disease (e.g., Crohn’s disease) and pelvic abscesses (pockets of pus). A stool culture (a laboratory test to identify bacteria and other organisms from a sample of feces) can be used to determine the specific virus or germ that is causing gastroenteritis.

Other diseases that could cause diarrhea and vomiting are pneumonia, septicemia (a disease caused by toxic bacteria in the bloodstream), urinary tract infection, and meningitis (an infection that causes inflammation of the membranes of the spinal cord or brain).

Conditions that require surgery, such as appendicitis (an inflammation of the appendix), intussusception (a condition in which the intestine folds into itself, causing blockage) and Hirschsprung’s disease (a condition where nerve cells in the intestinal walls do not develop properly) can also cause symptoms similar to gastroenteritis.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567938585072-2-10″][vc_column_text]

How is gastroenteritis treated?

The body can usually fight off the disease on its own within a few days. The most important factor when treating gastroenteritis is the replacement of fluids and electrolytes that are lost because of the diarrhea and vomiting.

Foods that contain electrolytes and complex carbohydrates, such as potatoes, lean meats (for example, fish and chicken), and whole grains can help replace nutrients. You can also buy electrolyte and fluid replacement solutions at grocery and drug stores. Or, if hospitalization is required, the nutrients can be replaced intravenously (injected directly into the veins).

Antibiotics will not be effective if the cause of gastroenteritis is a viral infection. Doctors usually do not recommend antidiarrheal medications (such as Loperamide) for gastroenteritis because they tend to prolong infection, especially in children.

[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Hair Loss in Women” use_theme_fonts=”yes”][vc_column_text]Any girl or woman can be affected by hair loss, but it is more common in certain groups. Normal hair loss amounts to about 50-100 hairs per day. Causes of excessive loss of hair range from heredity to medical conditions to styling issues.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”a077319b-4ebc-3″][vc_column_text]

What is hair loss in women?

Hair loss in women is just that—when a woman experiences unexpected heavy loss of hair. Generally, people shed from 50 to 100 single hairs per day. Hair shedding is part of a natural balance—some hairs fall out while others grow in. When the balance is interrupted—when hair falls out and less hair grows in—hair loss happens. Hair loss is different than hair shedding. The medical name for hair loss is alopecia.

Hair goes through three cycles:

The anagen phase (growing phase) can last from two years to eight years. This phase generally refers to about 85% to 90% of the hair on your head.
The catagen phase (transition phase) is the time that hair follicles shrink and takes about two to three weeks.
The telogen phase (resting phase) takes about two to four months. At the end of this phase, the hair falls out.

How common is hair loss in women?

Many people think that hair loss only affects men. However, it is estimated that more than 50% of women will experience noticeable hair loss. The most significant cause of hair loss in women is female-pattern hair loss (FPHL), which affects some 30 million women in the United States.

Who is affected by hair loss in women?

Any girl or woman can be affected by hair loss. However, it is usually more common in:

Women older than 40
Women who have just had babies
Women who have had chemotherapy and those who have been affected by other medications
Women who often have hairstyles that pull on the hair (like tight ponytails or tight braids) or use harsh chemicals on their hair.

What causes hair loss in women?

Family history (heredity): Causes thinning of hair along the top of the head. This type of hair loss is female-pattern hair loss. (FPHL is also called androgenetic alopecia or androgenic alopecia.) This type of hair often gets worse when estrogen is lost during menopause.

Hair style: Causes hair loss when hair is styled in ways that pull on roots, like tight ponytails, braids, or corn rows. This type of hair loss is called traction alopecia. If hair follicles are damaged, the loss can be permanent.

Extreme stress or shock to the body: Causes temporary hair loss. This category includes events like losing a lot of weight, surgeries, illness, and having a baby. This type of hair loss is called telogen effluvium. It happens to hair in the resting stage.

Toxic substances, including chemotherapy, radiation therapy, and some medications: Cause sudden hair loss that can occur anywhere on the body. This type of hair loss is called anagen effluvium. It happens to hair in the growth stage. Sometimes, this type of hair loss can be permanent if the hair follicles are damaged.
Other medical conditions:
- Alopecia areata is an autoimmune skin disease that causes patchy hair loss on the head and possibly other places on the body. It is usually not permanent.

What is the relationship between hair loss in women and menopause?

During menopause, you might see one of two things happen with your hair. You might start growing hair where you did not have it before. Or, you might see the hair you have start to thin. One cause may be changing levels of hormones during menopause. Estrogen and progesterone levels fall, meaning that the effects of the androgens, male hormones, are increased. Other factors, such as stress, your diet, and heredity, may contribute to hair loss.

The aging process may mean that some women experience female-pattern hair loss (FPHL). This is also called androgenetic alopecia or androgenic alopecia. This type of hair loss may get worse due to hormone changes.

During and after menopause, hair might become finer (thinner) because hair follicles shrink. Hair grows more slowly and falls out more easily in these cases. FPHL often means that thinning hair is centered at the crown and top of the head.

Your healthcare provider will do a thorough examination and take a detailed history to help you deal with changes in hair growth. You may be directed to have your iron levels or thyroid hormone levels tested. Your medications might be changed if what you take is found to affect hair loss or growth.

Antiandrogens might be prescribed for either excess hair (hirsutism) or for hair loss, but the studies on usage are not clear. For hair loss, minoxidil lotion or shampoo combined with antiandrogen drugs like spironolactone is one approach. Another is to use antidandruff shampoos with ingredients like ketoconazole and zinc pyrithione. You might also be told to try things that do not actually repair hair loss but do allow you to hide it.

If you are already taking hormone therapy (HT) for menopausal symptoms, you might see an improvement in the condition of your hair. However, HT is not recommended solely to treat hair loss.

What are the symptoms or signs of hair loss in women?

Seeing more hair fall out daily either on your brush, on the floor, in showers, on your pillows, or on the sink
Seeing noticeable patches of thinner or missing hair, including a part on the top of your head that gets wider
Having smaller ponytails
Seeing hair break off

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How will a doctor diagnose hair loss in women?

Contact a doctor if you are concerned about hair loss. A dermatologist can help you diagnose or treat hair loss. The doctor will take a medical history, which will include asking about things like:

What medications and/or supplements you take
What type of food you eat (protein is important for hair growth)
What might be going on in your life in terms of stressful situations
Which family members might have had hair loss
What kind of hair styles you tend to have and what hair care products and processes you have used
Whether or not you have a habit of pulling your hair out (trichotillomania)

After reviewing this information, the doctor might do or order certain tests, including:

Gentle hair pulling to determine how many hairs come out
Blood tests to test for vitamin and mineral levels (like vitamin D, vitamin B, zinc, and iron), and hormone levels (including thyroid and sex hormones)
Scalp examination under a microscope
Scalp biopsy to remove and examine a very small piece of tissue

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How is hair loss in women treated?

Treatment depends on the cause of the hair loss.

In cases where the loss is due to stress or hormone changes like pregnancy, there might be no treatment needed. The hair loss will stop after a period of time.
In cases of hair loss being due to hair styling practices, like tight braids or ponytails or certain chemicals, treatment depends on not doing the things that caused the damage.
In cases due to nutritional deficiencies, you might be told to take supplements. For instance, you might be told to take a multivitamin and 3-5 mg of biotin daily.
Minoxidil (Rogaine®) is approved for treating FPHL. The 2% or 5% solution can be purchased in stores. However, you have to follow directions exactly and use the product indefinitely.
The HairMax Lasercomb® low light laser is approved by the US FDA to treat FPHL. Another FDA-approved laser product is the Theradome LH80 PRO® helmet.
Other medications that have been studied, but not approved, for hair loss in women include:
- Spironolactone and other anti-androgens
- Finasteride and other alpha-reductase enzyme inhibitors
- Estrogens
- Prostaglandin analogs
- Steroids
- Light treatments

It is important to note that premenopausal women should not take medications for hair loss treatment without using contraception. Many drugs, including minoxidil and finasteride, are not safe for pregnant women or women who want to get pregnant.

Hair transplant surgery is another option. Small pieces of scalp with hair follicles are taken from the back of the head and moved to slits in the areas of baldness. Potential problems with this treatment include the usual risks of surgery like infection, such as folliculitis, and shock loss—where the hair falls out in the transplant area. In cases where the bald areas are large, there might be trouble trying to find enough hair to transplant. In addition, the surgery can be costly and is usually not covered by insurance.
Injections of something called protein-rich plasma (PRP) have also been done to encourage hair growth. PRP is generally made from blood drawn from a patient. The platelets are removed and concentrated and then added back to the blood for injection.

[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1567938997017-3-10″][vc_column_text]

How can hair loss in women be prevented?

Preventing hair loss is not possible when it is due to disease, aging, heredity or physical stressors like injuries. You can prevent hair loss caused by caustic chemicals or tight hairstyles by avoiding these. You might be able to prevent some hair loss by eating a healthy diet that provides necessary nutrients in terms of vitamins and minerals. You can stop smoking if you smoke.[/vc_column_text][/vc_tab][vc_tab title=”Outlook / Prognosis” tab_id=”1567939687472-4-6″][vc_column_text]

What is the prognosis/outlook for women with hair loss?

While hair loss is not itself dangerous, women with hair loss tend to be very upset by the changes to their appearance. These negative feelings can affect self-esteem and social lives. Recent studies suggest that FPHL can be associated with conditions that include metabolic syndrome and diabetes.[/vc_column_text][/vc_tab][vc_tab title=”Living With” tab_id=”1567939835274-5-5″][vc_column_text]

What tips are there for dealing with hair loss in women?

There are some things you can do on your own. You might check with your stylist or try some of these things:

Coloring your hair adds volume to the strands, making your hair seem fuller.
Massaging your head, like when you are washing your hair, can stimulate blood flow to the scalp and hair follicles.
Getting your hair cut shorter, and having layers added, can make your hair seem fuller.
Using the right kind of shampoo can also help. Look for a shampoo that adds volume without using sulfate detergents.
Using the right kind of product at the right time can also help. There are products that add volume that you add while your hair is still wet. However, using too much product can add weight.

[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Kidney Stones” use_theme_fonts=”yes”][vc_column_text]A kidney stone is a solid mass formed from substances that are normally found in the urine, but become highly concentrated when there are not enough liquids to flush them out in urine. Treatments range from no treatment, to medications, to shock wave lithotripsy or ureteroscopy, to surgery (nephrolithotomy).[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”a077319b-4ebc-3″][vc_column_text]

What is a kidney stone?

A kidney stone is a solid mass formed from substances in the urine. These substances are normally found in the urine, but become highly concentrated when there are not enough liquids to flush them out of the body in the urine. These stone-forming substances are:

Calcium
Oxalate
Urate
Cysteine
Xanthine
Phosphate

These and other chemicals are the “waste products” that must exit the body.

Kidney stones usually range in size from as small as a grain of sand to a pearl. Although rare, some stones can be as large as golf balls. Smaller stones can pass through the urinary tract on their own without any pain or notice. Larger stones can get trapped in the kidney or lodged in the ureters. When this happens, the stones keep urine from exiting the body. Blocking the flow of urine causes severe pain or bleeding. Stones that can’t pass on their own are treated with medications or surgery. The decision is based on stone size/shape, location, type, and number of stones.

What are the risk factors for developing kidney stones?

Risks for developing kidney stones include:

Not drinking enough liquids.
Repeat urinary tract infections.
Blockage in the urinary tract.
Family history of kidney stones.
Health conditions that affect the levels of the substances in the urine that can cause stones to form:
- Hypercalciuria, which is high calcium levels in the urine.
- High blood pressure.
- Diabetes.
- Obesity.
- Osteoporosis.
- Gout.
- Kidney cysts.
- Cystic fibrosis
- Parathyroid disease.
- Inflammatory bowel disease.
- Chronic diarrhea.
- Some surgical procedures, including weight loss surgery or other stomach/intestine surgeries.
Medications:
- Diuretics (“water pills”).
- Calcium-based antacids.
- Crixivan® (used to treat HIV infections).
- Topamax® and Dilantin® (used to treat seizures).
- Cipro® (ciprofloxacin).
- Ceftriaxone (antibiotics).
Certain foods and flavor enhancers including:
- Animal proteins (meat and poultry).
- Diets high in salt (sodium).
- Sugars (fructose, sucrose, and corn syrup).
- Foods specific to the type of kidney stone formed.

What are the signs and symptoms of kidney stones?

Signs and symptoms include:

Pain in the lower back or side of body. Pain can start as a dull ache that may come and go. Pain can become severe and result in a trip to the emergency room.
Nausea and/or vomiting with the pain.
Blood in the urine.
Pain when urinating.
Unable to urinate.
Feeling the need to urinate more often.
Fever/chills.
Urine that smells bad or looks cloudy.

Smaller kidney stones may not cause pain or other symptoms and are able to pass on their own.[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”da36d529-d880-10″][vc_column_text]

How are kidney stones diagnosed?

Diagnosis starts with a physical exam and review of your medical history. Other tests include:

Blood test: to measure how well your kidneys are functioning, to look for signs of infection, and to look for biochemical problems that lead to forming kidney stones.
Urine sample test: to look for signs of an infection and to examine the levels of the stone-forming substances – calcium, oxalate, urate, cysteine, xanthine, and phosphate.
Imaging tests: to see the size, shape, and location of the stones; determine the most suitable treatment, and sometimes to review the result of treatment. Types of imaging tests used are X-rays, CT scan, and ultrasound. Both X-ray tests and CT scans use a small amount of radiation to create their images.

Two types of X-rays are used: a standard X-ray of the urinary tract or a special type of X-ray called an intravenous pyelogram (IVP). If an IVP is ordered, you receive an injection of a dye in your vein before the X-ray is taken. The dye is used to get a sharper image of problems in the kidneys, ureters, and bladder resulting from urine being blocked.

A CT scan of the abdomen is an imaging test that creates a 3-dimensional view of the organs within the abdominal cavity. It is used with or without the injection of a dye in your vein. This test shows the stone size and location and conditions that may have caused the stone to form. In addition, the other organs within this area of the body can be evaluated.

An ultrasound of the urinary tract uses sound waves to detect kidney stones and indirect signs of kidney stones, such as changes in the kidney’s size and shape.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567938585072-2-10″][vc_column_text]

How are kidney stones treated?

Treatment options include:

No treatment: Allow stones to pass on their own.
Medications: To relax the ureter to allow stones to pass.
Minimally-invasive procedures: Procedure carried out by entering the body through a small incision in the skin or through the body’s natural openings.
Surgery.

No treatment. Depending on the size and location of the kidney stone, sometimes stones can pass through urine on their own. Drinking plenty of liquids helps the kidney stones travel through the urinary tract. Passing the stone may take up to 3 weeks.

Medications. Severe pain, requiring an emergency room visit, can be managed with IV narcotics, IV anti-inflammatory drugs, and IV drugs to manage nausea/vomiting. Stones causing less pain can be managed with an anti-inflammatory drug such as ibuprofen. (Caution: Ask your doctor before taking ibuprofen. This drug can increase the risk of kidney failure if taken while having an acute attack of kidney stones – especially in those who have a history of kidney disease and associated illnesses such as diabetes, hypertension, and obesity.) Other medications may be given to relax the ureter such as tamsulosin (Flomax®) or nifedipine (Adamant®, Procardia®) so that the stones can pass on their own.

Procedures. There are 3 types of minimally invasive surgery – ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy:

Ureteroscopy. To perform this procedure, a small instrument, called an ureteroscope, is inserted in the urethra, through the bladder, and into the ureter. This instrument allows stones to be seen and then retrieved in a surgical “basket” or broken apart using a laser. These smaller pieces of kidney stones are then more easily able to exit the body through the urinary tract.
Shock wave lithotripsy. In this procedure, the patient is placed on a special type of surgical table or tub. High-energy shock waves are sent through water to the stone(s) location. The shock waves break apart the stones, which are then more easily able exit the body through the urinary tract.
Percutaneous nephrolithotomy. When kidney stones can’t be treated by the other procedures – either because there are too many stones, the stones are too large or heavy, or because of their location – percutaneous nephrolithotomy is considered.

In this procedure, a tube is inserted directly into the kidney through a small incision made in your back. If the stones are large, an ultrasound probe and/or laser are inserted and deliver shock waves to the stones to break them apart. Fragments of stones are either suctioned out (so you do not have to pass them through your urine) or removed through a tube (called a nephrostomy) that has been inserted through the skin and into the kidney. This tube drains urine, as well as any small pieces of stone, into a urine collection bag. This procedure requires a short hospital stay (2 to 3 days).

Open stone surgery. Open stone surgery, a major surgical procedure, is rarely performed. It is currently only done in 0.3 to 0.7% of cases.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1567938997017-3-10″][vc_column_text]

How can kidney stones be prevented?

Ways to decrease your risk of kidney stones include:

Drink more fluids, especially water. Drink at least 64 ounces of liquids per day. Liquids help you stay hydrated. Staying more hydrated helps you urinate more often, which helps “flush away” the buildup of the substances that cause kidney stones. If you sweat a lot from your activities, be sure to drink more water.
Limit the amount of salt (sodium) in your diet.
Lose weight if you are overweight.
Limit the types of foods and drinks that led to the development of your specific type of kidney stone. You may be asked to collect your urine over a 24-hour period. Stone fragments and minerals in the urine can help identify what may have caused your kidney stone. Based on the stone’s content, another healthcare professional, a dietitian, can suggest changes in your diet to help decrease your risk of developing more stones.
Take medication prescribed by your doctor to help prevent kidney stones based on your specific stone type and any health problems that make you more likely to form a stone.

[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Knee Pain (Chondromalacia Patella)” use_theme_fonts=”yes”][vc_column_text]Chondromalacia patella (knee pain) is the softening and breakdown of the tissue (cartilage) on the underside of the kneecap (patella). Pain results when the knee and the thigh bone (femur) rub together. Dull, aching pain and/or a feeling of grinding when the knee is flexed may occur. The most common way to treat symptoms of chondromalacia patella is to rest the knee.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”a077319b-4ebc-3″][vc_column_text]

What is chondromalacia patella?

Chondromalacia patella (knee pain) is the softening and breakdown of the tissue (cartilage) on the underside of the kneecap (patella). Pain results when the knee and the thigh bone (femur) rub together.

Who is at risk for chondromalacia patella?

People who are at risk for developing chondromalacia patella include:

Those who are overweight
People who have had an injury, fracture, or dislocation related to the kneecap
Runners, soccer players, bicyclists, and other people who exercise often
Teenagers and healthy young adults, more often females

What causes chondromalacia patella?

Chondromalacia patella often occurs when the undersurface of the kneecap comes in contact with the thigh bone causing swelling and pain. Abnormal knee cap positioning, tightness or weakness of the muscles associated with the knee, too much activity involving the knee, and flat feet may increase the likelihood of chondromalacia patella.

What are the symptoms of chondromalacia patella?

Dull, aching pain that is felt:

Behind the kneecap
Below the kneecap
On the sides of the kneecap

A feeling of grinding when the knee is flexed may occur. This can happen:

Doing knee bends
Going down stairs
Running down hill
Standing up after sitting for awhile

[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”da36d529-d880-10″][vc_column_text]

How is chondromalacia patella diagnosed?

A doctor will perform a physical examination of the knee to determine the cause of pain. If the diagnosis is not clear or symptoms do not improve a doctor may order one of the following:

Blood tests and/or a standard knee X-ray – This may help to rule out some types of arthritis or inflammation.
MRI scan- A tests that shows details of the knee joint and can reveal many cases of chondromalacia patella.
Arthroscopy – A tiny, flexible camera is inserted into the knee to see exactly what the cartilage looks like.

[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567938585072-2-10″][vc_column_text]

How is chondromalacia patella treated?

The most common way to treat symptoms of chondromalacia patella is to rest the knee. Other ways to treat the symptoms include:

Placing of an ice or cold pack to the area for 15-20 minutes, four times daily, for several days. Do not apply ice directly to the skin. Wrap the ice or cold pack with a towel.
Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief—These include ibuprofen, naproxen, and aspirin.
Topical pain medication— These include creams or patches that are applied to the skin to help with soft tissue pain.
Prescription pain relievers.

Other treatments or self-care include:

Changing the way you exercise
Doing exercises to both stretch and strengthen the quadriceps and hamstring muscles
Losing weight (if you need to)
Using special shoe inserts and support devices
Taping to realign the kneecap
Wearing the right kind of sport or running shoes

[/vc_column_text][/vc_tab][vc_tab title=”Outlook / Prognosis” tab_id=”1567938997017-3-10″][vc_column_text]

What is the prognosis (outlook) for chondromalacia patella?

Individuals suffering from knee pain caused by chondromalacia patella often make a full recovery. Recovery can be as fast as a month or take years, depending on the case. Many long-term recoveries occur in teenagers because their bones are still growing. Symptoms tend to disappear once adulthood is reached.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Lower Back Pain” use_theme_fonts=”yes”][vc_column_text]Lower Back Pain[/vc_column_text][vc_column_text]

Lower Back Pain Fundamentals

By far the most common cause of lower back pain among young athletes is a strain of the lumbar musculature, a sprain of the lumbosacral ligaments, or a combination of the two. Perhaps the most important concept to keep in mind, however, is the possibility of other less common but potentially more serious conditions that can masquerade as a routine lower back pain problem. In order to label an athlete as having a lumbosacral strain, the conditions listed below must be excluded:

Herniated Lumbar Disc
The herniated lumbar disc includes severe lumbosacral spasm, increased leg pain when raising a straight leg, and usually a positive neurological finding such as diminished reflex, muscle weakness, or an area of numbness. The majority of these individuals will respond to a period of rest and rehabilitation, although at times surgical excision of the extruded disc is required.
Spondylolysis/Spondylolisthesis
Defects of the pars interarticularis (spondylolysis) are being found with increasing frequency in particular types of athletes. It is especially common in those individuals whose activity requires repeated hyperextension of the spine, such as in gymnastics. Most of these individuals can be managed with rest and specific flexibility exercises. However, since this lesion commonly represents a stress fracture, there is some evidence that an extended period of rest in the early development of a spondylolysis may actually enable the lesion to heal. In addition, spondylolysis may be associated with a forward slipping of one vertebrae on another (spondylolisthesis). Spondylolisthesis is particularly vulnerable to progressive slipping during the adolescent growth spurt period. At times, a spinal fusion is indicated to control a significant or progressive spondylolisthesis. These two conditions, however, do not exclude participation in athletics as long as symptoms can be managed conservatively.
Tumor
The young athlete who presents with lower back pain of a severe nature that is present at rest as well as during activity should alert one to the possibility of a more serious underlying problem. This can include irritative lesions of the spine such as tumor or infection. These diagnoses are frequently difficult to establish and require thorough physical and radiological investigations. Bone scans are helpful in detecting and localizing inflammatory or neoplastic lesions. Treatment is dependent upon the particular lesion present.
Fracture
Fractures of the lumbar spine, excluding spondylolysis, are infrequent. They usually involve significant trauma and are detected by X-ray examination. Treatment is dependent upon the neurological status of the patient and the inherent stability of the fracture.
Infection of the Disc (Discitis)
In this condition, the adolescent has persistent and severe back pain that is fairly constant although markedly aggravated by any sort of activity. X-rays initially may be entirely normal. Laboratory studies that reflect an inflammation, such as an elevated sedimentation rate, are usually present. A bone scan and, at time, tomograms of the spine may be helpful in localizing and defining the problem. The true infectious nature can be difficult to establish although at least 50% of the time it is bacterial in origin. The primary treatment for discitis is prolonged rest. This can involve strict bed rest for several weeks until the symptoms subside and at times a body cast is applied. This disease is usually self-limiting and results in a spontaneous fusion between the adjacent vertebral bodies.

What are the symptoms?

Lower back pain
Exacerbation of pain associated with activity
Relief during periods of rest
Some pain in the buttocks and back of legs

What are my child’s treatment options?

Physical examination may demonstrate some mild to moderate spasm of the lumbosacral musculature, some reversal of the normal lumbar lordosis, inability to fully forward flex and touch one’s toes, and a normal neurological examination. X-rays may appear normal.

Treatment of this condition involves, above all else, a period of rest. This rest may only involve the elimination of that particular activity or exercise that aggravates the symptoms or, in more severe cases, strict bed rest for a week or two.

If the aggravating activity is continued, the back pain may also continue. Medication plays a secondary role in the management of acute lower back pain. Of more importance is the management of this condition; that is prevention of recurrence. This primarily involves the institution of an exercise program that stresses postural techniques for the lumbosacral spine, increased abdominal tone, and enhanced flexibility. Specific techniques in lifting or performing one’s particular activity are individualized.

What are the risks of surgery?

Risks include nerve injury, infection, bleeding, and stiffness.[/vc_column_text][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Malaria” use_theme_fonts=”yes”][vc_column_text]Malaria is an infection transmitted by mosquitoes. The disease, although mostly eliminated in the US, is of concern due to the huge amount of international travel to places where mosquitoes are infected. Untreated malaria can lead to serious consequences.[/vc_column_text][vc_tabs][vc_tab title=”Prevention” tab_id=”1567940880829-4-5″][vc_column_text]

Can malaria be prevented?

Yes, malaria can be prevented. Here are some important tips to help keep you from getting the disease:

Check with your Health Department to find out if malaria is a risk when traveling out of the country.
If you are traveling to a country where malaria is common, talk to your doctor or health department about taking medication that could keep you from getting malaria.
When traveling in areas with mosquito infestation, put on insect repellent that contains N,N-Diethyl-meta-toluamide (DEET).
Wear clothing that does not leave your skin exposed to mosquitoes.
When living in or visiting a country where malaria is commonly found, sleep under treated mosquito netting.

[/vc_column_text][/vc_tab][vc_tab title=”Overview” tab_id=”a077319b-4ebc-3″][vc_column_text]

What is malaria?

Malaria is a disease that occurs when blood is infected by parasites that are passed on through mosquito bites. There are five different types of malaria-causing parasites that can affect humans. Malaria has been mostly wiped out in the United States but is still a serious threat to human life in many parts of the world. It is a threat not only to those living in countries where it is common, but to anyone traveling to these areas. This means malaria can be rapidly spread even in areas where it is not usually found.

How common is malaria?

Malaria is a worldwide problem. With the number of people traveling throughout the world, it continues to be a risk, even in countries where it does not commonly occur.

Malaria is very common in developing countries and areas with high humidity and warm but moderate temperatures. Areas where malaria is most common include:

Parts of Central and South America
Haiti
The Dominican Republic
Africa
Eastern Europe
South and Southeast Asia
The South Pacific

The deadliest types of malaria are most common in Africa.

Who can get malaria?

People who can get malaria include those who are:

Exposed to a mosquito that is infected with the parasites that cause malaria;
Living in or traveling to one of the areas where malaria occurs;
Exposed to blood that is infected with malaria.

In addition, a fetus can become infected with malaria during pregnancy or birth if the mother is infected.

What causes malaria?

Malaria occurs when a mosquito infected with a malarial parasite bites a person and passes the parasite into his or her bloodstream. The parasite multiplies in the red blood cells, destroys them, and causes the person to become very sick.

An uninfected mosquito picks up the parasite when it bites an infected person. The parasite then multiplies in the mosquito and can be passed on to other people. It is easy to see how quickly many people can become infected.

What are the symptoms of malaria?

The symptoms of malaria include:

High fever
Chills
Shaking
Extreme sweating
Fatigue
Body aches and general discomfort
Headache
Muscle ache
Nausea
Vomiting

If the symptoms of malaria are not treated, the disease can lead to death.[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”da36d529-d880-10″][vc_column_text]

How is malaria diagnosed?

Doctors may suspect malaria in patients who have traveled to an area where malaria is common and who have fever or flu-like symptoms. They can reach a more definite diagnosis with a small sample of the patient’s blood (taken by a finger prick) and expert microscopic examination of the sample. Doctors can then see if the patient has malaria, and which type(s).

There are some “rapid” testing methods available when expert microscopic review of a blood smear is not possible, but these are often costly. They can help guide treatment while waiting for confirmation of the diagnosis by microscopy.

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How is malaria treated?

To begin treating malaria, doctors must first know what type of parasite has caused the disease. Depending on the area where the infection took place, some of these parasites can be resistant to certain drugs.

It is important to start treatment as soon as possible. Malaria can be deadly, and treatment is more effective when it is started early.

Malaria drugs can be taken orally (by mouth) or through an intravenous (IV) line. IV drugs are recommended for those who cannot take medications orally or for patients who are severely ill.

What are the side effects of treatment for malaria?

Side effects of some drugs used to treat malaria include:

Sensitivity to sunlight
Nausea
Blurred vision
Headache
Ringing in the ears
Mouth ulcers

What complications are associated with malaria?

Untreated malaria can cause death, so it’s important to seek treatment immediately.

The development of drug-resistant parasites is also a serious worry in the treatment of malaria. Some of these parasites are now able to survive and multiply despite anti-malarial drugs. To successfully treat malaria, it is important to tell your doctor what areas you have traveled to and when you were there.[/vc_column_text][/vc_tab][vc_tab title=”Outlook / Prognosis” tab_id=”1567938997017-3-10″][vc_column_text]

What is the prognosis (outlook) for people with malaria?

Early treatment is the most important part of treating malaria; it is curable if it is treated early enough. Severe malaria can lead to serious complications or death.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Male Infertility” use_theme_fonts=”yes”][vc_column_text]Male Infertility[/vc_column_text][vc_column_text]

What is male infertility?

Infertility is a disease of the reproductive system that impairs one of the body’s most basic functions: the conception of children. It is defined in practical terms as a couple’s inability to achieve pregnancy after a year of unprotected intercourse.

Infertility is a common problem, with more than 5 million couples in the United States dealing with these problems. Infertility affects one in every six couples who are trying to conceive. In at least half of all cases of infertility, a male factor is a major or contributing cause. This means that about 10% of all men in the United States who are attempting to conceive suffer from infertility.

The specialists in Cleveland Clinic’s Center for Male Infertility understand your concerns from an emotional perspective as well as the medical one and are here to help. We offer a unique, comprehensive, team approach to diagnosing and treating male infertility to help you achieve your personal goals and dreams for the future. Rapid research advances in the area of male reproduction have brought about dramatic changes in the ability to both diagnose and treat male infertility. The majority of couples suffering from infertility can now be helped to conceive a child on their own.

What causes male infertility?

Conception is a complicated process that depends upon many factors: the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm’s ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman’s uterus; and good embryo quality.

Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman’s hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.

Male infertility can be related to a man’s inability to produce sperm cells, known in medical terms as azoospermia. Or it can be related to the production of low or poor quality sperm, oligospermia. Other problems that can occur include malformed sperm that cannot live long enough to fertilize the egg and genetic diseases that impair fertility.

The good news is that many cases of male infertility are treatable, allowing couples to achieve their goal of having a family.

Many biological and environmental factors can impact male fertility

What are the symptoms of male infertility?

Besides the inability to conceive children, there are many other issues that accompany male infertility.

Psychological and Emotional Issues

The statistics tell only part of the story about male infertility. It is much more difficult to describe the psychological and emotional impact infertility has on a couple who want to have children. Many times, conceiving a child becomes the total focus of their lives. Feelings of depression, loss, grief, inadequacy and failure are common in men as well as women seeking pregnancy.

Individuals or couples experiencing any of these feelings are encouraged to seek professional help from a counselor or psychologist experienced in dealing with infertility issues. A professional can help you deal realistically with the situation and provide support even while you are going through treatment.

At the Cleveland Clinic Center for Male Infertility, we have the world-class resources of Cleveland Clinic behind us. We believe in a team approach and work closely with mental health professionals who can help each couple cope with their situation in a healthy way.

How is male infertility diagnosed?

Diagnosis begins with a complete physical examination of the man to determine his general state of health and identify any physical problems that may impact his fertility. The doctor also interviews the couple about their sexual habits. If the physical examination and history do not indicate any reason for the couple’s inability to conceive, the next step is to conduct testing to identify the cause of infertility.

For men, we begin with a detailed sperm analysis. Physicians in the Male Infertility Center are among the most experienced in the country in performing in–depth analyses to determine sperm counts, viability (sperm’s ability to survive), morphology (sperm quality and shape) and motility (the sperm’s ability to move to the egg to fertilize it). This information is invaluable in planning the appropriate treatment for each couple. You may also undergo additional tests, including hormone testing to make sure your body is producing the right level of hormones related to fertility and/or genetic testing to evaluate the man’s genetic signature and his DNA.

Women who have not previously undergone infertility testing may be referred to a female infertility specialist in the Cleveland Clinic Ob/Gyn & Women’s Health Institute.

Computer-Assisted Routine Semen Analysis

The semen analysis provides the most comprehensive assessment of semen quality and is considered the foundation of the basic infertility workup of a couple. It includes a determination of sperm volume, pH, sperm concentration, total sperm count, percent of motility, velocity, linearity, morphology, color and viscosity.

Our computerized semen analysis system is among the most technologically advanced available and yields extremely accurate, quantifiable results.

Other Testing Available:

Leukocytospermia quantitation/Endtz test
Kruger’s strict morphology classification
W.H.O. morphology for sperm assessment
Special staining for azoospermic specimen
Semen biochemistry fructose test
Sperm antibody tests (direct and indirect immunobead)
Reactive oxygen species
Sperm DNA assessment

How is male infertility treated?

With modern technology and methods, the number of treatment options for male infertility has expanded. Depending on the cause of infertility, treatment may include:

Medical Therapy for Male Infertility

When sperm production is too low to achieve pregnancy, medication to increase the number of sperm produced is an option. We offer the newest, most effective medications for this problem. For men with low hormone levels, hormone therapy may be required to correct the balance.

We also counsel our patients as needed regarding lifestyle practices that may improve their fertility.

We also offer sperm banking for fertility preservation in men who will be undergoing cancer treatment.

Surgical Treatment of Male Infertility

Depending on the cause of infertility, a surgical procedure may be necessary to correct a defect or remove an obstruction. Our physicians are among the most experienced in the country in surgical procedures to restore fertility. The most common procedures performed here include vasectomy reversal and varicocele repair.

Vasectomy Reversal and Microsurgical Reconstructive Surgery

Vasectomy reversal – a vasovasostomy or vasoepididymostomy – are common procedures that we perform in an outpatient setting. In either procedure, the surgeon reconnects the vas deferens, the tube in the scrotum through which the sperm passes. Viewing the vas deferens through a high-power surgical microscope, the surgeon carefully sews the ends back together.

Blockages in the vas deferens are repaired with a similar technique. The vas deferens is surgically split, the blockage is removed, and the ends of the tube are reconnected. When the original vasectomy was performed many years previously, an additional blockage may have formed in the epididymis, the coiled tube that lies against the testicle where sperm cells mature. Blockage at the epididymis also can occur due to infection or injury. Whatever the cause, the surgeon will fix the problem by bypassing the blockage in the epididymis in a procedure called a vasoepididymostomy.

In Vitro Fertilization

For some couples dealing with male infertility, in vitro fertilization (IVF) is the treatment of choice. Cleveland Clinic has one of the leading IVF programs in the country with excellent success rates. During the IVF process, the ovaries are stimulated with injectable fertility medications to cause multiple eggs to mature. When the eggs are ready, they are collected in a minor procedure.

Fertilization is accomplished by exposing the eggs to sperm in a culture dish, or by directly injecting a single sperm into each mature egg, a process called intracytoplasmic sperm injection (ICSI). After fertilization, embryo development is monitored over the next three to five days, and two to three embryos then are placed into the uterus by way of a small catheter inserted through the cervix.

Intracytoplasmic Sperm Injection

Artificial techniques of reproduction have advanced to the point where a single sperm can be physically injected into an egg. This procedure, called intracytoplasmic sperm injection (ICSI) has dramatically changed the treatment available for even the most severe male factor infertility. Because of this technique, 90% of all infertile men have the potential to conceive their own genetic child.

In intracytoplasmic sperm injection (ICSI), a single sperm is injected into an egg in a special culture medium. This illustration shows the development of an embryo following fertilization of the egg using ICSI.

Sperm Extraction for In Vitro Fertilization

Approximately 1% of all infertile men are born with the congenital absence of the vas deferens, the “biologic equivalent” of a vasectomy. Unfortunately, there are no artificial tubes that can replace the vas deferens. However, we now are able to help such men conceive using a non-surgical procedure to retrieve sperm from the tiny ducts of the epididymis, freeze them and use them later for in-vitro fertilization (IVF) with the injection of the single sperm directly into an egg.

“Non-obstructive” azoospermia is a condition in which the man does not have sperm in his ejaculation. In about 50% of men with this condition, sperm can be found in the testicles using a microscope. Advances in technology now make it possible to extract those sperm and use them in ICSI.[/vc_column_text][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Nail Infection (Paronychia)” use_theme_fonts=”yes”][vc_column_text]Paronychia is an infection of the skin that surrounds a fingernail. The infected tissue can be tender and painful with swelling. Conditions that can contribute to nail infections include split or cracked nails, closely trimmed nails or trauma to the nail.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”f8731088-44bc-9″][vc_column_text]

What is nail infection (paronychia)?

A nail infection, or paronychia, is an infection of the skin that surrounds a fingernail. The infected tissue can be tender and painful with swelling. Paronychia is considered acute if it lasts less than 6 weeks, or chronic if it lasts longer.

What causes a nail infection (paronychia)?

Staphylococcus aureus and Streptococcus pyogenes bacteria are the most common culprits in acute paronychia but there are other causes as well.

Chronic paronychia tends to be caused by repeated inflammation from irritants, moisture or allergens, and may involve multiple nails. Infection with fungus and bacteria may also occur. Paronychia may be seen in people with eczema or psoriasis, or as a side effect of a medication.

How does a nail infection (paronychia) occur?

Any trauma to the nail or skin surrounding the nail such as aggressively trimming or manicuring your nails can create a way for bacteria to enter and cause an infection. People who have jobs that frequently expose their hands to water or irritants such as chemicals used in washing dishes are at an increased risk of chronic paronychia. Persons with diabetes or diseases that compromise the immune system are more likely to develop infections.[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”a9c94b9c-b992-6″][vc_column_text]

How can I tell if I have a nail infection (paronychia)?

With acute paronychia, a crack in the nail fold or trauma to the nail is usually seen first. Then your finger and nail fold may become red, tender and swollen.

In contrast, chronic paronychia is diagnosed after 6 weeks of inflammation, and may affect several nails and may cause the nail to appear deformed.

How is a nail infection (paronychia) diagnosed?

Most often, the diagnosis is made by the appearance of the nail and the skin around it. Your doctor will decide if a culture (taking a bit of tissue from the area for lab examination) is necessary.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567941448695-2-4″][vc_column_text]

How is a nail infection (paronychia) treated?

Paronychia will be diagnosed by your doctor. The treatment will be based on the severity of inflammation and infection and may include drainage, topical or oral medications.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1567941478708-3-6″][vc_column_text]

How can I prevent a nail infection (paronychia)?

Taking proper care of your nails will greatly reduce the chance of an infection. Do not chew on your nails or pick at the skin around them. Do not trim the cuticles (the skin at the base of the nail). Disrupting the nail or cuticle will create an entry for bacteria and fungi. In general, you should keep your hands away from chronic water exposure and avoid any irritants or allergens from coming in contact with your skin.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Obesity in Children” use_theme_fonts=”yes”][vc_column_text]Approximately one in five children in the United States is overweight. Reasons for obesity in children and ways to combat obesity are discussed.[/vc_column_text][vc_tabs][vc_tab title=”Resources” tab_id=”1567941855198-4-5″][vc_column_text]

What are some resources to help my child reach a healthy weight?

Fit Youth Program
Be Well Kids Clinic

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What is the rate of obesity in children and adolescents in the United States?

According to the Centers for Disease Control and Prevention (CDC), 9% of children age 2 to 5 years, 21% of children age 6 to 11 years, and 17% of children age 12 to 19 years are obese. Overall, 17% of children, or 12.7 million children in the United States, are considered obese.

Obesity in children and adolescents has tripled over the past 30 years. Overweight children are more likely to become overweight adults. This increases their risk to develop diseases such as heart disease and diabetes later in life.

What causes children to become overweight?

Children become overweight for many different reasons. The most common causes are lack of physical activity, unhealthy eating patterns, genetic factors (“runs in the family”), or a combination of these factors. Only in rare cases is being overweight caused by a medical condition such as a hormone disorder. A physical exam and some blood tests will rule out the possibility of a medical condition.

Although weight problems run in families, not all children with a family history of obesity will be overweight. Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves, but this can be related to shared family behaviors such as eating and activity habits. Genetic factors can increase the likelihood that a child will be overweight.

A child’s diet and activity level play an important role in determining a child’s weight. Today, many children spend a lot time being inactive. For example, the average child spends approximately 24 hours each week watching television. As computers, video games, tablets and smartphones continue to grow in popularity, the number of hours of inactivity may only increase.[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”a9c94b9c-b992-6″][vc_column_text]

How do I know if my child is overweight?

The best person to determine whether or not a child is overweight is the child’s health care provider. If you think that your child is overweight, arrange an appointment with the child’s health care team. Your child will have his/her weight and height measured to determine if his or her weight is within a healthy range.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567941448695-2-4″][vc_column_text]

If my child is overweight, how can I help?

For overweight or obese children, it is very important to be supported in their journey towards health. Children’s feelings about themselves often are based on their parents’ feelings about them; if you accept your children at any weight, they will be more likely to feel good about themselves.

It is also important to talk to your children about their weight in a nonjudgmental way, allowing them to share their concerns with you. You can help you child by gradually changing your family’s physical activity and eating habits so that the entire family can benefit from new healthy behaviors.

There are many ways to involve the entire family, but increasing physical activity is especially important. Some ways to accomplish this include the following:

Lead by example. If your children see that you are physically active and having fun, they are more likely to be active and stay active for the rest of their lives.
Plan family activities that provide everyone with exercise, like walking, biking or swimming.
Be sensitive to your child’s needs. It is important to help your child find physical activities that he or she enjoys and that aren’t too difficult.
Make an effort to reduce the amount of time you and your family spend in sedentary (stationary) activities, such as watching TV or playing video games.

Make the most of the opportunities that you and your family have to be healthier and more active.

How can I teach my child healthy eating habits?

The eating habits your children pick up when they are young will help them maintain a healthy lifestyle when they are adults. If you are unsure about how to select and prepare a variety of foods for your family, ask your healthcare provider or registered dietitian for nutrition counseling.

Do not place your child on a restrictive diet. Children should never be placed on a restrictive diet to lose weight, unless a doctor supervises one for medical reasons.

One way to begin teaching healthy eating habit is to serve a variety of fruits and vegetables to your family. Provide a “rainbow” of fruits and vegetables with meals and as snacks. Avoid sugary drinks like soda pop, fruit-flavored drinks, sweet tea, lemonade and sugary sports drinks. The average child takes in more than 120 calories per day from sugary drinks alone.

Other approaches you can take in helping your overweight child include the following:

Guide your family’s choices rather than dictate foods. Make a wide variety of healthful foods available in the house. This practice will help your children learn how to make healthy food choices.
Encourage your child to eat slowly. A child can detect hunger and fullness better when eating slowly.
Eat meals together as a family as often as possible. Try to make mealtimes pleasant with conversation and sharing, not a time for scolding or arguing. If mealtimes are unpleasant, children may try to eat faster to leave the table as soon as possible. They then may learn to associate eating with stress.
Involve children in food shopping and preparing meals. These activities offer parents hints about children’s food preferences, teach children about nutrition, and provide children with a feeling of accomplishment. In addition, children may be more willing to eat or try foods that they help prepare.
Plan for snacks. Continuous snacking may lead to overeating, but snacks that are planned at specific times during the day can be part of a nutritious diet, without spoiling a child’s appetite at meal times. You should make snacks as nutritious as possible.
Discourage eating meals or snacks while watching TV. Try to eat only in designated areas of your home, such as the dining room or kitchen. Eating in front of the TV may make it difficult to pay attention to feelings of fullness, and may lead to overeating.
Try not to use food to punish or reward your child. Withholding food as a punishment may lead children to worry that they will not get enough food. For example, sending children to bed without any dinner may cause them to worry that they will go hungry. As a result, children may try to eat whenever they get a chance. Similarly, when foods, such as sweets, are used as a reward, children may assume that these foods are better or more valuable than other foods. For example, telling children that they will get dessert if they eat all of their vegetables sends the wrong message about vegetables.
Make sure your child’s meals outside the home are balanced. Find out more about your school lunch program, or pack your child’s lunch to include a variety of foods. Also, select healthier items when dining at restaurants. Be mindful of large portion sizes when eating out. Be a good example for your children and take half of the meal home for a second meal.

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Should I enroll my child in a weight-loss program?

If your efforts at home don’t help your child reach a healthy weight, and your child’s healthcare provider determines that your child’s health is at risk unless he or she loses weight steadily, you may want to consider a formal treatment program.

Look for the following characteristics when choosing a weight-control program for your child. The program should:

Be staffed with a variety of health professionals. The best programs may include registered dietitians, exercise physiologists, pediatricians, family physicians, nurse practitioners, psychiatrists or psychologists.
Perform a medical evaluation of the child. Before being enrolled in a program, your child’s weight, growth and health should be reviewed by a healthcare provider. During enrollment, your child’s weight, height, growth, and health should be monitored by a health professional at regular intervals.
Focus on the whole family, not just the overweight child.
Be adapted to the specific age and capabilities of the child. Programs for 4-year-olds are different from those for children 8 or 12 years old in terms of the responsibilities of the child and parents.
Focus on behavioral changes.
Teach the child how to select a variety of foods in appropriate portions.
Encourage daily activity and limit sedentary activity, such as watching TV.
Include a maintenance program and other support and referral resources to reinforce the new behaviors and to deal with underlying issues that contributed to the child becoming overweight.

Childhood obesity: a complex problem

Cleveland Clinic dietitians say childhood obesity is a complex problem resulting from a variety of cultural and lifestyle changes. Kids are increasingly sedentary, spending an estimated five hours a day in front of the TV or computer.

And portion sizes have exploded. Super-size has become standard fare. Geography, genetics and household income contribute, as well.

But the basic equation is simple: too many calories in and too few calories out. It can all add up to a lifetime of health problems including heart disease, diabetes, bone and joint problems, sleep disorders and depression.

Isn’t it baby fat?

“A child with good eating habits and daily exercise is on the right track to a healthy physique,” says Cleveland Clinic dietitian Jill Fisher.

“Unfortunately, seven out of 10 overweight adolescents will become overweight adults. If the child has an overweight parent, that number jumps to eight out of 10,” she says.

Fortunately, through a series of small changes, families can turn the tide. Structured programs like Cleveland Clinic’s Fit Youth are helping parents and their kids learn to eat better and move more.

What is the Fit Youth program?

“We focus on healthy changes they can adopt for the rest of their lives,” says Mrs. Fisher, who helped launch Fit Youth in 2005. Participants in the 10-week program learn to think about food choices to avoid mindless eating, and to find enjoyable ways to exercise. When kids learn to make healthy lifestyle choices when they are young, they can avoid many of the long-term effects, she says.

Find out more about Fit Youth:

Contact Cleveland Clinic Children’s Hospital
216.445.0299

New Video Games Promote Fitness

Parents tired of chasing their kids outside to play are getting a break. Exercise video games like Dance Dance Revolution and Wii Sports can get kids’ hearts racing indoors.

Recent studies presented to the American College of Sports Medicine echo what doctors have suspected. Engaging in exercise based video games boosts children’s activity levels enough to meet health guidelines for moderate- intensity activity.

Cleveland Clinic sports medicine specialists say exercise-based video games shouldn’t replace tried and true activities like riding bikes and playing tag. But they can be used as an additional tool for keeping kids moving, particularly during Cleveland’s long winters. Video games like boxing and tennis use more than twice the energy of traditional video games. Cleveland Clinic specialists can help your child exercise safely.[/vc_column_text][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Osteoporosis in Men” use_theme_fonts=”yes”][vc_column_text]Osteoporosis is a disease that causes the skeleton to weaken and the bones to break. It poses a significant threat to millions of men in the United States.

Despite these compelling figures, surveys suggest that a majority of American men view osteoporosis solely as a “woman’s disease.” Moreover, among men whose lifestyle habits put them at increased risk, few recognize the disease as a significant threat to their mobility and independence.

Osteoporosis is called a “silent disease” because it progresses without symptoms until a fracture occurs. It develops less often in men than in women because men have larger skeletons, their bone loss starts later and progresses more slowly, and they have no period of rapid hormonal change and bone loss. However, in the past few years the problem of osteoporosis in men has been recognized as an important public health issue, particularly in light of estimates that the number of men above the age of 70 will continue to increase as life expectancy continues to rise.

What Causes Osteoporosis?

Bone is constantly changing—that is, old bone is removed and replaced by new bone. During childhood, more bone is produced than removed, so the skeleton grows in both size and strength. For most people, bone mass peaks during the third decade of life. By this age, men typically have accumulated more bone mass than women. After this point, the amount of bone in the skeleton typically begins to decline slowly as removal of old bone exceeds formation of new bone.

Men in their fifties do not experience the rapid loss of bone mass that women do in the years following menopause. By age 65 or 70, however, men and women are losing bone mass at the same rate, and the absorption of calcium, an essential nutrient for bone health throughout life, decreases in both sexes. Excessive bone loss causes bone to become fragile and more likely to fracture.

Fractures resulting from osteoporosis most commonly occur in the hip, spine, and wrist, and can be permanently disabling. Hip fractures are especially dangerous. Perhaps because such fractures tend to occur at older ages in men than in women, men who sustain hip fractures are more likely than women to die from complications.

Primary and Secondary Osteoporosis

There are two main types of osteoporosis: primary and secondary. In cases of primary osteoporosis, either the condition is caused by age-related bone loss (sometimes called senile osteoporosis) or the cause is unknown (idiopathic osteoporosis). The term idiopathic osteoporosis is typically used only for men younger than 70 years old; in older men, age-related bone loss is assumed to be the cause.

The majority of men with osteoporosis have at least one (sometimes more than one) secondary cause. In cases of secondary osteoporosis, the loss of bone mass is caused by certain lifestyle behaviors, diseases, or medications. The most common causes of secondary osteoporosis in men include exposure to glucocorticoid medications, hypogonadism (low levels of testosterone), alcohol abuse, smoking, gastrointestinal disease, hypercalciuria, and immobilization.

Causes of Secondary Osteoporosis in Men

Glucocorticoid excess
Other immunosuppressive drugs
Hypogonadism (low testosterone levels)
Excessive alcohol consumption
Smoking
Chronic obstructive pulmonary disease and asthma
Cystic fibrosis
Gastrointestinal disease
Hypercalciuria
Anticonvulsant medications
Thyrotoxicosis
Hyperparathyroidism
Immobilization
Osteogenesis imperfecta
Homocystinuria
Neoplastic disease
Ankylosing spondylitis and rheumatoid arthritis
Systemic mastocytosis

Glucocorticoid medications: Glucocorticoids are steroid medications used to treat diseases such as asthma and rheumatoid arthritis. Bone loss is a very common side effect of these medications. The bone loss these medications cause may be due to their direct effect on bone, muscle weakness or immobility, reduced intestinal absorption of calcium, a decrease in testosterone levels, or, most likely, a combination of these factors.

When glucocorticoid medications are used on an ongoing basis, bone mass often decreases quickly and continuously, with most of the bone loss in the ribs and vertebrae. Therefore, people taking these medications should talk to their doctor about having a bone mineral density (BMD) test. Men should also be tested to monitor testosterone levels, as glucocorticoids often reduce testosterone in the blood.

A treatment plan to minimize loss of bone during long-term glucocorticoid therapy may include using the minimal effective dose, and discontinuing the drug or administering it through the skin, if possible. Adequate calcium and vitamin D intake is important, as these nutrients help reduce the impact of glucocorticoids on the bones. Other possible treatments include testosterone replacement and osteoporosis medication.

Hypogonadism: Hypogonadism refers to abnormally low levels of sex hormones. It is well known that loss of estrogen causes osteoporosis in women. In men, reduced levels of sex hormones may also cause osteoporosis.

Although it is natural for testosterone levels to decrease with age, there should not be a sudden drop in this hormone that is comparable to the drop in estrogen experienced by women at menopause. However, medications such as glucocorticoids (discussed above), cancer treatments (especially for prostate cancer), and many other factors can affect testosterone levels. Testosterone replacement therapy may be helpful in preventing or slowing bone loss. Its success depends on factors such as age and how long testosterone levels have been reduced. Also, it is not yet clear how long any beneficial effect of testosterone replacement will last. Therefore, doctors usually treat the osteoporosis directly, using medications approved for this purpose.

Research suggests that estrogen deficiency may also be a cause of osteoporosis in men. For example, estrogen levels are low in men with hypogonadism and may play a part in bone loss. Osteoporosis has been found in some men who have rare disorders involving estrogen. Therefore, the role of estrogen in men is under active investigation.

Alcohol abuse: There is a wealth of evidence that alcohol abuse may decrease bone density and lead to an increase in fractures. Low bone mass is common in men who seek medical help for alcohol abuse.

In cases where bone loss is linked to alcohol abuse, the first goal of treatment is to help the patient stop, or at least reduce, his consumption of alcohol. More research is needed to determine whether bone lost to alcohol abuse will rebuild once drinking stops, or even whether further damage will be prevented. It is clear, though, that alcohol abuse causes many other health and social problems, so quitting is ideal. A treatment plan may also include a balanced diet with lots of calcium- and vitamin D-rich foods, a program of physical exercise, and smoking cessation.

Smoking: Bone loss is more rapid, and rates of hip and vertebral fracture are higher, among men who smoke, although more research is needed to determine exactly how smoking damages bone. Tobacco, nicotine, and other chemicals found in cigarettes may be directly toxic to bone, or they may inhibit absorption of calcium and other nutrients needed for bone health. Quitting is the ideal approach, as smoking is harmful in so many ways. As with alcohol, it is not known whether quitting smoking leads to reduced rates of bone loss or to a gain in bone mass.

Gastrointestinal disorders: Several nutrients, including amino acids, calcium, magnesium, phosphorous, and vitamins D and K, are important for bone health. Diseases of the stomach and intestines can lead to bone disease when they impair absorption of these nutrients. In such cases, treatment for bone loss may include taking supplements to replenish these nutrients.

Hypercalciuria: Hypercalciuria is a disorder that causes too much calcium to be lost through the urine, which makes the calcium unavailable for building bone. Patients with hypercalciuria should talk to their doctor about having a BMD test and, if bone density is low, discuss treatment options.

Immobilization: Weight-bearing exercise is essential for maintaining healthy bones. Without it, bone density may decline rapidly. Prolonged bed rest (following fractures, surgery, spinal cord injuries, or illness) or immobilization of some part of the body often results in significant bone loss. It is crucial to resume weight-bearing exercise (such as walking, jogging, dancing, and lifting weights) as soon as possible after a period of prolonged bed rest. If this is not possible, you should work with your doctor to minimize other risk factors for osteoporosis.

What Are the Risk Factors for Men?

Several risk factors have been linked to osteoporosis in men:

Chronic diseases that affect the kidneys, lungs, stomach, and intestines or alter hormone levels.
Regular use of certain medications, such as glucocorticoids
Undiagnosed low levels of the sex hormone testosterone.
Unhealthy lifestyle habits (e.g., smoking, excessive alcohol use, low calcium intake, inadequate physical exercise).
Age: The older you are, the greater your risk.
Race: Caucasian men appear to be at particularly high risk, but all men can develop this disease.

How Is Osteoporosis Diagnosed in Men?

Osteoporosis can be effectively treated if it is detected before significant bone loss has occurred. A medical workup to diagnose osteoporosis will include a complete medical history, x-rays, and urine and blood tests. The doctor may also order a bone mineral density test. This test can identify osteoporosis, determine your risk for fractures (broken bones), and measure your response to osteoporosis treatment. The most widely recognized BMD test is called a central dual-energy x-ray absorptiometry, or central DXA test. It is painless a bit like having an x-ray, but with much less exposure to radiation. It can measure bone density at your hip and spine.

It is increasingly common for women to be diagnosed with osteoporosis or low bone mass using a BMD test, often at midlife when doctors begin to watch for signs of bone loss. In men, however, the diagnosis is often not made until a fracture occurs or a man complains of back pain and sees his doctor. This makes it especially important for men to inform their doctors about risk factors for developing osteoporosis, loss of height or change in posture, a fracture, or sudden back pain.

What Treatments Are Available?

Once a man has been diagnosed with osteoporosis, his doctor may prescribe one of the medications approved by the FDA for this disease. The treatment plan will also likely include the nutrition, exercise, and lifestyle guidelines for preventing bone loss listed at the end of this fact sheet.

If bone loss is due to glucocorticoid use, the doctor may prescribe a medication approved to prevent or treat glucocorticoid-induced osteoporosis, monitor bone density and testosterone levels, and suggest using the minimum effective dose of glucocorticoid.

Other possible prevention or treatment approaches include calcium and/or vitamin D supplements and regular physical activity.

If osteoporosis is the result of another condition (such as testosterone deficiency) or exposure to certain other medications, the doctor may design a treatment plan to address the underlying cause.

How Can Osteoporosis Be Prevented?

There have been fewer research studies on osteoporosis in men than in women. However, experts agree that all people should take the following steps to preserve their bone health:

Avoid smoking, reduce alcohol intake, and increase your level of physical activity.
Ensure a daily calcium intake that is adequate for your age.
Ensure an adequate intake of vitamin D. Dietary vitamin D intake should be 600 IU (International Units) per day up to age 70. Men over age 70 should increase their uptake to 800 IU daily . The amount of vitamin D found in 1 quart of fortified milk and most multivitamins is 400 IU.
Engage in a regular regimen of weight-bearing exercises in which bones and muscles work against gravity. This might include walking, jogging, racquet sports, climbing stairs, team sports, weight training, and using resistance machines. A doctor should evaluate the exercise program of anyone already diagnosed with osteoporosis to determine if twisting motions and impact activities, such as those used in golf, tennis, or basketball, need to be curtailed.
Discuss with your doctor the use of medications that are known to cause bone loss, such as glucocorticoids.
Recognize and seek treatment for any underlying medical conditions that affect bone health.

What is an ovarian cyst?

An ovarian cyst is a sac filled with fluid or a semisolid material that forms on or within one of the ovaries, the small organs in the pelvis that make female hormones and hold egg cells.

There are different types of cysts, many of which are normal and harmless (benign). Functional cysts, which are not disease-related, occur as a result of ovulation (the release of an egg from the ovary). Functional cysts generally shrink over time, usually within 60 days, without specific treatment.

Functional ovarian cysts, which are relatively common, should not be confused with other types of cysts that are disease-related. Conditions such as polycystic ovary syndrome and ovarian cancer also involve growths on the ovaries. Tell your healthcare provider if you have any of the symptoms listed in the symptoms section. He or she can determine the type of cyst you have.

What causes an ovarian cyst?

The exact cause of ovarian cysts is not known.

What are the symptoms of an ovarian cyst?

Some smaller cysts cause no symptoms; you may not even know you have a cyst. Larger cysts may cause the following symptoms:

Pelvic pain or a dull ache in your back.
A feeling of fullness (bloating) in your lower belly.
Pain during intercourse.
Painful periods.

Some prolonged symptoms may be associated with a condition called polycystic ovary syndrome, a hormonal imbalance that causes irregular periods and other hormone-related problems, including obesity and infertility. Other symptoms of polycystic ovary syndrome include hirsutism (increased growth of body hair) and obesity.[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”a9c94b9c-b992-6″][vc_column_text]

How is an ovarian cyst diagnosed?

Your health care provider will first rule out pregnancy as the cause of your symptoms. He or she then may use the following tests to diagnose an ovarian cyst:

A pelvic exam: During this exam, the doctor uses an instrument to widen the vagina, which allows the doctor to examine the vagina, cervix and uterus. The doctor also feels the reproductive organs for any lumps or changes.
Blood tests: These tests are used to measure the levels of certain hormones in the blood.
Ultrasound: This test uses sound waves to create images of the body’s internal organs. It can be used to detect cysts on the ovaries.
Laparoscopy: This is a procedure, performed in an operating room, in which the doctor inserts a small device through an incision (cut) in the abdomen. He or she views the reproductive organs and pelvic cavity using the device. If a cyst is diagnosed at this time, it can be removed.

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How is an ovarian cyst treated?

Functional ovarian cysts generally go away without treatment. Your healthcare provider may give you medications containing hormones (such as birth control pills) to stop ovulation. If you do not ovulate, you will not form functional cysts. In some cases, surgery may be necessary to remove a cyst.

Types of surgery

The type of surgery used depends on the size of the cyst and how it appears on the ultrasound. The different procedures used include:

Laparoscopy: This is a procedure in which the doctor inserts a small device through an incision in the abdomen. He or she views the reproductive organs and pelvic cavity using the device. The doctor can remove the cyst through tiny incisions.
Laparotomy: This procedure uses a bigger incision to remove the cyst. The cyst will be tested for cancer. If it is cancer, the doctor may need to remove one or both ovaries, the uterus, a fold of fatty tissue called the omentum and some lymph nodes. Lymph nodes are small, bean-shaped structures found throughout the body that produce and store infection-fighting cells, but may contain cancer cells.

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When should I call my healthcare provider?

Call your healthcare provider if any of the following occur:

Your menstrual periods are late, irregular, or painful.
Your abdominal pain doesn’t go away.
Your abdomen becomes enlarged or swollen.
You have trouble urinating or emptying your bladder completely.
You have pain during intercourse.
You have feelings of fullness (bloating), pressure, or discomfort in your abdomen.
You lose weight for no apparent reason.
You feel generally ill.

[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1567941855198-4-5″][vc_column_text]

Can ovarian cysts be prevented?

Taking medications that contain hormones (such as birth control pills) will stop ovulation. However, many women taking low-dose oral contraceptives may still ovulate. Although there has been no study that shows that oral contraceptive pills reduce the formation of the ovarian cysts, many physicians still do prescribe this regimen.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Pet Allergies” use_theme_fonts=”yes”][vc_column_text]Dogs, cats, and other companion animals can cause pet allergies. Symptoms range from mild to severe and include sneezing, runny nose, and itchy skin.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”f8731088-44bc-9″][vc_column_text]

What are pet allergies?

Pet allergies are allergic reactions to certain proteins, called allergens. These allergens are found on animal fur and skin, urine, and in animal saliva. Most animal companions, including cats, dogs, rabbits, rodents and birds produce allergens.

Not everyone experiences pet allergies. Some people are only allergic to certain animals. For those with allergies, their bodies launch an immune system response when they encounter allergens. This allergic reaction occurs because the body mistakes a substance that is harmless to others (the allergen) as a damaging invader.

When your immune system responds to any allergen, it forms specific proteins, called antibodies. Antibodies alert cells to release histamine and other cellular substances, which cause allergy symptoms. People can be allergic to many substances, including pollens and other plant materials, certain foods, dust, mold, insect stings and even medications.

What are the symptoms of pet allergies?

You may have several allergy symptoms while you are around a pet or soon afterward. In most cases, pet allergy symptoms include:

Itchy, watery eyes
Sneezing
Runny nose
Nasal congestion
Itchy skin
Scratchy throat or mouth
Coughing
Raised, red patches on the skin (hives)
Asthma symptoms, including chest tightness, difficulty breathing or wheezing

Pet allergy symptoms mimic those caused by other allergens, like pollen, dust or mold. Many of these symptoms, such as sneezing and runny nose, can also result from illnesses like influenza or the common cold. Your doctor can help you pinpoint the cause of your symptoms.[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”a9c94b9c-b992-6″][vc_column_text]

How are pet allergies diagnosed?

Doctors diagnose pet allergies with a simple skin or blood test. In some cases, doctors use self-reported evidence as proof of pet allergies. For example, your doctor may diagnose pet allergies if you get hives after being around a certain type of animal.

During skin testing, a doctor:

Uses a very small needle to prick your skin
Puts small amounts of different allergens into your skin
Adds a neutral agent as a comparison
Watches for skin reactions, such as redness, swelling (bumps) or itching

Your skin reacts only to the specific allergens that affect your body. Skin reactions to allergens usually occur within 15 minutes of exposure.

Your doctor may recommend a blood test if you are taking certain medications or if a skin prick test would be unsafe.

[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1567941448695-2-4″][vc_column_text]

How are pet allergies treated?

The best way to avoid pet allergies is to avoid animals that trigger allergic reactions. These animals may include cats, dogs and small mammals, like rabbits.

If avoiding animals is not possible, you can take steps to prevent or reduce the severity of your symptoms by:

Avoiding hugging, petting or kissing animals
Having someone with no pet allergies brush the pet outdoors frequently
Using a microfilter vacuum bag and HEPA air filters to remove as many pet allergens as possible from the home
Removing rugs and carpets that can trap pet allergens
Keeping pets out of your bedroom and off upholstered furniture

Your doctor may recommend certain medications, like nasal steroids and antihistamines, to help control pet allergy symptoms and lessen your allergic reaction.

In severe cases, it may be necessary to rehome an animal.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1567941855198-4-5″][vc_column_text]

Can pet allergies be prevented?

The best way to prevent pet allergies is to avoid exposure to animals that cause an allergic reaction. Following your doctor’s recommended regimen of allergy medication can minimize your reactions and reduce symptoms when you are around animals.

For some people, allergy shots (immunotherapy) offer a long-term treatment solution to managing pet allergies. Each time you have an allergy shot, your body responds by lowering your sensitivity to the allergen. Depending on your unique situation, allergy shots may help prevent pet allergy symptoms even after you stop receiving this treatment. Talk with your doctor about whether allergy shots may be a good choice for you.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Rashes (Red Skin)” use_theme_fonts=”yes”][vc_tabs][vc_tab title=”Overview” tab_id=”d6d34e1d-0962-2″][vc_column_text]Contact dermatitis is inflammation of the skin (rash) that may result when the skin is touched by irritants or substances that cause an allergic reaction. Contact dermatitis can occur from exposure to many different compounds found both in the home and at work. There are two types of contact dermatitis:

Allergic contact dermatitis occurs when skin, which has become sensitized to a certain substance (allergen), comes in contact with that substance again
Irritant contact dermatitis occurs when the skin is exposed to a mild irritant (such as detergent or solvents) repeatedly over a long period of time or a strong irritant (such as acid, alkali, solvent, strong soap or detergent), which can cause immediate skin damage

Common sources of allergic contact dermatitis

Not everyone reacts to allergens. However, some people will react to an allergen which they had previously tolerated for many years. Skin can become allergic to a substance after many exposures or after just one exposure. Most people will have an allergic reaction to poison ivy after one exposure, for instance. This is a delayed skin reaction that typically develops 12 to 72 hours after exposure.

Common sources of allergic contact dermatitis include:

Nickel (a common metal used in jewelry) and other metals. Nickel has been reported to cause contact dermatitis in up to 10 percent of women. Gold is also becoming a widespread allergen. This type of allergic contact dermatitis can begin with intermittent rashes under earrings or other jewelry.
Fragrances – for example, those found in perfumes, soaps, lotions, and shampoos
Cosmetics
Topical medications such as antibiotics or anti-itch preparations – these cause worsening of the problem and are often misinterpreted as infection
Preservatives, which keep topical products from spoiling
Sunscreens – commonly cause a hive-like rash that can appear hours or days after sun exposure
Rubber ingredients – common source of work-related allergy. Rubber can cause immediate allergic reactions, such as itching, burning, or welts. Some people experience itching and tearing eyes or even shortness of breath.

Common sources of irritant contact dermatitis

Detergents, soaps, cleaners, waxes and chemicals are substances that can irritate the skin. They can wear down the oily, protective layer on skin’s surface and lead to irritant contact dermatitis. Irritant contact dermatitis is most common among people who regularly work with strong chemicals, such as restaurant, maintenance, and chemical workers.

Symptoms of Allergic contact Dermatitis and Irritant contact Dermatitis:

Allergic contact dermatitis

Reddening of skin (either in patches or all over the body)
Intermittent dry, scaly patches of skin
Blisters that ooze
Burning or itching that is usually intense without visible skin sores (lesions)
Swelling in the eyes, face, and genital areas (severe cases)
Hives
Sun sensitivity
Darkened, “leathery” and cracked skin

Allergic contact dermatitis can be very difficult to distinguish from other rashes.

Irritant contact dermatitis

Mild swelling of skin
Stiff, tight feeling skin
Dry, cracking skin
Blisters
Painful ulcers on the skin

[/vc_column_text][/vc_tab][vc_tab title=”Frequently Asked ” tab_id=”e33e0200-25ea-1″][vc_column_text]

Q: Are certain occupations at greater risk?

A. Some occupations have more exposure to chemicals or substances that can result in sensitization and cause allergic contact dermatitis. These include dental workers, health care workers, florists, hairdressers, machinists, and photographers among many others.

Q: What are the symptoms of contact dermatitis?

A. Contact dermatitis symptoms can range from mild redness and dryness to severe pain and peeling that can be disabling.

Q: How can I know if I have contact dermatitis?

A. If you have a skin rash that won’t go away, visit your health care provider. If he or she suspects allergic contact dermatitis, patch testing may be performed. In this test, small samples of chemicals are placed on an area of skin to see if a rash develops. There are no needles or pricking of the skin. The areas of the skin are then evaluated after 48 hours and again at 96 hours or one week.

The advantage of patch testing is that the allergens can be identified and your health care provider can effectively treat the rash. This avoids the need for chronic medications that have many potential side effects.

There are no tests that can be done for irritant contact dermatitis. Tell your health care provider about any irritating substances or chemicals that you regularly come into contact with (including cosmetics, lotions, and nail polish).

With either type of contact dermatitis, you can avoid substances you suspect and see if the rash goes away.

Q: How is contact dermatitis treated?

A. The form of treatment will depend on the cause of contact dermatitis. Common treatments include: cortisone-type creams, antihistamines, lotions and creams or oatmeal baths (to relieve itching).

Q:How can I prevent contact dermatitis?

A. For allergic contact dermatitis:

Avoid contact with substances that cause the skin rash.
Wash any area that comes into contact with allergic substances.
Learn to recognize poison oak and poison ivy.

For irritant contact dermatitis:

Wear cotton gloves under rubber gloves for all wet work. Or, use petroleum jelly to the protect the skin. Reapply the petroleum jelly two or three times a day and after washing your hands.
Avoid contact with substances that irritate the skin.
Use mild soaps.
Use hand creams and lotions frequently.

[/vc_column_text][vc_custom_heading stripe_pos=”hide” text=”Rashes (Red Skin)” use_theme_fonts=”yes”][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Rheumatoid Arthritis” use_theme_fonts=”yes”][vc_column_text]Rheumatoid arthritis is a type of chronic (ongoing) arthritis that occurs in joints on both sides of the body (for instance, both hands, wrists, and/or knees). Symptoms include joint pain and swelling and stiffness. Treatment options include non-pharmacologic therapies and/or medications.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”30eddb53-3d28-7″][vc_column_text]

What is rheumatoid arthritis?

Arthritis is a general term for inflammation (redness, warmth, swelling, and pain) in joints. Rheumatoid arthritis is a type of chronic (ongoing) arthritis that occurs in joints on both sides of the body (for instance, both hands, wrists, and/or knees), which helps distinguish it from other types of arthritis.

In addition to affecting the joints, rheumatoid arthritis may occasionally affect other parts of the body, including the skin, eyes, lungs, heart, blood, nerves, or kidneys.

Rheumatoid arthritis is an autoimmune disease, meaning that patient’s immune system (the body’s infection-fighting system) is overreacting against itself. The result can cause some or all of the symptoms of rheumatoid arthritis.

Who is affected by rheumatoid arthritis?

Rheumatoid arthritis affects more than 1.3 million people in the United States.
It is 2.5 times more common in women than in men.
It usually occurs in people who are between the ages of 20 and 50; however, young children and the elderly can also develop rheumatoid arthritis.

What causes rheumatoid arthritis?

The exact cause of rheumatoid arthritis is unknown. However, it is believed to be caused by a combination the following factors:

Genetics (heredity)
Abnormal immunity
The environment
Hormones

Normally, the immune system protects the body from disease. In people who have rheumatoid arthritis, something—possibly infections, cigarette smoking, and physical or emotional stress, among other causes—triggers the immune system to attack the joints (and sometimes other organs).

Gender, heredity, and genes largely determine a person’s risk of developing rheumatoid arthritis. For example, women are about three times more likely than men to develop rheumatoid arthritis.

What are the symptoms of rheumatoid arthritis?

The symptoms of rheumatoid arthritis include the following:

Joint pain and swelling
Stiffness, especially in the morning or after sitting for long periods
Fatigue (tiredness and excessive sleepiness)

Rheumatoid arthritis affects each person differently. In most people, joint symptoms may develop gradually over several years. In other people, rheumatoid arthritis may proceed rapidly. A few people may have rheumatoid arthritis for a limited period of time and then go into remission (a time with no symptoms).

Cartilage normally acts as a “shock absorber” between the joints. Uncontrolled inflammation causes the destruction and wearing down of the cartilage, which leads to joint deformities. Eventually, the bone itself erodes, potentially leading to fusion of the joint (an effort of the body to protect itself from constant irritation). This process is aided by specific cells and substances of the immune system, which are produced in the joints but also circulate and cause symptoms throughout the body.[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”1cd96a8c-06cc-2″][vc_column_text]

How is rheumatoid arthritis diagnosed?

The diagnosis of rheumatoid arthritis is based on a combination of factors, including:

Morning stiffness that lasts at least one hour and has been present for at least six weeks;
Swelling of three or more joints for at least six weeks;
Swelling of the wrist, hand, or finger joints for at least six weeks;
Swelling of the same joints on both sides of the body;
Changes in hand x-rays that are hallmarks of rheumatoid arthritis;
Rheumatoid nodules (lumps) of the skin
Blood test that is positive for rheumatoid factor* and/or anti-citrullinated peptide/protein antibodies

* The rheumatoid factor may be present in people who do not have rheumatoid arthritis. Other diseases can also cause the rheumatoid factor to be produced in the blood. A test called CCP antibody can sometimes help to determine whether the rheumatoid factor antibody is due to rheumatoid arthritis or some other disease. This is why the diagnosis of rheumatoid arthritis is based on a combination of several factors and NOT just the presence of the rheumatoid factor in the blood.

It is also important to note that not all of these features are present in people with early rheumatoid arthritis, and these problems may be present in some people with other rheumatic conditions.

In some cases, it may be necessary to monitor the condition over time before a definitive diagnosis of rheumatoid arthritis can be made.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1568279206463-2-1″][vc_column_text]

How is rheumatoid arthritis treated?

The goals of rheumatoid arthritis treatment are to:

Control a patient’s signs and symptoms.
Prevent joint damage.
Maintain the patient’s quality of life and ability to function.

Joint damage generally occurs within the first two years of diagnosis, so it is important to diagnose and treat rheumatoid arthritis in the “window of opportunity” to prevent long-term consequences.

Treatments for rheumatoid arthritis include medications, rest, exercise, physical therapy/occupational therapy, and surgery to correct damage to the joint.

The type of treatment will depend on several factors, including the person’s age, overall health, medical history, and the severity of the arthritis.

Non-pharmacologic therapies

Non-pharmacologic therapy is the first step in treatment for all people who have rheumatoid arthritis. Non-pharmacologic therapies include the following:

Rest

When joints are inflamed, the risk of injury to the joint and to nearby soft tissue structures (such as tendons and ligaments) is high. This is why inflamed joints should be rested. However, physical fitness should be maintained as much as possible. Maintaining a good range of motion in your joints and good fitness overall are important in coping with the overall features of the disease.

Exercise

Pain and stiffness often prompt people with rheumatoid arthritis to become inactive. However, inactivity can lead to a loss of joint motion, contractions, and a loss of muscle strength. These, in turn, decrease joint stability and increase fatigue.

Regular exercise, especially in a controlled fashion with the help of physical therapists and occupational therapists, can help prevent and reverse these effects. Beneficial workouts include: range-of-motion exercises to preserve and restore joint motion; exercises to increase strength, and; exercises to increase endurance (walking, swimming, and cycling).

Physical and occupational therapy

Physical and occupational therapy can relieve pain, reduce inflammation, and help preserve joint structure and function for patients with rheumatoid arthritis.

Specific types of therapy are used to address specific problems of rheumatoid arthritis:

The application of heat or cold can relieve pain or stiffness.
Ultrasound can help reduce inflammation of the sheaths surrounding tendons (tenosynovitis).
Exercises can improve and maintain range of motion of the joints.
Rest and splinting can help reduce joint pain and improve joint function.
Finger-splinting and other assistive devices can prevent deformities and improve hand function.
Relaxation techniques can relieve secondary muscle spasm.

Occupational therapists also focus on helping people with rheumatoid arthritis continue to actively participate in work and recreational activity, with special attention to maintaining good function of the hands and arms.

Nutrition and dietary therapy

Weight loss may be recommended for overweight and obese people to reduce stress on inflamed joints.

People with rheumatoid arthritis have a higher risk of developing coronary artery disease. High blood cholesterol (a risk factor for coronary artery disease) can respond to changes in diet. A nutritionist can recommend specific foods to eat or avoid in order to reach a desirable cholesterol level.

Changes in diet have been investigated as treatments for rheumatoid arthritis, but no diet has been proven to cure it. No herbal or nutritional supplements, such as cartilage or collagen, can cure rheumatoid arthritis. These treatments can be dangerous and are not usually recommended.

Medications

There are many medications to decrease joint pain, swelling, and inflammation, and prevent or slow down the disease. The type of drugs that your doctor recommends will depend on how severe your arthritis is and how well you respond to the medications.

These medications include:

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen
Corticosteroids (oral and injectable forms)
COX-2 inhibitor (celecoxib [Celebrex®])
Disease-modifying anti-rheumatic drugs (DMARDs) such as hydroxychloroquine (Plaquenil), methotrexate (Rheumatrex®, Trexall®), sulfasalazine (Azulfidine®), and leflunomide (Arava®)

It may take four to six weeks of treatment with methotrexate, one to two months with sulfasalazine, and two to three months with hydroxycholoroquine to see an improvement in symptoms.

Biologic agents, such as infliximab (Remicade®), etanercept (Enbrel®), adalimumab (Humira®), certolizumab (Cimzia®), golimumab (Simponi®), tocilizumab (Actemra®), rituximab (Rituxan®), abatacept (Orencia®), anakinra (Kineret®), tofacitinib (Xeljanz®)

Biologics tend to work rapidly, within two weeks for some medications and within four to six weeks for others. Biologics may be used alone or in combination with other DMARDs. Usually they are reserved for patients who do not adequately respond to DMARDs, or if the prognosis (outlook) for the patient is problematic.

Other precautions to note with these drugs:

DMARDs and biologic agents interfere with the immune system’s ability to fight infection and should not be used by people who have serious infections.
Anti-TNF agents such as infliximab, etanercept, adalimumab, certolizumab and golimumab are not recommended for people who have lymphoma or who have been treated for lymphoma. People with rheumatoid arthritis–especially those with severe disease–have an increased risk of lymphoma, regardless of what treatment is used. Anti-TNF agents have been associated with a further increase in the risk of lymphoma in some studies but not others. More research is needed to define this risk.
Testing for tuberculosis (TB) is needed before starting anti-TNF therapy. People who have evidence of earlier TB infection should be treated for TB, because there is an increased risk of developing active TB while receiving anti-TNF therapy.

Some of these medications are traditionally used to treat other conditions, such as cancer, inflammatory bowel disease and malaria. When these drugs are used to treat rheumatoid arthritis, the doses are much lower and the risks of side effects tend to be considerably less. However, the risk of side effects from treatment must be weighed against the benefits on an individual basis.

When you are prescribed any medication, it is important to meet with your physician regularly so he or she can watch for any side effects.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1568279284014-3-6″][vc_column_text]

Smoking and alcohol

Smoking is a risk factor for rheumatoid arthritis. Since quitting smoking can improve rheumatoid arthritis symptoms, people who smoke should quit completely. Help in quitting is available and should be obtained, if needed.

Drinking alcohol in moderation is not harmful for people who have rheumatoid arthritis, although it may increase the risk of liver damage from some drugs such as methotrexate. Recommendations for alcohol use depend on the medications a person is taking and on his or her other medical conditions. Discuss the safety of alcohol use with your doctor.

Measures to reduce bone loss

Inflammatory conditions such as rheumatoid arthritis can cause bone loss, which can lead to osteoporosis. The use of prednisone further increases the risk of bone loss, especially in postmenopausal women.

You can do the following to help minimize the bone loss associated with steroid therapy:

Use the lowest possible dose of glucocorticoids for the shortest possible time, when possible, to minimize bone loss.
Get an adequate amount of calcium and vitamin D, either in the diet or by taking supplements.
Use medications that can reduce bone loss, including that which is caused by glucocorticoids.
Control rheumatoid arthritis itself with appropriate medications prescribed by your doctor.

[/vc_column_text][/vc_tab][vc_tab title=”Outlook / Prognosis” tab_id=”1568279343497-4-6″][vc_column_text]

What is the prognosis (outlook) for people who have rheumatoid arthritis?

Although there is no cure for rheumatoid arthritis, there are many effective methods for decreasing the pain and inflammation and slowing down the disease process. Early diagnosis and effective treatment are very important.

Extensive research is being done to learn the cause of rheumatoid arthritis and the best methods of treatment.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Scabies” use_theme_fonts=”yes”][vc_column_text]Scabies is a skin condition caused by mites that burrow under the skin and produce small red bumps and severe itching. The causes and treatment of this condition are discussed.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”0152f30a-fe5c-3″][vc_column_text]

What is scabies?

Scabies is a skin condition caused by mites (little bugs) that burrow under the skin and produce small red bumps and severe itching. The mites easily spread from person to person, especially among people who share close living spaces. If one family member has scabies, other family members and close contacts must be checked and treated at the same time.

The mites live in the folds and narrow cracks of the skin. Common mite sites include:

Folds in between the fingers and toes.
Bends at the wrists.
Area around the belt line.
Bends at the knees.
Under fingernails.
Folds in thighs.
Under rings, watch bands, and bracelets.
Folds in genitals.
Area around the nipples (in women).

Who gets scabies?

Anyone can get scabies. Poor hygiene does not lead to scabies. People who are more likely to get scabies include:

People who live in close, crowded conditions.
Infants and children. (Children have a lot of close, physical contact with others, including their mothers, parents, friends, family members and classmates.)
The elderly, especially those living in nursing homes.
Health care workers who care for people not known to have scabies.

What are the symptoms of scabies?

The symptoms of scabies include:

Intense itching.
Skin rash of tiny red bumps that look like bites or pimples. (These spread slowly over a period of weeks or months.)
Intense itch that leads to loss of sleep.
Bumps that sometimes become infected as a result of scratching.

Children with scabies may have itching all over their bodies and may be cranky or tired from lack of sleep due to itching at night.

A person can be infected with scabies for 4 to 6 weeks before having symptoms. It’s important that you get rechecked up to 6 weeks after you think you may have been exposed or any time symptoms occur, even if you were already screened for scabies.[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”0390303c-7322-3″][vc_column_text]

How can I know if I or my child has scabies?

Visit your healthcare provider. Most cases of scabies can be confirmed just by looking closely at the skin. Your health care provider may also apply mineral oil to the rash and use a scalpel to get a small sample of skin. The sample is placed under a microscope and examined for mites and mite eggs.

Can I see the mite?

The mite is very small, about the size of a needle point, and very difficult to see. It is white to creamy white in color. When magnified, its 8 legs and round body are visible.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1568279552636-2-0″][vc_column_text]

How can I know if I or my child has scabies?

Can I see the mite?

The mite is very small, about the size of a needle point, and very difficult to see. It is white to creamy white in color. When magnified, its 8 legs and round body are visible.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1568279693093-3-6″][vc_column_text]

How can I prevent spreading scabies?

You can prevent spreading scabies by:

Washing bed linens, towels, and clothing in hot water and machine dry.
Making sure family members and others in close contact with the infected person get checked for scabies.

[/vc_column_text][/vc_tab][vc_tab title=”Outlook / Prognosis” tab_id=”1568279726929-4-9″][vc_column_text]

If my child has scabies, how soon can she/he return to school?

Your child can return to school the day after treatment.

Can a person get scabies more than once?

Yes. You can get scabies any time that you come into close contact with an infected person.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Scars” use_theme_fonts=”yes”][vc_column_text]Throughout our lives, we all have experiences that injure our skin, leaving behind a scar. How you scar depends on many factors: the depth and size of your wound, your age, heredity, even your sex and ethnicity. There are four main types of scars.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”357ffe47-3ee6-3″][vc_column_text]The skin is an organ that protects our bodies from infection. Throughout our lives, we have experiences that injure our skin, leaving behind a scar. The formation of scars depends on many factors, including:

How large the wound is;
The person’s age, sex, and ethnicity (nationality/heritage); and
Genetic (inherited) factors.

There are four main types of scars. Various treatments can help reduce their size and appearance. Before you begin, however, remember this basic truth: scars will never completely disappear.

What are the four main types of scars?

Hypertrophic scars: These are red scars that rise above the skin. They do not spread beyond the spot where the injury occurred. Possible treatments include steroid injections and laser surgery.
Keloids: These scars jut out from the skin and spread beyond the spot where the injury occurred. They are caused by the overproduction of certain cells. Over time, keloids may affect mobility (ability to move). Possible treatments include surgery, laser surgery, radiation, or steroid injections. Smaller keloids can be removed with cryotherapy (freezing therapy using liquid nitrogen). You can also prevent keloids by using pressure treatment, silicone gel. Keloids are more common in darker skin types, specifically people of African or Asian descent.
Contracture scars: These scars typically occur after the skin is burned. They cause tightening (contracting) of the skin that can reduce the ability to move. This type of scar can go into muscles and nerves.
Acne scars: Any type of acne can leave behind scars. There are many types of acne scars, and they can be shallow or quite deep. Treatment depends on the type of scars.

[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”23be6b6f-7109-2″][vc_column_text]

What are possible treatments for scars?

Over-the-counter or prescription creams, ointments, or gels: These products may reduce scars that are caused by surgical incisions (cuts) or other injuries or wounds. If you are under the care of a dermatologist or plastic surgeon, ask your doctor for recommendations. Treatment options include corticosteroids or antihistamine creams (if your scars are sensitive and cause itching). Your doctor may also recommend intralesional steroid injections, pressure dressings, or silicone gel sheeting to prevent acne scars and to help treat existing scars.

Surgery: There are many options under this category, including skin grafts, excision (removal), or laser surgery. When looking into surgery, discuss with your doctor whether you will have local anesthesia with an oral sedative, or general anesthesia. If you’ve recently had plastic, cosmetic, or other surgery that has caused your scars, it is best to wait at least one year before making a decision about scar removal treatment. Many scars fade and become less noticeable over time.

Injections: In the case of protruding scars such as keloids or hypertrophic scars, your doctor may choose to use steroid injections to flatten the scars. Such injections can be used as a stand-alone treatment, or in combination with other treatments.

Laser surgery: Vascular (blood vessel)-specific lasers may be used to lighten flat or raised scars that are pink to purple in color. Vascular laser treatment may also help flatten raised scars. A carbon dioxide ablative laser can also be used to treat different types of scars.

Will insurance cover scar removal treatments?

If your scar is hurting you physically, your insurance plan may cover the cost. You can ask your doctor to write a letter about your particular case. He or she can also take photos to support your case.

If you are having scar removal treatment for cosmetic purposes (for your appearance), you will probably have to pay for it yourself. If your scars resulted from cosmetic surgery, your insurance company may or may not pay for treatment. Some plans will not cover treatments that arise from elective surgery that is not medically necessary. It is best to check with your insurance plan.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Smallpox” use_theme_fonts=”yes”][vc_column_text]Smallpox is a serious, contagious, and sometimes fatal infectious disease caused by the variola virus. Although smallpox has been eradicated, there is growing concern that it could be used in a bioterrorist attack.[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”b0d54c74-01bb-9″][vc_column_text]

What is smallpox?

Smallpox is a serious, contagious, and sometimes fatal infectious disease caused by a virus called the variola virus. The disease gets its name from the Latin word for “spotted” and refers to the small pus-filled blisters that appear on the face and body of an infected person.

The smallpox vaccine offers the best protection against contracting the smallpox virus.

Is smallpox fatal?

About 30% of people who become infected with smallpox die from their illness.

How is smallpox spread?

Smallpox is spread from person to person by several means, including:

Direct, face-to-face, and fairly prolonged contact with an infected person. For instance, the saliva of the infected person can spread the disease.
Direct contact with the fluid in the blisters in the infected person’s skin or other infected bodily fluids
Direct contact with contaminated objects, such as blankets, towels or clothes touched by an infected person Smallpox is rarely spread through the air in settings such as buses, trains, or office buildings.

What are the symptoms of smallpox?

People infected with smallpox develop some symptoms (for example, fever, headache, backache, and general fatigue) that are typical of many less serious diseases. However, the telltale sign is the development of a unique skin rash. The rash, which has an indentation (hollow area) at its center, covers the entire body. The rash progresses to a raised bump, then to a pus-filled blister that crusts and scabs over before finally falling off about three weeks later, leaving behind a pitted scar.

How long does it take smallpox symptoms to appear?

After exposure, there’s a period of seven to 17 days (called the incubation period) during which an infected person may not show any symptoms. Then, over the next two to four days, an infected person may become sick with cold and flu-like symptoms (this is called the prodromal stage). The classic smallpox rash begins after these cold and flu symptoms disappear. So, the earliest outward symptoms of smallpox would appear about nine days after exposure, when the rash develops.

A person with smallpox is most contagious to others while the rash is present, but is still considered contagious until the last smallpox scab falls off. A person is not contagious during the incubation period, and only sometimes contagious during the prodromal stage.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”ae6f0a3b-a966-3″][vc_column_text]

How is smallpox treated?

There are no drugs to treat smallpox once a person develops the disease. (Drugs can be given to relieve some of the cold and flu symptoms and other illnesses that might arise in addition to the smallpox.) Instead, a vaccine is given to prevent people from contracting the disease in the first place.

Currently, only military personnel who might be exposed to smallpox as a biological weapon of warfare and U.S. healthcare workers (“first responders”) are offered the vaccine. However, enough vaccine has been manufactured to inoculate every man, woman, and child in the United States should a bioterrorist attack with smallpox occur.

If there is an outbreak of smallpox, vaccination within three days of exposure will completely prevent or significantly modify the severity of disease in most patients. Vaccination within four to seven days of exposure will likely offer some protection against the disease. The vaccine provides protection from smallpox for three to five years.

How is the smallpox vaccine given?

A bifurcated (two-pronged) needle that has been dipped into the vaccine solution is used to prick the skin of the upper arm several times. The pricking is not deep, but will cause a sore spot and one or two droplets of blood to form. If the vaccination is successful, red, itchy bumps develop at the vaccination site. This is followed a few days later by a blister, and finally a scab that falls off about three weeks later.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1568280138143-2-2″][vc_column_text]

Is the smallpox vaccine safe?

The smallpox vaccine offers the best protection against contracting the smallpox virus. The vaccine is not without some risks, however. Based on the history of smallpox vaccination:

Between 14 and 52 people per one million vaccinated will have a potentially life-threatening reaction.
One to two of these people will die from these reactions.
About 1,000 people per one million vaccinated will have serious but not life-threatening reactions.

It is important to note that smallpox cannot be contracted from the vaccine.

In the spring of 2003, several people who received the vaccine suffered heart attacks and died. The Centers for Disease Control and Prevention (CDC) is conducting an investigation to determine if there is any association between smallpox vaccination and the development of heart problems. The government agency recommends that anyone with a history of heart disease, or who is suffering from three or more major risk factors for heart disease, be excluded from the vaccination program. Risk factors for heart disease include diabetes, high blood pressure, high cholesterol levels, and smoking.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Soy Allergy” use_theme_fonts=”yes”][vc_column_text]

If you have wheezing, itching or shortness of breath after eating soy or soy products, you may be allergic. You may also react to other legumes like garbanzo beans or lentils. Tests can confirm soy allergies.

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Who gets soy allergy?

Although soy allergy occurs most often in infants and children, it can appear at any age and can be caused by foods that had been previously eaten without any problems. Many infants can lose their allergy as they grow older.

Soybeans are legumes. Other foods in the legume family include peanut, navy beans, kidney beans, lima beans, string beans, pinto beans, chickpeas (garbanzo beans), lentils, peas, black-eyed peas, and licorice. Some people with soy allergy may have a reaction after eating other legumes. If you have soy allergy, you should talk with your doctor about what other legumes you might need to avoid.

What are the symptoms of soy allergy?

Allergic reactions to foods usually begin within minutes to a few hours after eating the food. The severity of symptoms can vary widely from one person to another. Mildly allergic persons may have itching and a few hives, while severely allergic persons may experience severe, life-threatening symptoms such as breathing problems or swelling of the throat. The symptoms of food allergy may include any or several of the following:

Itching
Hives
Eczema
Tingling or swelling of the lips, tongue, or throat
Chest tightness, shortness of breath, or difficulty breathing
Wheezing
Abdominal pain
Nausea, vomiting, or diarrhea
Dizziness
Fainting
Anaphylaxis: sudden, severe, potentially fatal, systemic allergic reaction that can involve several areas of the body

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How is soy allergy diagnosed?

Your healthcare provider will examine you after asking for a medical history. You might be asked to keep track of your food and any symptoms you might have.

There are other tests for soy allergy. They are:

A blood test: A blood sample will be tested for immunoglobulin E (IgE) antibodies to soy. This may indicate an allergy.
A skin-prick test: A drop or two of liquid composed of soy protein is put on your back or on your forearm. A sterile probe pokes the area which lets the liquid get into the skin. If your skin produces a red bump in about 15 minutes, you might be allergic.
An oral food challenge: You will be asked to eat some type of soy food item. This will happen at the doctor’s office or a special food challenge center with medication and emergency equipment ready to deal with any reaction.

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How is soy allergy treated?

If you have soy allergy, strict avoidance of soy is the only way to prevent a reaction. Your doctor might suggest antihistamines or injectable epinephrine for treating reactions.

Avoiding products made with soy is difficult because soy is contained in many processed food products. The Food and Drug Administration (FDA) requires food manufacturers to list common food allergens on food labels in plain terms to make it easier to identify the food allergens. Food labels must clearly list eight allergens which account for almost 90 percent of all food allergies: cow’s milk, soy, wheat, egg, peanut, tree nuts, fish, and shellfish. Generally, soy lecithin and soy oil are tolerated by soy allergic individuals.

How can I best manage living with a soy allergy?

Always know what you are eating and drinking.
Always check the label ingredients before you use a product, even if the food was safe the last time you ate it. Manufacturers can change recipes and a soy-containing food may be added to the recipe.
Teach children with soy allergy not to accept food from classmates or friends.
When dining out, ask detailed questions about ingredients and how the food was prepared.
Wear a medical alert bracelet with information about your allergy or carry an alert card with you.
Talk with your doctor about how to prepare for a reaction. Mild reactions may be treated with oral antihistamines. Your doctor may prescribe self-injectable epinephrine to carry with you at all times in case you have a severe reaction.

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How can I find out if soy is in a food product?

All FDA-regulated manufactured food products that contain as an ingredient a “major food allergen” (milk, wheat, egg, peanut, tree nuts, fish, crustacean shellfish, and soy) are required by U.S. law to list that allergen on the product label. For tree nuts, fish, and crustacean shellfish, the specific type of nut or fish must be listed. (Food Allergy Labeling and Consumer Protection Act, effective 1/2006.)

Reading a nutrition food level

This guide provides information on how you can select soy-free foods by properly reading Nutrition Facts food labels. A Registered Dietitian can provide detailed nutrition education to help you develop a personal action plan.

A soy-free diet is indicated for soy protein allergy. The common allergens are listed either within the ingredient list or after the list. For example, if a product contains natto, a food made with fermented soybean, the product’s label should list the term “soy” either after the term natto, or state “contains soy” after the list of ingredients. The FDA currently does not require manufacturers to state if the food was processed in a facility that also processes the 8 common food allergens.

Anyone allergic to soy should avoid the following ingredients and foods:

Soy: in all forms, including soy flour, soy fiber, soy albumin, soy grits
Soy milk, soy ice cream, soy cheese, soy yogurt
Soybean (curd and granules)
Soy protein (concentrate, isolate, hydrolyzed)
Soya
Soy nuts and soy sprouts
Soy sauce and shoyu sauce
Tofu and textured vegetable protein (TVP)
Edamame
Miso
Natto
Tempeh
Tamari
Hoisin

You might want to avoid or be mindful when considering the following:

Certain foods that may contain soy protein include Asian cuisine or foods that contain natural and artificial flavoring, vegetable broth, vegetable gum, or vegetable starch.
Be cautious or avoid items labeled as hydrolyzed plant protein, hydrolyzed vegetable protein, protein extender, and protein filler.
Soy has been found in things like vodka, alternative nut butters, ice cream, baby food, and low-fat peanut butter.

Studies have shown that most people with soy allergy can safely eat foods containing soy lecithin and soybean oil. The oil should not be cold-pressed,
expeller-pressed, or extruded.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Thyroid Disease” use_theme_fonts=”yes”][vc_column_text]

People of all ages and races can get thyroid disease. Learn what causes it and how it’s treated.

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What is the thyroid?

The thyroid is a small gland, shaped like a butterfly, that rests in the middle of the lower neck. Its primary function is to control the body’s metabolism (rate at which cells perform duties essential to living). To control metabolism, the thyroid produces hormones, T4 and T3, which tell the body’s cells how much energy to use.

A properly functioning thyroid will maintain the right amount of hormones needed to keep the body’s metabolism functioning at a satisfactory rate. As the hormones are used, the thyroid creates replacements.

The quantity of thyroid hormones in the bloodstream is monitored and controlled by the pituitary gland. When the pituitary gland, which is located in the center of the skull below the brain, senses either a lack of thyroid hormones or a high level of thyroid hormones, it will adjust its own hormone (TSH) and send it to the thyroid to tell it what to do.

What is thyroid disease?

When the thyroid produces too much hormone, the body uses energy faster than it should. This condition is called hyperthyroidism. When the thyroid doesn’t produce enough hormone, the body uses energy slower than it should. This condition is called hypothyroidism. There are many different reasons why either of these conditions might develop.

Who is affected by thyroid disease?

Currently, about 20 million Americans have some form of thyroid disease. People of all ages and races can get thyroid disease. However, women are 5 to 8 times more likely than men to have thyroid problems.

What causes thyroid disease?

There are several different causes of thyroid disease. The following conditions cause hypothyroidism:

Thyroiditis is an inflammation of the thyroid gland. This can lower the amount of hormones produced.
Hashimoto’s thyroiditis is a painless disease of the immune system that is hereditary.
Postpartum thyroiditis occurs in 5% to 9% of women after giving birth. It is usually a temporary condition.
Iodine deficiency is a problem affecting approximately 100 million people around the world. Iodine is used by the thyroid to produce hormones. Although prevalent before the 1950s in the United States, iodine deficiency has been virtually wiped out by the use of iodized salt.
A non-functioning thyroid gland affects one in 4,000 newborns. If the problem isn’t corrected, the child will be physically and mentally retarded. All newborns are given a screening blood test in the hospital to evaluate thyroid function.

The following conditions cause hyperthyroidism:

With Graves’ disease, the entire thyroid gland might be overactive and produce too much hormone. This problem is also called diffuse toxic goiter (enlarged thyroid gland).
Nodules might be overactive within the thyroid. A single nodule is called toxic autonomously functioning thyroid nodule, while several nodules are called a toxic multi-nodular goiter.
Thyroiditis, a disorder that can be painful or painless, can also release hormones that were stored in the thyroid gland causing hyperthyroidism for a few weeks or months. The painless variety occurs most frequently in women after childbirth.
Excessive iodine is found in a number of drugs such as Amiodarone, Lugol’s solution (iodine), and some cough syrups, and might cause the thyroid to produce either too much or too little hormone in some individuals.

What are the symptoms of hypothyroidism and hyperthyroidism?

The following are symptoms for hypothyroidism:

Fatigue
Frequent, heavy menstrual periods
Forgetfulness
Weight gain
Dry, coarse skin and hair
Hoarse voice
Intolerance to cold

The following are symptoms for hyperthyroidism:

Irritability/nervousness
Muscle weakness/tremors
Infrequent, scant menstrual periods
Weight loss
Sleep disturbances
Enlarged thyroid gland
Vision problems or eye irritation
Heat sensitivity

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How is thyroid disease diagnosed?

Thyroid disease can be difficult to diagnose because symptoms are easily confused with other conditions. Fortunately, there is a test, called the thyroid stimulating hormone (TSH) test, that can identify thyroid disorders even before the onset of symptoms. The Journal of the American Medical Association found that screening for mild thyroid failure in women and men over age 35 is as cost-effective as screening for more common problems such as high cholesterol or high blood pressure.

When thyroid disease is caught early, treatment can control the disorder even before the onset of symptoms.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1568280804246-2-6″][vc_column_text]

How is thyroid disease treated?

The goal of treatment for any thyroid disorder is to restore normal blood levels of thyroid hormone.

Hypothyroidism is treated with a drug called levothyroxine. This is a synthetic hormone tablet that replaces missing thyroid hormone in the body. With careful monitoring, your doctor will adjust your dosage accordingly, and you’ll soon be able to return to your normal lifestyle.

Hyperthyroidism, generally more difficult to treat, requires the normalization of thyroid hormone production. Treatment could involve drug therapy to block hormone production, radioactive iodine treatment that disables the thyroid, or even thyroid surgery to remove part or the entire gland.

The most popular treatment is radioactive iodine. This therapy often results in hypothyroidism, requiring the use of levothyroxine (synthetic replacement hormone) in order to restore normality.

Thyroid diseases are life-long conditions. With careful management, people with thyroid disease can live healthy, normal lives.

The bacteria that cause typhoid fever is spread through contaminated food, drink, or water. If you are traveling to an area where typhoid fever is common, talk with your doctor about getting vaccinated.

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What is typhoid fever?

Typhoid fever is a bacterial infection that can be life-threatening. Most cases of typhoid fever occur in developing nations. However, the disease can occur anywhere, including industrialized countries like the U.S.

Who is most at risk for getting typhoid fever?

Individuals are most at risk for the disease in developing nations where good sanitation is lacking and people have limited access to clean water and safe foods. These areas are primarily in parts of Asia, Central and South America, Africa, and the Caribbean. Typhoid fever is less common in industrialized nations like the U.S. Most cases of typhoid fever in developed countries occur in returning travelers who can spread the illness to others or in contaminated foods. It is estimated that approximately 5,700 cases occur each year in the U.S. (but only 400 are confirmed).

What causes typhoid fever?

The bacterium Salmonella typhi (S. typhi) causes typhoid fever. The bacteria spreads through contaminated food, drink, or water. People infected with Salmonella typhi carry the bacteria in their intestinal tract and blood.

Salmonella typhi is shed (discarded from the body) in feces (stool). You may get typhoid fever if you ingest food or beverages prepared by someone who is shedding the bacteria and who does not wash their hands properly. In less developed countries, sewage containing Salmonella typhi may contaminate local water supplies.

In some cases, people who have previously had typhoid fever still carry Salmonella typhi bacteria. These people are carriers of the disease. They may spread the infection even when they have no symptoms (the famous case of “Typhoid Mary” in the U.S.).

What are the symptoms of typhoid fever?

In early stages of the disease, symptoms include: abdominal pain, fever, and a general feeling of being unwell. These initial symptoms are similar to other illnesses.

As typhoid fever gets worse, symptoms often include:

High fever of up to 104 degrees Fahrenheit
Headaches
Abdominal pain, constipation then perhaps diarrhea later
Small, red spots on your abdomen or chest (rose-colored spots)
Loss of appetite and weakness

Other symptoms of typhoid fever include:

Body aches
Bloody stools
Chills
Severe fatigue
Difficulty paying attention
Agitation, confusion, and hallucinations (seeing or hearing things that are not real)

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How is typhoid fever diagnosed?

Doctors use a simple blood or stool test to diagnose typhoid fever. This test identifies the presence of Salmonella typhi in blood or stool samples.

In the U.S., doctors may not consider typhoid fever at first because it is uncommon. It’s important to tell your doctor if you have traveled to an area where typhoid fever could be present or if you think you’ve been exposed to someone who could have the infection.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1568281577107-2-3″][vc_column_text]

How is typhoid fever treated?

Antibiotics are used to treat typhoid fever. These medications kill the bacteria that cause the infection. Several different types of antibiotics are used to treat typhoid fever. In many cases, typhoid fever is treated with ampicillin, chloramphenicol, or cotrimoxazole (Bactrim®). However, doctors also use fluoroquinolones (including Cipro® and Levaquin®), cephalosporins (including Cefepime®), and azithromycin.

Your doctor will choose based on the most up-to-date recommendations. Antibiotics are widely available in the United States and in most other countries in the world. Do not attempt to self-treat with leftover antibiotics.

Some people need supportive therapies, such as fluid or electrolyte replacement, depending on the severity of the infection.

What complications are associated with typhoid fever?

People who do not receive treatment for typhoid fever may have symptoms of the disease for months. In those cases, complications, like kidney failure or intestinal hemorrhage (severe bleeding), are possible. In severe cases, typhoid fever is fatal if left untreated. They may also become carriers and spread the illness to others.

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Can typhoid fever be prevented?

If you are traveling outside the U.S., you can lower your risk of contracting the disease by:

Receiving a typhoid fever vaccination. Currently, two vaccines are available to help prevent the spread of typhoid fever. Talk with your doctor about getting vaccinated.
Avoiding food that is raw or undercooked
Drinking only bottled water or water that has been boiled
Thoroughly washing your hands each time before eating
Avoiding raw fruits and vegetables that cannot be peeled.
Avoiding eating foods and beverages purchased from street vendors.

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What is the prognosis (outlook) for people with typhoid fever?

For most people who receive treatment with antibiotics, typhoid fever symptoms improve within 2 to 4 weeks. Your symptoms may return if you do not finish your entire treatment that your doctor recommends.[/vc_column_text][/vc_tab][vc_tab title=”Living With” tab_id=”1568281689026-5-1″][vc_column_text]

When should I call my doctor?

If you develop any of the symptoms of typhoid fever or your condition does not improve, contact your doctor immediately. He or she can evaluate you to determine if you are infected. If you are traveling outside the U.S. and develop any of the symptoms of typhoid fever, contact that country’s U.S. consulate for a list of recommended doctors.

Tonsillitis is an infection of the tonsils that causes a very sore throat. Most common in children, tonsillitis can affect all ages. Treatment depends on the cause of the infection.

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What is tonsillitis?

Tonsillitis occurs when the tonsils become infected and inflamed. Tonsils are the two small lumps of soft tissue — one on either side — at the back of the throat. You can see your tonsils in a mirror by opening your mouth and sticking out your tongue.

As part of your immune system, tonsils trap some of the germs that make you sick. When tonsils become infected, they get swollen and sore, and swallowing may hurt. Tonsillitis is also called tonsillopharyngitis, but most people call it a sore throat.

How common is tonsillitis?

Tonsillitis is very common. Most people have tonsillitis at least once in their lifetime.

Who is affected by tonsillitis?

Tonsillitis is most common in children, but it can affect people of all ages. Tonsillitis rarely occurs in children under the age of 3.

What are the symptoms of tonsillitis?

Symptoms of tonsillitis usually come on suddenly. Common symptoms include:

Sore or scratchy throat
Pain or difficulty swallowing
Red, swollen tonsils and throat
Whitish spots on the tonsils, or a white, yellow or gray coating on the tonsils
Fever above 100.4 degrees
Swollen lymph nodes (glands on the sides of your neck below your ears)
Stomachache or vomiting (more frequently in younger children)

What causes tonsillitis?

A virus or bacteria causes tonsillitis. The two types of tonsillitis are:

Viral tonsillitis: Most cases (up to 70 percent) of tonsillitis are caused by a virus such as cold or flu (influenza).
Bacterial tonsillitis (strep throat): Other cases of tonsillitis are caused by group A Streptococcus bacteria. Bacterial tonsillitis is commonly called strep throat.

How do people get tonsillitis?

The viruses and bacteria that cause tonsillitis are highly contagious. They are passed along by:

Kissing or sharing utensils, food or drink
Coming into close contact with someone who is sick
Touching a contaminated surface and then touching your nose or mouth
Inhaling tiny particles that become airborne when a sick person sneezes or coughs

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How is tonsillitis diagnosed?

To diagnosis tonsillitis, your doctor will:

Examine your throat for redness, swelling or white spots on the tonsils
Ask about other symptoms you’ve had, such as a fever, cough, runny nose, rash or stomachache
Look in your ears and your nose for other signs of infection
Feel the sides of your neck to see if the lymph nodes are swollen and tender

After confirming a tonsillitis diagnosis, your doctor will need to determine whether the infection results from a virus or bacteria (strep throat).

How is strep throat diagnosed?

Your doctor may order a throat culture — also known as a strep test — to determine if you have strep throat. A throat culture is a simple test that checks for the presence of specific bacteria in your throat. During a throat culture:

Your doctor will swipe the back of your throat with a long cotton swab to gather saliva and cells. The test may feel uncomfortable, but it is not painful.
While you wait, your doctor will test the cells to check for bacteria. This test is called a “rapid strep test.” The results are ready in about 10-15 minutes.
If the results are positive and the test does detect bacteria, your doctor will prescribe an antibiotic to treat you for strep throat.
If the results are negative and the rapid strep test does not detect bacteria, your doctor may send the sample away to a lab for more thorough testing. This longer lab test usually takes 2-3 days to get results.
If the lab test results come back negative, you’ll know the tonsillitis is viral, not bacterial.

How do I know if I have tonsillitis?

If you have a sore throat, swollen tonsils and pain with swallowing, you may have tonsillitis. You should visit your doctor to determine whether bacteria or a virus is causing the tonsillitis. The treatment varies based on the type of infection.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1568281064310-2-3″][vc_column_text]

What are the treatments for tonsillitis?

The treatment you receive depends on the infection’s cause. While the symptoms of viral tonsillitis and bacterial tonsillitis can be similar, their treatments are different.

What is the treatment for strep throat?

Strep throat (tonsillitis caused by bacteria) is treated with an antibiotic medication. Antibiotics require a prescription from your doctor. You usually take antibiotics orally (by mouth) for about 10 days. The most common antibiotics for strep throat are:

Penicillin
Clindamycin
Cephalosporin

It is very important to follow your doctor’s instructions and take the full course of antibiotics, even if you are feeling better after a couple of days. You must finish the antibiotics so the infection doesn’t come back, get worse, or spread to another part of your body.

What are the side effects of the treatment for strep throat?

Side effects from antibiotics used to treat bacterial tonsillitis (strep throat) include:

Upset stomach
Diarrhea
Vomiting
Headache
Vaginal itching and yeast infection

What is the treatment for viral tonsillitis?

The antibiotics used to treat strep throat (bacterial tonsillitis) will not work on tonsillitis caused by a viral infection. To relieve the symptoms of viral tonsillitis, your doctor will recommend:

Plenty of rest
Fluids to stay hydrated
Over-the-counter pain relievers like ibuprofen or acetaminophen
Throat lozenges

What are the complications associated with tonsillitis?

Complications from tonsillitis are usually associated with strep throat and the streptococcal bacteria. They include:

Chronic tonsillitis: People who have tonsillitis more than 7 times a year may have chronic tonsillitis. Doctors may recommend surgery to remove the tonsils, especially if you are snoring or having trouble sleeping at night. This surgery is called tonsillectomy.
Scarlet fever: Strep throat can progress into scarlet fever, causing a red rash and fever. Scarlet fever occurs more often in children than adults, but it is not common.
Peritonsillar abscess: In severe cases of tonsillitis, an abscess (a collection of pus) can form around the tonsil. Peritonsillar abscesses occur more often in adults and adolescents than in children. Doctors often recommend surgery to drain the abscess.
Rheumatic fever: Although rare, rheumatic fever can occur if strep throat is not treated or you don’t complete the full course of antibiotics. Rheumatic fever occurs in children more often than adults. It can lead to permanent heart damage.
Spread of infection: When left untreated, streptococcal bacteria can spread from the throat to the middle ear, sinuses, or other parts of the body. This infection can lead to complications such as sinusitis, glomerulonephritis, or necrotizing fasciitis.

What can I do to help relieve symptoms of tonsillitis?

To relieve the symptoms of viral and bacterial tonsillitis, you can:

Take an over-the-counter pain reliever such as acetaminophen or ibuprofen.
Drink warm liquids, like tea, apple cider or broth.
Gargle with warm salt water.
Try throat lozenges.

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How can you prevent tonsillitis?

To reduce your risk of developing tonsillitis, you should:

Wash your hands often, especially before touching your nose or mouth.
Avoid sharing food, drink, or utensils with someone who is sick.
Replace your toothbrush regularly.

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What is the outlook for people who have tonsillitis?

Most cases of viral tonsillitis clear up in a few days with fluids and plenty of rest. Antibiotics usually eliminate bacterial tonsillitis (strep throat) in about 10 days. Tonsillitis usually doesn’t cause any serious or lasting health problems.

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When should I call my doctor about tonsillitis?

You should contact your doctor if you have:

Sore throat for more than 2 days
Fever over 101 degrees
Trouble or pain when swallowing
Difficulty breathing
Tonsils that are swollen or painful

A urinary tract infection (UTI) causes the lining of the urinary tract to become red and irritated, which may produce symptoms including pain, blood in the urine, and an urgent need to urinate.

[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”10ad5775-bbdd-2″][vc_column_text]The urinary tract makes and stores urine, one of the body’s liquid waste products. The urinary tract includes the following parts:

Kidneys, which produce urine by removing waste and water from the blood
Ureters, the tubes that carry urine from the kidneys to the bladder
Bladder, the sac-like container for storing urine
Urethra, the tube that carries urine from the bladder to outside of the body

What is a urinary tract infection?

Normal urine contains no bacteria (germs). Sometimes, however, bacteria from outside the body get into the urinary tract, and cause infection and inflammation. This is a urinary tract infection. The infection can involve the urethra (a condition called urethritis), kidneys (a condition called pyelonephritis) or bladder, (a condition called cystitis). Cystitis is the most common type of urinary tract infection.

How common are urinary tract infections?

Urinary tract infections are very common, occurring in 1 out of 5 women sometime in their lifetime. One to 2% of children develop urinary tract infections. Each year, 8 million to 10 million visits to doctors are for urinary tract infections.

Who gets urinary tract infections?

Anyone can get a urinary tract infection, but they are more common in women. This is because the urethra in females is shorter and closer to the anus, where E. coli bacteria are common. Older adults also are at higher risk for developing cystitis. This increased risk may be due to incomplete emptying of the bladder related to various medical conditions, including an enlarged prostate or a bladder prolapse (i.e., falling down or slipping of the bladder from its usual position). If you get frequent urinary tract infections, your doctor may do tests to check for other health problems—such as diabetes or an abnormal urinary system—that may be contributing to your infections.

What are the symptoms of a urinary tract infection?

A urinary tract infection causes the lining of the urinary tract to become red and irritated, which may produce some of the following symptoms:

Pain in the flank (side), abdomen or pelvic area
Pressure in the lower pelvis
Frequent need to urinate (frequency)
Painful urination (dysuria)
Urgent need to urinate (urgency)
Incontinence (urine leakage)
The need to urinate at night
Abnormal urine color (cloudy urine)
Blood in the urine
Strong or foul-smelling urine

Other symptoms that may be associated with a urinary tract infection include:

Pain during sex
Penis pain
Flank (side of the body) pain
Fatigue
Fever (temperature above 100oF)
Chills
Vomiting
Mental changes or confusion

What causes a urinary tract infection?

Urinary tract infections are caused by microorganisms—usually bacteria—that enter the urethra and bladder, causing inflammation and infection. The bacteria also may travel up the ureters and infect the kidneys.

More than 90 percent of cystitis cases are caused by E. coli, a bacterium normally found in the intestines.

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How are urinary tract infections diagnosed?

Your doctor will use the following tests to diagnose a urinary tract infection:

Urinalysis to examine the urine for red blood cells, white blood cells and bacteria (The number of white and red blood cells can indicate an infection.)
Urine culture to determine the type of bacteria in the urine. This is important to help determine the appropriate treatment.

If your infection does not respond to treatment or if you get repeated infections, your doctor may use the following tests to examine your urinary tract for disease or injury:

Intravenous pyelogram (IVP), a series of X-rays of the bladder, kidneys and ureters after a special dye is injected (The dye helps the structures to show up better on the X-ray.)
Ultrasound, a test that uses sound waves to form images of internal organs
Cystoscopy, a test that uses a special instrument fitted with a lens and a light source (cystoscope) to see inside the bladder from the urethra
CT scan, a type of X-ray that takes cross sections of the body (like slices) – much more precise than typical X-rays

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How are urinary tract infections treated?

Antibiotics, medicines that kill the bacteria, are used to treat urinary tract infections. Your doctor will choose a drug that best treats the bacteria causing your infection. Commonly used antibiotics include:

Nitrofurantoin
Sulfonamides (sulfa drugs)
Amoxicillin
Cephalosporins
Trimethoprim/sulfamethoxazole (Bactrim®)
Doxycycline
Quinolones (such as ciprofloxacin [Cipro®])

It is very important that you follow your doctor’s directions for taking the medicine. Do not stop taking the antibiotic because your symptoms go away and you start feeling better. If you have a history of frequent urinary tract infections, you may be given a prescription for antibiotics that you would take at the first onset of symptoms. Other patients may be given antibiotics to take every day, every other day, or after sexual intercourse to prevent the infection. If the infection is not treated completely with the full course of antibiotics, it can return.

What are the complications of a urinary tract infection?

A urinary tract infection that is not treated can lead to a more serious infection of the kidneys.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1568282276817-3-8″][vc_column_text]

Can urinary tract infections be prevented?

There are some steps you can take to reduce your risk of developing a urinary tract infection:

Follow good hygiene practices of the genital area (especially women). After a bowel movement, the genitals should be wiped from front to back to reduce the chance of dragging E. coli bacteria from the rectal area to the urethra.
Urinate frequently. This flushes bacteria out of the bladder and may reduce the risk of cystitis in those who are prone to urinary tract infections. Drinking plenty of fluids encourages frequent urination. Avoid fluids and foods that irritate the bladder, such as alcohol, citrus juices, drinks containing caffeine and spicy foods. Also avoid smoking during this time.
Urinate immediately before and after sex. This may help flush out bacteria that may have been introduced during intercourse. Wash the genital area with warm water before having sex.
Apply an estrogen-containing vaginal cream in post-menopausal women to reduce the risk of a urinary tract infection. Your physician will decide with you if this is something that may benefit you. The estrogen cream changes the pH of the vagina to make one less susceptible to infections.
Drink at least 6-8 glasses of water a day
Don’t douche
Don’t use feminine deodorants on your genital area
Change tampons and feminine pads often
Use a water-based lubricant during sex if you have vaginal dryness
Check with your doctor if you think your diaphragm is causing infection
Wear cotton underwear
Take showers instead of baths
Avoid tight-fitting clothing and pantyhose

[/vc_column_text][/vc_tab][vc_tab title=”Outlook / Prognosis” tab_id=”1568282288826-4-8″][vc_column_text]

What is the prognosis (outlook) for a person with a urinary tract infection?

While urinary tract infections may be uncomfortable, they generally respond well to treatment.[/vc_column_text][/vc_tab][vc_tab title=”Living With” tab_id=”1568282343885-5-6″][vc_column_text]

When should I call my health care provider?

Call your health care provider if you have symptoms of a urinary tract infection. Also call if you have been diagnosed with an infection and your symptoms get worse or you develop new symptoms, especially fever, back pain and vomiting.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”Varicose & Spider Veins” use_theme_fonts=”yes”][vc_tabs][vc_tab title=”Overview” tab_id=”16237664-f49d-1″][vc_column_text]

What are varicose and spider veins?

Varicose veins are abnormal, dilated blood vessels caused by a weakening in the vessel wall. They may appear as swollen, twisted clusters of blue or purple veins. Varicose veins are sometimes surrounded by thin, red capillaries known as spider veins (group of tiny blood vessels located close to the surface of the skin, also called telangiectasias).

Varicose and spider veins can appear anywhere, but most often appear on the legs and in the pelvic area. Most varicose veins develop near the surface of the skin.

Who gets varicose and spider veins?

Varicose veins are common and are usually not a sign of a serious medical problem. Varicose and spider veins are seen more often in women than in men. They become more prevalent with age and have been reported to affect from 30 to 50 percent of the adult population. The incidence varies depending on the group of people who are studied.

What causes varicose and spider veins?

Varicose veins occur when healthy vein walls become weak and the vein enlarges. Blood can “pool” or collect inside the vein. Varicose veins are related to increased pressure in the leg veins or defective valves in the veins.

The exact cause of varicose veins is unknown, but there are a number of factors that contribute to the development of varicose and spider veins. Risk factors for varicose and spider veins include:

Varicose Veins

Heredity or family history of varicose veins
Advancing age
Prolonged standing (especially for people who work in occupations such as nurses, beauticians, teachers, factory workers and others)
Being overweight
Hormonal influences during pregnancy
The use of birth control pills
Post-menopausal hormonal replacement therapy
Prolonged sitting with legs crossed
Wearing tight undergarments or clothes
A history of blood clots
Injury to the veins
Conditions that cause increased pressure in the abdomen including liver disease, fluid in the abdomen, previous groin surgery, or heart failure

Other reported factors include topical steroids, trauma or injury to the skin, previous venous surgery and exposure to ultra-violet rays.

When should I call the doctor?

Call your doctor if:

Varicose veins make walking or standing painful
A sore or tender lump develops on or near a varicose vein
You have swelling in the feet or ankles
Your leg suddenly becomes swollen and painful
Skin over a varicose vein bleeds on its own or when injured
You have any other symptoms that cause concern

What are the symptoms of varicose veins?

Some people do not have symptoms but may be concerned about the appearance of the veins. If symptoms occur, they may include:

Tiredness, burning, throbbing, tingling or heaviness in the legs
Itching around the vein
Swollen legs
Muscle cramps, soreness or aching in the legs
Brown discoloration of the skin, especially around the ankles
Leg ulcers

Symptoms usually worsen after prolonged standing or sitting. In women, symptoms may be worse during menstruation or pregnancy. Occasionally varicose veins can form a painful blood clot, referred to as superficial thrombophlebitis (inflammation of a vein).[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”5411868c-e11f-6″][vc_column_text]

How are varicose veins diagnosed?

During a physical exam, the doctor will check your legs while you are standing. Your doctor also may request that you have a Doppler scan, an ultrasound exam to check the blood flow in the veins near the skin’s surface (called superficial) and the deep veins.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”1568282623742-2-8″][vc_column_text]

When is treatment necessary?

Varicose and spider veins may require medical treatment. If varicose veins make walking or standing painful, you should ask your doctor for advice. You also should call your doctor if a sore develops on or near a varicose vein or if your feet or ankles swell.

In some cases, varicose veins can be harmful to your health when they are associated with these conditions:

Venous stasis ulcers that result when the enlarged vein does not provide enough drainage of fluid from the skin. As a result, an ulcer (open sore) may form.
Fungal and bacterial infections may occur as the result of skin problems caused by fluid buildup (edema) in the leg. These infections also increase the risk of tissue infection (cellulitis).
Thrombophlebitis: Inflammation of the vein due to blood clot formation.
Venous hemorrhage: Bleeding in the vein.

Complications are more likely when varicose veins are the result of a problem or disease in the deep veins or in the perforating veins which connect the deep and superficial veins, such as deep vein thrombosis (DVT) or chronic venous insufficiency. Ask your doctor if you have an increased risk of developing any of these conditions.

What are the treatment options?

The goals of treatment are to reduce symptoms and reduce the risk of complications. Since not all varicose and spider veins require medical treatment, the goal of treatment may be simply to improve the appearance of the affected areas.

Compression therapy and lifestyle change

Wearing properly fitting support hose (also called compression stockings) is the most conservative approach for treating varicose veins, especially when the veins are symptomatic. Compression stockings can be purchased at some pharmacies and medical supply stores and come in various styles including below-the-knee, above- the-knee and pantyhose styles. They also come in different compressions varying from 8 to 10 mmHg, up to as high as 40 to 50 mmHg. Your doctor can recommend the compression that is right for you.

Other conservative treatment methods include:

Practicing good skin hygiene
Losing weight if you are overweight
Exercising regularly (especially walking)
Avoiding prolonged periods of sitting or standing
Elevating your legs while sitting and sleeping

When you need to stand for long periods, take frequent breaks – sit down and elevate your feet.

If you do not achieve satisfactory relief of symptoms with conservative treatment, or if the appearance of the veins is bothersome, other treatments may be offered, depending on your overall medical condition and the size and location of the veins. Other treatment options include sclerotherapy, laser and light therapy, minimally invasive procedures and surgery. These techniques are described below.

Sclerotherapy

Sclerotherapy involves the injection of a solution directly into the varicose veins that cause them to collapse and disappear. Several sclerotherapy treatments usually are required to achieve the desired results.

Foam sclerotherapy is a variation of the procedure performed under ultrasound guidance that involves the injection of a foaming agent mixed with a sclerosing agent. The foaming agent moves blood out of the vein so the sclerosing agent will have better contact with the vein wall.

Sclerotherapy is a simple procedure that can be performed in the doctor’s office. Sclerotherapy can eliminate the pain and discomfort of varicose veins and helps prevent complications such as venous hemorrhage and ulceration. It is also frequently performed for cosmetic reasons.

Laser and Light Therapy

Laser and pulse-light therapy are used to heat the blood vessel to shrink it. Laser therapy is most effective for the treatment of small varicose veins and spider veins. Laser therapy may be used as an additional treatment after sclerotherapy, endovenous procedures, or surgery of larger veins. Lasers are also being used for endovenous ablation of larger varicose veins. Laser treatments may require several sessions, spaced at six-week intervals, to properly treat the vein.

High-intensity, pulsed light (photoderm or light therapy) is another treatment option. It is different than laser and pulse-light therapy because a spectrum of light is emitted during treatment, rather than a single wave-length. It can be used to selectively shrink abnormal veins including small spider veins, certain varicose veins and vascular birthmarks.

This treatment may be recommended when sclerotherapy or laser therapy does not effectively treat the vein or for patients who do not like needles.

Minimally Invasive Procedures

Endovenous thermal ablation therapy is a procedure that uses laser or high-frequency radio waves are to create intense local heat in the varicose vein. A tiny cut is made in your skin near the varicose vein (generally below the knee). Your doctor inserts a small catheter (tube) into the vein. A device at the tip of the catheter heats up the inside of the vein and closes it off. The technology is different with each type of energy source, but both forms of local heat close up the targeted vessel. This treatment closes off the problem veins but leaves them in place so there is minimal bleeding and bruising. You are awake during this procedure, but your doctor numbs the area around the vein. Compared with ligation and stripping, endovenous thermal ablation results in less pain and a faster return to normal activities, with similar symptomatic improvement and cosmetic results.

Micropuncture or micro-incision or stab phlebectomy is performed in an outpatient surgery center. The physician makes a tiny incision and uses a surgical instrument or a large needle to hook the problem vein through the opening. The vein is then removed a tiny piece at a time.

Transilluminated power phlebectomy is an enhanced version of stab phlebectomy and was developed to reduce the number of incisions, pain, bleeding and scarring. The procedure involves inserting a fiberoptic light under the skin while simultaneously injecting a mixture of saline and local anesthetic. This creates a silhouette of the veins to guide the surgeon in placing a powered tissue resector. This instrument cuts the vein into smaller pieces and suctions the pieces from the space.

Surgery

Surgery may be the best treatment when varicose veins are severe and associated with problems such as bleeding, or symptoms including pain or swelling. Several surgical treatments are available, including endoscopic options. Before choosing any treatment option, it is important to discuss the potential benefits, risks, and side effects with your health care provider. Surgical treatments are performed in the hospital or outpatient setting by a vascular specialist.

Ligation and stripping often are performed in combination. Vein ligation is a surgical treatment for varicose veins. In this minor procedure, a vascular specialist cuts and ties off the problem veins. Most patients recover in a few days and can resume their normal activities.

Stripping is the surgical removal of larger varicose veins through two small incisions. Stripping is a more extensive procedure and may require up to 10 days for recovery. It usually causes bruising for several weeks after surgery.

Will my insurance cover the cost of treatment?

Many insurance companies cover the cost of treating varicose veins, but generally not spider veins. Please check with your insurance company before considering a particular treatment option.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1568282701335-3-10″][vc_column_text]

How can I prevent varicose veins?

Avoid wearing tight-fitting undergarments and clothing that constricts the waist, groin or legs.
Avoid crossing your legs while seated.
Avoid sitting or standing in one position for prolonged periods of time.
Exercise regularly to increase circulation.
Lose weight if you are overweight.
Sit or lay down and elevate your legs at least twice a day for 30 minutes at a time.

Article discusses complications of being overweight and offers tips on sensible weight control.

[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”c33854e6-8774-6″][vc_column_text]

How do I know if I am obese?

Obesity is defined as an excess proportion of total body fat. Speak with your doctor if you are concerned about your weight and if you are attempting weight loss. You should call your doctor if you need help in losing weight or if you fall into either of these categories:

Body mass index (BMI): If your BMI is 30 or greater, you’re considered obese and should talk to your doctor about losing weight for your health.
Waist circumference: If you have an “apple shape” — a “potbelly” or “spare tire” — you carry more fat in and around your abdominal organs. Fat in your abdomen increases your risk of many of the serious conditions associated with obesity. Women’s waist measurement should fall below 35 inches. Men’s should be less than 40 inches. If you have a large waist circumference, talk to your doctor about weight loss.

Can being overweight lead to medical problems?

Yes. Being overweight is linked to a number of health problems, including:

Heart disease and stroke
High blood pressure
Diabetes
Cancer
Gallbladder disease and gallstones
Osteoarthritis
Gout
Breathing problems, such as sleep apnea (when a person stops breathing for a short time during sleep) and asthma

Someone who is 40% overweight is twice as likely to die prematurely as an average-weight person. (This effect is seen after 10 to 30 years of being obese.)

Doctors generally agree that the more obese a person is, the more likely it is that he or she will have health problems. People who are 20% or more overweight can gain significant health benefits from weight loss. Many obesity experts believe that people who are less than 20% above their healthy weight should try to lose weight if they have any of the following risk factors.

Family history of certain chronic diseases: People with close relatives who have had heart disease or diabetes are more likely to develop these problems if they are obese.
Pre-existing medical conditions: High blood pressure, high cholesterol levels, or high blood sugar levels are all warning signs of some obesity-associated diseases.
“Apple” shape: People whose weight is concentrated around the abdomen may be at greater risk of developing heart disease, diabetes, or cancer than people of the same weight who are “pear-shaped.”

Fortunately, even a modest weight loss of 10 to 20 pounds can bring significant health improvements, such as lower blood pressure and cholesterol levels.

What causes obesity?

In scientific terms, obesity occurs when a person’s calorie intake exceeds the amount of energy he or she burns. What causes this imbalance between consuming and burning calories is unclear. Evidence suggests that obesity often has more than one cause. Environmental, psychological, genetic, and other factors all may play a part.

Environmental factors: A person’s environment plays a significant role in weight status. Environment includes lifestyle behaviors, such as what a person eats and how active he or she is. Americans tend to have high-fat diets, often putting taste and convenience ahead of nutritional content when choosing meals. People can change what they eat and how active they are as a means of changing their weight status.

Psychological factors: Psychological factors also may influence eating habits. Many people eat in response to negative emotions such as boredom, sadness, or anger.

About 30% of those who seek treatment for serious weight problems have difficulties with binge eating. During a binge eating episode, people eat large amounts of food while feeling they can’t control how much they are eating. Those with the most severe binge eating problems are considered to have what is called binge eating disorder. These people may have more difficulty losing weight and keeping the weight off than people without binge eating problems. Some will need special help, such as counseling or medication, to control their binge eating before they can successfully manage their weight.

Genetic factors: Obesity tends to run in families, suggesting that it may have a genetic cause. However, family members share not only genes but also diet and lifestyle habits that may contribute to obesity. Separating these lifestyle factors from genetic ones is often difficult. Still, growing evidence points to heredity as a strong determining factor of obesity. In one study of adults who were adopted as children, researchers found that their subjects’ adult weights were closer to their biological parents’ weights than their adoptive parents’. The environment provided by the adoptive family apparently had less influence on the development of obesity than the person’s genetic makeup. However, many people genetically predisposed to obesity do not become obese or are able to lose weight and keep it off.

Other causes of obesity: Some illnesses can lower the metabolism or trigger an increased appetite which can cause obesity. These include hypothyroidism, Cushing’s syndrome, depression, and certain neurologic problems. Certain drugs, such as steroids and some antidepressants, may cause excessive weight gain through the same methods. A doctor can determine if a patient has any of these conditions, which are believed to be responsible for only about 1% of all cases of obesity.[/vc_column_text][/vc_tab][vc_tab title=”Management and Treatment” tab_id=”f2404e31-22dc-10″][vc_column_text]

How is obesity treated?

The treatment of obesity needs to be long-term; it cannot be short-term. Weight loss should be gradual, and careful follow-up is necessary to prevent rebound weight gain. Changing behavior and lifestyle are the only ways to change a person’s weight permanently. These changes focus on gradual and permanent changes in eating and exercise habits. There are six ways you can change your behavior and lifestyle that will help you maintain weight loss:

Learning about nutrition
Changing your eating habits
Increasing your physical activity
Changing your attitudes about eating
Joining a weight loss program
Developing support systems
Following any drug therapies ordered by your doctor

The keys to weight management include making lifestyle changes, such as increasing exercise and activity and changing dietary habits.

What about prescription weight loss medications?

Prescription drugs are another approach to treating obesity. Drug therapy may help the patient learn and adapt to a healthier lifestyle. It should be used along with a program of diet and exercise and should help you follow your overall treatment plan.

The anti-obesity medications that are currently available work mainly by suppressing the appetite. They raise specific hormones such as noradrenalin or serotonin in the nervous system, creating a feeling of fullness. These medications will not work, however, unless you also make changes in your diet and lifestyle.

The level of success with anti-obesity drugs is rather modest. Studies show a mean weight loss of six to 10 pounds total and about one-half pound a week greater weight loss than with a placebo (for 12 weeks or less of treatment). Some individuals respond very well while others may not respond at all.

A weight loss medication is not a cure-all. The use of weight loss medications should be combined with physical activity and improved diet to lose and maintain weight successfully over the long term.

Weight loss medications can be considered for:

People with a BMI greater than 30 with no obesity-related conditions
People with a BMI of greater than 27 with two or more obesity-related conditions

Currently, most available weight-loss medications approved by the FDA are for short-term use, meaning a few weeks or months.

What about weight loss surgery?

Another treatment option may be surgery. Surgery should only be considered after all other attempts to lose weight have been unsuccessful, or if a person has an obesity-related disease. Surgery should only be done at centers committed to long-term follow-up and as an addition to diet, exercise, and behavior modification programs. Currently, candidates for these surgeries have to be:

Severely obese (A BMI greater than 35)
Well-informed
Assessed by dietician, psychologist, endocrinologist, and other specialists before being considered for the procedure

Surgical procedures have had the most long-term success, but it is important to consider the reasons for success or failure of previous weight-loss attempts as well as the risks and benefits of the surgery.[/vc_column_text][/vc_tab][vc_tab title=”Prevention” tab_id=”1568359627309-2-3″][vc_column_text]

How much exercise should I do?

Studies show that even the most inactive people can gain significant health benefits if they accumulate just 30 minutes or more of physical activity per day.

For the greatest overall health benefits, experts suggest 30 minutes of moderate-intensity aerobic exercise three or more times per week, plus some form of anaerobic exercise, such as muscle-strengthening activity and stretching twice a week.

If you have been inactive for a while, you may want to start with less strenuous activities, such as walking or swimming at a comfortable pace. Beginning at a slow pace will allow you to become physically fit without straining your body. Once you are in better shape, you can gradually do more strenuous activity.

How can I lose weight and then prevent gaining it back?

Keep the following tips in mind.

Set realistic weight loss goals, such as a one- to two-pound weight loss per week. Those who lose weight slowly, by eating less and exercising more, tend to keep their lost weight off. Even a half pound weight loss per week would result in a 25-pound loss over one year.
Eat fewer calories by cutting down on portion sizes. An easy way to portion a plate is to put fruits and vegetables on half, starch on one quarter of the plate, and protein on the other quarter of the plate.
Aim for at least five handfuls of fruits and vegetables per day.
Do not skip meals. This slows down metabolism and can lead to increased hunger and binging. Four to five “mini-meals” regularly spaced throughout the day may help satisfy your hunger while keeping your weight under control.
Feel free to include planned, healthy snacks between meals if you find you struggle with physical hunger during the day. Some examples would be fat-free Greek yogurt, cottage cheese and fruit, vegetables and hummus, string cheese and fresh fruit, or a palm full of nuts.
Choose foods high in fiber, such as whole grain breads, cereals, pasta, rice, fruits, and vegetables. These foods will give you more chewing satisfaction, while the higher fiber content may make you feel fuller on fewer calories.
To ensure that you are eating healthy, keep an accurate food journal. Write down everything you eat or drink. Be honest and accurate, otherwise the journal is not as helpful. The food journal will help you learn about your eating habits and help you assess the food choices you are making.
Eat a variety of foods. Include all food groups to get all the nutrients you need.
Limit restaurant foods.
Plan ahead: plan meals for the week, create a grocery list, and keep healthy foods available to you in your kitchen and pantry. Keep trigger foods out of the house and office.

[/vc_column_text][/vc_tab][vc_tab title=”Living With” tab_id=”1568359682182-3-9″][vc_column_text]

How do I spot a fad diet?

Fad diets typically do not support long-lasting weight loss results. Avoid fad diets, and focus instead of portion control, cutting down on empty calories like sweets and sugary drinks, and increasing exercise. While there is no set approach to identifying a fad diet, many have the following characteristics:

Recommendations that promise a quick fix
Dire warnings of dangers from a single product or regimen
Claims that sound too good to be true
Simplistic conclusions drawn from a complex study
Recommendations based on a single study
Dramatic statements that are refuted by reputable scientific organizations
Lists of “good” and “bad” foods
Recommendations made to help sell a product
Recommendations based on studies published without review by other researchers
Recommendations from studies that ignore differences among individuals or groups
Elimination of one or more of the five food groups

A wheat allergy develops when your immune system overreacts to the wheat you have eaten in foods such as cereal, pasta and bread. The overreaction could be in the form of hives, tongue, lip or throat swelling, stomach pain or something else.

[/vc_column_text][vc_tabs][vc_tab title=”Overview” tab_id=”845e5cab-f8b0-5″][vc_column_text]

What is wheat allergy?

A wheat allergy develops when your body, specifically your immune system, overreacts to the wheat you have eaten. This wheat could be found in foods such as cereal, pasta and bread. Your body’s overreaction could be in the form of hives, tongue, lip or throat swelling, stomach pain or something else. Currently there is no definitive, well-supported cure for wheat allergy, although food desensitization is being researched.

How common is wheat allergy?

Wheat allergy is most common in children but anyone can develop an allergy. Typically about two-thirds of children outgrow it. Some people with wheat allergy can eat other grains.

What are the risk factors of having a wheat allergy?

The risk of having a wheat allergy is greater if both your parents have allergies. If only one parent has allergies, your risk is lower.

What are the symptoms of a wheat allergy?

Symptoms of wheat allergy vary from person to person. They range from mild to severe and even deadly. The following are potential symptoms of someone with an allergic reaction to wheat:

Hives or skin rash
Nausea
Stomach cramps
Indigestion
Vomiting
Diarrhea
Stuffy or runny nose
Sneezing
Headaches
Asthma

These symptoms typically occur within 30-45 minutes of eating wheat, and each time ingestion takes place. Anaphylaxis – which can cause your body to go into shock due to low blood pressure, difficulty breathing, airway collapse or throat closing – is a life-threatening symptom of wheat allergy. During this reaction, your body releases chemicals that can lower blood pressure and narrow your airways.

What are the causes of wheat allergy?

Wheat allergy is caused when your body senses wheat as a dangerous and foreign substance and creates an immunoglobulin against it.[/vc_column_text][/vc_tab][vc_tab title=”Diagnosis and Tests” tab_id=”81ad5e65-5eaa-10″][vc_column_text]

How is a wheat allergy diagnosed?

An allergist will be able to tell you if you have an allergy or if it is another ailment.

The allergist will ask about your medical history. This includes information about allergies your parents may have.
The allergist will order a skin-prick test or a blood test. During the skin-prick test, a small amount of liquid containing wheat protein is placed on your back or forearm. It is then pricked with a small, sterile probe. If a raised, reddish mark forms, it could mean you are allergic to wheat.
For the blood test, a blood sample is sent to a laboratory. The test checks for the presence of immunoglobulin E antibodies to wheat protein. The results tell the allergist if there is a wheat allergy.
If these two tests do not give conclusive results, another test called a graded oral challenge may be performed. You would eat a small amount of wheat and see if a reaction develops. This food challenge takes place under medical supervision, since a severe reaction could occur.

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How is wheat allergy managed?

Managing wheat allergy means strictly avoiding wheat ingredients in food and nonfood goods. By law, manufacturers must include the presence of wheat on the ingredient label of packaged foods sold in the U.S. Wheat is found in a variety of food products such as pasta, crackers and some varieties of ice cream and hot dogs.

Other things to watch for in managing a wheat allergy:

For nonfood items, such as Play-Doh, where wheat is an ingredient, the labeling law does not apply. If unsure of the ingredients in a nonfood item, the manufacturer’s website or customer service center at the company will be able to give you more accurate product ingredients.
If you have a wheat allergy, you should also avoid products with cautionary labeling such as “made on shared equipment with wheat.” Not all manufacturers use this voluntary labeling.
When baking with a wheat allergy, you would need to use substitute grains such as soy, potato starch or rice. In addition when grocery shopping, you would need to be aware of selecting foods with grains other than wheat, such as oats, rye and barley.
Always read labeling on food and nonfood items and call the manufacturer if uncertain certain ingredients. As another precaution, always wash your hands and surfaces you touch to prevent accidental exposure to the allergen.

How is wheat allergy treated?

The first line of treatment is avoidance. This may be difficult and accidental exposures can occur. Patients with a severe allergy may experience anaphylaxis with even small accidental exposures. All allergic individuals should be prescribed an epinephrine auto-injector and be taught how and when to use it

Your allergist may also prescribe an antihistamine or corticosteroids to help with symptoms. However, these will not treat anaphylaxis.[/vc_column_text][/vc_tab][vc_tab title=”Outlook / Prognosis” tab_id=”1568360025805-3-7″][vc_column_text]

How do you live with wheat allergy?

Living with wheat allergy can be challenging, as symptoms can range from mild to severe. There is no way to predict how your body will react. One exposure to wheat may show a severe reaction and the next exposure a mild reaction. However, with caution and education, you can live a fulfilling life. Your allergist can recommend resources, support groups and dietitians who can help you with your day-to-day meals.[/vc_column_text][/vc_tab][/vc_tabs][/vc_column][/vc_row][vc_row el_class=”o-sapgap”][vc_column][vc_separator style=”dashed” border_width=”2″][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading stripe_pos=”hide” text=”White Tongue” use_theme_fonts=”yes”][vc_column_text]

White tongue is a condition in which the tongue is coated by a noticeable white film. The coating may cover the entire surface of the tongue, the back part of the tongue only, or may appear in patches. In most cases, white tongue is not a serious or long-lasting condition.

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What is white tongue?

In most cases, white tongue is not a serious or long-lasting condition.

What causes white tongue?

White tongue is commonly caused by a buildup of bacteria and/or fungi, along with dead cells trapped between the papillae (small bumps that contain the taste buds) on the surface of the tongue.

Since papillae are raised up, they create a large surface area on which debris and micro-organisms inside the mouth can easily collect. This buildup almost certainly contributes to bad breath and may also be a factor in poor gum health.

In rarer cases, white tongue may be caused by an infection or by the following conditions:

Leukoplakia: Leukoplakia is a common condition caused by overproduction of cells in the lining of the mouth. These cells combine with deposits of the protein keratin to form white patches. In many cases, irritation to the mouth and tongue comes from drinking alcohol or using tobacco products. Sometimes no cause can be found. The condition is usually not serious; however, in some cases, it can turn cancerous years or even decades after first appearing.
Oral lichen planus: Oral lichen planus, a chronic (long-term) inflammatory mouth condition, is caused by a disorder of the immune system (the body’s defense mechanism against microbes) and other outside invaders. It cannot be passed on to others.
Geographic tongue: Geographic tongue occurs while the skin on the tongue is renewing. Parts of the upper layer of skin on the tongue shed too quickly, leaving tender red areas that are prone to infection, while other parts of the skin remain in place too long and take on a white appearance. This condition cannot be passed on to others.
Oral thrush: Oral thrush is an infection in the mouth caused by the Candida yeast. Although Candida is normally found inside the mouth, it becomes a problem when it multiplies too much. The following situations can encourage overgrowth of Candida:
- Diabetes
- Being very young or very old
- Use of antibiotics
- A shortage of iron or vitamin B12 in the diet
- Weak immune system
- Wearing dentures
- Poor oral hygiene
- Dry mouth caused by a medical condition or the use of medications
- Smoking
- Cancer treatments
- Hypothyroidism (underactive thyroid)
Syphilis: Syphilis is a bacterial infection that is passed through sexual contact.

What are the symptoms of white tongue?

Leukoplakia: Leukoplakia produces one or more white patches in the mouth or on the tongue that cannot be removed by scraping. The patch is usually painless and somewhat raised. Patches may also appear on the top or bottom of the mouth, the insides of the cheeks, the lower lip, or the gums.
Oral lichen planus: Oral lichen planus produces white patches on the gums, tongue, or insides of the cheeks. A mild case is usually not painful; in more serious cases, the patient may have a burning sensation, painful red gums, and sore patches on the insides of the cheeks, especially when eating or drinking.
Geographic tongue: Geographic tongue appears on the top and sides of the tongue, and sometimes on the bottom, as wavy white lines surrounding red areas. This makes the condition look like the outlines of a map (where the condition gets its name). After some weeks or months, the lines and patches may change their position or shape.
Oral thrush: Oral thrush is marked by the following:
- White patches in the mouth that can be wiped away, leaving behind red or even bloody skin
- Burning sensation of the tongue and mouth
- Loss of taste, or unpleasant taste in the mouth
- Red areas inside the mouth and throat
- Cracked corners on the mouth

Symptoms will continue unless the condition is treated. In severe cases that are not treated, serious infection could spread to other areas of the body.

Syphilis: A small painless sore on the tongue may appear from 10 days to three months after exposure to infection during oral sex. If it is not treated, a condition called syphilitic leukoplakia will produce white plaques on the tongue. Other symptoms may include headache, joint pain, fever, and swollen glands.

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How is white tongue diagnosed?

Leukoplakia: In addition to visual examination, the doctor may take a biopsy (a tissue sample that can be examined under a microscope) of the patch to see if it is cancerous.
Oral lichen planus: Diagnosis may be made by a dentist or doctor by looking in the mouth. A biopsy may be taken to confirm the diagnosis.
Geographic tongue: Diagnosis can be made simply by observing the appearance of the tongue.
Oral thrush: Diagnosis can be made by examining the mouth. In some cases, blood tests may be ordered to search for related conditions such as diabetes or nutritional imbalances.
Syphilis: Diagnosis is made with a blood test and laboratory testing of fluids removed from sores.

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How is white tongue treated?

White tongue that is caused by a buildup of debris in the mouth is treated by practicing good oral hygiene on a regular basis:

Use a soft toothbrush when brushing the teeth.
Use a mild toothpaste (one that does not include sodium lauryl sulphate).
Brush the tongue or use a tongue scraper to remove the white coating. If a tongue scraper is not available, you can use a turned-over teaspoon.
Use a straw to drink cold drinks.
Avoid things that can irritate the tongue, such as alcohol, cigarettes, and food and drinks that are spicy, salty, acidic or very hot in temperature.
Take over-the-counter painkillers if there is discomfort.

Treatments for more serious causes of white tongue include the following:

Leukoplakia: If the white patch does not go away on its own after about two weeks, you should see a dentist. Treatments include:
- Avoiding alcohol
- Discontinuing tobacco use (both smoking and chewing)
- Regular follow-up visits with the dentist or doctor. This is necessary to make sure the condition does not advance to cancer.
- Removing the patch with surgery if the risk of oral cancer is high. Removal will ensure that the cells found in the patch do not turn cancerous.
Oral lichen planus: Lichen planus in the mouth can last for several years. A doctor can prescribe mouthwashes and sprays that will reduce discomfort from symptoms such as burning or sore gums. It is also important to maintain good oral hygiene, such as brushing your teeth thoroughly at least twice a day. Avoid food and drink that irritates the mouth, as well as alcohol and mouthwashes that contain alcohol.
Geographic tongue: There are no special treatments for geographic tongue. You should avoid food and drink that are known to increase discomfort. Topical applications used to treat oral thrush may provide some relief. On a long-term basis, there is no risk of this condition becoming cancerous.
Oral thrush: Antifungal medications in the form of gels or liquids may be applied to the patches inside the mouth. Treatment usually requires several applications per day for one or two weeks. Oral antifungal medications may also be prescribed.
Syphilis: Syphilis will not go away on its own. If it is not treated, it can damage the nervous system and cause serious long-term health problems. Treatment consists of one to three injections of antibiotics, or taking antibiotics by mouth for two to four weeks, depending on how serious the condition is.

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