Thursday, July 5, 2012

What Is Gonorrhea? What Causes Gonorrhea?

Gonorrhea (from Late Latin gonorrhoia where gonos means "seed" and rhoe means "flow") is a sexually transmitted bacterial infection that tends to attack the mucous membranes of the body. It is the second most common sexually transmitted disease in the U.S.; the first being Chlamydia. The bacteria reside in the warm and moist body cavities of both men and women and are highly contagious. Gonorrhea is the most common cause of female infertility and is also known as "the clap" or "the drip". Only a fraction of women infected with the disease show any symptoms, leaving them unaware of their condition. If left untreated, gonorrhea patients can develop pelvic inflammatory disease or PID (women), or an inflammation of the epididymis, prostate gland, or urethral structure (men), all of which are far more difficult to treat.

What causes gonorrhea?

Gonorrhea is caused by the growth and proliferation of the bacteria Neisseria gonorrhoeae. The disease can survive in the eye, rectum, mouth, penis, throat, or vagina. This means that it can be transmitted through any variety of sexual contact.

Once infected, a person runs a high risk of spreading the bacteria to other parts of their body. For instance, someone with gonorrhea may rub his or her eye, inadvertently spreading the infection and elongating the treatment period. The infection can also be spread from mothers to babies during childbirth.

Who is at risk of getting gonorrhea?

Any sexually active person can become infected with gonorrhea. Rates of infection are highest among teenagers and young adults between the ages of 15 and 29. Those who have been diagnosed with and treated for gonorrhea in the past have no resistance to the bacteria.

What are the symptoms of gonorrhea?

Symptoms of gonorrhea, usually appearing between two and ten days after exposure, can take up to 30 days to occur and are sometimes so mild they are mistaken for something else. Most women with gonorrhea show no symptoms. In men, the symptoms include:
  • Yellow, green, or white discharge from the penis
  • Testicular swelling and/or pain
  • Burning during urination
Women may experience:
  • Yellow, green, or white vaginal discharge
  • Pain or burning during urination
  • Pain in the pelvic region
  • Conjunctivitis (pink-eye)
  • Irregular bleeding (between periods)
  • Vulvitis (swelling of the vulva)
  • Spotting after intercourse
The infection, if spread to the rectum, can cause anal itching, anal discharge, and painful bowel movements. Gonorrhea, as a result of oral sex, can also occur in the throat, characterized by burning sensations and swollen glands. Many women with gonorrhea interpret the symptoms as those of a yeast infection due to the vaginal discharge.

How is gonorrhea diagnosed?

If you suspect that you have gonorrhea, a professional health care worker can take a sample of discharge from the urethra (men) or cervix (women) and use it to conduct laboratory tests. Throat and anal cultures may also be taken if any symptoms suggest a spreading infection. Due to the large amount of cases in which the two occur together, the samples will be tested for both gonorrhea and Chlamydia in a laboratory. It often takes a few days for the test results to be reported. A urine test can also be done that checks for the presence of the bacteria responsible for gonorrhea.

How is gonorrhea treated?

Because gonorrhea is a bacterial infection, it can be treated with antibiotics. Antibiotics for the infection can be taken orally or via injection. It is important that the patient does not engage in sexual interactions until he/she has finished all of the prescribed treatment. Feeling better does not always mean that the infection is gone. Medical professionals will advise that any infected person notify everyone with whom they have had relations with in the past month about the infection.

How can gonorrhea be prevented?

Using a condom every time you have sex reduces your chance of contracting gonorrhea. Bacterial infections such as gonorrhea are more common among the promiscuous. If you have even the slightest inclination that you or your partner may be infected with gonorrhea, abstain from sex until consulting with a medical professional.
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What Is Ibuprofen? What Is Ibuprofen Used For?

Ibuprofen is an NSAID (non-steroidal anti-inflammatory drug) that is commonly used for the relief of symptoms of arthritis, fever, primary dysmenorrhea (menstrual pains), and as an analgesic (a medication given to reduce pain without resulting in loss of consciousness). Ibuprofen also has an antiplatelet effect (protects from blood clots), though less than aspirin. The World Health Organization (WHO) includes ibuprofen in its "Essential Drugs List"; a list of minimal medical needs for a basic health care system.

How does ibuprofen work?

Ibuprofen blocks the production of prostaglandins, substances our body releases in response to illness and injury. Prostaglandins cause pain and swelling (inflammation); they are released in the brain and can also cause fever.

Ibuprofen's painkilling effects kick in soon after a dose is taken. Ibuprofen's anti-inflammatory effects can take a bit longer, sometimes a few weeks.

Most common uses of ibuprofen

  • Fever
  • Inflammation
  • Headache
  • Toothache
  • Back pain
  • Arthritis, including juvenile arthritis
  • Menstrual main
  • Minor injuries

History of ibuprofen

Ibuprofen was derived form propionic acid by researchers at the Boots Company (Boots Group Plc), UK, during the 1960s. The Boots Group is a large chain of UK pharmacies. It was discovered by Stewart Adams, with colleagues John Nicholson, Andrew RM Dunlop, Jeffery Bruce Wilson & Colin Burrows, and was patented in 1961. Dr. Adams initially tested the drug on a hangover.

In 1969 it was launched as a medication for the treatment of rheumatoid arthritis in the UK in 1969, and in the USA in 1974. The Boots Group was awarded the Queen's Award for Technical Achievement for the development of ibuprofen in 1987.

What is an NSAID (non-steroidal anti-inflammatory drug)?

Non-steroidal anti-inflammatory drugs, or NSAIDs, also known as non-steroidal anti-inflammatory agents/analgesics (NSAIAs) or non-steroidal anti-inflammatory medicines (NSAIMs), are medications with analgesic, antipyretic (something that reduces a fever), and in higher doses anti-inflammatory effects.

Non-steroidal means they are not steroids, which often have similar effects. As analgesics, NSAIDs are generally non-narcotic (do not cause insensibility or stupor).

The most prominent NSAIDs are aspirin, ibuprofen and naproxen - mainly because most of them are OTC (over-the-counter, no prescription required) medications.

Brand names of ibuprofen

Ibuprofen brand names include Brufen, Calprofen, Genpril, Ibu, Midol, Nuprin, Cuprofen, Nurofen, Advil and Motrin - there are many others. If you are buying the medication at a pharmacy, check the packaging for other brand names, in case they contain ibuprofen.

Some medications, such as decongestants, have ibuprofen added.

Ibuprofen is available as gels, sprays, tablets or mousses.


Do not take ibuprofen if you..
    ..are sensitive to aspirin or any other NSAID
    ..have a peptic ulcer
    ..have had a peptic ulcer
    ..have severe heart failure.
The following people should use ibuprofen with caution - if you are not sure, check with your doctor or a qualified pharmacist:
    people with, or who have had..

      ..liver problems
      ..kidney problems
      ..mild heart failure
      ..hypertension (high blood pressure)
      ..angina, heart attacks (ischemic heart disease)
      ..narrowing of the arteries (peripheral arterial disease)
      ..a history that includes any episode of stomach bleeding

What are the side effects of ibuprofen?

The most common side-effects include:
  • Diarrhea
  • Nausea
  • Vomiting
  • Dyspepsia (upper abdominal pain, bloating, indigestion)
  • Any pain in the stomach or intestines
The following side-effects are also possible, but less common:
  • Dizziness (if you experience this, don't drive or operate heavy machinery)
  • Edema (fluid retention, bloating)
  • Hypertension (elevated blood pressure)
  • Stomach inflammation
  • Ulcers in the digestive system
  • Rash, and some other allergic reactions
  • Worsening of asthma symptoms
The following side effects are possible, but extremely rare:
  • Bleeding in the stomach which may be presented as..
      ..malaena (black stools)
      ..hematemesis (vomiting with blood)
Some women may have reduced fertility after long-term use of ibuprofen. This problem stops soon treatment is over.

Ibuprofen problems if taken along with other medications - interactions

Sometimes one medication can interfere with the effects of another medication - this is known as drug interaction. Below is a list of some common interactions; if you are taking medications not listed below check with your doctor or pharmacist to make sure:
  • Antihypertensive medications - these are drugs taken for high blood pressure (hypertension). In some cases ibuprofen can cause the patient's blood pressure to rise if they are taking antihypertensives.

  • Anti-inflammatory painkillers - if you are taking diclofenac (Voltarol), indometacin, or naproxen you should not take ibuprofen because of the increased risk of stomach bleeding. Also, ibuprofen will probably not provide any additional pain relief. This includes topical ibuprofen (applied onto the skin).

  • Aspirin - ibuprofen taken in combination with aspirin significantly raises the risk of stomach bleeding. Patients taking low-dose aspirin for blood thinning should not take ibuprofen, because the blood thinning effect will be diminished.

  • Digoxin - often used for the treatment of atrial fibrillation. Ibuprofen taken in combination with digoxin can raise blood levels.

  • Lithium - A medication sometimes prescribed for certain mental disorder and illnesses. Ibuprofen can make it harder for the body to eliminate lithium, resulting in high and potentially dangerous levels of lithium in the body.

  • Methotrexate - used in the treatment of cancer and some auto-immune diseases. Ibuprofen can make it harder for the body to eliminate methotrexate, resulting in high and potentially dangerous levels of methotrexate in the body.

  • Tacrolimus - this drug is mainly used with patients who have received an organ transplant so that the body's immune system does not reject the new organ. Ibuprofen with tacrolimus can cause kidney damage.

  • SSRI (selective serotonin reuptake inhibitors) antidepressants - drugs, such as citalopram, fluoxetine, paroxetine and sertraline, taken with ibuprofen can increase the risk of bleeding.

  • Warfarin - this is an anticoagulant drug (a blood thinner); it stops the blood from clotting. Ibuprofen taken with warfarin can reduce the drug's anticoagulant effects.

Ibuprofen and children

According to the NHS (National Health Service), UK, ibuprofen can be given to children over the age of three months as long as they weigh over 5 kilograms, for pain relief, inflammation and to control fever. In some cases doctors may prescribe ibuprofen for younger children if other fever controlling medications are unsuitable.

Ibuprofen is also used for juvenile idiopathic arthritis.

Canadian scientists found that ibuprofen is a more effective pain reliever for children with acute musculoskeletal injuries than acetaminophen and codeine.
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What Is Watering Eye (epiphora)? What Causes Watering Eye (epiphora)?

Watering eye, also known as epiphora or tearing, is a condition in which there is an overflow of tears onto the face, often without a clear explanation. There is insufficient tear film drainage from the eye(s) - instead of all the tears draining through the nasolacrimal system, they overflow onto the face.

Epiphora can develop at any age. It is, however, more common among babies aged under 12 months, and adults over the age of 60 years. The condition may present symptoms in just one or both eyes.

In most cases watering eye can be treated effectively.

Depending on the severity of symptoms, watering eye can sometimes make driving difficult and dangerous.

According to Medilexicon's medical dictionary, epiphora (tearing, watering eye) is:
"An overflow of tears on the cheek, due to imperfect drainage by the tear-conducting passages."

What are the causes of epiphora (watering eye)?

There are two main causes of epiphora - blocked tear ducts or excessive production of tears.
  • Blocked tear ducts - some humans are born with underdeveloped tear ducts. It is not uncommon for newborns to have watery eyes. Generally, this problem goes away within a few weeks as the ducts develop.

    The most common cause of watering eyes among adults and older children is blocked ducts, or ducts that are too narrow. Narrowed tear ducts usually become so as a result of swelling (inflammation).

    If a patient's tear ducts are narrowed or blocked their tears will not be able to drain away and will build up in the tear sac. Stagnant tears in the tear sac increase the risk of infection in that area and the eye will produce a sticky liquid, further exacerbating the problem. Infection can also lead to inflammation on the side of the nose, next to the eye.

    Narrow drainage channels on the insides of the eyes (canaliculi) can become blocked. This is caused by swelling or scarring.

  • Over-production of tears - irritated eyes may produce more tears than normal as the body tries to rinse the irritant away. The following irritants can cause the over-production of tears:

    • Some chemicals, such as fumes, and even onions
    • Infective conjunctivitis
    • Allergic conjunctivitis
    • An injury to the eye, such as a scratch or a bit of grit (tiny pebble or piece of dirt)
    • Trichiasis - inward-growing eyelashes, often caused by marginal entropion (the eye lid turns in at the edges towards the eye)
    • Ectropion - this is when the lower eyelid turns outwards
The tears of some patients have a high fat (lipid) content. This may interfere with the even spread of liquid across the eye, leaving dry patches which become sore, irritated and cause the eye to produce more tears.

How is epiphora (watering eye) diagnosed?

Epiphora is a fairly easy condition for a GP (general practitioner, primary care physician), or any doctor to diagnose. The doctor will try to find out whether it has been caused by a lesion, infection, entropion (inward-turning eyelid) or ectropion (outward-turning eyelid).

If the GP cannot clearly determine the cause of the watering eye the patient may be referred to an eye-care specialist doctor (ophthalmologist). The specialist will examine the patient's eye(s) carefully - usually, the patient will be anesthetized.

A probe might be inserted into the narrow drainage channels on the inside of the eye (canaliculi) to see whether they are blocked.

Liquid may be inserted into a tear duct to find out whether it comes out of the patient's nose. If it is found to be blocked, a dye may be injected to find the exact location of the blockage - this will be done by using an X-ray image of the area. The dye shows up on the X-ray.

What is the treatment for watering eye?

Treatment options depend on the severity of the epiphora and its causes. In mild cases doctors may recommend just watchful waiting - doing nothing and monitoring the patient's progress.
  • Treatment for irritation - if the watering eye is caused by infective conjunctivitis the doctor may prefer to wait for a week or so to see if the problem resolves itself without antibiotics.

    When allergic conjunctivitis is the cause the patient may be prescribed an antihistamine, which is effective in bringing down the inflammation.

  • In cases of Trichiasis - an inward-growing eyelash, or some foreign object that lodged in the eye, the doctor will remove it.

  • If the patient has ectropion - the eyelid turns outwards - the patient may need to undergo surgery in which the tendon that holds the outer eyelid in place is tightened.

  • Blocked tear ducts - surgery which creates a new channel from the tear sac to the inside of the nose may be necessary. This allows the tears to bypass the blocked part of the tear duct. This surgical procedure is called DCR (dacryocystorhinostomy).

    If the drainage channels on the inside of the eye (canaliculi) are narrowed, but not entirely blocked, the doctor may use a probe to make them wider. When the canaliculi are completely blocked an operation may be required.

  • Epiphora (watering eye) in babies - in the majority of cases the condition resolves itself on its own within a few weeks. Sometimes a sticky liquid may form around the baby's eye(s). In such cases, using a piece of cotton wool that has been soaked in sterile water can be used to clean the eye(s). Sterile water needs to be boiled - make sure it is cooled before dipping the cotton wool into it.

    Sometimes tears can be dislodged if you gently massage the tear ducts. Apply light pressure with the finger and thumb to the outside of the baby's nose.
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Study Of Relationships Between Adult Children And Parents

The majority of parents and adult children experience some tension and aggravation with one another, a new study says.

But parents generally are more bothered by the tensions - and the older the child, the greater the bother.

"The parent-child relationship is one of the longest lasting social ties human beings establish," said Kira Birditt, lead author of the study and a researcher at the University of Michigan Institute for Social Research (ISR). "This tie is often highly positive and supportive but it also commonly includes feelings of irritation, tension and ambivalence."

The study will be featured in an upcoming issue of the journal Psychology and Aging.

For the study, supported by a grant from the National Institutes of Health, Birditt and colleagues at Purdue and Pennsylvania State universities analyzed data on 474 parents and adult children who were at least 22 years old. The adult children lived within 50 miles of their parents. African Americans made up one-third of the sample and the rest were European Americans.

The researchers asked about tensions related to a variety of topics, including personality differences, past relationship problems, children's finances, housekeeping habits, lifestyles, and how often they contacted each other.

Parents and adult children in the same families had different perceptions of tension intensity, with parents generally reporting more intense tensions than children did particularly regarding issues having to do with the children's lifestyle or behavior (finances, housekeeping). According to Birditt, tensions may be more upsetting to parents than to children because parents have more invested in the relationship. Parents are also concerned with launching their children into successful adulthood.

Both mothers and fathers reported more tension in their relationships with daughters than with sons. Daughters generally have closer relationships with parents that involve more contact which may provide more opportunities for tensions in the parent-daughter tie.

Both adult sons and adult daughters reported more tension with their mothers than with their fathers, particularly about personality differences and unsolicited advice. "It may be that children feel their mothers make more demands for closeness," Birditt said, "or that they are generally more intrusive than fathers."

Birditt found it surprising that parental perceptions of tension increased with the adult children's age, particularly about topics having to do with how they interact (e.g., personality differences). "Middle-aged children may be less invested in the parent-child tie than young adult children because they're more likely to have formed their own families and experience multiple role demands," Birditt said. And as parents age and come to want or need more from their relationship with adult children, adult children may pull away, creating greater relationship tensions.

Although most parents and adult children experience at least a little tension, Birditt found that some topics were more harmful than others to parent-child relationships.

"Relationship problems like basic personality differences and parents providing unsolicited advice tend to cause more problems," Birditt said. "It may be that these kinds of tensions are longer-term, and reflect deep-seated conflicts that you just can't escape, whereas conflicts about lifestyles, education or finances can sort of be put off to the side if you make an effort."

In related, unpublished research, Birditt analyzed the strategies parents and adult children used to cope with relationship tensions. The good news is that both parents and children were most likely to deal with problems constructively by trying to accommodate each other's wishes when problems came up, working to find solutions to problems, and trying to accept and understand the other's point of view.

The more intense the tension level, though, the less likely parents and children were to use constructive strategies and the more likely they were to try avoiding the issues or use destructive strategies such as yelling or arguing. And according to Birditt, that is bad news. Avoidance and destructive strategies are associated with poorer quality relationships overall.

"The old adage, 'If you can't say something nice, don't say anything at all,' isn't good advice for parents and adult children," she said. "Avoidance doesn't work as a strategy for dealing with conflicts. It appears to make things worse."
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What Are Hives? What Is Urticaria? What Causes Hives?

Hives are also known as urticaria, welts, wheals, or nettle rash. It is a red, raised, itchy skin rash that is sometimes triggered by something that produces an allergic reaction - an allergen. When there is an allergic reaction the body releases a protein called histamine. When histamine is released our capillaries (tiny blood vessels) leak fluid. The fluid accumulates in the skin and causes a rash.

According to Medilexicon's medical dictionary, urticaria is "An eruption of itching wheals, colloquially called hives, usually of systemic origin; it may be due to a state of hypersensitivity to foods or drugs, focus of infection, physical agents (heat, cold, light, friction), or psychic stimuli."

Urticaria can be triggered by:
  • Certain foods.

  • Insect bites and stings.

  • Contact with an irritant, such as nettles, chemicals or latex.

  • Certain medications - such as NSAIDs (nonsteroidal anti-inflammatory drugs), used to treat pain, ACE inhibitors, used to treat hypertension (high blood pressure).

  • Extremes of temperatures.

  • Sunlight.

  • Water on the skin.
Experts say that in about half of all cases of urticaria the cause is never found.

According to the National Health Service (NHS), UK, about 1 in every 6 people will suffer from urticaria at some time in their life. Children and women are more commonly affected than adult men. Urticaria is not contagious - you cannot pass it on to another person.

Acute urticaria or Acute hives

When symptoms last less than 6 weeks it is called acute urticaria. This is by far the most common type. 25% of people with acute urticaria also have angioedema - swelling in the deeper layers of skin.

Chronic urticaria or Chronic hives

If symptoms of urticaria continue for more than six weeks it is called chronic urticaria. Dermatologists say that about 1 in every 1,000 people suffers from chronic urticaria. Experts are not completely sure what the causes of chronic urticaria are. However, most agree that it is closely linked with our immune system. In some cases, chronic hives may be related to an underlying autoimmune disorder, such as thyroid disease or lupus. 50% of people with chronic urticaria also have angioedema.

Angioedema is similar to urticaria, but occurs deeper inside the skin. The swelling causes a burning sensation and typically occurs on the face and neck, fingers, toes, and in the genitals of males.

What are the symptoms of urticaria (hives)?

Swellings, known as wheals, appear on the skin as a rash. They are usually pink or red and have an oval or round shape, and range from a few millimeters in diameter to a several inches. They can be extremely itchy. The wheals may be surrounded by a red flare.

The wheals usually occur in batches, and frequently appear on the face or the extremities (arms, hands, fingers, legs, feet, and toes).

In most cases a welt will disappear after a few hours, but me be replaced by new ones. They can appear on just one part of the body, or several parts.

In the majority of cases symptoms are present for no more than 8 to 12 hours, and rarely continue for more than 24 hours. However, with some patients the problems may continue for quite a few days, and even several months.


Anaphylaxis is a severe allergic reaction. The patient can have serious breathing difficulties, and can even lose consciousness and die if not treated quickly. The allergic reaction may involve the whole body. Anaphylaxis is a medical emergency. If somebody has urticaria it is important to be alert for further symptoms which could indicate an anaphylaxis reaction. Anybody who experiences the symptoms listed below should call the emergency services immediately:
  • Nausea and vomiting.
  • Swelling of the lining of the mouth, tongue, lips and throat; causing breathing difficulty.
  • Cold and clammy skin.
  • Rapid heartbeat.
  • Feeling faint or lightheaded.
  • An unexpectedly abrupt feeling of intense anxiety.

What are the causes of urticaria (hives)?

Experts say that urticaria occurs when the body releases histamine and other chemicals from under the surface of the skin. The histamine and chemicals cause inflammation and fluid to accumulate under the skin, causing wheals. In about 50% of all acute urticaria cases the trigger is unknown. The following are examples of some known triggers:
  • Medications - including NSAIDs, such as aspirin and antibiotics.

  • Foods - several different types of foods have been known to trigger urticaria. The most common ones are nuts, chocolate, some citrus fruits, shellfish, food additives, eggs, and wheat products.

  • Infections - including influenza, the common cold, glandular fever and hepatitis B.

  • War zones - Throughout the history of warfare, dermatologic diseases have been responsible for troop morbidity, poor morale and combat ineffectiveness . Dermatitis, benign moles, hives and cancerous skin lesions are among the most common diagnoses among military personnel who were evacuated from combat zones for ill-defined dermatologic diseases.

  • Intestinal parasites.

  • Extremes of temperature.

  • Some pets.

  • Dust mites.

  • Floods and hurricanes - skin diseases/disorders are commonly found among people after floods and hurricanes, including urticaria. Construction workers who help repair damaged structures are also more likely to suffer from skin diseases/disorders, a study revealed.

  • Sunlight exposure (less common).

  • Latex.

  • Nettles.

  • Some plants.

  • Insect bites.

  • Some chemicals.

  • Chronic illness - such as thyroid disease or lupus.
Chronic urticaria (long term urticaria), on the other hand, is hardly ever caused by these triggers. Chronic urticaria generally starts as an autoimmune response in which certain cells (mast cells) cause the release of histamine and various chemicals to be released under the skin, causing tiny blood vessels to leak, which results in swelling and wheals. Experts do not know why this happens.

How is urticaria diagnosed?

Acute urticaria diagnosis

A GP (general practitioner, primary care physician) can easily diagnose acute urticaria by examining the rash on the skin. The doctor will attempt to find out what the trigger was, as this may help the patient prevent recurrences. Typically, the doctor will ask the patient the following questions:
  • When the episode began.

  • Where the episode began.

  • Whether the patient lives or works in a place where potential triggers may exist, such as latex gloves, chemicals, or animals.

  • What medications the patient has been taking, including herbal supplements.

  • The patient's medical history.

  • Whether the patient had been bitten by an insect.

  • Whether any close relatives also have/had urticaria.
In half of all cases the doctor and patient will never find out what the trigger was. However, most cases will resolve themselves within a few days and never recur.

If a doctor believes there may be a trigger which is causing an allergic reaction the patient may be referred to an allergy clinic (UK). Allergy clinics test the patient's blood and skin to find out whether there is an allergy to specific substances, such as chemicals, dust mites, or some food.

Chronic urticaria diagnosis

If the urticaria continues for more than six weeks the likelihood of there being some external trigger is extremely small; which is why allergy tests are not recommended. Nevertheless, the GP will be interested in factors which may exacerbate the existing urticaria, such as alcohol, caffeine intake, mental health (stress), etc. If there are any underlying causes for the chronic urticaria the doctor may order the following tests:
  • A blood test to find out whether the patient is suffering from anemia.

  • A stool sample to check for parasites.

  • ESR (erythrocyte sedimentation rate) test - this can identify problems with the patient's immune system.

  • Thyroid function test - this identifies either hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).

  • Liver function tests - these can identify whether the patient has any liver problems.

What is the treatment for urticaria?

Allergic skin disorders, such as urticaria and atopic dermatitis, can cause much discomfort, have an impact on quality of life, and can sometimes cause serious complications. Like other allergic conditions, these disorders can often be effectively treated, according to the American College of Allergy, Asthma and Immunology.

Acute urticaria treatment

Generally, no treatment is needed for acute urticaria because symptoms are usually mild and the condition is short-lived and rarely recurs.
  • Antihistamines - However, if symptoms are more severe, or if the condition persists the patient may be given antihistamines. Antihistamines block the effects of histamines and reduce the rash and stop the itching.

    Current antihistamines do not make most patients drowsy. Unfortunately, some patients may be affected and should check how they react to the antihistamine before operating heavy machinery or driving a car. Antihistamines often cause drowsiness if the patient has alcohol in his/her system.

    Some patients may benefit from antihistamines that do cause drowsiness, especially if the itchiness is causing sleep problems.

    Pregnant women should not take antihistamines, unless the GP prescribes it. Very occasionally GPs may prescribe an antihistamine called chlorphenamine for pregnant women if it is felt the benefits are greater than the risks. In the UK thousands of pregnant women have taken chlorphenamine, and so far there have been no reports of any harmful effects to the unborn baby.

  • Corticosteroids - If symptoms are very severe the doctor may prescribe a short course of high-dose oral corticosteroids, which suppress the immune system which usually results in either eliminating or reducing the symptoms of urticaria. Corticosteroids should not be taken for more than 5 days. The longer a patient takes Corticosteroids the greater his risks are of getting an infection.
Chronic urticaria treatment

Patients with chronic urticaria will have treatment which is aimed at controlling symptoms and avoiding triggers that may make them worse.

Patients who have chronic urticaria and angioedema should be referred to an immunologist, an allergist or a dermatologist (skin specialist doctor). Angioedema can cause breathing difficulties which can potentially cause serious problems.

Patients who only have chronic urticaria and nothing else, but whose symptoms are still severe should also be referred to a specialist.
  • Antihistamines - antihistamines can treat the symptoms of chronic urticaria. If symptoms are causing sleep problems the patient may benefit from also taking the antihistamines that cause drowsiness.

  • Menthol cream - this has been shown to be a useful alternative or addition to antihistamines for patients with itchiness.

  • Corticosteroids - these may be prescribed for chronic urticaria patients whose symptoms are more severe.

  • Avoiding triggers - as triggers can make the existing urticaria worse, it is important for the patient to identify these triggers and avoid them. Remember, that with chronic urticaria the triggers do not cause the condition, but they can make it worse. The patient may have to abstain from consuming alcohol, or cut down consumption. He/she may have to avoid certain medications as well. Avoiding stress may help - however, this may not be easy, especially if the symptoms are affecting the patient's quality of life. Some soaps may be making symptoms worse, as well as skin creams and detergents.

  • Meditation or hypnosis - relaxation techniques, such as medication or hypnosis have been found to help reduce symptoms and levels of stress in severely affected patients.

  • Diet - many patients swear that certain foods make their symptoms worse. This is a controversial subject in which experts seem to have different opinions. The following foods are known to trigger histamine production - spinach, fish, yoghurt, fish, tomato, processed, meats, chocolate, and strawberries.

What are the complications of urticaria?

Acute urticaria complications

Approximately one quarter of all patients with acute urticaria also develop acute angioedema, which should resolve itself within about three days. Patients who have breathing problems should call the emergency services immediately. Angioedema is treated with antihistamines and oral corticosteroids.

Chronic urticaria complications

About half of all chronic urticaria patients will get better within 3 to 5 years. One quarter of all patients will continue having symptoms for over 10 years. As with any chronic condition, the patient can become frustrated and distressed. Approximately 15% of chronic urticaria patients report feelings of depression. Patients with symptoms of depression should inform their doctor. Depression is treatable.
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What Is Amnesia? What Causes Amnesia?

When people lose their ability to memorize data they have amnesia. Amnesia also refers to an inability to recall information that is stored in memory. In simple terms, amnesia is the loss of memory. The causes of amnesia may be organic or functional.

Organic causes may include brain damage through injury, or the use of specific drugs - usually sedative drugs. Amnesia may be one of the symptoms of some degenerative brain diseases, such as Alzheimer's disease.

Functional causes are psychological factors, such as defense mechanisms.

People with amnesia also find it hard to imagine the future, because our constructions of future scenarios are closely linked to our recollections of past experiences. Researchers from Washington University in St. Louis used advanced brain imaging techniques to show that remembering the past and envisioning the future may go hand-in-hand, with each process sparking strikingly similar patterns of activity within precisely the same broad network of brain regions.

According to Medilexicon's medical dictionary, amnesia is "A disturbance in the memory of stored information of very variable durations, minutes to months, in contrast to short-term memory, manifest by total or partial inability, to recall past experiences."

Our ability to recollect events and experiences is a very complex brain process. In fact, experts say we are only now starting to scratch at the surface in understanding exactly what happens when we commit something to memory, or when we try to retrieve data that was stored by our brain.

Being a little forgetful is completely different to having amnesia. Amnesia refers to a large-scale loss of memories that should not have been forgotten. These may include important milestones in life, memorable events, key people in our lives, and vital facts we have been told or taught.

Most people with amnesia are usually lucid and have a sense of self. However, they may experience severe difficulties in learning new information and forming new memories, as well as finding it extremely difficult to recall memories of past experiences and information.

Although amnesia is a popular theme for movies and books, it is a very rare condition.

What are the types of amnesia?

There are many different types of amnesia. Below is a list of the most common ones:
  • Anterograde amnesia - the patient cannot remember new information. Things that happened recently, information that should be stored into short-term memory disappear. This is usually caused by brain trauma (brain damage from a blow to the head, for example). However, a patient with anterograde amnesia can remember data and events which happened before the injury.

  • Retrograde amnesia - often thought of as the opposite of anterograde amnesia. The patient cannot remember events that occurred before his/her trauma, but remembers things that happened after it normally.

  • Transient global amnesia - a temporary loss of all memory. The patient with transient global amnesia also finds it very hard to form new memories - he/she has severe anterograde amnesia. The loss of past memories is milder. This is a very rare form of amnesia. A transient global amnesia patient tends to be older, and usually has a vascular disease (a problem with the blood vessels).

  • Traumatic amnesia - memory loss caused by a hard blow to the head. People who lose their memory as the result of a car accident may have traumatic amnesia. People with traumatic amnesia may experience a brief loss of consciousness, or even go into a coma. In the majority of cases the amnesia is temporary - how long it lasts usually depends on how severe the injury is. Sports scientists say that amnesia is an important indicator of concussion.

  • Wernike-Korsakoff's psychosis - this type of memory loss is caused by extended alcohol abuse. The disorder tends to be progressive - it gradually gets worse and worse over time. Patients with Wernike-Korsakoff's psychosis also tend to have neurological problems, such as poor coordination, and the loss of feelings in the toes and fingers. It can also be caused by malnutrition. It is linked to thiamin deficiency.

  • Hysterical (fugue) amnesia - this is a very rare phenomenon. Patients forget not only their past, but their very identity. A person could wake up and suddenly not have any sense at all of who they are - even if they look in the mirror they do not recognize their own reflection (the person in the mirror is a stranger). All the details in their wallet - driving license, credit cards, IDs - are meaningless. This type of amnesia is usually triggered by an event that the person's mind is unable to cope with properly. In most cases the memory either slowly or suddenly comes back within a few days. However, the memory of the shocking event itself may never come back completely. It is important that doctors diagnosing patients for epilepsy eliminate this type of amnesia from their list of alternative illnesses.

  • Childhood amnesia (infantile amnesia) - the patient cannot recall events from early childhood. Experts say this type of amnesia may be associated with language development. Others say it is possible that some memory areas of the brain were not fully mature during childhood.

  • Posthypnotic amnesia - events during hypnosis cannot be recalled.

  • Source amnesia - the person can remember certain information, but does not know how or where they got that information.

  • Blackout phenomenon - amnesia caused by a bout of heavy drinking. The person cannot remember chunks of time during his/her binge.

  • Prosopamnesia - the person cannot remember faces. People can either acquire prosopamnesia, or be born with it.

What are the symptoms of amnesia?

  • The ability to learn new information following the onset of amnesia is impaired. Simply put, the patient finds it hard to remember new stuff. (Anterograde amnesia).

  • The ability to remember past events and previously familiar information is impaired. Simply put, the patient finds it hard to remember past stuff. (Retrograde amnesia).

  • False memories - these may be either completely invented or made up of real memories misplaced in time. (Confabulation). An interesting French study, called "Do you remember what you did on March 13, 1985?, looked at how one specific patient responded to questions.

  • Uncoordinated movements, sometimes tremors (Neurological problems).

  • Confusion or disorientation.

  • Problems with short-term memory.

  • Partial loss of memory.

  • Total loss of memory.

  • Failure to recognize faces.

  • Inability to recognize places.
Amnesia is different from dementia. Although dementia includes memory loss, it also involves other important cognitive problems which may affect the patient's ability to carry out daily activities.

What causes amnesia?

Any disease or injury that affects the brain can interfere with the intricacies of memory. Memory function engages many different parts of the brain simultaneously. Damage to brain structures that form the limbic system, the hippocampus and thalamus, can lead to amnesia - the limbic system controls our emotions and memories. Scientists at the University of Liverpool discovered dramatic differences in the memory performance of patients with damage to the hippocampus.

Causes of neurological or organic amnesia

This refers to amnesia caused by brain injury or damage. Possible causes are:
  • Stroke.

  • Encephalitis - brain inflammation. This can be caused by a virus infection, such as herpes simplex (HSV), or an autoimmune reaction to cancer in another part of the body (paraneoplastic limbic encephalitis, PLE).

  • Celiac disease - although no clear link has been completely agreed on. Researchers reported that the most common reasons for seeking medical help among patients with celiac disease were amnesia, confusion and personality changes.

  • Oxygen deprivation - any illness or situation which undermines the supply of oxygen to the brain, such as a heart attack, respiratory distress, or carbon monoxide poisoning.

  • Some medications - such as the sleeping drug, ambien. This interesting study explains why so many people report not remembering what they did after taking ambien (zolpidem).

  • Subarachnoid hemorrhage - bleeding in the area between the skull and the brain.

  • A brain tumor that lies in a memory-controlling part of the brain.

  • Some seizure disorders.

  • ECT (electroconvulsive therapy) - also known as electroshock therapy. This is a well established psychiatric treatment in which seizures are induced for therapeutic effect on anesthetized patients. It is sometimes used for patients with major depression whose illness has not responded to other treatment. ECT is also sometimes used for treating schizophrenia, bipolar disorder and catatonia. The memory loss is nearly always temporary.

  • Head injuries - such as those that occur in car accidents, can lead to memory problems. In most cases the amnesia is not severe and is not long-lasting.
Causes of functional or psychogenic amnesia

Also known as dissociative amnesia. This is caused by an emotional shock, such as:
  • Being the victim of a violent crime.
  • Sexual abuse.
  • Child abuse.
  • Being involved in combat (soldiers).
  • Being involved in a natural disaster.
  • Being present during a terrorist act.
The list is endless - basically, any intolerable life situation which causes severe psychological stress and internal conflict.

How is amnesia diagnosed?

Initially, the health care professional will need to rule out any other possible causes of memory loss, including dementia, Alzheimer's disease, depression, or a brain tumor. The doctor will require a detailed medical history - this may be difficult if the patient does not remember things, so family members or caregivers may also have to be present. A doctor will need the patient's permission to talk about his/her medical details with somebody else.

The doctor will try to cover the following issues:
  • Can the patient remember recent events, and/or remote events (events further back in time)?

  • When did the memory problems start?

  • How did the memory problems evolve?

  • Were there any factors which may have caused the memory loss, such as a head injury, surgery, or stroke?

  • Is there a family history of any neurological or psychiatric diseases or conditions?

  • Details about the patient's alcohol intake.

  • Is the patient currently on any medication?

  • Has the patient taken illegal drugs, such as cocaine, marijuana, etc.?

  • Are the patient's symptoms undermining his/her ability to look after himself/herself?

  • Does the patient have a history of depression?

  • Has the patient ever had cancer?

  • Does the patient have a history of seizures?
The physician may also carry out a physical exam. This may include checking the patient's:
  • Reflexes.
  • Sensory function.
  • Balance.
  • Some other aspects of the brain and nervous system.
The doctor may also check the patient's:
  • Judgment
  • Short-term memory
  • Long-term memory
The memory assessment will help determine the extent of memory loss. This will assist in deciding on the best treatment.

In order to find out whether there is any physical damage or brain abnormality, the doctor may order:
  • An MRI (magnetic resonance imaging) scan - a machine uses a magnetic field and radio waves to create detailed images of any part of the body; in this case, the brain. An MRI scan is better than a CT scan (below) at detecting a tumor in the brain.

  • A CT (computerized tomography) scan - a medical imaging method that employs tomography. Tomography is the process of generating a two-dimensional image of a slice or section through a 3-dimensional object (a tomogram). The medical device (the machine) is called a CTG scanner; it is a large machine and uses X-rays. A CT scan is exceptionally good at detecting bleeding in the brain (especially from injury).

  • An EEG (electroencephalogram) - this is a tool which provides an image of the brain while the patient is performing a cognitive task - a task that requires thinking. It allows the doctor to detect the location and magnitude of brain activity involved in several types of cognitive functions. Images are created by using electrodes to monitor the amount of electrical activity at different points on the patient's scalp.
Blood tests may also reveal the presence of any infection, or nutritional deficiencies.

What are the treatments for amnesia?

Fortunately, in the majority of cases amnesia resolves itself without treatment. However, if an underlying physical or mental disorder is present, it should be treated (if possible).

Psychotherapy may sometimes be effective for some patients. Hypnosis can be an effective way of recalling memories that have been forgotten.

Family support is crucial in helping a patient with amnesia get better. Psychologists and psychiatrists say that reality orientation aids may help to nudge patients back into their environment if they are surrounded with familiar objects, photographs, smells, and sounds (music).

The aim of amnesia treatment often involves techniques and strategies to help compensate for the memory problem. This may involve:
  • Working with an occupational therapist to acquire new information to replace lost memories, or to use existing memories as a basis for acquiring new information.

  • Learning various strategies for organizing information so that it is easier to store.

  • Learning how to make best use of a personal digital assistant (PDA), such as an iPhone or Blackberry. With the right training, even patients with severe memory loss can become quite competent with day-to-day tasks. The PDA can be used to remind the patient about important events, when to take medications, appointments, and key commitments. Patients who cannot remember people's names or faces can store a long list of photographs of faces and check them whenever they wish.
There are currently no drugs for the restoration of memory for patients with amnesia. As Wernicke-Korsakoff syndrome involves a thiamin deficiency, targeted nutrition can help. Whole grain cereals, legumes (beans and lentils), nuts, lean pork, and yeast are rich sources of thiamin.

What are the complications of amnesia?

Complications depend on the severity and scope of the amnesia. However, even for people with mild symptoms, difficulties in dealing with daily life can take their toll. Patients can experience employment, school, and social problems.

Some individuals never recover lost memories.

In very severe cases, people may require some kind of supervision, or extended care facility.
Continue to Read more ...

What Is Goiter (goitre)? What Causes Goiter?

Goiter (UK: goitre) is the enlargement of the thyroid gland and is not cancerous. A person with goiter can have normal levels of thyroid hormone (euthyroidism), excessive levels (hyperthyroidism) or levels that are too low (hypothyroidism).

The thyroid is a gland, shaped like a butterfly, located at the base of the neck, just below the Adam's apple. If the thyroid gland grows larger than normal the patient has a condition known as goiter. Goiters are generally painless; however, if the gland gets very large the patient may have problems swallowing properly, and may also develop a cough.

Goiter refers both to the enlarged thyroid gland, and the condition of having an enlarged thyroid gland.

According to Medilexicon's medical dictionary, goiter is "A chronic enlargement of the thyroid gland, not due to a neoplasm, occurring endemically in certain localities, especially regions where glaciation occurred and the soil is low in iodine, and sporadically elsewhere."

Historically, goiter was commonly caused by a lack of iodine in a person's diet. However, as most countries add iodine to salt, it is more usually caused by an imbalance in thyroid hormone production, nodules that develop in the gland, or pregnancy. A significant number of people in some parts of the world still do develop goiter due to diet factors.

According to the National Health Service, UK, approximately 8.5% of British adults have goiter. However, in most cases the swelling is not enough to be noticeable or a problem. Goiters are more common in females than males. People of all ages can develop goiter. In some cases it may be present at birth.

What are the signs and symptoms of goiter?

A symptom is something the patient feels or reports, while a sign is something other people, including the doctor detects. For example, a headache may be a symptom while a rash may be a sign.

Some patients may have goiter and not know it because they have no symptoms.

The main symptom for a person with goiter is swelling of the thyroid gland. This may eventually become a noticeable lump in the throat. The patient may be more aware of it - a visible swelling at the base of the neck - when looking in the mirror and shaving or putting on makeup.

There are two types of goiter:
  • Diffuse small goiter - the whole thyroid gland swells. When touched it feels smooth.

  • Nodular goiter - certain parts of the thyroid gland - nodules - swell. The gland may feel lumpy when touched.
The following symptoms may also exist when a person has goiter:
  • Hoarseness (voice)
  • Coughing more frequently than usual
  • A feeling of tightness in the throat
  • Swallowing difficulties (less common)
  • Breathing difficulties (less common)

What are the causes and risk factors for goiter?

A risk factor is something which increases the chances of developing a condition or disease. For example, a risk factor for heart disease is smoking - if you smoke regularly your risk of developing heart disease is increased.

The possible causes and risk factors for goiter include:
  • A diet poor in iodine - may affect people who live in areas where there is not much iodine, or those who don't have access to iodine supplements. In many countries iodine deficiency used to be the main cause of goiter. It still is in some countries, and areas within some countries.

    Iodine, a trace element, exists in the soil and sea. Fish, seafood, many vegetables and dairy products contain iodine. Our thyroid gland needs iodine in order to make thyroid hormones. If there is not enough iodine in a person's body their thyroid gland will get bigger so that it can produce more hormones.

    In the UK, USA and many other countries iodine deficiency used to be common until iodine was added to salt in the early 1900s. As more people these days are opting for low salt and low dairy diets, the number of cases of iodine deficiency has started to rise in the UK and USA.

  • Gender - women are more likely to develop goiter compared to men.

  • Age - people over the age of 50 are significantly more likely to have goiter compared to younger people.

  • Autoimmune disease - individuals with a medical history of autoimmune disease, as well as those with a close relative who have/had autoimmune disease have a higher risk of developing goiter.

  • Pregnancy and menopause - goiter is more likely to happen after a woman becomes pregnant, or goes through the menopause.

  • Some medicines - antiretrovirals, immunosuppressants, amiodarone (heart medication), and lithium increase a patient's risk of developing goiter.

  • Radiation - people whose neck or chest areas have been exposed to radiation have a higher risk. This could be due to radiation treatment (radiotherapy), or having worked in a nuclear facility, being involved in a nuclear test or accident.

  • Hyperthyroidism - if the thyroid is over-active it can become over-stimulated and expand.

  • Hypothyroidism - an under-active thyroid gland can also result in goiter. If the body does not have enough of the hormones produced by the thyroid gland it will stimulate the gland to produce more, which can lead to swelling of the gland.

  • Smoking - some studies suggest that there is a link between regular smoking and goiter risk. A person who smokes and has a low-iodine diet has a significantly higher risk of developing goiter.

  • Some infections - there are some parasites, bacteria and fungi which are known to increase goiter risk of the patient becomes infected with them.

  • Some foods - some foods are known to suppress the function of the thyroid gland if too much of them is consumed - these are known as goitrogenic foods. They include peanuts, soybeans, tofu and spinach.

  • Too much iodine - consuming too much iodine can raise the risk of developing goiter.

  • Thyroid cancer - people who have thyroid cancer have a higher risk of developing goiter.

Diagnosis of goiter

A GP (general practitioner, primary care physician) may detect a swollen thyroid gland by feeling the patient's neck and asking him/her to swallow during a routine physical exam. Sometimes the nodules may also be detected simply by touch. A physical examination of the neck may also allow the doctor to assess the size of the thyroid gland and the extent of the swelling.

The doctor may order some more tests to find out what the underlying cause might be. Examples of possible tests include:
  • A hormone test - this will be done with a blood test which can show levels of hormones produced by the thyroid as well as pituitary glands. Low blood levels of thyroid hormone will mean the patient's thyroid is underactive. TSH (thyroid-stimulating hormone) levels will be high if thyroid hormone levels are low. TSH is produced by the pituitary gland in an attempt to stimulate the thyroid gland to produce more hormone. Inversely, an overactive thyroid will show higher-than-normal blood levels of thyroid hormone and lower-than-normal blood levels of TSH.

  • An antibody test - if the blood test confirms the presence of antibodies it could mean that the underlying cause is related to this.

  • Ultrasound - a transducer is held over the patient's neck. The ultrasound device produces sound waves which bounce through the neck and return, like an echo. The variations in the echo timings are processed and an image of the inside of the neck can be seen by the doctor on a screen. This procedure allows the doctor to see how big the thyroid gland is and whether there are any nodules.

  • A thyroid scan (radioactive iodine scan) - the patient is injected with a small amount of radioactive iodine, usually into a vein on the inside of the elbow. He/she lies on a table with the head stretched backward while a camera produces an image of the thyroid on a monitor.

    The radioactive iodine accumulates in the thyroid gland and shows up in the scan.

    This scan helps the doctor determine the size, structure and function of the thyroid gland.

    The amount of radiation is not hazardous to the patient's health. It may not be suitable for pregnant women.

What are the treatment options for goiter?

The type of treatment may depend on various factors, including the size of the thyroid gland, symptoms and their severity, and any underlying conditions. If the patient's goiter is small, the thyroid gland is working properly and there are no underlying conditions the doctor will probably recommend long-term monitoring, but no treatment.
  • Underactive thyroid - if the patient is found to have an underactive thyroid the doctor may prescribe the use of synthetic hormone, levothyroxine (Levothroid, Synthroid), to make up for the shortfall. The patient will swallow a pill once a day. Possible side effects of this hormone therapy may include:

    • Muscle cramps
    • Irregular heart beat
    • Pain in the chest

    In most cases side effects go away after a few days.

    These side effects are also possible, but they are rare:

    • Insomnia
    • Diarrhea
    • Hot flashes
    • Weight loss
    • Excessive sweating
    • Accelerated heart beat
    • Headaches

    Patients who experience any of these unusual side effects should tell their doctor immediately, because the dosage may need adjusting.

  • Over-active thyroid - patients with an overactive thyroid will most likely be prescribed thionamides, which help lower the amount of thyroids hormones being produced by the thyroid gland.

    This medication is generally taken by mouth (orally). Patients may not notice any effect for several weeks. Side effects may include:

    • Skin rash (usually mild)
    • Itchy skin
    • Joint pain
    • Nausea
    • Agranulocytosis - a serious drop in the number of granulocytes. Granulocytes are a kind of white blood cell filled with microscopic granules - small sacs containing enzymes that digest microorganisms. This side effect is extremely rare. If it does occur it will do so during the first three months of treatment.

    Any patient who develops a fever, sore throat, mouth ulcers, or any signs of infection, and is taking thionamides should seek immediate medical attention.

    Treatment with thionamides usually lasts from two to four months.

  • Radioactive iodine - this is a possible treatment option for patients with an overactive thyroid gland. The iodine is taken by mouth. The radioactive iodine destroys thyroid cells when it reaches the thyroid gland, resulting in a smaller goiter. The patient may end up with an under-active thyroid gland, and subsequently need hormone therapy.

  • Iodine supplements - the patient will be prescribed iodine supplements if the goiter is caused by an iodine deficiency. Iodine supplements are available OTC (over-the-counter, no prescription required). It is important to follow the dosage prescribed by your doctor. We do not all have the same iodine requirements.

  • Surgery - this is an option if the goiter is so large that the patient has problems breathing or swallowing and other treatments have not worked.

    In most cases half the thyroid gland will be surgically removed. The surgeon will remove enough of the gland to relieve symptoms, while at the same time try not to underme the gland's ability to manufacture hormones. Some patients, however, will need hormone therapy after surgery. Possible complications from surgery include:

    • Infection
    • Nerve damage that affects the voice box and gives the patient a permanent hoarse voice.
    • Damage to the parathyroid glands, which regulate body calcium levels.

What are the possible complications of goiter?

While small goiters do not usually cause any problems, large ones can make it hard for the patient to breathe and swallow properly, as well as causing a cough and hoarseness.

If the goiter is caused by an underlying problem, such as hypothyroidism or hyperthyroidism, the possible complications will be related to those conditions.
Continue to Read more ...

What Is Prostate Cancer? What Causes Prostate Cancer?

Prostate cancer is a disease which only affects men. Cancer begins to grow in the prostate - a gland in the male reproductive system. The word "prostate" comes from Medieval Latin prostate and Medieval French prostate. The ancient Greek word prostates means "one standing in front", from proistanai meaning "set before". The prostate is so called because of its position - it is at the base of the bladder.

What is the prostate?

The prostate is an exocrine gland of the male reproductive system, and exists directly under the bladder, in front of the rectum. An exocrine gland is one whose secretions end up outside the body e.g. prostate gland and sweat glands. It is approximately the size of a walnut.

The urethra - a tube that goes from the bladder to the end of the penis and carries urine and semen out of the body - goes through the prostate.

There are thousands of tiny glands in the prostate - they all produce a fluid that forms part of the semen. This fluid also protects and nourishes the sperm. When a male has an orgasm the seminal-vesicles secrete a milky liquid in which the semen travels. The liquid is produced in the prostate gland, while the sperm is kept and produced in the testicles. When a male climaxes (has an orgasm) contractions force the prostate to secrete this fluid into the urethra and leave the body through the penis.

Urine control

As the urethra goes through the prostate: the prostate gland is also involved in urine control (continence) with the use of prostate muscle fibers. These muscle fibers in the prostate contract and release, controlling the flow of urine flowing through the urethra.

The Prostate Produces Prostate-specific antigen (PSA)

The epithelial cells in the prostate gland produce a protein called PSA (prostate-specific antigen). The PSA helps keep the semen in its liquid state. Some of the PSA escapes into the bloodstream. We can measure a man's PSA levels by checking his blood. If a man's levels of PSA are high, it might be an indication of either prostate cancer or some kind of prostate condition.

prostate gland diagram
Diagram of the location of the prostate gland and nearby organs
It is a myth to think that a high blood-PSA level is harmful to you - it is not. High blood PSA levels are however an indication that something may be wrong in the prostate.

Male hormones affect the growth of the prostate, and also how much PSA the prostate produces. Medications aimed at altering male hormone levels may affect PSA blood levels. If male hormones are low during a male's growth and during his adulthood, his prostate gland will not grow to full size.

In some older men the prostate may continue to grow, especially the part that is around the urethra. This can make it more difficult for the man to pass urine as the growing prostate gland may be causing the urethra to collapse. When the prostate gland becomes too big in this way, the condition is called Benign Prostatic Hyperplasia (BPH). BPH is not cancer, but must be treated.

Prostate Cancer

In the vast majority of cases, the prostate cancer starts in the gland cells - this is called adenocarcinoma. In this article, prostate cancer refers just to adenocarcinoma.

Prostate cancer is mostly a very slow progressing disease. In fact, many men die of old age, without ever knowing they had prostate cancer - it is only when an autopsy is done that doctors know it was there. Several studies have indicated that perhaps about 80% of all men in their eighties had prostate cancer when they died, but nobody knew, not even the doctor.

Experts say that prostate cancer starts with tiny alterations in the shape and size of the prostate gland cells - Prostatic intraepithelial neoplasia (PIN). According to Medilexicon`s medical dictionary, Prostatic intraepithelial neoplasia means "dysplastic changes involving glands and ducts of the prostate that may be a precursor of adenocarcinoma; low grade (PIN 1), mild dysplasia with cell crowding, variation in nuclear size and shape, and irregular cell spacing; high grade (PIN 2 and 3), moderate to severe dysplasia with cell crowding, nucleomegaly and nucleolomegaly, and irregular cell spacing."

Doctors say that nearly 50% of all 50-year-old men have PIN. The cells are still in place - they do not seem to have moved elsewhere - but the changes can be seen under a microscope. Cancer cells would have moved into other parts of the prostate. Doctors describe these prostate gland cell changes as low-grade or high-grade; high grade is abnormal while low-grade is more-or-less normal.

Any patient who was found to have high-grade PIN after a prostate biopsy is at a significantly greater risk of having cancer cells in his prostate. Because of this, doctors will monitor him carefully and possibly carry out another biopsy later on.

Classification of prostate cancer

It is important to know the stage of the cancer, or how far it has spread. Knowing the cancer stage helps the doctor define prognosis - it also helps when selecting which therapies to use. The most common system today for determining this is the TNM (Tumor/Nodes/Metastases). This involves defining the size of the tumor, how many lymph nodes are involved, and whether there are any other metastases.

When defining with the TNM system, it is crucial to distinguish between cancers that are still restricted just to the prostate, and those that have spread elsewhere. Clinical T1 and T2 cancers are found only in the prostate, and nowhere else, while T3 and T4 have spread outside the prostate.

There are many ways to find out whether the cancer has spread. Computer tomography will check for spread inside the pelvis, bone scans will decide whether the cancer has spread to the bones, and endorectal coil magnetic resonance imaging will evaluate the prostatic capsule and the seminal vesicles.

The Gleason Score

A pathologist will look at the biopsy samples under a microscope. If cancer tissue is detected, the pathologist then grades the tumor. The Gleason System of grading goes from 2 to 10. The higher the number, the more abnormal the tissues are compared to normal prostate tissue.

Two numbers are added up to get a Gleason score:
    1. A number from 1 to 5 for the most common pattern observed under the microscope. This is the predominant grade and must be more than 51% of the sample.

    2. A number from 1 to 5 for the second most common pattern. This is the secondary grade and must make up more than 5% but less than 50% of the sample.
A Gleason score of 7 can have two meanings. Look at these two examples below:
    1. If the predominant grade is 3 and the secondary grade is 4, the Gleason score is 7.

    2. If the predominant grade is 4 and the secondary grade is 3, the Gleason score is also 7.
However, the first example, with a predominant score of 3, has a less aggressive cancer than the second example, with a predominant score of 4.

It is crucial that the tumor is graded properly, as this decides what treatments should be recommended.

What are the symptoms of prostate cancer?

During the early stages of prostate cancer there are usually no symptoms. Most men at this stage find out they have prostate cancer after a routine check up or blood test. When symptoms do exist, they are usually one or more of the following:
  • The patient urinates more often
  • The patient gets up at night more often to urinate
  • He may find it hard to start urinating
  • He may find it hard to keep urinating once he has started
  • There may be blood in the urine
  • Urination might be painful
  • Ejaculation may be painful (less common)
  • Achieving or maintaining an erection may be difficult (less common)
If the prostate cancer is advanced the following symptoms are also possible:
  • Bone pain, often in the spine (vertebrae), pelvis, or ribs
  • The proximal part of the femur can be painful
  • Leg weakness (if cancer has spread to the spine and compressed the spinal cord)
  • Urinary incontinence (if cancer has spread to the spine and compressed the spinal cord)
  • Fecal incontinence (if cancer has spread to the spine and compressed the spinal cord)

What are the causes of prostate cancer?

Nobody is really sure of what the specific causes are. There are so many possible factors, including age, race, lifestyle, medications, and genetics, to name a few.
    fruits and vegetables
  • Age

    Age is considered as the primary risk factor. The older a man is, the higher is his risk. Prostate cancer is rare among men under the age of 45, but much more common after the age of 50.

  • Genetics

    Statistics indicate that genetics is definitely a factor in prostate cancer risk. It is more common among certain racial groups - in the USA prostate cancer is significantly more common and also more deadly among Afro-Americans than White-Americans. A man has a much higher risk of developing cancer if his identical twin has it. A man whose brother or father had/had prostate cancer runs twice the risk of developing it, compared to other men. Studies indicate that the two genes - BRCA 1 and BRCA 2 - which are important risk factors for breast cancer and ovarian cancer have also been implicated in prostate cancer.

    In a study scientists found seven new sites in the human genome that are linked to men's risk of developing prostate cancer.

  • Diet

    A review of diets indicated that the Mediterranean diet may reduce a person's chances of developing prostate cancer. Another study indicates that soy, selenium and green tea, offer additional possibilities for disease prevention - however, a more recent study indicated that combination therapy of vitamin E, selenium and soy does not prevent the progression from high-grade prostatic intraepithelial neoplasia (HGPIN) to prostate cancer. A diet high in vegetable consumption was found in a study to be beneficial.

    A US pilot study on men with low risk prostate cancer found that following an intensive healthy diet and lifestyle regime focusing on low meat and high vegetable and fruit intake, regular exercise, yoga stretching, meditation and support group participation, can alter the way that genes behave and change the progress of cancer, for instance by switching on tumor killers and turning down tumor promoters.

    Other studies have indicated that lack of vitamin D, a diet high in red meat may raise a person's chances of developing prostate cancer.

  • Medication

    Some studies say there might be a link between the daily use of anti-inflammatory medicines and prostate cancer risk. A study found that statins, which are used to lower cholesterol levels, may lower a person's risk of developing prostate cancer.

  • Obesity

    A study found a clear link between obesity and raised prostate cancer risk, as well as a higher risk of metastasis and death among obese people who develop prostate cancer.

  • Sexually transmitted diseases (STDs)

    Men who have had gonorrhea have a higher chance of developing prostate cancer, according to research from the University of Michigan Health System.

  • Agent Orange

    Veterans exposed to Agent Orange have a 48% higher risk of prostate cancer recurrence following surgery than their unexposed peers, and when the disease comes back, it seems more aggressive, researchers say. Another study found that Vietnam War veterans who had been exposed to Agent Orange have significantly increased risks of prostate cancer and even greater risks of getting the most aggressive form of the disease as compared to those who were not exposed.

What are the treatments for prostate cancer?

Early stage prostate cancer

If the cancer is small and contained - localized - it is usually managed by one of the following treatments:
  • Watchful waiting - not immediate treatment is carried out. PSA blood levels are regularly monitored.

  • Radical prostatectomy - the prostate is surgically removed.

  • Brachytherapy - radioactive seeds are implanted into the prostate.

  • Conformal radiotherapy - the radiation beams are shaped so that the region where they overlap is as close to the same shape as the organ or region that requires treatment, thus minimizing healthy tissue exposure to radiation.

  • Intensity modulated radiotherapy - beams with variable intensity are used. An advanced form of conformal radiotherapy usually delivered by a computer-controlled linear accelerator.
    Treatment recommendations really depend on individual cases. In general, if there is a good prognosis and the cancer is in its early stages, all options can be considered. However, they all have their advantages and disadvantages. The patient should discuss available options thoroughly with his doctor.
More advanced prostate cancer
    If the cancer is more aggressive, or advanced, the patient may require a combination of radiotherapy and hormone therapy. Radiotherapy requires treatment on an everyday basis for up to about eight weeks. Radical surgery is also an option - the prostate is removed. Traditional surgery requires a hospital stay of up to ten days, with a recovery time that can last up to three months. Robotic keyhole surgery has the advantage just a couple of days in hospital, followed by a much shorter recover period. However, even robotic keyhole surgery may not be ideal for very elderly patients.

    In advanced prostate cancer hormone therapy is very effective in slowing down, and even stopping the growth of cancer cells. Even if the hormone therapy stops working after a while, there are still other options the patient will be able to discuss with his doctor, such as participating in clinical trials.

Video: Da Vinci Prostatectomy

This video provides an overview of the radical prostatectomy with the daVinci System from Dr. J.H. Witt St. Antonius Hospital Gronau, Germany.

View Video Here
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What Are Menstrual Cramps? What Causes Menstrual Cramps? What Are Period Pains?

Menstrual cramps, also known as dysmenorrhea or period pains, are painful sensations felt in the lower abdomen that can occur both before and during a woman's menstrual period. The pain ranges from dull and annoying to severe and extreme. Menstrual cramps tend to begin after an egg is released from the ovaries and travels down the fallopian tube (ovulation).

There are two primary types of these difficult or painful periods - primary and secondary dysmenorrhea:
  • Primary dysmenorrhea is the most common type and is characterized by pain in the lower abdomen and lower back pain beginning 1-2 days before the period and lasting from 2 to 4 days. There is no underlying problem that is causing the pain

  • Secondary dysmenorrhea is characterized by cramping pains that are due to an identifiable medical problem such as endometriosis, uterine fibroids, or pelvic inflammatory disease.

Who gets menstrual cramps?

About half of women experience menstrual cramps, and about 15% describe the pain as severe. It has been shown that women who do not exercise experience more painful menstrual cramps.

Certain psychological factors such as emotional stress may also increase the likelihood of having uncomfortable menstrual cramps. Additional risk factors for these cramps include:
  • Being younger than 20 years of age
  • Starting puberty at age 11 or younger
  • Menorrhagia - heavy bleeding during periods
  • Never having delivered a baby

What causes menstrual cramps?

During each menstrual period, if there is no sperm to fertilize the egg, the uterus contracts to expel its lining. This process is driven by the release of hormone-like substances called prostaglandins, which are associated with pain and inflammation in higher levels. These uterine contractions cause much of the pain felt during menstrual cramps because the contractions inhibit blood flow to the lining of the uterus (the endometrium).

In addition, substances known as leukotrienes are also elevated during menstruation, and they may be a cause of menstrual cramps.

Women with delayed sleep phase syndrome are more likely to report irregular menstrual cycles and premenstrual symptoms, as well as menstrual cramps, according to researchers from Northwestern University in Chicago, USA.

Several underlying medical conditions are also capable of causing menstrual cramps. These include:
  • Endometriosis - the tissue that lines the uterus develops outside the uterus.
  • Uterine fibroids - noncancerous tumors and growths in the wall of the uterus.
  • Adenomyosis - the tissue that lines your uterus grows into the muscular walls of the uterus.
  • Pelvic inflammatory disease (PID) - a sexually transmitted infection caused by a bacterium.
  • Cervical stenosis - the opening of the cervix is small and limits menstrual flow.

What are the symptoms of menstrual cramps?

Symptoms of menstrual include:
  • Dull, throbbing, cramping pain in the lower abdomen
  • Pain in the lower back and thighs
  • Nausea
  • Vomiting
  • Sweating
  • Dizziness
  • Diarrhea
  • Loose stools
  • Constipation
  • Bloating in your belly area
  • Headaches
  • Lightheadedness- feeling faint

How are menstrual cramps diagnosed?

Most women are able to identify menstrual cramps without the help of a physician. In cases of extreme pain or when underlying conditions may be contributing to the pain, a doctor may order images of the abdominal area, uterus, cervix, vagina, and fallopian tubes. These may include ultrasound, computerized tomography (CT) scan, magnetic resonance imaging (MRI), hysteroscopy, and laparoscopy. Imaging techniques are important for identifying cases of endometriosis, adhesions, fibroids, ovarian cysts, and ectopic pregnancy.

How are menstrual cramps treated?

Over-the-counter medication is available to treat most cases of menstrual cramps. These medications are often called anti-prostaglandins and they reduce cramping in the uterus, make period flow lighter, and relieve discomfort. Many of these medications also contain pain killers such as ibuprofen or naproxen, which are types of nonsteroidal anti-inflammatory drugs (NSAIDs).

NSAIDs are also used alone to reduce menstrual cramp pain.

Sometimes, physicians will prescribe hormonal birth control pills. These medicines will prevent ovulation and reduce the severity of menstrual cramps. 97% of physicians in a poll said that continuous oral contraceptive therapy to suppress menstruation is, in fact, medically safe and acceptable - even though many women do not know this, a study found.

Researchers at Imperial College London found that chamomile tea helps relieve menstrual pains.

Chinese herbal medicines have been found to help women with menstrual cramps, according to a study.

Menstrual cramps that are due to underlying medical conditions such as endometriosis or fibroids may require surgery to remove the abnormal tissue. Surgery may help to reduce some menstrual cramp symptoms but carries additional risks.

Additional treatments that have been suggested to relieve menstrual cramp pain include soaking in a hot bath, using a heating pad on your lower abdomen, sex, yoga, massages, meditation, acupuncture, transcutaneous electrical nerve stimulation (TENS), and dietary supplements (such as vitamin E, thiamin and omega-3). Women with menstrual cramps should not only get adequate rest and sleep, but also regular exercise.

How can menstrual cramps be prevented?

You may be able to prevent menstrual cramps. Recommended preventive measures include:
  • Eating fruits and vegetables and limiting intake of fat, alcohol, caffeine, salt, and sweets.
  • Exercising regularly.
  • Reducing stress.
  • Quitting smoking.
  • Yoga or relaxation therapy.
  • Acupuncture or acupressure.
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What Is Huntington's Disease? What Causes Huntington's Disease?

Huntington's disease is an incurable, hereditary brain disorder. It is a devastating brain disorder for which there is no currently 'effective' treatment. Nerve cells become damaged, causing various parts of the brain to deteriorate. The disease affects movement, behavior and cognition - the affected individuals' abilities to walk, think, reason and talk are gradually eroded to such a point that they eventually become entirely reliant on other people for their care. Huntington's disease has a major emotional, mental, social and economic impact on the lives of patients, as well as their families.

It used to be called Huntington's Chorea, because the involuntary movements made by patients with the disease can appear to be like jerky dancing - "chorea" comes from the Greek word choreia meaning "dancing". The English word "choreography" also comes from the Greek word choreia.

Huntington's disease (HD) affects both men and women equally and more commonly appears during middle-age. According to the Department of Health, UK, there are about 6,000 people in the UK with the disease. The Huntington's Society of America says 1 in every 10,000 Americans has the disease - 30,000 people. It is estimated that at least 150,000 other Americans have a 50% risk of developing HD, while thousands of their relatives carry a degree of risk too.

Prevalence of the disease varies according to ethnic ancestry - people with Asian or African inheritance have a 1 in 1,000,000 risk of becoming affected, while the risk for Caucasian people is 70 to 100 times higher.

The J. David Gladstone Institutes, Taube Philanthropies and the Koret Foundation initiated a groundbreaking research program aimed at preventing, treating, or curing Huntington's disease by the year 2020.

What are the signs symptoms of Huntington's disease?

Sings and symptoms can appear at any age, but most commonly do so between the ages of 35 and 55 years. They will progressively worsen for ten to twenty years until the patient ultimately dies.

A sign is what the doctor can detect, such as involuntary movements, or a rash. A symptom is what the patient tells the doctor, such as dizziness, or insomnia.

How sings and symptoms evolve and which ones appear first may vary from person to person. Some may develop depression before suffering problems with motor skills.

Initial symptoms may initially be either ignored or attributed to something else for some time by most patients and their family and friends. This is more likely if people are not aware that Huntington's disease exists in their family. Symptoms may initially include mood swings and peculiar behavior.

Subtle signs can help doctors predict that a person will develop Huntington's disease in the next few years, scientists at the University of Iowa revealed.

It is not uncommon for some people to deny they have the condition and take a long time to come to terms with the diagnosis.

Possible early signs and symptoms

Below is a list of early signs and symptoms which may be relevant in some cases. It is important to remember these may vary depending on the individual:
  • Slight uncontrollable movements
  • Clumsiness
  • Stumbling
  • Some slight signs of lack of emotion
  • Lack of focus, slight concentration problems
  • Lapses in short-term memory
  • Depression
  • Mood changes - this may include antisocial behavior and aggression
Distressing for those who don't know - if family and friends don't know what is going on the impact on relationships and family life can be demoralizing, distressing and sometimes shocking. Unexpected temper outbursts directed at a partner from somebody who has hitherto been regarded as warm, caring and loving is frightening and confusing.

Friends and family may get the impression that an individual with HD is lazy - but it is not the case. HD typically affects a person's personality in such a way that they come over as unmotivated, unfocussed, lethargic, and lacking in initiative.

Unnecessarily worrying for those who do know - those who do know they are at risk may become concerned when they wonder whether an HD sign has emerged. Examples may include dropping something, suddenly becoming angry, forgetting somebody's name, or stumbling. These 'signs' are things all of us do from time to time.

In both cases, whether you are aware of the risk, or have no idea what is happening, talking to your GP (general practitioner, primary care physician) is advisable. The GP may refer the patient to a neurologist.

As Huntington's disease progresses

As the disease progresses problems will become more severe. These will include:
    Physical changes not including uncontrollable movements

  • Difficulty in speech - individuals with Huntington's have problems putting thoughts into words and slur their speech

  • Weight loss - often a cause of complications because the patient becomes weaker. Although most people with HD generally have good appetites, the muscles in the mouth and the diaphragm may not work properly, making the whole experience of eating seem cumbersome, frustrating and messy.

  • Feeding problems - as coordination gets worse the person with HD may spill and drop food.

  • Swallowing difficulties get gradually worse - chocking on food and drink. Choking tends to occur more when the liquid is thin, like water. During the later stages choking becomes a major concern.

  • Uncontrollable movements

  • Uncontrollable movements of the face.

  • Jerking of parts of the face and the head.

  • Flicking or fidgety movements of the arms, legs and body.

  • Lurching and stumbling - caused when movements move from one area of the body to another.

  • As HD progresses the uncontrollable movements occur more often and with usually with more intensity.

  • Eventually the movements may become slower as the muscles become more rigid.

  • Emotional changes - sometimes changes may alternate sporadically

  • Aggression.
  • Anger.
  • Antisocial behavior.
  • Apathy.
  • Depression.
  • Excitement.
  • Frustration.
  • Lack of emotion becomes more apparent.
  • Moodiness.
  • Stubbornness.

  • Cognitive changes

  • Loss of initiative.
  • Loss of organizational skills.
  • Disorientation.
  • Problems focusing.
  • Problems focusing on more than one thing at a time.
Some patients and carers comment that the psychological changes are more of a problem than the physical ones. Although some psychological changes are caused by the disease, frustration at not being able to do things which used to be easy can become depressing.

In the later stages the person will require total round-the-clock nursing care. The patient will not be able to walk or talk, although he/she will usually understand most of what is being said and will be aware of friends and family members.

In the majority of cases people die from a complication of Huntington's disease, such as pneumonia, choking, or another infection, rather than Huntington's itself.

Weight loss can bring with it worsening symptoms, as well as weakening the patient's immune system, which makes him/her more vulnerable to infections and other complications. Throughout all the stages of Huntington's disease it is important to adjust the patient's diet to ensure adequate food intake.

Genetic testing

As Huntington's disease is inherited dominantly, a child of a parent who has/had the disease has a 50% chance of inheriting the defective gene. Often the disease affects several generations. Genetic testing for HD became possible in 1993 when the first non-sex-linked dominant disease gene was found.

If you have a family history of Huntington's you can discuss with your doctor about genetic testing - it will determine whether or not you carry the defective gene. Some people find the uncertainty of not knowing stressful and unpleasant. On the other hand, finding out they have the gene and will develop Huntington's is distressing too. If you are not sure what to you, you should consider talking to a genetic counselor who will help you think the whole thing through.

In the UK fewer than 1 in 5 people at risk of having the faulty gene choose to undergo genetic testing. A study published in the British Medical Journal reported that individuals with a family history of genetic disease are frequently discriminated by their relatives, friends and also by insurance companies.

What causes Huntington's diseases?

Genes and chromosomes

Genes are made up of DNA. They are packaged into strands we call chromosomes. Genes are the instructions for making any living thing: humans, bacteria, plants, animals, etc. Humans have 23 pairs of chromosomes - 46 in all.

The faulty gene that causes Huntington's disease is found on chromosome number 4. A normal copy of the gene produces huntingtin, a protein. The faulty gene is larger than it should be and produces a larger form of huntingtin.

Some of our brain cells are sensitive to the larger form of huntingtin - it undermines their function and eventually destroys them. Scientists are not sure exactly how this happens. Johns Hopkins brain scientists have figured out why a faulty protein accumulates in cells everywhere in the bodies of people with Huntington's disease, but only kills cells in the part of the brain that controls movement, causing negligible damage to tissues elsewhere. The answer lies in one tiny protein called "Rhes" that's found only in the part of the brain that controls movement.

A person with the Huntington's gene has one good copy of the gene and one faulty copy of the gene. His/her child will inherit either the good copy or the faulty one. The child who inherits the good copy will not develop Huntington's disease, while the child who inherits the faulty copy will. The child has a 50% chance of inheriting the faulty gene. If the child inherits the faulty gene, each of his/her children will have a 50% chance of inheriting the faulty gene.

Doctors and scientists refer to the disease as an autosomal dominant disorder - only one copy of the faulty gene, inherited from either the mother or the father, is necessary to produce the disease.

A child who does not inherit the faulty gene will not develop HD and cannot pass it on to his/her children. A child who inherits the faulty gene will develop HD if he/she reaches the age when symptoms are due to emerge.

3% of people with Huntington's disease apparently have no family history of it. Some of them were adopted and never knew whether their parents had it. Others may have had a parent with the faulty gene who died from something else before reaching the age when symptoms would have emerged. In some cases there may be a new error in the gene - a mutation (it has to start somewhere).

British scientists found high levels of an inflammation-causing protein called IL-6 in the blood of affected individuals more than a decade before they were expected to develop the nervous system symptoms of the Huntington's disease. It has always been presumed that brain deposits of the mutant protein that causes the disease, called huntingtin, lured an overactive immune response. But since the immune cells that make IL-6 also make huntingtin, it's possible that mutant huntingtin might wrongly set these cells on attack mode throughout the body. Early intervention strategies to suppress the production of IL-6 might thus stave off brain destruction.

How is Huntington's disease diagnosed?

German scientists discovered that profound changes (comparable to those seen in late-stage HD) actually occur well before any disease symptoms show up, and most of the changes are confined to a specific stage during disease progression.

The doctor will examine the patient; ask about family history, personal medical history, and recent emotional and intellectual changes. The doctor may also recommend a psychiatric evaluation.

Sometimes doctors order imaging tests to identify any changes in the patient's brain structure, as well as to rule out other disorders. This may include either a CT (computer tomography) scan or an MRI (magnetic resonance imaging) scan.
  • Genetic Testing to confirm diagnosis

    If it is known that there is a family history of Huntington's disease to doctor will recommend genetic testing to confirm the diagnosis. If there is no family history the doctor may recommend genetic testing if other possible diseases or conditions have been ruled out. Many countries have a minimum age for genetic testing for HD - in the USA and the UK it is 18 years (unless there is a medically compelling reason to test a minor). If someone is found to have the faulty gene but does not yet have symptoms, it is impossible to predict when they will appear.

    In the UK a GP (general practitioner) will arrange for an appointment at a regional genetic clinic. Genetic counseling will be offered free of charge (UK) and two blood samples will be taken. DNA in the blood sample is extracted and analyzed.

  • Genetic tests in pregnancy

    A genetic test can be done on the 11th week of pregnancy. The test will determine whether the embryo has the faulty gene. Genetic counseling is an integral part of the process. Most countries' guidelines say that the pregnant woman should be accompanied to all testing sessions by a companion (not a sibling).

  • Preimplantation genetic diagnosis

    If a partner has the faulty gene, it is possible to have in-vitro fertilization (IVF) treatment. The embryo is then genetically tested in a laboratory and is only implanted into the woman if it does not have the faulty gene.

What is the treatment for Huntington's disease?

Huntington's disease is incurable. There is no current treatment that can reverse its progression or slow it down.

Scientists at UT Southwestern Medical Center found that man-made molecules that selectively interfere with protein production can stop human cells from making the abnormal molecules that cause Huntington's disease. They added that "The work has been done only in cultured cells, and it will take years before the effectiveness of this process can be tested in patients."

Some symptoms can be managed with medication and therapies.

  • Tetrabenazine (Xenazine) - in August 2006 the FDA (Food and Drug Administration), USA approved tetrabenazine for the treatment of jerky, involuntary movements (chorea) associated with Huntington's disease - the first to be specifically approved for this in the country. The compound has been known since the 1950s. It promotes the early metabolic degradation of the neurotransmitter dopamine.

    Side effects include:

    • Drowsiness.
    • Nausea.
    • Restlessness.
    • Dizziness.
    • Depression - reported in roughly 15% of those who take the medication.

  • Tetrabenazine should not be taken by patients diagnosed with depression, especially people with suicidal thoughts.

  • Sometimes clonazepan (Klonopin) and haloperidol and clozapine (Clorazil) are prescribed to control movements, violent outbursts and hallucinations. These drugs may cause sedation, as well as stiffness and rigidity.

  • Fluoxetine (Prozac, Sarafem), sertraline (Zoloft) and nortriptyline (Pamelor), may be prescribed for depression and some of the obsessive-compulsive disorders that are associated with HD.

  • For extreme emotions and mood swings lithium (Eskalith, Lithobid) may be prescribed.
Speech therapy

Speech therapy can help patients who find strategies to utter words and phrases and communicate in a more effective way.

Physical and occupational therapy

Better muscle strength and flexibility can be achieved with a good physical therapist. Strength and flexibility will help the patient's balance and reduce the risk of falling. An occupational therapist can help the patient devise strategies for coping with concentration and memory problems, as well as making the home safer.

Gene Therapy

This is still in its infancy but some promising research is going on in many parts of the world.
  • Researchers from the University of Southern California have taken an important first step toward protecting against Huntington disease using gene therapy. Kelvin J. A. Davies, professor of gerontology in the USC Davis School of Gerontology, said "Our findings allow for the possibility that controlled over-expression of RCAN1-1L might in the future be a viable avenue for therapeutic intervention in Huntington disease patients."

  • Howard Hughes Medical Institute researchers designed tiny RNA molecules that shut off the gene that causes Huntington's disease without damaging that gene's healthy counterpart, which maintains the health and vitality of neurons.
Strengthening antioxidant defenses (potential therapy?)

Therapeutic strategies to strengthen antioxidant defenses could help to prevent the progression of Huntington's disease, scientists in Spain revealed. Their research was carried out using human brain samples obtained post mortem from people affected by HD, which were compared with samples from control patients who had died from unrelated illnesses or other causes.

The caregiver (UK/Ireland/Australia: carer)

Caregiving can become time-consuming and mentally and physically exhausting. Caring for somebody with HD, especially if you are a lone caregiver, will become increasingly so. If you can afford it, get somebody in to help out with either the household chores or the physical care of the person with HD. Inquire with local health agencies, your doctor, about support groups, assistance programs, nursing assistance, and other services.

Caregivers have a higher risk of becoming ill themselves, partly because of the stress involved in caregiving, and also because most caregivers are elderly themselves. If you are a caregiver it is important you see your doctor whenever you don't feel physically or mentally well. Joining a support group may give you the opportunity to "share the burden" which often helps.

During the final stages of Huntington's disease the caregiver may not be able to provide all the care the HD person needs. There are long-term facilities that can do this.
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