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Saturday, May 1, 2010

About Kidney Transplantation

* Definition of Kidney Transplantation
* Description of Kidney Transplantation
* Treatment of Kidney Transplantation
* Questions To Ask Your Doctor About Kidney Transplantation

Definition of Kidney Transplantation
Article updated and reviewed by Nader Najafian, MD, Assistant Professor of Medicine, Harvard Medical School and Associate Physician, Renal Division--Brigham & Women's Hospital on May 17, 2005.

Kidney Transplantation is the surgical procedure of placing a fully functioning kidney into a person with severe kidney failure. This procedure is usually an elective one, performed in patients who have undergone careful preoperative assessment and preparation, since dialysis enables these patients to be maintained in relatively good condition until the time of surgery. The transplanted kidney may originate from a deceased donor (cadaver transplantation) or from a related or unrelated person (living transplantation).

Description of Kidney Transplantation
The function of the kidneys is to filter the blood in the body and to purify it by ridding it of soluble waste products and excess water (which is then eliminated in the form of urine). Total kidney failure, which may be gradual or sudden in onset, results in the accumulation of these waste products and water in the blood. These waste products can poison you unless removed. In addition, the excess water can accumulate in the lungs and prevent the patient from getting enough oxygen. Either processes or a combination of both can result in death.

The most common causes of kidney failure include:

* infection and inflammation of any part of the kidney structure

*

* damage to kidney tissue from some systemic diseases such as uncontrolled high blood pressure and untreated diabetes) or injury

* • damage to kidney tissue through some medications, including overuse of some over the counter pain killers such as Motrin and Aspirin

* polycystic kidneys (an inherited condition in which the tissues of the kidneys are gradually destroyed by cysts)

* failure of normal kidney development from before birth

There are two major treatment modalities for patients with kidney failure: dialysis or transplantation. In dialysis, the blood is artificially filtered through a machine or by diverting the bloodstream through another permeable membrane in the body itself. Despite numerous medical and technological advances over the last few years, dialysis patients feel very unwell. This is not surprising as even the most efficient hemodialysis regimens can only remove 10-12% of the small solute toxins as compared to normal functioning kidneys. Even though the kidney dialysis can keep the patients alive, these patients still suffer from poor quality of life, extreme dietary restrictions and the psychological burden of depending on a machine. Kidney transplantation is the treatment of choice in qualified patients with kidney failure as it has the greatest potential for restoring a healthy and productive life. This operation allows a patient to lead an independent existence instead of being reliant on regular kidney dialysis. It also allows a liberating return to a normal diet. The transplant procedure success rate has improved over the last years with one-year graft survivals exceeding 90% in most centers. A critical shortage of donor organs is the major limitation to expanding the use of this treatment. Many patients with end-stage renal (kidney) disease are suitable for transplantation. Fifty percent of all kidney transplants are received from cadaver donors and the others are received from living, related, or unrelated donors.

Regular kidney dialysis is a short-term solution to kidney failure: the blood is artificially filtered through a machine or by diverting the bloodstream through another permeable membrane in the body itself. The ideal treatment for total kidney failure is kidney transplantation.

One-third to one-half of all patients with end-stage renal (kidney) disease are suitable for transplantation. Two-thirds of all kidney transplants are recieved from cadaveric donors, and one-third are recieved from living, related donors.

Kidney Transplantation Surgery

The aim of the surgery is to supply a single, fully functioning kidney. One kidney provides more than enough filtration and regulating capacity for all purposes and is grafted into its own position while the existing (non-functioning) kidneys remain in place. The existing kidneys are removed only if they cause persistent infection or high blood pressure, and they will not interfere with the transplant procedure or functioning of the new organ. As soon as the transplanted kidney is connected to the blood vessels, it will begin purifying the blood of waste products.

Patients are required to take medications such as corticosteroids, cyclosporine, and/or azathioprine to suppress their immune system in order to prevent rejection of the transplanted kidney.

Post-operative Effects

More often than not, the first week after kidney transplantation is a grace period when things keep getting better. However, the clear sailing can be misleading, since many kidney recipients spend time in the hospital soon after discharge when the functioning of their new kidney diminishes. These episodes are almost always successfully treated by adjusting the medication regimen.

By far the two most common causes of diminished renal function are rejection and the toxic effects of cyclosporine. About 70 percent of all recipients will manifest some signs of organ rejection, and most will also have some evidence of cyclosporine toxicity. Both problems manifest themselves as decreasing urinary output and rising laboratory values of blood BUN (Blood Urea Nitrogen) and creatinine (a component of urine). These problems are usually treated simultaneously by adding extra doses of steroids.

Managing Rejection

Immediately after kidney transplant surgery, the mainstays of drug therapy are prednisone and cyclosporine, and sometimes azathioprine. It should be emphasized that cyclosporine is enormously beneficial for two reasons: first, in improving long-term survival of the kidney; and second, in permitting the rapid tapering off of the prednisone. Nevertheless, it is critically important that, as long as the transplanted organ is functioning, some level of maintenance immunosuppression (suppression of immunologic response, usually with reference to grafts or organ transplants) is necessary. If at any point a recipient stops taking the medications, rejection can occur - even ten or fifteen years after the transplant.

The important point to remember is that most recipients can expect to have some problems getting adjusted to their new organ, and that after the initial discharge it may be necessary to return to the hospital for one or more additional short stays. New drugs may be needed, and the doses of the anti-rejection medications will probably require adjustment. This fine-tuning is a normal part of recovering.

The vast majority of renal transplants are successful. Thus, the statement that someone is suffering rejection, which understandably sounds disturbing, is not cause for undue alarm. Most cases of rejection can be reversed, and the other causes of abnormal renal function also can be corrected. Well over 80 percent of recipients leave the hospital with a kidney functioning sufficiently to keep them off of dialysis.
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Treatment of Kidney Transplantation
Kidney Transplantation Surgery

The aim of the surgery is to supply a single, fully functioning kidney. One kidney provides more than enough filtration and regulating capacity for all purposes and is grafted into its own position while the existing (non-functioning) kidneys remain in place. The existing kidneys are removed only if they cause persistent infection or high blood pressure, and they will not interfere with the transplant procedure or functioning of the new organ. As soon as the transplanted kidney is connected to the blood vessels, it will begin purifying the blood of waste products. Patients are required to take medications that suppress the immune system for the rest of their lives to avoid the rejection of the kidney grafts.

Post-operative Effects

In most cases, particularly in patients that get good quality kidneys from family and friends (living donors), the transplanted kidneys start working immediately after transplantation and no further hemodialysis is required. In 20-30% of cases, particularly patients who get cadaver kidneys with poorer organ quality, the kidney may not function immediately and further dialysis may be needed. Regardless, all the transplant patients need to be monitored very closely in the first month after the procedure, as many of the immunosuppressive drugs need to be adjusted carefully. This usually requires clinic visits up to two to three times a week in the first month. By far the two most common causes of diminished renal function are rejection and the toxic effects of cyclosporine. About 30% of all recipients will manifest some signs of organ rejection, and most will also have some evidence of cyclosporine toxicity. Both problems manifest themselves as decreasing urinary output and rising laboratory values of blood BUN (Blood Urea Nitrogen) and cretonne (a component of urine). These problems are usually treated simultaneously by adding extra doses of steroids. As too low a dose of immunosuppressant drugs can result in rejection, too much of it can result in infections or cancer over time. That is the reason why patients need close follow-up by a kidney transplant specialist.

Managing Rejection

After kidney transplant surgery, the mainstays of drug therapy are usually a combination of two to three immunosuppressive medications, such as prednisone, cyclosporine, tacrolimus, or rapamycin, and sometimes azathioprine or cellcept. Initially, higher doses of these drugs are used as the risk of rejection is highest immediately after transplantation. With time, the levels of these drugs can then be tapered down. Nevertheless, it is critically important that, as long as the transplanted organ is functioning, some level of maintenance immunosuppression (suppression of immunologic response, usually with reference to grafts or organ transplants) is necessary. If at any point a recipient stops taking the medications, rejection can occur - even ten or fifteen years after the transplant.

The vast majority of renal transplants are successful with over 90% of organs functioning after the first year. Thus, the statement that someone is suffering rejection, which understandably sounds disturbing, is not cause for undue alarm. Most cases of rejection can be reversed, and the other causes of abnormal renal function also can be corrected.

Questions To Ask Your Doctor About Kidney Transplantation
How long is the waiting time to get a cadaver kidney?

Who would be qualified to donate a kidney to me (family, spouse, and friends)?

How can potential interested donors be evaluated?

How is the surgery performed?

How long does the surgery take?

How many kidney transplantations have you performed?

What medications will you be prescribing?

What are the side effects of immunosuppressive drugs?

How long will you prescribe steroids or any other medication?

What should be expected after the surgery?

Juvenile Diabetes

* Definition of Juvenile Diabetes
* Description of Juvenile Diabetes
* Causes and Risk Factors of Juvenile Diabetes
* Symptoms of Juvenile Diabetes
* Diagnosis of Juvenile Diabetes
* Treatment of Juvenile Diabetes
* Questions To Ask Your Doctor About Juvenile Diabetes

Definition of Juvenile Diabetes
Juvenile diabetes mellitus is now more commonly called Type 1 diabetes. It is a syndrome with disordered metabolism and inappropriately high blood glucose levels due to a deficiency of insulin secretion in the pancreas.

Description of Juvenile Diabetes
After a meal, a portion of the food a person eats is broken down into sugar (glucose). The sugar then passes into the bloodstream and into the body's cells via a hormone called insulin. Insulin is produced by the pancreas.

Normally, the pancreas produces the right amount of insulin to accommodate the quantity of sugar. However, if the person has diabetes either the pancreas produces little or no insulin, or the cells do not respond normally to the insulin. Sugar builds up in the blood, overflows into the urine and passes from the body unused.

Diabetes can be associated with major complications involving many organs including the heart, eyes, kidneys, and nerves, especially if the blood sugar is poorly controlled over the years.

Types Of Diabetes

Diabetes mellitus is a chronic disease caused by the inability of the pancreas to produce insulin or by the body to appropriately use the insulin it does produce. There are two main types of diabetes, Type 1 and Type 2.

Type 1 diabetes (also called insulin-dependent diabetes or juvenile diabetes) is caused by autoimmune destruction of the B cells of the pancreas which normally secrete insulin. Those patients require insulin injections for survival.

Type 2 diabetes (or non-insulin-dependent diabetes) is much more common and results from insulin resistance, mainly due to obesity, with inadequate additional production of insulin by the body. In other words, the pancreas produces a reduced amount of insulin or the cells do not respond to the insulin, or both.

Complications of Diabetes

If juvenile diabetes is left unmanaged, damage can occur to:

* Eyes - leading to diabetic retinopathy and possible blindness

* Blood vessels - increasing risk of heart attack, stroke and peripheral artery obstruction

* Nerves - leading to foot ulcers, impotence, and digestive problems

* Kidneys - leading to kidney failure

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Causes and Risk Factors of Juvenile Diabetes
An estimated 17 million people in the U.S. have diabetes, of which about 1.4 million have Type 1 diabetes. The highest prevalence of Type 1 diabetes is in Scandinavia, where it comprises up to 20 percent of the total number of patients with diabetes.

The prevalence of Type 1 diabetes is about 5-10 percent of the total number of diabetes patients in the U.S., while in Japan and China, less than 1 percent of patients with diabetes have Type 1. Approximately 35 American children are diagnosed with juvenile diabetes every day.

The exact cause of Type 1 diabetes (juvenile diabetes) is still unclear. However, it is believed that Type 1 diabetes results from an infectious or toxic insult to persons whose immune system is genetically predisposed to develop an aggressive autoimmune response either against altered pancreatic B antigens (proteins) or against molecules of the B cell resembling a viral protein (called molecular mimicry). It is not caused by obesity or by eating excessive sugar.

The risk of juvenile diabetes is higher than virtually all other severe chronic diseases of childhood. Juvenile diabetes tends to run in families. Brothers and sisters of a child with juvenile diabetes have at least 100 times the risk of developing juvenile diabetes as a child in an unaffected family.

Symptoms of Juvenile Diabetes
The symptoms of Type 1 diabetes (juvenile diabetes) may occur suddenly, and include:

* Frequent urination

* Increased thirst

* Extreme hunger

* Unexplained weight loss

* Extreme weakness and fatigue

* Urinating at night (nocturnal enuresis)

* Blurred vision

* Numbness or tingling in the hands or feet

* Heavy or labored breathing

* Drowsiness or lethargy

* Fruity odor on the breath

Diagnosis of Juvenile Diabetes
A child with the above symptoms must be seen by a physician as soon as possible.

Besides a complete history and physical examination, the doctors will do a battery of laboratory tests. There are numerous tests available to diagnose diabetes such as urine test, blood test, glucose-tolerance test, fasting blood sugar and the glycohemoglobin (HbA1c) test.

A urine sample will be tested for glucose and ketones (acids that collect in the blood and urine when the body uses fat instead of glucose for energy). A blood test is used to measure the amount of glucose in the bloodstream. A glucose-tolerance test checks the body's ability to process glucose. During this test, sugar levels in the blood and urine are monitored for 3 hours after drinking a large dose of sugar solution.

The fasting blood sugar test involves fasting overnight and blood being drawn the next morning. The glycohemoglobin test reflects the cumulative effects of high blood glucose (and measures the degree of control over blood glucose after treatment begins).

Treatment of Juvenile Diabetes
Treatment of Type 1 diabetes involves:

* Diet

* Insulin

* Self-monitoring of blood glucose

* Exercise

Questions To Ask Your Doctor About Juvenile Diabetes
Does the child have Type 1 diabetes?

How can this best be managed?

What is diabetic ketoacidosis?

What changes in diet will be required?

Is there a specific meal plan?

What type of insulin should be used - what is the frequency and dosage?

How can exercise help the child - how much, and what type?

At what age should the child self-administer insulin?

What restrictions and limitations will be placed upon the child's life?

Should the child's teacher or school nurse be alerted to the situation?

Are there any support groups or organizations regarding the care of a child with diabetes?

What is the prognosis?

Amniocentesis

* Definition of Amniocentesis
* Description of Amniocentesis
* Questions To Ask Your Doctor About Amniocentesis

Definition of Amniocentesis
Amniocentesis is a simple medical procedure used to obtain small samples of the amniotic fluid surrounding the fetus.

Description of Amniocentesis
In the first half of the pregnancy (between the 14th and 18th week) the doctor may perform an amniocentesis when:

* The age of the mother is 35 years of age or older. The risk of bearing children with chromosomal birth defects increases as a woman ages, thus if a woman will be 35 or older at the time of delivery, most physicians offer the option of prenatal testing for chromosomal disorders. Among the most common of these disorders is Down syndrome, a combination of mental and physical abnormalities caused by the presence of an extra chromosome.

* A previous child or pregnancy resulted in a birth defect. If a couple already has a child (or pregnancy) diagnosed with a chromosomal abnormality, a biochemical birth defect, or a neural tube defect, the couple may be offered prenatal testing during subsequent pregnancies.

* Family history shows an increased risk of inheriting a genetic disorder. Couples without a previously affected child may also be offered prenatal testing if their family medical histories indicate their children may be at increased risk of inheriting a genetic disorder.

* One or both prospective parents may be "carriers" of a disorder, or a disorder may "run in the family." Prenatal testing would be done only if the suspected condition can be diagnosed prenatally.

* There is suspected neural tube defects. These defects of the spine and brain, including spina bifida and anencephaly, can be diagnosed by measuring the level of alphafetoprotein (AFP) in the amniotic fluid. Amniocentesis to measure AFP is offered if there is a family history of neural tube defects, or if earlier screening tests of AFP in the mother's blood indicate that the pregnancy is at increased risk.

* The doctor wants to assess fetal lung maturity. Fetal lung assessment is important if the mother needs to deliver the baby early. By testing the amniotic fluid doctors can tell whether the baby's lung's are developed enough to breathe on their own.

* Detection of Rh disease is needed. Rh disease causes antibodies in the mother's blood to attack fetal blood cells and an amniocentesis detects the disease and enables the doctors to take appropriate measures to reduce complications.

Questions To Ask Your Doctor About Amniocentesis
Should an amniocentesis be done?

Is there a possibility the baby will have birth defects?

When should the amniocentesis be done?

How will the test be done?

What will the amniocentesis show?

What are the possible outcomes?

Cesarean Section

* Definition of Cesarean Section
* Description of Cesarean Section
* Questions To Ask Your Doctor About Cesarean Section

Definition of Cesarean Section
Cesarean childbirth consists of an operation to deliver a baby through an incision in the abdomen.

Description of Cesarean Section
Until recently the operation was usually used as a last resort because of a high rate of maternal complications and death. With the availability of antibiotics to fight infection and the development of modern surgical techniques, the once high maternal mortality rate has dropped dramatically. As a result, the cesarean childbirth rate has increased dramatically.

There are three main types of cesarean operations, each named according the location and direction of the uterine incision:

Low Transverse, a transverse (horizontal) incision in the lower uterus

Low Vertical, a vertical incision in the lower uterus

Classical, a vertical incision in the main body of the uterus

Today, the low transverse incision is used almost exclusively. It has the lowest incidence of hemorrhage during surgery as well as the least chance of rupturing in later pregnancies.

Sometimes, because of fetal size (very large or very small) or position problems (breech or transverse), a low vertical cesarean may be performed.

In the classical operation, a larger vertical incision allows a greater opening; it is used in some emergency situations as well as for fetal size or position problems. This approach involves more bleeding in surgery and a higher risk of abdominal infection. All subsequent deliveries must be by cesarean section after a classical delivery due to the higher risk of uterine rupture.

Although any uterine incision may rupture during a subsequent labor, the classical is more likely to do so, and more likely to result in death for the mother and fetus than a low transverse or low vertical incision.

There are many reasons why a woman might need to deliver by Cesarean section, although not all doctors agree on when one is really necessary. The most common reason is failure to progress (FTP) in labor, where labor has stalled because the cervix has stopped dilating or uterine contractions are weak. The second most common reason for cesarean section is fetal distress. Sometimes the baby can not tolerate the strong contractions associated with labor. When the fetal heart tracing becomes non-reassuring, a cesarean section is usually performed. Another common reason for cesarean section is previous cesarean section or surgery on the uterus. Women who delivered by a classical cesarean section in a previous pregnancy must deliver by cesarean section for all following pregnancies. However, women with a history delivering by low transverse cesarean section are given the choice of scheduling a repeat cesarean section or trying to deliver vaginally. Also some women with a history of surgery to remove fibroids may need to deliver by cesarean section.

Other less common reasons for a cesarean section are listed below:

Cephalopelvic Distortion (CPD. Another indication of cesarean delivery is cephalopelvic disproportion (CPD), a rare condition in which the baby's head is too large to fit through the mother's pelvis.

Malposition of the fetus. In breech position, the baby's buttocks or feet are positioned to come out first instead of the head. Twins might need to be delivered by cesarean if the first baby or both are breech. Malposition of the fetus does not necessarily mean a cesarean delivery.

Vaginal bleeding/placenta previa/placental abruption. Vaginal bleeding late in pregnancy often indicates placenta previa, a low-lying placenta that covers part or all of the inner opening of the cervix. If the bleeding does not stop with bedrest, the doctor probably will perform a cesarean, to prevent hemorrhage. Vaginal bleeding late in pregnancy also may indicate placental abruption, where the placenta separates from the uterine wall before delivery. In some cases of mild abruption, it may be possible to deliver vaginally. If there is heavy bleeding or fetal distress caused by abruption (abruption can lead to maternal shock, which, together with a reduced amount of functioning placenta, can deprive the fetus of adequate oxygen), a cesarean generally is necessary.

Other situations. If you have vaginal herpes and active sores in the vaginal area, your doctor might do a cesarean to try to prevent your passing on the disease to your baby. A cesarean section is usually performed in mothers with HIV before labor to prevent transmission HIV from mother to baby. Women diagnosed with invasive cervical cancer who have bulky cancer lesions on the cervix are offered classical cesarean section to deliver the baby. Lastly, women pregnant with a baby with bleeding problems may be offered a cesarean section to prevent birth trauma to the infant.

Malpractice concerns, a woman’s preference, obesity and insurance coverage are also factors which may play a role in whether to perform a cesarean delivery.

Until recently, it was medically accepted that once a woman had a cesarean, she should have all of her children by cesarean because of the concern about tearing the incision. Yet studies have shown "once a cesarean, always a cesarean," no longer holds true for most women. Today, the option of attempting to give birth through the vagina is open to women who have had previous low transverse incision cesarean births, and over half of these have successful vaginal deliveries.

If vaginal delivery is a possibility for you, here are some reasons why you may wish to attempt it:

Less risk. A vaginal delivery usually has fewer complications for the mother than a cesarean birth. As there is no abdominal incision, the risks of infection, bleeding, or other problems resulting from surgery or anesthesia are much lower.

Shorter recovery. Your stay in the hospital is likely to be briefer after vaginal delivery. The average time spent in the hospital is 1 to 3 days, whereas the average stay after a cesarean birth is 3 to 5 days. Recovery at home is faster as well, since women who deliver by cesarean must limit their activity for 4 to 6 weeks to allow the abdominal incision to heal.

More involvement. Some women wish to be awake and fully involved in the birth process. There may also be more limitations on the presence of others in the room during the cesarean birth process

Questions To Ask Your Doctor About Cesarean Section
What circumstances require cesarean delivery?

Are indications of fetal distress confirmed by a fetal scalp blood test?

Is a second opinion sought before proceeding to all but emergency surgery?

Must I have intravenous infusion during labor, or can I eat and drink lightly?

What are some specifics about the facility where I will deliver. Does it require a specific management plan, such as active management of labor?

Does it offer a constant labor companion, or allow you to bring your own?

CD4 Lymphocyte Monitoring

* Description of CD4 Lymphocyte Monitoring
* Questions To Ask Your Doctor About CD4 Lymphocyte Monitoring

Description of CD4 Lymphocyte Monitoring
Monitoring lymphocyte counts in a patient with HIV infection is one way to assess the degree of immunosuppression and the risk of developing opportunistic infections.

For several years after exposure to human immunodeficiency virus (HIV), an infected person will typically have either no symptoms or only minor ones such as chronically swollen lymph nodes. However, despite the absence of noticeable symptoms, HIV may be silently causing damage.

HIV infects and kills certain white blood cells called CD4 lymphocytes, reducing their number. The number of CD4 cells usually declines over time in an HIV-infected person. CD4 lymphocytes act as the 'on switch' for part of the immune system, so as the number of CD4 cells drops, damage to the immune system may progress.

Over time, individuals become increasingly susceptible to infections caused by organisms that are usually controlled by people with adequate immune systems. Those infections are called opportunistic infections.

Years after infection, HIV-infected people may develop symptoms such as night sweats, chronic diarrhea, fatigue, fever, and various skin problems. These symptoms vary in severity for each individual. If the individual receives no treatment and further immune impairment occurs, the body becomes susceptible to life-threatening complications.

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Questions To Ask Your Doctor About CD4 Lymphocyte Monitoring
What is the CD4 count?

Has the count dropped since it was last taken?

How accurate is the count?

At what level should treatment begin?

How can the symptoms be controlled?

What preventive measures should be taken?

When should the count be repeated?

Is HIV counseling available?

Congestive Heart Failure

* Definition of Congestive Heart Failure
* Description of Congestive Heart Failure
* Causes and Risk Factors of Congestive Heart Failure
* Symptoms of Congestive Heart Failure
* Diagnosis of Congestive Heart Failure
* Treatment of Congestive Heart Failure
* Questions To Ask Your Doctor About Congestive Heart Failure

Definition of Congestive Heart Failure
Article updated and reviewed by Neil Siecke, MD, Clinical Insturctor, UCSD Division of Cardiology on July 28, 2005.

Congestive heart failure (or heart failure) occurs when the heart is unable to pump enough blood (which provides oxygen) to the muscles, tissues, and other organs of the body.

Statistics on Heart Failure

* A person aged 40 years or older has a one in five chance of developing heart failure.

* About five million Americans have been diagnosed with heart failure.

* About 550,000 new cases are diagnosed each year.

* Heart failure is the most common hospital discharge diagnosis with more than one million hospital stays each year.

* The costs of treating heart failure in the United States exceed $27 billion.

* The risk of heart failure increase with age: 10% of both men and women over 75 have been diagnosed with heart failure.

Statistics derived from the American Heart Association, Heart Disease and Stroke Statistics — 2005 Update

Description of Congestive Heart Failure
There are three ways that the pumping ability of the heart can be affected:

1. The mechanical pump can be ineffective, reducing the ability of the heart to move blood forward.

2. The valves that allow blood to go forward and prevent it from going backwards can fail.

3. The electrical controls for the pump can fail.

Problems with the Pump

Problems with the pumping functions of the heart are the most common cause of heart failure. The heart is actually made up of two pumps, one which pumps blood to the lung (the right heart) and the other which pumps blood to the rest of the body (the left heart). The left heart is usually stronger and is also more likely to fail.

The heart can fail for one of two reasons. If it is weak, it can not expel the appropriate amount of blood with each heart beat. It will try to compensate by beating faster, but there are limits to this. How much blood is expelled with each beat is called the ejection fraction (EF). Normally the heart expels about 50% of the blood in chamber with each beat; however, when the heart is weak, this number can fall to 30% or even lower. Symptoms typically begin when the EF falls to around 40%. This type of failure is known as systolic dysfunction.

The other type of heart failure is called diastolic dysfunction. With diastolic dysfunction, the EF is normal. The problem is that the heart does not fill appropriately. It becomes too stiff and can not enlarge fast enough to accept the appropriate amount of blood into the chamber before contracting to move the blood forward. Because the heart is not filling fast enough, blood backs up behind the heart in the lungs.

The right heart can also fail. The right heart is designed to pump against low pressure, as the blood pressure in the lungs is usually < 40 mmHg. If this pressure becomes elevated, the pump is unable to push the blood forward and it will collect in the veins of the legs and abdomen. The most common cause for high blood pressure in the lungs is backing-up from left heart failure, but other causes such as pulmonary hypertension, blood clots in the lungs, and severe emphysema can also raise this pressure.

Causes for Systolic Dysfunction (Weak Hearts:

* A previous heart attack is the most common cause for a weak heart; the muscle tissue in this area dies and is replaced by scar tissue which has no pumping activity; just having multiple areas of blocked arteries can also weaken the heart

* Certain kinds of viral infections can attack the heart muscle

* Alcohol abuse

* Illicit drugs such as methamphetamine and cocaine

* Certain, mostly older, chemotherapy drugs

* Some auto-immune disorders

* Rarely the heart weakens after pregnancy, known as post-partum cardiomyopathy

Causes for Diastolic Dysfunction (Stiff Hearts):

* High blood pressure for many years is the most common cause of a stiff hear; a blood pressure greater than 160/90 mmHg doubles the risk of a person with a blood pressure of 140/80

* Diabetes seems to worsen the effects of high blood pressure

* Hypertrophic Cardiomyopathy (a group of genetic abnormalities that results in thickened hearts)

* Infiltrative diseases such as amyloidosis

* Some valvular problems also cause the heart to become stiff

* Certain diseases of the pericardium, or lining, around the heart

Problems with the Valves

The heart has four valves that allow the blood to move forward and prevent it from going backwards. The valves can fail either because they become clogged and do not allow blood to move forward easily, or they can become leaky in which case too much blood flows backward, and not enough moves forward.

Most valve problems will result in a murmur. The murmur may begin many years before the problem becomes noticeable, but this is not always the case.

Reasons that the valves can fail include the following:

* Congenital (birth) defects

* Calcification of the valve

* Infection of the valve (Rheumatic Fever is the most common)

* Heart attacks can also damage the valve

Problems with the Electrical Controls of the Heart

The electrical system controls how often, or how fast, the heart beats and coordinates the movements among the various chambers of the heart for optimal efficiency. Beating too fast, too slow, or irregularly can all result in heart failure. The generic name for these problems is an arrhythmia.

The normal heart rate is 60 to 80 beats per minute. The most common reason for the heart to beat to rapidly is excess stimulation, such as a thyroid problem. The most common reason for beating too slow is bad connection between the chambers (heart block). An irregularly beating heart is often caused by atrial fibrillation.

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Causes and Risk Factors of Congestive Heart Failure
The two most common causes of heart failure are high blood pressure and coronary artery disease (disease of the artery). Up to 75 percent of all patients with heart failure have a history of high blood pressure, and at least 50 percent have a history of coronary artery disease.

Specific causative factors for the four (4) forms of heart failure are listed below.

1. Systolic heart failure can be caused by coronary artery disease; high blood pressure; metabolic disorders, such as thyroid disease, vitamin deficiency or diabetes; infection; toxin exposure to cobalt, alcohol, cocaine and chemotherapeutic agents; infiltrative diseases, such as cardiac amyloidosis and hemochromatosis; neuromuscular disease; collagen vascular disease; valvular heart disease or peripartum cardiomyopathy.

2. Diastolic heart failure can be caused by coronary artery disease; high blood pressure; myocardial relaxation; left ventricular elastic recoil; ventricular-ventricular interaction; pericardial restraint; intrathoracic pressure or passive chamber properties.

3. Left-sided heart failure can be caused by high blood pressure; hypertrophic cardiomyopathy (an enlarged left ventricle and a thick ventricular wall); anemia; hyperthyroidism; heart valve defect, such as aortic valve stenosis and aortic insufficiency; congenital heart defect; heart arrhythmias; myocardial infarction or cardiomyopathy (disease of the heart muscle).

4. Right-sided heart failure can be caused by pulmonary hypertension; lung disease, such as chronic bronchitis and emphysema; tricuspid insufficiency or congenital heart defect, such as septal defect, pulmonary stenosis or tetralogy of Fallot.

Symptoms of Congestive Heart Failure
All of the types of heart failure can result in similar symptoms, including the following:

* Shortness of breath, especially with activity such as walking

* Difficulty breathing when lying flat in the bed

* Waking up at night short of breath

* Fatigue

* Weakness

* Pale, blue or cool skin

* Palpitations

* Changes in blood pressure

* Fainting for no apparent reason

* Swelling in the abdomen

* Swollen legs

Symptoms of right-sided heart failure include:

* Swollen legs

* Liver and spleen enlargement

* Swollen neck veins

* Fluid buildup in the stomach

* Swollen abdomen

* Slow weight gain

* irregular heart rhythm

* Nausea

* Vomiting

* Appetite loss

* Weakness

* Fatigue

* Dizziness

* Fainting episodes

Diagnosis of Congestive Heart Failure
A health history, physical exam, chest x-ray, and electrocardiogram (EKG) should be done in every person suspected of heart failure. Most patients will also have an echocardiogram (an ultrasound study of the heart). A blood test (BNP) can also be useful in diagnosing heart failure.

The health history will consist of questions about symptoms and how long they have been present, previous heart problems, other health problems, , and use of alcohol or other drugs.

During the physical exam, the doctor will listen to the heart and lungs with a stethoscope to detect the sounds associated with heart failure (such as murmurs or the sound of fluid in the lungs).

Additionally, the doctor will look for evidence of fluid build-up, such as swollen or enlarged neck veins, an enlarged liver, an expanding abdomen and swollen ankles.

A chest x-ray may reveal an enlarged heart or fluid in the lungs. It may also suggest another reason for the symptoms such as pneumonia or damage to the lungs.

An echocardiogram uses ultrasound waves to obtain images of heart structures. The echocardiogram can tell if the heart pumping ability is weak or stiff. It can also diagnose problems with the valves, or it may suggest that a person has had a previous heart attack.

Treatment of Congestive Heart Failure
The treatments for heart failure have improved dramatically over the last five to 10 years. Most subjects can be managed to the point where they have few symptoms, but this often requires that they take five or more medications per day.

When deciding how to treat heart failure, the most important question is what caused the heart failure in the first place and to reverse that if possible. If the problem is from a bad valve, surgery will usually be required to replace or repair the valve. If the problem is electrical, a pacemaker may be needed to regulate the heart beat or other treatments to slow the heart rate. If the problem is from blocked arteries, either an angioplasty or a bypass surgery is usually attempted. Most patients will end up taking several medications to improve their symptoms or help the heart recover.

Medication

The first treatment is usually a diuretic medication. These medicines work by forcing the kidney to excrete more salt and water. This will help to remove the excess fluid from the lungs and/or the legs. These medications can quickly make a patient feel better. Examples include furosemide (Lasix), bumetanide (Bumex), and hydrochlorothiazide (HCTZ).

Angiotensin-converting enzyme inhibitors (ACE inhibitors) are used to reduce the blood pressure and to encourage the healthy recovery of the heart function. They work by restoring imbalances in several hormones. There are approximately 10 different brands available with similar effectiveness. Examples include: captopril (Capoten), enalapril (Vasotec), and lisinopril (Prinivil, Zestril).

Some patients will develop a cough when treated with an ACE Inhibitor. They will usually be prescribed a closely related type of medication known as an angiotensin receptor blocker (ARB). Examples include valsartan (Diovan) and losartan (Cozaar).

Recently, some studies have suggested that African-Americans may not respond as well as other ethnicities to ACE inhibitors. They may instead be prescribed a combination of hydralazine and isosorbide. Beta-blockers were originally thought to be harmful for subjects with heart failure as they tend to reduce the pumping ability of the heart. They work by blocking the effect of adrenaline, a stress hormone, that can be very high in patients with heart failure. We now know that adrenalin is harmful to the heart. Beta blockers can dramatically improve the function of the heart over time, but if the heart muscle is weak, they must be started at low doses and gradually increased over time. Examples of beta-blockers include carvedilol (Coreg) and metoprolol (Toprol XL).

Digoxin (Lanoxin) has been used for several centuries to treat heart failure. It is an herbal extract that mildly increases the heart's pumping action so more blood is ejected with each heartbeat. Care must be taken to avoid high blood levels of this medication.

Other medications may also be needed to lower the blood pressure, lower the level of cholesterol, replace potassium lost in the urine, or prevent blood clots.

Electrical Devices:

* Defibrillators (ICDs) have been shown to prevent sudden cardiac death (a fatal arrhythmia) in certain groups of people with heart failure. These are small devices that are placed under the patient’s skin and monitor the electrical activity of the heart. If a problem is detected, the device will give the heart an electrical shock which is designed reset the heart and restore a healthy heart rhythm.

* Biventricular Pacemakers are advanced types of pacemakers that can stimulate both the right and left side of the heart at the same time if an electrical problem has caused them to become out of sync. These devices function much like typical pacemakers, but they require a more complicated installation to reach the left side of the heart.

Dietary, Lifestyle and Health Changes

* Restrict salt (sodium) intake. Restricting sodium minimizes fluid retention.

* Avoid caffeine. Avoiding caffeine lowers the risk of an increased heart rate or abnormal heart rhythms.

* Limit or stop alcoholic beverage consumption.

* Check your weight everyday. If your weight suddenly increases, you may be retaining fluid and may need to adjust your medications.

* Don't smoke or chew tobacco.

* Don't use illegal drugs.

* Exercise regularly, within your doctor's guidelines.

* Rest. Adequate rest helps conserve energy and decreases demands on the heart.

* Reduce stress.

* Get a flu and pneumonia shot.

Questions To Ask Your Doctor About Congestive Heart Failure
What form of heart failure is it?

What is the cause of the condition?

How serious is the condition?

Should a specialist be consulted?

What type of treatment will you be recommending?

Will surgery be recommended?

Will you be prescribing any medication?

What are the side effects?

Thursday, April 29, 2010

Baldness

* Definition of Baldness
* Description of Baldness
* Causes and Risk Factors of Baldness
* Treatment of Baldness
* Questions To Ask Your Doctor About Baldness

Definition of Baldness
Common baldness, sometimes called male- or female-pattern baldness, accounts for 99 percent of hair loss in men and women. Although its exact causes are unknown, heredity, hormones and age are contributing factors. Unlike hair loss resulting from disease or other non-hereditary factors, hair loss due to common baldness is permanent.

Male baldness usually begins with thinning at the hairline, followed by the appearance of a thinned or bald spot on the crown of the head.

Women with common baldness rarely develop bald patches. Instead, they experience a diffuse thinning of their hair.

Description of Baldness
Hair is a conspicuous element in many cultural definitions of fashion, youth and sexuality. So, it is not surprising that many cringe at the first sign of thinning hair.

Most people lose between 50 and 100 strands of hair daily, with little impact. As hairs fall out naturally, new hairs grow in. So there is no need to despair if you spot a hair or two in your sink. However, with age this natural regrowth process may slow or stop, and thinning and baldness may occur. If you are concerned about it, see your doctor for an evaluation to find out if your hair loss is due to an underlying medical disorder.

Like your skin and nails, your hair goes through a finely tuned cycle of growth and rest. Excessive hair loss can occur at any time this delicate cycle is upset.

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Causes and Risk Factors of Baldness
Factors such as diet, medications, natural hormones, pregnancy, improper hair care and certain diseases can cause temporary hair loss. Once the underlying cause is pinpointed and eliminated, the hair may grow back. See the Hair Loss report for more detailed causes of temporary hair loss.

Treatment of Baldness
There is no cure for common baldness, but surgical hair replacement can give you back a head of your own hair. Available since the 1950s, surgical hair replacement is a low-risk procedure.

Surgeons remove tiny plugs (grafts) of your hair-bearing skin and transplant them into tiny holes made in your scalp. They take these plugs from the band of hair extending from above your ears around the back of your scalp.

During one session, your surgeon may transplant between 60 and 100 hair plugs, each about the diameter of a pencil eraser. Local anesthesia and mild sedation minimize discomfort during surgery.

Hospitalization usually is unnecessary. Within a few days after the operation, tiny scabs form around each hair graft. When the scabs disappear, the donor hairs usually fall out. New hairs generally start to grow within a few months.

If the baldness and thinning is extensive, one should not expect to walk out of the first surgery with a full, natural-looking head of hair. Even after the transplanted hairs begin growing, these widely scattered clumps may look conspicuous. Additional surgeries may be needed to fill the void. It may take a year or two before you will be pleased with your new appearance.

The quest for a new look may cost in the range of $2,000 for each round of surgery. Typically, it takes three or fours sessions to cover a bald area.

Questions To Ask Your Doctor About Baldness
Is the baldness caused by a medical disorder rather that the regrowth process stopping?

If baldness runs in the family, will the male family members evidently start going bald?

Will certain kinds of medicine cause hair loss?

Do you recommend hair replacement?

Is this procedure successful?

Do you recommend using Rogaine or Propecia?

What are the side effects of using these drugs?

Vitiligo

* Definition of Vitiligo
* Description of Vitiligo
* Causes and Risk Factors of Vitiligo
* Symptoms of Vitiligo
* Diagnosis of Vitiligo
* Treatment of Vitiligo
* Questions To Ask Your Doctor About Vitiligo

Definition of Vitiligo
Vitiligo, also called white spot disease or leukoderma, is a disease in which the skin loses its pigment due to the destruction of melanocytes.

Description of Vitiligo
Melanocytes are pigment cells located in the surface layer of the skin called the epidermis and are responsible for producing melanin. Melanin is a dark pigment that gives skin its color and protects against ultraviolet radiation. When melanocytes stop producing melanin, the skin becomes pale, leaving areas of white patches - this is called vitiligo.

Vitiligo can start at any age, but it often occurs between the ages of 20 and 30. Vitiligo may begin on the face above the eyes, or on the neck, armpits, groin, hands or knees. Vitiligo may appear as a few small pigmented patches or spread over the entire body. In many cases, initial pigment loss will occur, then, after several months, the number and size of the light areas become stable and may remain so for a long time. Episodes of pigment loss may appear again later.

Vitiligo is present in about 1 percent of the population.

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Causes and Risk Factors of Vitiligo
The actual cause of vitiligo is unknown, however researchers believe that there are many factors and/or conditions listed below that contribute to the disease:

* Heredity (over 30 percent of affected persons have reported vitiligo in a parent, sibling, or child)

* Exposure to chemicals such as phenol (disinfectant) or catechol (used in dyeing or tanning)

* Emotional or physical stress

* Autoimmune disorder is which the body may be destroying its own melanocytes

* Autotoxic response is which the melanocytes self-destruct leaving a toxic residue, that, in turn destroys new melanocytes

* Skin injury

* Burns

* Inflammatory skin disorders

* Associative disorders such as diabetes, pernicious anemia, hyper- and hypo-thyroidism, Addison's disease (adrenal insufficiency), uveitis (inflammation of the eyes) or alopecia areata (patches of hair loss).

Symptoms of Vitiligo
The symptoms of vitiligo are:

* Chalk white patches of skin often located symmetrically on both sides of the body

* White hairs within depigmented patches

Diagnosis of Vitiligo
The medical history is important, but diagnosis can usually be made solely by observation of characteristic skin changes. For fair-skinned people, the doctor will use a special light, called a Wood's lamp, to shine on the skin in a dark room to identify the vitiliginous patches. In some cases, a skin biopsy may be required.

Treatment of Vitiligo
Depending on the severity of the condition, the treatment method may vary. Treatment methods include:

* Avoidance of tanning. For fair-skinned individuals, avoiding tanning of normal skin can make the areas of vitiligo almost unnoticeable.

* Use a sunscreen with an SPF of at least 30.

* Use a cosmetic cover-up solution. Make-up, self-tanning compounds with dihydroxyacetone, and dyes (such as Covermark, Walnut Stain, Vita Dye or Dermablend) help temporarily conceal the white patches of vitiligo.

* Repigmentation. The restoration of the normal pigment and can be achieved with repigmentation therapy or corticosteroids. To get repigmentation, new pigment cells must be produced from existing ones, such as ones found at the base of hair follicles, from the edge of the patch or from the patch itself if depigmentation is not complete.

In repigmentation therapy, a patient is given a psoralen drug (orally) and then is exposed to ultraviolet light A (UV-A) in the doctor's office. This therapy is called PUVA. When psoralen drugs are activated by UV-A, they stimulate repigmentation by increasing the availability of color-producing cells at the skin's surface. Psoralen is also available in a topical form that can be applied to the body for patients with small, scattered patches. Topical corticosteroids (such as Temovate or Psorcon) are prescribed for patients with small patches of vitiligo.

* Depigmentation is the destruction of the remaining melanocytes. Patients with vitiligo over half of their exposed body may want to consider using this method. A bleaching chemical called monobenzylether of hydroquinone (Benzoquin) is applied to normally pigmented skin. Treatment may take up to one year.

Questions To Ask Your Doctor About Vitiligo
Is vitiligo contagious?

Could there be an underlying condition causing this?

Will this reoccur?

What treatment method do you recommend?

Vertigo

* Definition of Vertigo
* Description of Vertigo
* Causes and Risk Factors of Vertigo
* Symptoms of Vertigo
* Treatment of Vertigo
* Questions To Ask Your Doctor About Vertigo

Definition of Vertigo
Vertigo is a type of dizziness felt as a shift in a person's relationship to the normal environment (a feeling that the room is spinning is common) or a sense of movement in space.

Although dizziness and vertigo are often used interchangeably, they are not the same thing. While all vertigo is dizziness, not all dizziness is vertigo.

True vertigo, from the Latin "vertere," to turn, is a distinct, often severe form of dizziness that is a movement hallucination.

Description of Vertigo
There are four major types of dizziness - vertigo, presyncope, disequilibrium, and lightheadedness.

Most patients with true vertigo have a peripheral vestibular disorder, such as benign positional vertigo. This is usually associated with tinnitus and hearing loss.

Central disorders, such as brain stem or cerebellar lesions, tend to be more chronic but less intense than peripheral disorders and are not associated with hearing loss. Central disorders account for only 15 percent of patients with vertigo.

Vertigo is the illusion that you - or your surroundings - are moving. You may feel that you are spinning, tilting, rocking, or falling through space. You may vomit or have ringing in the ears (tinnitus). Also, your eyes may uncontrollably jerk back and forth (a condition called nystagmus).

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Causes and Risk Factors of Vertigo
There are several causes of vertigo:

Benign positional paroxysmal vertigo (BPPV) is a disorder of the inner ear. The cause usually is unknown, but an upper respiratory tract infection or a minor blow to the head may be responsible. This type of vertigo occurs abruptly when you move your head up and down, or when you turn over in bed. Symptoms can be distressing but they fade in a few seconds. Avoiding positions that bring this on may reduce its occurrence.

BPPV is the commonest form of vertigo, with attacks lasting 30 to 60 seconds, typically set off when rolling over in bed, moving the head to one side or reaching for something ("top-shelf vertigo"). Sufferers can usually describe specific head movements that trigger it.

Although BPPV often occurs for no apparent reason, it can follow an ear infection, head or ear injury, and is thought to result from the dislodgement of normal crystalline structures in the ear's balance detectors. People with BPPV are often relieved to hear that it is due to an inner ear condition and does not signify some serious disorder such as a stroke or tumor.

Labyrinthitis refers to a variety of conditions within the inner ear. It may be associated with inflammation, an upper respiratory infection or nerve deterioration, but often occurs independently of other problems.

Central nervous system disorders that can cause vertigo as a symptom include multiple sclerosis, epilepsy, neck injuries, certain forms of migraine, acoustic neuroma, cerebellar and brain stem tumors, and TIAS (transient ischemic attacks).

Symptoms of Vertigo
A patient may experience severe vertigo for days or weeks. Nausea, vomiting, and involuntary eye movements are common. The condition gradually improves, but symptoms can persist for weeks or months.

Treatment of Vertigo
Treatment depends on the diagnosis. A complete medical evaluation is recommended for anyone with vertigo. This can reveal the true cause and suggest one or more solutions based upon treating the underlying disorder.

Questions To Ask Your Doctor About Vertigo
Is it true vertigo?

What is the probable cause?

Is it related to a central nervous system disorder?

How can the symptoms be controlled?

Do I need to see a specialist?

Varicella (Chicken Pox)

* Definition of Varicella (Chicken Pox)
* Description of Varicella (Chicken Pox)
* Symptoms of Varicella (Chicken Pox)
* Treatment of Varicella (Chicken Pox)
* Prevention of Varicella (Chicken Pox)
* Questions To Ask Your Doctor About Varicella (Chicken Pox)

Definition of Varicella (Chicken Pox)
Varicella, otherwise known as chicken pox, is a generalized infection caused by the varicella zoster virus. It is an extremely contagious disease that is characterized by a blistery rash. It occurs most frequently in children, between the ages of five and eight. Less than 20 percent of all cases in the U.S. affect people over the age of 15. Chicken pox is transmitted so easily that almost everyone gets the disease.

Description of Varicella (Chicken Pox)
Chicken pox is contracted by touching an infected person's blisters or anything that has been contaminated by contact with them. The virus is also thought to be airborne since it may be caught from an infected person by coughing and sneezing even before the rash develops. Another way to get chicken pox is by exposure to shingles, a localized rash caused by the same virus.

The incubation period (time between exposure to the illness and the appearance of symptoms) of chicken pox is 10 to 21 days. It is contagious for about six to eight days after the rash appears or until all of the blisters have dried out.

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Symptoms of Varicella (Chicken Pox)
There are usually no symptoms before the rash occurs but occasionally there is fatigue and some fever in the 24 hours before the rash is noticed. The typical rash goes through a number of stages:

1. First it appears as flat red splotches

2. They become raised and may resemble small pimples

3. They develop into small blisters, called vesicles, which are very fragile

4. They may look like drops of water on a red base

5. As the vesicles break, the sores become pustular and form a crust - the crust is made of dried serum, and not true pus. The crust falls away between days nine and 13. (Itching is severe in the pustular stage.)

The vesicles tend to appear in crops within two to six days. All stages may be present in the same area. They often appear on the scalp and in the mouth, and then spread to the rest of the body, but they may begin anywhere. They are most numerous over shoulders, chest and back. There may be only a few sores, or there may be hundreds.

The doctor should be called if the rash involves an eye, if fever is higher than 103, if there is much vomiting, or if there are signs of bacterial infection (such as a green or yellow discharge from the blisters, or any blisters with red streaks radiating outwards). Go to the emergency room if there is difficulty breathing or if the person is confused and disoriented or has seizures.

Treatment of Varicella (Chicken Pox)
The major problem in dealing with chicken pox is control of the intense itching and reduction of the fever. Warm baths containing baking soda can help; sometimes cool compresses or cool baths will calm itching.

Aspirin should not be used for children or adolescents with chicken pox because of the associated risk of Reye's syndrome, a rare but life-threatening condition. Fever can be treated with acetaminophen or ibuprofren.

Cut the fingernails or use gloves to prevent skin damage from intense scratching. When lesions occur in the mouth, gargling with salt water may provide comfort. Drink cold fluids, and avoid hot, spicy and acidic foods (orange juice).

Hands should be washed three times a day and all of the skin should be kept gently but scrupulously clean in order to prevent a complicating bacterial infection. A minor bacterial infection will respond to soap and time. If it becomes severe and results in the return of a fever, see a physician.

Scratching and infection can result in permanent scars. A visit to the physician may not be necessary, unless a complication seems possible.

Acyclovir (Zovirax), a drug primarily used for treating herpes simplex infections in adults, is a safe and effective treatment for chicken pox in normal children, especially older children and teenagers, when therapy is initiated during the first 24 hours of a rash. Adverse effects of acyclovir are minimal, the most common being gastrointestinal.

Because chickenpox is extremely contagious, keep children home from daycare or school until the blisters are all crusted over.

Prevention of Varicella (Chicken Pox)
Chicken pox can be prevented through vaccination (now recommended by almost all major national health and public health groups). Recommendations are:

* Children and Adolescents: Healthy children can be vaccinated, optimally at age 12 to 18 months or anytime up until the age of 13, if they have no history of chicken pox. Adolescents 13 years and older who have no history of chicken pox, should receive two doses of vaccine four to eight weeks apart. Duration of immunity after vaccination is not completely known. Re-vaccination with a booster dose may be required to sustain immunity through adulthood.

* Adults: Two doses of varicella vaccine four to eight weeks apart are recommended for healthy adults with no history of chicken pox or previous vaccination. Health care workers, daycare workers, employees of colleges or residential facilities, family members of immunocompromised individuals, and others who live or work in environments in which transmission may be easy are particularly encouraged to receive vaccination.

Questions To Ask Your Doctor About Varicella (Chicken Pox)
Is someone contagious 24 hours prior to having a fever?

At what age is the greatest risk of complications?

Do you recommend calamine lotion to help the itching?

Do you recommend any medications to decrease the severity of this virus?

What are the side effects?

Are showers less likely to spread the disease verses baths?

Can you get chicken pox a second time?

Does having a mild case or a severe case affect your chances of acquiring the virus?

As a parent, what can I do to avoid acquiring chicken pox for the first time or as a repeat?

Does chicken pox increase the chances of developing shingles?

What are some of the complications?

What are the signs and symptoms that should be reported to the doctor?

Are there any measures that can help prevent scarring, such as vitamin E?

Wednesday, April 28, 2010

Birth Control

* Definition of Birth Control
* Description of Birth Control
* Questions To Ask Your Doctor About Birth Control

Definition of Birth Control
Birth control is a term used to describe an artificial or natural means to prevent pregnancy.

Description of Birth Control
There are various methods of birth control available today. The most common artificial methods are male/female condoms, spermicides, sponge, diaphragm, cervical cap, oral contraceptives (birth control pills), injectable contraceptions (Depo-Provera, Lunelle), IUDs and surgical sterilization.

The natural methods include complete abstinence (no sexual intercourse), periodic abstinence and withdrawal.

Male/Female Condom

The male condom (also known as a prophylactic or rubber) is a thin sheath, usually made of latex rubber, that covers the erect penis. When used correctly, a latex condom is about 85 percent effective, both for preventing pregnancy and decreasing the chance of contracting most STDs, including AIDS. Condoms can be made of animal membrane; however, some experts believe that the pores in such natural "skin" condoms may allow the virus to pass through. To be effective, the condom must be undamaged, applied to the erect penis before any genital contact, and must remain intact and snugly in place until completion of the sexual activity.

The female condom is a lubricated sheath with a flexible polyurethane ring on each end. One ring is inserted into the vagina while the other remains outside. The ring outside covers the labia and keeps the condom in place during intercourse. When in place, the vaginal condom lines the vaginal wall and creates a covered passageway for the penis. To be effective, the condom must be undamaged and inserted before any genital contact. It must also remain inside of the vagina until the completion of intercourse. The estimated effectiveness of the female condom is 74 to 79 percent.

Risks and side effects: The risks of using a male or female condom are minimal. Some people can experience a slight irritation and allergic reaction.

Spermicides

Spermicides are available in foam, jelly, gel and suppositories, and work by forming a physical and chemical barrier to sperm. They can be inserted into the vagina on a diaphragm, a cervical cap, a condom or alone, within an hour before sexual intercourse. If intercourse is repeated, more spermicide should be inserted. The estimated effectiveness is about 70 to 80 percent when used with other barrier contraceptives. They are not very effective when used alone. Risks and side effects: The risks of using spermicides are minimal. Some people can experience a slight irritation and allergic reaction.

Sponge

The sponge is made of white polyurethane foam (shaped like a small donut) and contains a spermicide. The sponge is inserted into the vagina to cover the cervix during and after intercourse. It is held in place by the vaginal walls and the dimple covering the cervix. It can be kept in place up to 24 hours. The estimated effectiveness is 72 to 82 percent. Risks and side effects: The risks of using a sponge are minimal. Some people may experience a slight irritation and allergic reaction, difficulty in removal, and very rarely, toxic shock syndrome (a bacterial infection associated with the use of highly absorbent tampons).

Diaphragm

A diaphragm is made of soft rubber and is shaped like a shallow cup. It has a flexible metal spring rim that fits snugly over the cervix. Before insertion, a spermicidial cream or jelly should be applied into the shallow cup. The diaphragm must be fitted by a health professional and the correct size must be prescribed to ensure a snug seal with the vaginal wall. It must be kept in the vagina at least six to eight hours after intercourse. It is most effective when used with a spermicide. The estimated effectiveness is 82 to 94 percent.

Risks and side effects: The risks of using a diaphragm are minimal. Some people may experience a slight irritation, an allergic reaction, a bladder infection and very rarely, toxic shock syndrome (a bacterial infection caused by use of highly absorbent tampons).

Women who have a severely displaced uterus, cystocoele (a protrusion of the bladder through the vaginal wall), fistulas (openings in the vagina), scoliosis (curvature of the spine), spina bifida, chronic urinary tract infections or a history of toxic shock syndrome, should not use a diaphragm.

Cervical Cap

The cervical cap is a thimble-shaped rubber cap that fits snugly over the cervix. Like the diaphragm, it blocks sperm from entering the cervical opening. Usually, a small amount of spermicide is used on the inside of the cap to kill any sperm that may break through the seal. The cervical cap must be fitted by a health professional and the correct size prescribed to ensure a snug seal. It must be kept in the vagina at least six to eight hours after intercourse. It is most effective when used with a spermicide. It has an estimated effectiveness of about 82 percent.

Risks and side effects: The risks of using a cervical cap may include abnormal pap tests, vaginal or cervical infections, and very rarely, toxic shock syndrome.

Women who have a severely displaced uterus, fistulas, scoliosis, spina bifida, chronic urinary tract infections, a history of toxic shock syndrome, cervical erosion or laceration, or an elongated or irregular cervix, should not use a cervical cap.

Oral Contraceptives (Birth Control Pills)

At present, more than 20 brand names and more than twice that number of formulations of oral contraceptives are available. Because they are 98 to 99 percent effective, oral contraceptives offer women the most reliable form of easily reversible contraception (other than abstinence) from sexual intercourse.

Birth control pills use synthetic hormones similar to the ones made in the ovaries. There are two types of pills currently manufactured in the United States: a combination pill, with both synthetic progesterone (progestin) and synthetic estrogen; and mini-pills, which contain only progestin.

Although all oral contraceptives prevent sperm from uniting with an egg, they work in slightly different ways. The combination pill keeps the ovaries from releasing an egg. The mini-pill is less reliable in suppressing egg release, but creates changes in the cervix and uterus that make conception less likely.

The mini-pill is less effective than the combination pill, but does not have the risks attributed to estrogen, such as increased possibility of blood clots and nausea. However, the mini-pill causes more problems with spotting and bleeding between periods and therefore, its use is not widespread.

Combination pills come in two types. One provides the same combined dose of synthetic progestin and synthetic estrogen throughout the entire cycle. Others, sometimes called biphasic or triphasic pills vary the levels of these two hormones to more closely approximate a woman's normal hormonal variations. In some women, these pills have a lower risk of side effects.

The pill essentially works by interfering with a woman's normal fluctuations in hormone levels, which in turn prevents the egg from maturing and being released. It also acts on the climate of the cervix, uterine lining and fallopian tubes, making them all inhospitable for egg, sperm or embryo.

Combination pills are packaged in several ways: the most common is the 21-day pack. One pill is taken each day for 21 days, then none during the next seven days (for the average 28-day cycle during which menstruation occurs). There are also 28-day packs, with 21 active pills followed by seven inactive ones (placebos).

The mini-pills must be taken at the same time (within three hours) every day.

In addition to effectiveness in preventing conception, oral contraceptives offer other benefits. Menstrual periods are usually lighter, making iron deficiency less likely, and there may be less cramping. Ovarian cysts, ovarian cancer, and perhaps endometrial cancer occur less often among pill users. In addition, ectopic pregnancy occurs less frequently among pill users (in the rare instance when pregnancy occurs at all).

Risks and side effects: Minor side effects include headaches, sore breasts, weight gain, feeling sick to your stomach, irregular bleeding, and depression. Serious possible side effects are more likely to occur in women over the age of 35. These include an increased risk of heart attack, stroke and formation of blood clots in the veins (thrombosis). These side effects are even more likely to occur among women who smoke; thus, the pill is not recommended for women who smoke. Women with a history of blood clots, high blood pressure, severe diabetes, or breast or uterine cancer, should not take the pill.

Possible Interactions: There is a possibility that the herb St. John’s wort may interfere with the pill’s effectiveness, therefore it is best not to take this herb at the same time that you are on the pill. Also, several antibiotics can interfere with the effectiveness of the birth control pill. It is best to consult with a pharmacist or your doctor to determine if any medication you are taking might interfere with the pill.

Ortho Evra, Contraceptive Patch

The Contraceptive Patch has the similar properties as the oral birth control pill, but is applied to the skin of the lower abdomen, buttocks, upper arm or upper body. It is worn continuously for 7 days and then replaced with another patch every week for 3 weeks, followed by one week without a patch. Estrogen levels are higher with the patch than with birth control pills. In theory, higher estrogen levels may increase the risk of blood clots. It is currently unclear if women who use the patch have higher risks of blood clots when compared to women who use birth control pills.

Risks and side effects: Side effects of the Contraceptive Patch may include nausea or breast tenderness, and rare risks of blood clots, heart attack and stroke, particularly if women smoke while using the contraceptive.

Contraceptive Vaginal Ring

The contraceptive vaginal ring or NuvaRing is a plastic ring coated with both estrogen and progesterone. It has similar properties to birth control pills but it is inserted in the vagina. It is worn continuously for three weeks followed by one week without the ring. Lower doses of hormones are released from the NuvaRing than from birth control pills.

Risks and side effects: Side effects of the vaginal ring may include nausea or breast tenderness, and rare risks of blood clots, heart attack and stroke, particularly if women smoke while using the contraceptive.

Depo-Provera

Depo-Provera is an injectable form of a progestin (like the oral minipill). Each injection provides contraceptive protection for 14 weeks. It is injected every three months into a muscle in the buttocks or arm. Its estimated effectiveness is 99 percent.

Risks and side effects: The risks of using Depo-Provera may include menstrual cycle irregularity, headaches, nervousness, depression, nausea, dizziness, change of appetite, breast tenderness, weight gain, enlargement of ovaries and/or fallopian tubes, excessive growth of body and facial hair. Depo-Provera can also cause bone loss. Women who use this method for two years or longer should get a special X-ray to measure the strength of their bones.

Implanon

Implanon is a progesterone-only implant. It lasts for three years and is effective within 24 hours of insertion. It is inserted in the upper arm in a doctor’s office using local numbing medicine. It is made to gradually release progesterone. Its estimated effectiveness is 99 percent.

Risks and side effects: The risks of using Implanon are rare but may include rash, infection or movement of the rod in the arm. Other effects may include menstrual cycle irregularity, change of appetite, breast tenderness, and weight gain.

The Morning After Pill (Emergency Contraceptive)

The morning after pill (MAP) is an increasingly accepted means of contraception. It is best used in situations when intercourse happens infrequently or unexpectedly. The MAP is a special formulation of the same (or similar) hormones used in birth control pills. It is given in one or two doses. To be effective, the first dose must be taken within 72 hours of intercourse, the sooner the better.

Risks and side effects: It can cause nausea and breast tenderness, and it can disrupt the regularity of the menstrual cycle.

RU486

Approved in the U.S. in September 2000, RU486 (mifepristone) causes the uterine lining to shed after an egg is implanted. It is taken as a series of pills over the course of a few weeks and will interrupt a very early pregnancy. It is very widely used in Europe and has been approved in the U.S. since September 2000. It is best to have this pill prescribed by a physician or health care setting that is familiar with its use and can follow users carefully to assure optimal outcomes.

Risks and side effects: Possible side effects include weight gain, sore breasts, menstrual cycle irregularity, and very rarely life-threatening infection.

IUDs

IUDs are small devices that fit inside the uterus. Some contain copper or synthetic progesterone; others are made of white plastic. One or more strings are usually attached to IUDs. When the IUD is in place, these strings extend into the upper vagina. The IUD alters the uterine and tubal fluids, which inhibits the transport of sperm through the cervical mucus and uterus. Its estimated effectiveness is 96 percent.

Risks and side effects: The risks of using IUDs are cramps, bleeding, pelvic inflammatory disease (PID) an infection of the uterus and fallopian tubes, infertility, and very rarely, perforation of the uterus.

IUDs should not be used by women who are pregnant, who have an active/recent or recurrent pelvic infection, acute cervicitis, vaginitis, abnormal pap tests, irregular or abnormal pelvic bleeding, disorders of the blood, endometriosis, exposure to DES in utero, an abortion within the last three months that led to an infection, diabetes, sickle cell anemia, anemia, bicornate uterus, cervical stenosis, endometrial polyps, severe menstrual cramps or bleeding, small uterus or valvular heart disease.

Surgical Sterilization

Female sterilization (tubal ligation) involves either cutting, constricting, clipping cutting or blocking the fallopian tubes to prevent the male sperm from reaching the ova. This can be done with a laparoscope (camera through the belly button) or hysteroscope (camera through the vaginal to the uterus). Male sterilization (vasectomy) involves cutting the two vas deferens (the ducts that carry sperm from the testes to the seminal vesicles).

Both of these procedures are about 99 percent effective.

Risks and side effects: Both of these have the normal risks associated with surgery, including infection or bleeding after the operation.

Complete Abstinence and Periodic Abstinence

Complete abstinence is not engaging in any type of sexual intercourse. Periodic abstinence is not having sexual intercourse during a woman's fertile period. Also called "natural family planning" or the "rhythm method", periodic abstinence is dependent on the ability to identify the approximate 10 days in each menstrual cycle that a woman is fertile. Its estimated effectiveness varies from 53 to 86 percent. However, it is important to recognize that many experts in family planning feel that the actual effectiveness of this method is much lower. This is because many women vary from month to month with respect to when they are most fertile.

Withdrawal

Withdrawal involves removing the penis from the vagina just before ejaculation so that the sperm is deposited outside the vagina and away from the lips of the vagina, as well. Withdrawal is not very effective, because the drops of fluid that come out of the penis right after it becomes erect can contain enough sperm to cause pregnancy.

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Questions To Ask Your Doctor About Birth Control
Which birth control method do you recommend?

If the condom is recommended, which is more effective - the male or female condom?

What should be done if the condom breaks during intercourse without our knowledge?

If sponges, diaphragms or cervical caps are recommended, how will I know if they are inserted correctly?

Which birth control pill do you recommend?

What happens if I miss a pill?

How long can a woman remain on the pill?

What are the side effects?

Can I have a prescription for the morning after pill, just in case I need it?

Attention Deficit/Hyperactivity Disorder

* Description of Attention Deficit/Hyperactivity Disorder
* Causes and Risk Factors of Attention Deficit/Hyperactivity Disorder
* Symptoms of Attention Deficit/Hyperactivity Disorder
* Diagnosis of Attention Deficit/Hyperactivity Disorder
* Treatment of Attention Deficit/Hyperactivity Disorder
* AlternativeAttention Deficit/Hyperactivity Disorder
* Questions To Ask Your Doctor About Attention Deficit/Hyperactivity Disorder

Description of Attention Deficit/Hyperactivity Disorder
Attention Deficit/Hyperactivity Disorder (ADHD) is a genetically determined hereditary disorder. It is a syndrome characterized by chronic behavior patterns of inattentiveness, lack of impulse control and excess energy (hyperactivity). The symptoms may be mild or severe and are associated with functional deviations of the central nervous system without signs of major neurologic or psychiatric disturbance.

Inattentiveness is when the child is easily distracted and has difficulty focusing or concentrating on a task.

Lack of impulse control is when the child may get into frequent fights or act aggressively toward others with little cause.

Hyperactivity is when the child seems to fidget, squirm and move about constantly and can't sit still for any length of time.

It is important for parents, teachers and caregivers to understand that ADHD is not caused by poor parenting or a chaotic home environment. ADHD affects approximately 3 to 5 percent of all American children. The syndrome is 4 to 6 times more likely to occur in males than in females. In about half the cases, the age of onset occurs before age 4.

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Causes and Risk Factors of Attention Deficit/Hyperactivity Disorder
A single biologic model to explain the syndrome has not been established. Some researchers believe that ADHD is due to a genetic defect that results in altered brain biochemistry. Differences in biochemistry are considered to be the cause of poor regulation of attention, impulsivity and motor activity.

In 1990, the New England Journal of Medicine published a landmark study by researchers at the National Institute for Mental Health which documented the neurobiological effects of ADHD through brain imaging. The rate at which the brain uses glucose, its main energy source, was shown to be lower in persons with ADHD, especially in the portion of the brain that is responsible for attention, handwriting, motor control and inhibition responses.

Additionally, some researchers suggest that prenatal conditions such as maternal alcohol or drug abuse and birth complications may contribute in some cases.

Symptoms of Attention Deficit/Hyperactivity Disorder
ADHD characteristics often arise in early childhood. The Diagnostic and Statistical Manual, 4th Edition (DSM-IV) lists the following symptoms for Childhood ADHD:

Inattention

* often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

* often has difficulty sustaining attention in tasks or play activities

* often does not seem to listen when spoken to directly

* often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

* often has difficulty organizing tasks and activities

* often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

* often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books or tools)

* often easily distracted by extraneous stimuli

* often forgetful in daily activities

Hyperactivity-Impulsivity

* often fidgets with hands or feet or squirms in seat

* often leaves seat in classroom or in other situations in which remaining seated is expected

* often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

* often has difficulty playing or engaging in leisure activities quietly

* is often "on the go" or often acts as "driven by a motor"

* often talks excessively

* often blurts out answers before questions have been completed

* often has difficulty awaiting turn

* often interrupts or intrudes on others

Diagnosis of Attention Deficit/Hyperactivity Disorder
The fact that the child exhibits ADHD-like behaviors does not prove that they are suffering from this disorder. It is quite possible that some other problem is causing these symptoms. In order to correctly diagnose ADHD, the doctor must first rule out these "look-alike" factors by conducting a thorough physical examination and administering laboratory and other diagnostic tests:

Medical conditions. Allergy and effects of allergy medication, hearing loss, thyroid disorders, visual disturbances, genetic disorders (such as Fragile X syndrome), seizure disorders and chronic medical conditions.

Mental disorders. Anxiety disorders, conduct disorder, depressive disorders, oppositional defiant disorder, pervasive development disorder or Tourette's syndrome.

Behavioral and neurologic conditions. Articulation problems, coordination problems, encopresis (a type of soiling problem whereby children defecate in inappropriate places), enuresis (bed-wetting), night terrors and sleep difficulties.

Learning and language disabilities. Difficulties with listening, speaking, thinking, reading, writing, reasoning and performing mathematical calculations.

Additionally, the doctor will take a thorough medical history and consult rating scales to confirm ADHD. The history should include a family, birth and general medical history gathered from family as well as school and day-care (if applicable) workers.

Children suspected of having ADHD can be evaluated at the school’s expense and, if found to be eligible, provided services under either of two federal laws: (1) the Individuals with Disabilities Education Act (IDEA), or (2) Section 504 of the Rehabilitation Act of 1973.

Treatment of Attention Deficit/Hyperactivity Disorder
Most ADHD therapy today involves a "biopsychosocial" approach - "bio" refers to medication, "psycho" refers to counseling and psychotherapy and "social" refers to instruction in self-management and training in social skills.

Medications

For decades, medications have been used to treat the symptoms of ADD. Medications in the class of drugs known as stimulants seem to be the most effective in both children and adults. These are methylphenidate (Ritalin, Methlyn), mixed salts of single entity amphetamine product (Adderall), and dextroamphetamine (Dexedrine or Dextrostat), and pemoline (Cylert). Cylert may cause serious liver damage.

For many people, these medicines dramatically reduce the hyperactivity and improve their ability to focus, work and learn. The medications may also improve physical coordination, such as handwriting and ability in sports.

Stimulants are not appropriate for every child with attention disorder. For instance, they are not intended for anyone with a primary psychiatric illness (such as schizophrenia, in which the person loses touch with reality) because they can worsen the disturbances. They can aggravate emotional problems, such as anxiety. They can bring out tics (involuntary movements) in a patient with a family history of tics.

Even a correctly administered stimulant can cause adverse effects, for no drug is completely without risk. The side effects most frequently reported are decreased appetite and insomnia. Less common are drowsiness, hypersensitivity, weight loss, headache, nausea, and blood pressure changes.

Whether a child should be given stimulants is a case-by-case decision in which the benefits are weighed against the risks. In the past, most stimulant treatments for ADHD were prescribed only for two to three years and only for children. But today, treatment may extend over longer periods and may be given to adolescents and adults. Stimulants clearly are not intended to be the sole treatment.

Other medications prescribed for symptoms of ADHD include clonidine (Catapres) and tricyclic antidepressants.

Behavior Modification

Parents and children can be instructed in positive reinforcement techniques for rewarding desirable behavior and reducing negative behavior. Here are some strategies:

o Discipline can best be maintained by establishing a few consistent rules with immediate consequences whenever each rule is broken. Rules should be phrased positively in terms of what the child should do. Praise the child and reward him or her for good behavior.

o Structure a system of rewards for good behavior. This system encourages the child to work to earn privileges or rewards he or she wants by accumulating points for desired behaviors and removing points for undesirable behaviors.

o Make a written agreement (a contract) with the child in which the child agrees to do his or her homework every night or to demonstrate other desired behavior in return for a privilege.

o Provide a specified time-out location for when the child is out of control. This should not be seen as a place of punishment but as a "calm down" spot.

o Set up a study area away from distractions and establish a specific time each day to do homework.

o Have the teacher make a checklist of homework to be done.

o Put up a calendar of long-term assignments and other tasks.

o Avoid emotional reactions such as anger, sarcasm and ridicule.

Counseling and Psychotherapy

There are three different types of psychotherapy available: individual psychotherapy, cognitive behavioral therapy and family therapy.

Individual therapy helps children with anxiety, difficulties with self-esteem, depression and other emotional problems. Cognitive behavioral therapy teaches children to modify their behavior by correcting the way they think about it. Family therapy assists the child and his or her family in understanding the condition.

Close communication between the physician and school personnel is essential.

Self-management/Social Skills

Self-management and training in social skills helps children curb aggressive, impulsive and socially maladaptive behaviors.

AlternativeAttention Deficit/Hyperactivity Disorder
There is no evidence to support the use of dietary management. Megavitamins, restriction of sugar, and supplementary trace minerals do not appear effective. Diets low in food additives or coloring are not effective.

Questions To Ask Your Doctor About Attention Deficit/Hyperactivity Disorder
Can my child have ADHD and not be hyperactive?

How do you diagnose a hyperactive child?

How do you know the child's disorder is caused by deviations of the central nervous system versus just environmental discipline problems?

Would you prescribe a medication for part of the treatment?

What are the side effects?

How should I expect the child's behavior to change after starting the medication?

How long will the medication have to be taken?

Are there any drug-free treatments for ADHD?

What can be done to prevent social and emotional problems?

Does eliminating sugar and caffeine products help reduce hyperactivity?

What kind of behavior therapy will be planned?

And will someone be able to work with the family and teachers to follow the behavioral plan?

Does my child qualify for special education or other assistance from his/her school?

With medications and behavior-modification techniques, when should we start to see a change in the child's behavior and learning problems?

Angina Pectoris

* Definition of Angina Pectoris
* Description of Angina Pectoris
* Causes and Risk Factors of Angina Pectoris
* Symptoms of Angina Pectoris
* Diagnosis of Angina Pectoris
* Treatment of Angina Pectoris
* Questions To Ask Your Doctor About Angina Pectoris

Definition of Angina Pectoris
Angina pectoris is a term that describes chest pain caused by myocardial ischemia - a condition in which the amount of oxygen getting to the heart muscle is insufficient. It usually occurs on exertion and is relieved by rest. Angina generally is a symptom of coronary artery disease. In most severe cases, it may occur with minimal effort or at rest.

Description of Angina Pectoris
Angina pectoris is a common manifestation of coronary artery disease. The pain is caused by reduced blood flow to a segment of heart muscle (myocardial ischemia). It usually lasts for only a few minutes, and an attack is usually quickly relieved by rest or drugs (such as nitroglycerin). Also, it is possible to have myocardial ischemia without experiencing angina.

Typically, angina is described as a "pressure" or "squeezing" pain that starts in the center of the chest and may spread to the shoulders or arms (most often on the left side, although either or both sides may be involved), the neck, jaw or back. It is usually triggered by extra demand on the heart: exercise, an emotional upset, exposure to cold, digesting a heavy meal are common examples.

Some people experience angina while sleeping or at rest. This type of angina may be caused by a spasm in a coronary artery, which most commonly occurs at the site of atherosclerotic plaque in a diseased vessel.

Most people with angina learn to adjust their lives to minimize attacks. There are cases, however, when the attacks come frequently and without provocation - a condition known as unstable angina. This is often a prelude to a heart attack and requires special treatment, primarily with drugs. Angina affects both men and women, usually in middle age. Men are much more likely than women to experience it before age 60. It may develop weeks, months or even years before a heart attack, or may be experienced only after a heart attack has occurred.
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Causes and Risk Factors of Angina Pectoris
The two main causes of angina are coronary artery spasm, and atherosclerotic plaque buildup which causes critical blockage of the coronary artery.

The risk factors include:

* smoking

* sedentary lifestyle

* high blood pressure, or hypertension

* high blood fats or cholesterol

* hypercholesterolemia

* diabetes

* family history of premature ischemic heart disease

Men are at higher risk than women.

Symptoms of Angina Pectoris
Classic or typical angina occurs predictably with physical exertion or strong emotional reactions, and goes away just as predictably with rest. Starting immediately behind the sternum (breast bone), the pain may radiate to the left arm and shoulder or up to the jaw.

Most people describe the pain as a kind of squeezing pressure, tightness or heaviness.

There may be anxiety, increased or irregular heart rate, paleness and cold sweat, and a feeling of doom. The symptoms are like the ones for a heart attack.

In some instances, chest pain results from other types of heart problems, including diseases that affect the heart muscle itself or the valves that control blood flow through the heart. Occasionally, ulcers, gallstones, abnormal contractions of the esophagus or severe anxiety and panic attacks can cause chest pain. However, if you do experience these symptoms, your best plan of action is to get immediate help. Stop doing whatever is causing the symptoms and call 911. Lie down with your head slightly elevated. If you are not allergic to it, take one adult aspirin.

Diagnosis of Angina Pectoris
Diagnosis of angina is based upon the classic history of chest pain on exertion and by means of tests, demonstrating the presence of coronary artery disease.

Treatment of Angina Pectoris
In most instances, drugs are recommended for the treatment of angina before surgery is considered. The major classes of drugs used to treat angina include the following:

Nitrates. These come in several forms: nitroglycerine tablets to be slipped under the tongue during or in anticipation of an attack; ointment to be absorbed through the skin; long-acting medicated skin discs; or long-acting tablets. The latter three forms are used mostly to prevent rather than relieve attacks. The nitrates work by reducing the oxygen requirements of the heart muscle.

Beta-blocking Drugs. These agents act by blocking the effect of the sympathetic nervous system on the heart, slowing heart rate, decreasing blood pressure, and thereby, reducing the oxygen demand of the heart. Recent studies have found that these drugs also can reduce the chances of dying or suffering a recurrent heart attack if they are started shortly after suffering a heart attack and continued for two years.

Calcium-channel Blocking Drugs. These drugs are prescribed to treat angina that is thought to be caused by coronary artery spasm. They can also be effective for stable angina associated with exercise. All muscles need varying amounts of calcium in order to contract. By reducing the amount of calcium that enters the muscle cells in the coronary artery walls, the spasms can be prevented. Some calcium-channel blocking drugs also decrease the workload of the heart and some lower the heart rate as well.

Questions To Ask Your Doctor About Angina Pectoris
Could the chest pain be the result of any other disorder other than heart disease?

What is the cause of the angina?

Are there any tests recommended to determine the degree of heart disease?

What is the procedure for this test?

What medications will be prescribed?

What are the side effects?

Do the medications just relieve the symptoms or do they help relieve the cause?

What are the chances that surgery will be needed?

What other procedures are used to alleviate the coronary problem?

What preventive measures can be taken to decrease the risk of angina and the chance of a heart attack?

If angina is brought on by exercise, then what form of physical activity can be done to decrease heart disease and keep me healthy?