Alcohol intolerance

Alcohol intolerance

Definition:

Alcohol intolerance can cause immediate, unpleasant reactions after you consume alcohol. The most common signs and symptoms of alcohol intolerance are nasal congestion and skin flushing. This condition is sometimes inaccurately referred to as an alcohol allergy. Alcohol intolerance is caused by a genetic condition in which the body is unable to break down alcohol. The only way to prevent alcohol intolerance is to avoid alcohol altogether.

In some cases, what may seem to be alcohol intolerance is caused by a reaction to something else in an alcoholic beverage — such as chemicals, grains or preservatives. In other cases, reactions are caused by combining alcohol with certain medications. In rare instances, reactions to alcohol can be a sign of a serious underlying health problem that requires diagnosis and treatment.


Symptoms:

Alcohol intolerance symptoms — or symptoms of a reaction to ingredients in an alcoholic beverage — can include:

• Facial redness (flushing)
• Warm, red, itchy bumps on the skin (hives)
• Worsening of pre-existing asthma
• Runny or stuffy nose
• Headache
• Low blood pressure
• Nausea
• Vomiting

When to see a doctor
You may not need to see a doctor if you have a mild intolerance to alcohol or something else in alcoholic beverages. You may simply need to avoid alcohol, limit how much you drink or avoid certain types of alcoholic beverages that seem to be causing your symptoms. However, if you have a serious reaction or you suspect your symptoms could be linked to an allergy or underlying health problem or a medication you're taking, see your doctor.

Causes : 

Alcohol intolerance occurs when your body doesn't have the proper enzymes to break down (metabolize) the toxins in alcohol. This is caused by inherited (genetic) traits.
Intolerance reactions can also be caused by a number of other ingredients commonly found in alcoholic beverages, especially in beer or wine.  These include:

• Sulfites or other preservatives
• Chemicals, grains or other ingredients
• Histamine, a byproduct of fermentation or brewing

In some cases, reactions can be triggered by an allergy to a grain such as corn, wheat or rye or to another substance contained in alcoholic beverages.
Rarely, severe pain after drinking alcohol is a sign of a more serious underlying disorder, such as Hodgkin lymphoma.

Complications:

Depending on the cause, complications of alcohol intolerance or other reactions to alcoholic beverages can include:

• Migraines. Histamines, contained in some alcoholic beverages and also released by your immune system during an allergic reaction, may trigger migraines in some people.
• A severe allergic reaction. In very rare cases, an allergic reaction can be life-threatening (anaphylactic reaction) and require emergency treatment.

Treatments and drugs:

The only way to avoid alcohol intolerance symptoms or an allergic reaction is to avoid alcohol or the particular beverage or ingredients that cause the problem. For a minor reaction, over-the-counter or prescription antihistamines may help reduce symptoms, such as itching or hives. However, antihistamines can't treat a serious allergic reaction.

If you've had a severe allergic reaction to a certain food, wear a medical alert bracelet or necklace that lets others know that you have an allergy in case you have a reaction and you're unable to communicate. Ask your doctor if you need to carry emergency epinephrine (adrenaline) in the form of an autoinjector (EpiPen, Twinject). This prescription device has a concealed needle that injects a single dose of epinephrine when you press it against your thigh.

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Albinism

Albinism

Definition:

Albinism, a group of inherited disorders, results in little or no production of the pigment melanin. The type and amount of melanin your body produces determines the color of your skin, hair and eyes. Most people with albinism are sensitive to sun exposure and are at increased risk of developing skin cancer.

Melanin also plays a role in the development of certain optical nerves. All forms of albinism cause problems with the development and function of the eyes.
Although there's no cure for albinism, people with the disorder can take steps to improve vision and avoid too much sun exposure. Albinism doesn't limit intellectual development, though people with albinism often feel socially isolated and may experience discrimination.

Symptoms:

Signs of albinism are usually, but not always, apparent in a person's skin, hair and eye color. Regardless of the effect of albinism on appearance, all people with the disorder experience vision impairments.

Skin
Although the most recognizable form of albinism results in milky white skin, skin pigmentation can range from white to brown, and may be nearly the same as that of parents or siblings without albinism.
For some people with albinism, skin pigmentation never changes. For others, melanin production may begin or increase during childhood and adolescence, resulting in slight changes in pigmentation. With exposure to the sun, some people may develop:

• Freckles
• Moles, with or without pigment
• Large freckle-like spots (lentigines)
• The ability to tan

Hair
Hair color can range from very white to brown. People of African or Asian descent who have albinism may have hair color that is yellow, reddish or brown. Hair color may also change by early adulthood.

Eye color
Eye color can range from very light blue to brown and may change with age.
The lack of pigment in the colored part of the eyes (irises) makes them somewhat translucent. This means that the irises can't completely block light from entering the eye. Because of this translucence, very light-colored eyes may appear red in some lighting. This occurs because you're seeing light reflected off the back of the eye and passing back out through the iris again — similar to red eye that occurs in a flash photograph.

Vision
Signs and symptoms of albinism related to eye function include:

• Rapid, involuntary back-and-forth movement of the eyes (nystagmus)
• Inability of both eyes to stay directed at the same point or to move in unison (strabismus)
• Extreme nearsightedness or farsightedness
• Sensitivity to light (photophobia)
• Astigmatism

When to see a doctor
If your child lacks pigment in his or her hair or skin at birth — as is often the case in infants with albinism — your doctor will order an eye examination and closely follow any changes in your child's pigmentation.

For some infants the first sign of albinism is a rapid back-and-forth shifting (nystagmus) in the eyes, particularly if the type of albinism has little effect on pigmentation or if the family is mostly fair-skinned. If you observe nystagmus in your child's eyes, talk to your doctor.
Contact your doctor if your child with albinism experiences frequent nosebleeds, easy bruising or chronic infections, as these signs and symptoms may indicate the presence of Hermansky-Pudlak or Chediak-Higashi syndromes.

Causes:

The cause of albinism is a mutation in one of several genes. Each of these genes provides the chemically coded instructions for making one of several proteins involved in the production of melanin. Melanin is produced by cells called melanocytes, which are found in your skin and eyes. A mutation may result in no melanin production at all or a significant decline in the amount of melanin.
In most types of albinism, a person must inherit two copies of a mutated gene — one from each parent — in order to have albinism (recessive inheritance). If a person has only one copy, then he or she won't have the disorder.

Impact of mutations on eye development
Regardless of which gene mutation is present, vision impairment is a common characteristic with all types of albinism. These impairments are caused by irregular development of the nerve pathways from the eye to the brain and from abnormal development of the retina.
Types of albinism
The system for classifying types of albinism is based primarily on which mutated gene caused the disorder rather than by outward signs. Nonetheless, most types of albinism have some features that distinguish them from each other. Types of albinism include:

• Oculocutaneous albinism. Oculocutaneous albinism is caused by a mutation in one of four genes. These mutations result in signs and symptoms related to vision (ocular) and those related to skin (cutaneous), hair and iris color.
  
  Oculocutaneous albinism type 1 is caused by a mutation in a gene on chromosome 11. Most people with this type of albinism have milky white skin, white hair and blue eyes at birth. Some people with this disorder never experience changes in pigmentation, but others begin to produce melanin during childhood and adolescence. Their hair may become a golden blond or brown. Their skin usually doesn't change color, but it may tan somewhat. The irises may also change color and lose some of their translucence.
  
  Oculocutaneous albinism type 2 is caused by a mutation in a gene on chromosome 15. It's more common in Sub-Saharan Africans, African-Americans and Native Americans than in other population groups. The hair may be yellow, auburn, ginger or red, the eyes can be blue-gray or tan, and the skin is white at birth. In people of African descent, the skin may be light brown, and in those of Asian or Northern European descent, the skin is usually white. In either case, the skin color is generally close to the family's coloring, but a little bit lighter. With sun exposure, the skin may over time develop freckles, moles or lentigines.
  
  The rarer oculocutaneous albinism type 3 is caused by a gene mutation on chromosome 9 and has been primarily identified in black South Africans. People with this disorder usually have reddish-brown skin, ginger or reddish hair, and hazel or brown eyes.
  Oculocutaneous albinism type 4, caused by a gene mutation on chromosome 5, is an uncommon form of the disorder generally presenting signs and symptoms similar to those of type 2. This type of albinism may be one of the most common forms among people of East Asian descent.
  
  
• X-linked ocular albinism. The cause of X-linked ocular albinism, which occurs almost exclusively in males, is a gene mutation on the X chromosome. People who have ocular albinism have the developmental and functional vision problems of albinism. But skin, hair and eye color are generally in the normal range or slightly lighter than that of others in the family.
  
• Hermansky-Pudlak syndrome. Hermansky-Pudlak syndrome is a rare albinism disorder caused by a mutation in one of at least eight genes associated with this syndrome. People with this disorder have signs and symptoms like those of oculocutaneous albinism, but they also develop lung and bowel diseases and a bleeding disorder.
  
• Chediak-Higashi syndrome. Chediak-Higashi syndrome is a rare form of albinism that's associated with a mutation in the LYST gene. Signs and symptoms are similar to those of oculocutaneous albinism. The hair is usually brown or blond with a silvery sheen, and the skin is usually creamy white to grayish. People with this syndrome have a defect with white blood cells that results in a susceptibility to infections.

Complications:

Complications of albinism include physical risks as well as social and emotional challenges.

Skin disorders
One of the most serious complications associated with albinism is the risk of sunburn and skin cancer.

Social and emotional factors
The reactions of other people to those with albinism can often have a negative impact on people with the condition:

• Children with albinism may experience name-calling, teasing or questions regarding their appearance, eyewear or visual aid devices.
• Many people with albinism find the word "albino" hurtful because they're being labeled simply on the basis of a condition rather than being thought of as individuals.
• A long history of myths has attributed supernatural powers or deviant personalities to people with albinism.
• People with albinism usually look very different from members of their own families or ethnic groups and, therefore, may either feel like outsiders or be treated like outsiders.

All of these factors may contribute to social isolation, poor self-esteem and stress.

Treatments and drugs:

Because albinism is a genetic disorder, treatment is limited. Your child will most likely need to wear prescription lenses, which provide improvements in vision, and he or she should receive annual examinations by an ophthalmologist.

Although surgery is rarely part of treatment for albinism, your ophthalmologist may recommend surgery on optical muscles that minimizes nystagmus. Surgery to correct strabismus may make the condition less noticeable, but it won't improve vision.
Your doctor will also conduct an annual assessment of your child's skin to screen for skin cancer or lesions that can lead to cancer. Adults with albinism need annual eye and skin exams throughout their lives.

People with Hermansky-Pudlak and Chediak-Higashi syndromes usually require regular specialized care to prevent complications.

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Airplane ear

Airplane ear

Definition:

Airplane ear is the stress exerted on your eardrum and other middle ear tissues when the air pressure in your middle ear and the air pressure in the environment are out of balance. You may experience airplane ear at the beginning of a flight when the airplane is climbing or at the end of a flight when the airplane is descending. These fast changes in altitude cause air pressure changes and can trigger airplane ear.

Airplane ear is also called ear barotrauma, barotitis media or aerotitis media.
Usually self-care steps — such as yawning, swallowing or chewing gum — can prevent or correct the differences in air pressure and improve airplane ear symptoms. However, a severe case of airplane ear may need to be treated by a doctor.

Symptoms:

Airplane ear can occur in one or both ears. Airplane ear signs and symptoms may include:

• Moderate discomfort or pain in your ear
• Feeling of fullness or stuffiness in your ear
• Muffled hearing or slight to moderate hearing loss

If airplane ear is severe or lasts more than a few hours, you may experience:

• Severe pain
• Pressure in your ear similar to being underwater
• Moderate to severe hearing loss
• Ringing in your ear (tinnitus)
• Spinning sensation (vertigo)
• Vomiting resulting from vertigo
• Bleeding from your ear

When to see a doctor
Usually you can do things on your own to treat airplane ear. If discomfort, fullness or muffled hearing lasts more than a few hours or if you experience any severe signs or symptoms, call your doctor.

Causes:

Airplane ear occurs when an imbalance in the air pressure in the middle ear and air pressure in the environment prevents your eardrum (tympanic membrane) from vibrating as it should. Air pressure regulation is the work of a narrow passage called the eustachian tube. One end is connected to the middle ear. The other end has a tiny opening where the back of the nasal cavity and the top of the throat meet (nasopharynx).

When an airplane climbs or descends, the air pressure in the environment changes rapidly, and your eustachian tube doesn't react quickly enough. Swallowing or yawning activates muscles that open the eustachian tube and allow the middle ear to replenish its air supply, often eliminating the symptoms of airplane ear.
Problems similar to airplane ear
Ear barotrauma also may be caused by:

• Scuba diving
• Being slapped or hit on the ear
• Explosions nearby

You may also experience a minor case of barotrauma while riding an elevator in a tall building or driving in the mountains.

Complications:

Airplane ear usually isn't serious and responds to self-care. Long-term complications may occur when the condition is serious or prolonged or if there's damage to middle or inner ear structures.
Rare complications may include:

• Permanent hearing loss
• Ongoing (chronic) tinnitus

Treatments and drugs:

For most people, airplane ear usually heals with time. When the symptoms persist, you may need treatments to equalize pressure and relieve symptoms.

Medications
Your doctor may prescribe medications or direct you to take over-the-counter medications to control conditions that may prevent the eustachian tubes from functioning well. These drugs may include:

• Decongestant nasal sprays
• Oral decongestants
• Oral antihistamines

To ease discomfort, you may want to take a nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others), or an analgesic pain reliever, such as acetaminophen (Tylenol, others).

Self-care therapies
With your drug treatment, your doctor will instruct you to use a self-care method called the Valsalva maneuver. To do this, you pinch your nostrils shut, close your mouth and gently force air into the back of your nose, as if you were blowing your nose. Once the medications have improved the function of the eustachian tubes, use of the Valsalva maneuver may force the tubes open.

Surgery
Surgical treatment of airplane ear is rarely necessary. However, your doctor may make an incision in your eardrum (myringotomy) to equalize air pressure and drain fluids.
Severe injuries, such as a ruptured eardrum or ruptured membranes of the inner ear, usually will heal on their own. However, in rare cases, surgery may be needed to repair them.

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Agoraphobia

Agoraphobia

Definition:

Agoraphobia is a type of anxiety disorder in which you avoid situations that you're afraid might cause you to panic. You might avoid being alone, leaving your home or any situation where you could feel trapped, embarrassed or helpless if you do panic.

People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. The fears can be so overwhelming that you may be essentially trapped in your own home.

Agoraphobia treatment can be tough because it usually means confronting your fears. But with medications and psychotherapy, you can escape the trap of agoraphobia and live a more enjoyable life.

Symptoms:

Agoraphobia is a type of phobia. A phobia is the excessive fear of a specific object, circumstance or situation. Agoraphobia is excessive worry about having a panic attack in a public place. Commonly feared places and situations are elevators, sporting events, bridges, public transportation, shopping malls, airplanes, crowds or lines of people.
Typical agoraphobia symptoms include:

• Fear of being alone in any situation
• Fear of being in crowded places
• Fear of losing control in a public place
• Fear of being in places where it may be hard to leave, such as an elevator or train
• Inability to leave your house for long periods (housebound)
• Sense of helplessness
• Overdependence on others
• A sense that your body is unreal

In addition, you may also have signs and symptoms similar to a panic attack, including:

• Lightheadedness
• Trouble breathing
• Dizziness
• Excessive sweating
• Rapid heart rate
• Flushing
• Nausea
• Upset stomach or diarrhea
• Chest pain
• Feeling a loss of control
• Trouble swallowing

When to see a doctor
Agoraphobia can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands.
Some people with agoraphobia have "safe zones," or places they can go without severe worry, especially if accompanied by a trusted friend or relative. Sometimes they may muster up the courage to go somewhere, but they still feel extremely uncomfortable.
Often, however, agoraphobia can make you feel like a prisoner in your own home. If you believe you're going to have a panic attack when you go out in public, you may indeed have one — causing a vicious cycle. The number of places you're able to go may become fewer and fewer.
Don't let agoraphobia make your world smaller. Call your doctor if you have symptoms of agoraphobia.

Causes:

Agoraphobia is usually a complication of panic disorder. Panic disorder is a type of anxiety disorder in which you experience attacks of intense fear (panic attacks) that for no apparent reason trigger intense physical symptoms. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.

You may develop agoraphobia when you begin to make a connection between your panic attacks and one or more situations in which those attacks have occurred. You may avoid similar situations in an attempt to prevent future panic attacks. People with agoraphobia are especially likely to avoid circumstances in which it would be difficult or embarrassing to escape if a panic attack were to occur, such as in a crowded stadium or an airplane.

In some cases, fear of having a panic attack may be so great that you may not be able to leave the safety of your home. In other cases, you may be able to overcome your fear and tolerate most situations as long as you're accompanied by a trusted companion.
Rarely, agoraphobia may occur without an accompanying panic disorder.

Complications:

Agoraphobia can greatly limit your life's activities. In severe cases, you may not even be able to leave your house. Without treatment, some people become housebound for years. You may not be able to visit with family and friends, go to school or work, walk your dog, run errands or take part in other normal daily activities.

You may become dependent on others for help, such as grocery shopping.
Agoraphobia can also lead to depression and anxiety. And people with agoraphobia may turn to alcohol or substance abuse to help cope with the fear, guilt, hopelessness, isolation and loneliness.

Treatments and drugs:

Agoraphobia treatment usually includes both medication and psychotherapy. It may take some time, but treatments can help you get better.
Medications
Antidepressant and anti-anxiety medications are often used to treat agoraphobia and panic symptoms. You may have to try several different medications before you find one that works best for you.
Your doctor is likely to prescribe one or both of the following:

• A selective serotonin reuptake inhibitor (SSRI). Drugs in this category that are FDA-approved for the treatment of panic disorder with agoraphobia include paroxetine (Paxil, Paxil CR) and fluoxetine (Prozac, Prozac Weekly, Sarafem).
  
• Another type of antidepressant, such as a tricyclic antidepressant or monoamine oxidase inhibitor. While these drugs may effectively treat agoraphobia, they're associated with more side effects than are SSRIs.
  
• An anti-anxiety medication. Also called benzodiazepines, these drugs can help control symptoms of anxiety and panic attacks. However, these medications can cause dependence if taken in doses larger than prescribed or over a longer period of time than prescribed. Your doctor will weigh this risk against the potential benefit of this class of drugs. Drugs in this category that are FDA-approved for the treatment of panic disorder with agoraphobia include alprazolam (Xanax) and clonazepam (Klonopin).

Both starting and ending a course of antidepressants can cause side effects that seem just like a panic attack. For this reason, your doctor likely will gradually increase your dose at the beginning of your treatment, and slowly decrease your dose when he or she feels you're ready to stop taking medication — often over the course of a year or more after your agoraphobia symptoms are controlled.

Psychotherapy
Several types of psychotherapy or counseling can help agoraphobia. One common therapy that's used is cognitive behavioral therapy.
Cognitive behavioral therapy has two parts. The cognitive part involves learning more about agoraphobia and panic attacks and how to control them. You learn what factors may trigger a panic attack or panic-like symptoms and what makes them worse. You also learn how to cope with these symptoms, such as using breathing and relaxation techniques.

The behavioral part of cognitive behavioral therapy involves changing unwanted or unhealthy behaviors through desensitization, sometimes called exposure therapy. This technique helps you safely face the places and situations that cause fear and anxiety. A therapist may join you on outings to help you stay safe and comfortable, such as trips to the mall or driving your car. The more you go to feared places and realize you're okay, the more your anxiety will lessen.

If you have trouble leaving your home, you may wonder how you can possibly go to a therapist's office. Therapists who treat agoraphobia will be well aware of this problem. They may offer to see you first in your home, or they may meet you in one of your safe zones. They may also offer some sessions over the phone or through email. Look for a therapist who can help you find alternatives to in-office appointments, at least in the early part of your treatment. You may also try taking a trusted relative or friend to your appointment who can offer comfort and help, if needed.

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Age spots (liver spots)

Age spots (liver spots)

Definition:

Age spots — also called liver spots and solar lentigines — are flat gray, brown or black spots. They vary in size and usually appear on the face, hands, shoulders and arms — areas most exposed to the sun. Though age spots are very common in adults older than age 40, they can affect younger people as well.

True age spots are harmless and don't need treatment, but they can look like cancerous growths. For cosmetic reasons, age spots can be lightened with skin-bleaching products or removed. However, preventing age spots — by avoiding the sun and using sunscreen — may be the easiest way to maintain your skin's youthful appearance and to avoid these dark skin spots.

Symptoms:

Age spots typically develop in people with a fair complexion, but they can be seen in those with darker skin. Age spots:

• Are flat, oval areas of increased pigmentation
• Are usually brown, black or gray
• Occur on skin that has had the most sun exposure over the years, such as the backs of hands, tops of feet, face, shoulders and upper back

Age spots range from freckle-size to more than a half inch (1 centimeter) across and can group together, making them more prominent.

When to see a doctor
You may not like the way they look, but age spots are usually harmless and don't require medical care. However, your doctor should evaluate spots that are dark or have changed in appearance, because these changes can be signs of melanoma, a serious form of skin cancer.
It's best to have any new skin changes evaluated by a doctor, especially if a spot or lesion:

• Is darkly pigmented
• Is rapidly increasing in size
• Has an irregular border
• Has an unusual combination of colors
• Is accompanied by itching, redness, tenderness or bleeding

Causes:

Age spots are caused primarily by years of exposure to ultraviolet (UV) light from the sun. The use of commercial tanning lamps and tanning beds can also contribute to the development of age spots.
The pigment in the upper layer of skin (epidermis) that gives your skin its normal color is called melanin. UV light accelerates the production of melanin, creating a tan that helps protect deeper layers of skin from UV rays.

On areas of the skin that have years of frequent and prolonged sun exposure, age spots appear when melanin becomes "clumped" or is produced in particularly high concentrations. In addition to sun exposure, simply becoming older can cause the extra production of melanin.
Your genetic makeup may also play a role in how susceptible you are to the development of age spots.

Treatments and drugs:

If you're unhappy with the appearance of age spots, treatments are available to lighten or remove them. Since the pigment is located at the base of the epidermis — the topmost layer of skin — any treatments meant to lighten the age spots must penetrate this layer of skin.
Age spot treatments include:

• Medications. Prescription bleaching creams (hydroquinone) used alone or with retinoids (tretinoin) and a mild steroid may gradually fade the spots over several months. Sun protection with a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 is strongly advised if you use medication treatments. The treatments may result in temporary itching, redness, burning or dryness.
  
• Laser therapy. Laser therapy destroys melanin-producing cells (melanocytes) without damaging the skin's surface. Treatments with a laser typically require several sessions. After treatment, age spots fade gradually over several weeks or months. Laser therapy has few side effects, but it may result in slight discoloration of the skin.
  
• Freezing (cryotherapy). This procedure involves applying liquid nitrogen or another freezing agent to the age spots to destroy the extra pigment. As the area heals, the skin appears lighter. Freezing is typically used on a single age spot or a small grouping of age spots. The treatment may temporarily irritate the skin and poses a slight risk of permanent scarring or discoloration.
  
• Dermabrasion. This procedure consists of sanding down (planing) the surface layer of your skin with a rapidly rotating brush. This procedure removes the skin surface, and a new layer of skin grows in its place. Temporary redness and scab formation can result from this treatment
  .
• Chemical peel. A chemical peel involves applying an acid, which burns the outer layer of your skin, to the age spots. As your skin peels, new skin forms to take its place. Several treatments may be necessary before you notice any results. Sun protection is strongly advised following this treatment. Temporary irritation is likely, and there's a slight risk of discoloration.

Because age spot treatments are considered cosmetic, your insurance may not pay for them. And because the procedures can have side effects, discuss your options carefully with your dermatologist. Also, make sure your dermatologist is specially trained and experienced in the technique you're considering.

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Compulsive gambling

Compulsive gambling

Definition:

Compulsive gambling is the uncontrollable urge to keep gambling despite the toll it takes on your life. If you're prone to compulsive gambling, you may continually chase bets, lie or hide your behavior, and resort to theft or fraud to support your addiction.
Compulsive gambling is a serious condition that can destroy lives. Although treating compulsive gambling can be challenging, many compulsive gamblers have found help through professional treatment.

Symptoms:

Signs and symptoms of compulsive (pathologic) gambling include:

• Gaining a thrill from taking big gambling risks
• Taking increasingly bigger gambling risks
• A preoccupation with gambling
• Reliving past gambling experiences
• Gambling as a way to escape problems or feelings of helplessness, guilt or depression
• Taking time from work or family life to gamble
• Concealing gambling
• Feeling guilt or remorse after gambling
• Borrowing money or stealing to gamble
• Failed efforts to cut back on gambling
• Lying to hide gambling

Compulsive gambling typically begins in the late teen years. On rare occasions, gambling becomes a problem with the very first wager. But more often, a gambling problem progresses over time. In fact, many people spend years enjoying social gambling without any problems. But more frequent gambling or life stresses can turn casual gambling into something much more serious. During periods of stress or depression, the urge to gamble may be especially overpowering. Eventually, a person with a gambling problem becomes almost completely preoccupied with gambling and getting money to gamble.

For most compulsive gamblers, betting isn't as much about money as it is about the excitement. Sustaining the thrill gambling provides usually involves taking increasingly bigger risks and placing larger bets. Those bets may involve sums you can't afford to lose. Unlike most casual gamblers, compulsive gamblers are compelled to keep playing to recoup their money — a pattern that becomes increasingly destructive over time.

When to see a doctor or mental health provider
Have family members, friends or co-workers expressed concern about your gambling? If so, listen to their worries. Because denial is almost always a characteristic of compulsive or addictive behavior, it may be difficult for you to recognize that you have a problem and seek treatment.
Gambling is out of control if:

• It's affecting your relationships, your finances or your work life
• You're devoting more and more time and energy to gambling pursuits
• You've unsuccessfully tried to stop or cut back on your gambling
• You try to conceal your gambling from family or health professionals
• You resort to theft or fraud to get gambling money
• You ask others to bail you out of financial woes because you've gambled money away

Causes:

 Exactly what causes someone to gamble compulsively isn't well understood. Like many problems, compulsive gambling may result from a combination of biological, genetic and environmental factors.

Complications:

Compulsive gambling can have profound and long-lasting consequences for your life, including:

• Relationship problems
• Financial problems, including bankruptcy
• Legal problems or incarceration
• Job loss or professional stigma
• Development of associated problems, such as alcohol or drug abuse
• Suicide

Treatments and drugs:

Treating compulsive gambling can be challenging. That's partly because most people have a hard time admitting they have a problem. Yet a major component of treatment is working on acknowledging that you're a compulsive gambler. If your family or your employer pressured you into therapy, you may find yourself resisting treatment. But treating a gambling problem can help you regain a sense of control — and perhaps even help heal damaged relationships or finances.
Treatment for compulsive gambling involves three main approaches:

• Psychotherapy. Psychological treatments, such as behavior therapy or cognitive behavioral therapy, may be beneficial for compulsive gambling. Behavior therapy uses systematic exposure to the behavior you want to unlearn (gambling) and teaches you skills to reduce your urge to gamble. Cognitive behavioral therapy focuses on identifying unhealthy, irrational and negative beliefs and replacing them with healthy, positive ones.
• Medications. Antidepressants and mood stabilizers may help problems that often go along with compulsive gambling — such as depression, obsessive compulsive disorder or ADHD — but not necessarily compulsive gambling itself. Medications called narcotic antagonists, which have been found useful in treating substance abuse, may help treat compulsive gambling.
• Self-help groups. Some people find self-help groups, such as Gamblers Anonymous, a helpful part of treatment.

Even with treatment, you may return to gambling, especially if you spend time with people who gamble or in gambling environments. If you feel that you'll start gambling again, contact your care provider or sponsor right away to head off a full-blown relapse.

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Drug addiction

Drug addiction

Definition:

Drug addiction is a dependence on an illegal drug or a medication. When you're addicted, you may not be able to control your drug use and you may continue using the drug despite the harm it causes. Drug addiction can cause an intense craving for the drug. You may want to quit, but most people find they can't do it on their own.

For many people, what starts as casual use leads to drug addiction. Drug addiction can cause serious, long-term consequences, including problems with physical and mental health, relationships, employment and the law.

You may need help from your doctor, family, friends, support groups or an organized treatment program to overcome your drug addiction and stay drug-free.

Symptoms:

Most drug addictions start with casual or social use of a drug. For some people, using the drug becomes a habit, and its use becomes more and more frequent. As time passes, you may need larger doses of the drug to get high. Soon you may need the drug just to feel good. As your drug use increases, you may find that it becomes increasingly difficult to go without the drug. Stopping may cause intense cravings and make you feel physically ill (withdrawal symptoms).
Drug addiction symptoms or behaviors include:

• Feeling that you have to use the drug regularly — this can be daily or even several times a day
• Failing in your attempts to stop using the drug
• Making certain that you maintain a supply of the drug
• Spending money on the drug, even though you can't afford it
• Doing things to obtain the drug that you normally wouldn't do, such as stealing
• Feeling that you need the drug to deal with your problems
• Driving or doing other risky activities when you're under the influence of the drug
• Focusing more and more time and energy on getting and using the drug

Recognizing drug abuse in teenagers
It can sometimes be difficult to distinguish normal teenage moodiness or angst from signs of drug use. Possible indications that your teenager is using drugs include:

• Problems at school. Frequently missing classes or missing school, a sudden disinterest in school or school activities, or a drop in grades may be indicators of drug use.
• Physical health issues. Lack of energy and motivation may indicate your child is using certain drugs.
• Neglected appearance. Teenagers are generally concerned about how they look. A lack of interest in clothing, grooming or looks may be a warning sign of drug use.
• Changes in behavior. Teenagers enjoy privacy, but exaggerated efforts to bar family members from entering their rooms or knowing where they go with their friends might indicate drug use. Also, drastic changes in behavior and in relationships with family and friends may be linked to drug use.
• Spending money. Sudden requests for money without a reasonable explanation for its use may be a sign of drug use. You may also discover money stolen from previously safe places at home. Items may disappear from your home because they're being sold to support a drug habit.

Recognizing signs of drug use and dependence
The particular signs and symptoms of drug use and dependence vary depending on the type of drug. You might be able to tell that a family member or a friend is using or abusing a drug based on the physical and behavioral signs and symptoms associated with the drug.

Marijuana and hashish
It's possible to develop a psychological addiction to cannabis compounds including tetrahydrocannabinol (THC) found in marijuana and hashish. People who have a marijuana addiction generally use the drug on a daily basis. They don't actually have a chemical dependence on the drug but rather feel the need to regularly use the drug.
Signs of use and dependence can include:

• A heightened sense of visual, auditory and taste perception
• Poor memory
• Increased blood pressure and heart rate
• Red eyes
• Decreased coordination
• Difficulty concentrating
• Increased appetite
• Slowed reaction time
• Paranoid thinking

Barbiturates and benzodiazepines
Barbiturates and benzodiazepines are prescription central nervous system depressants. Phenobarbital, amobarbital (Amytal) and secobarbital (Seconal) are examples of barbiturates. Benzodiazepines include tranquilizers, such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and chlordiazepoxide (Librium). If you're prescribed these drugs, take them exactly as ordered. If you feel your need for these medications is increasing, talk to your doctor.
Signs of use and dependence can include:

• Drowsiness
• Slurred speech
• Lack of coordination
• Memory problems
• Confusion
• Slowed breathing and decreased blood pressure
• Dizziness
• Depression

Methamphetamine, cocaine and other stimulants
This class of drugs includes amphetamines, methamphetamine, cocaine and methylphenidate (Ritalin).
Signs of use and dependence can include:

• Euphoria
• Decreased appetite
• Rapid speech
• Irritability
• Restlessness
• Depression as the drug wears off
• Nasal congestion and damage to the mucous membrane of the nose in users who snort drugs
• Insomnia
• Weight loss
• Increased heart rate, blood pressure and temperature
• Paranoia

Methamphetamine, also known as "meth," is a particularly dangerous drug. It's highly addictive and causes a number of short-term and long-term health consequences. Methamphetamine is relatively inexpensive and widely available.

Club drugs
Club drugs are drugs commonly used by teens and young adults at clubs, concerts and parties. Examples include Ecstasy (MDMA), GHB, Rohypnol ("roofies") and ketamine. These drugs are not all classified in the same category, but they share some similar effects and dangers.
Signs of club drug use and dependence can include:

• An exaggerated feeling of great happiness or well-being (euphoria)
• Reduced inhibitions
• A heightened or altered sense of sight, sound and taste
• Amphetamine-like effects (with ketamine and Ecstasy)
• Decreased coordination
• Poor judgment
• Memory problems or loss of memory
• Increased or decreased heart rate and blood pressure
• Drowsiness and loss of consciousness (with GHB and Rohypnol)

GHB and Rohypnol are particularly dangerous. At high doses, they can cause seizures, coma and death. The danger increases when these drugs are taken with alcohol. Because they worsen consciousness and memory and they're easy to give someone without his or her knowledge or consent, these drugs are both commonly used as date-rape drugs.

One particular danger of club drugs is that the liquid, pill or powder forms of these drugs available on the street often contain unknown substances that can be harmful, including other illegally manufactured or pharmaceutical drugs.

Hallucinogens
Use of hallucinogens produces different signs and symptoms depending on the drug. The most common hallucinogens are LSD and phencyclidine (PCP).
Signs of LSD use include:

• Hallucinations
• Greatly reduced perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors
• Permanent mental changes in perception
• Rapid heart rate
• High blood pressure
• Tremors
• Flashbacks, a re-experience of the hallucinations — even years later

Signs of PCP use include:

• Hallucinations
• Euphoria
• Delusions
• Panic
• Loss of appetite
• Depression
• Aggressive, possibly violent behavior

Inhalants
The signs and symptoms of inhalant use vary depending on what substance is inhaled. Some commonly inhaled substances include glue, paint thinners, correction fluid, felt tip marker fluid, gasoline, cleaning fluids and household aerosol products.
When inhaled, these products can cause brief intoxication and a decreased feeling of inhibition. Long-term use may cause seizures and damage to the brain, liver and kidneys. Inhalant use can also cause death.

Narcotic painkillers
Opioids are narcotic, painkilling drugs produced naturally from opium or made synthetically. This class of drugs includes heroin, morphine, codeine, methadone and oxycodone (OxyContin). If you're prescribed these medications by a doctor, take them exactly as directed. Don't increase your dose without first talking to your doctor.
Signs of narcotic use and dependence can include:

• Reduced sense of pain
• Sedation
• Depression
• Confusion
• Constipation
• Slowed breathing
• Needle marks (if injecting drugs)

When to see a doctor
If you think your drug use is out of control or is causing problems, get help. The sooner you seek help, the greater your chances are for a long-term recovery. Your family doctor may be a good place to start, or you may see a mental health provider such as a psychologist or psychiatrist.
Make an appointment to see a doctor if:

• You can't stop using a drug.
• Your drug use has led to unsafe behavior, such as sharing needles or unprotected sex.
• You think you may be having withdrawal symptoms. If you're reluctant to approach a doctor, help lines or hotlines may be a good place to learn about treatment. You can find these lines listed in the phone book or on the Internet.

Seek emergency help if you or someone you know has taken a drug and:

• May have overdosed
• Loses consciousness
• Has trouble breathing
• Has seizures
• Has signs of a heart attack, such as chest pain or pressure
• Has any other troublesome physical or psychological reaction to use of the drug

Causes:

Like many psychological disorders, drug addiction and dependence depends on several things. Two main factors include:

• Environment. Environmental factors, including your family's beliefs and attitudes and exposure to a peer group that encourages drug use, seem to play a role in initial drug use.
• Genes. Once you've started using a drug, the development into addiction may be influenced by inherited traits.

Changing brain pathways
Physical addiction appears to occur when repeated use of a drug alters the way your brain feels pleasure. The addicting drug causes physical changes to some nerve cells (neurons) in your brain. Neurons use chemicals called neurotransmitters to communicate.

Complications:

Dependence on drugs can create a number of life-changing complications. They can include:

• Health problems. Drug addiction can lead to a range of both short- and long-term mental and physical health problems. These depend on what drug is taken.
• Unconsciousness, coma and sudden death. Taking some drugs can be particularly risky, especially if you take high doses or combine them with other drugs or alcohol.
• Getting a communicable disease. People who are addicted to a drug are more likely to get an infectious disease, such as HIV, either through unsafe sex or by sharing needles.
• Accidents. If you're addicted to a drug, you're more likely to drive or do other dangerous activities while intoxicated.
• Suicide. People who are addicted to drugs commit suicide more often than do people who aren't.
• Family problems. Behavioral changes may cause marital or family strife and custody issues.
• Work issues. Work performance may decline, and you may be absent from work more often.
• Problems at school. Academic performance and motivation to excel in school may suffer.
• Legal issues. These can stem from stealing to support your drug addiction, driving while under the influence of drugs or alcohol, and disputes over child custody.
• Financial problems. Spending money to support your habit takes away money from your other needs, could put you into debt, and could lead you into illegal or unethical behaviors.

Treatments and drugs:

Drug addiction treatments include organized inpatient or outpatient treatment programs, counseling, and self-help groups to help you resist using the addictive drug again. Depending on your level of addiction, you may need steps to help you withdraw from using the drug (detoxification).
Therapies such as counseling, addiction treatment programs and self-help group meetings can help you overcome an addiction and stay sober.

• Treatment programs. Treatment programs generally include educational and therapy sessions focused on getting sober and preventing relapse. This may be accomplished in individual, group or family sessions. These programs are available in various settings from outpatient to residential and inpatient programs.
  
• Counseling. Individual or family counseling with a psychologist, psychiatrist or addiction counselor may help you resist the temptation to resume using addicting drugs. Behavior therapies can help you develop ways to cope with your drug cravings, suggest strategies to avoid drugs and prevent relapse, and offer suggestions on how to deal with a relapse if it occurs. Counseling can also involve talking about your job, legal problems, and relationships with family and friends. Counseling with family members can help them develop better communication skills and be more supportive.
  
• Self-help groups. Many, though not all, of these groups tend to use the 12-step model first developed by Alcoholics Anonymous. Self-help groups, such as Narcotics Anonymous, exist for people addicted to drugs, such as cocaine, sedatives and narcotics. The message is that addiction is a chronic disorder with a danger of relapse and that ongoing maintenance treatment — which may include medications, counseling and self-help group meetings — is necessary to prevent a relapse. Your doctor or counselor can help you locate a self-help group. You also can find listings for self-help groups in the phone book, at the library and on the Internet.

Withdrawal therapy
The goal of withdrawal therapy (detoxification) is for you to stop taking the addicting drug as quickly and safely as possible. Detoxification may involve gradually reducing the dose of the drug or temporarily substituting other substances, such as methadone, that have less severe side effects. For some people, it may be safe to undergo withdrawal therapy on an outpatient basis; others may require admission to a hospital or a residential treatment center.
Withdrawal from different categories of drugs produces different side effects and requires different approaches.

• Depressants (includes barbiturates, benzodiazepines and others). Minor side effects of withdrawal may include restlessness, anxiety, sleep problems and sweating. More-serious signs and symptoms also could include hallucinations, whole-body tremors, seizures, and increased blood pressure, heart rate and body temperature. Withdrawal therapy may involve gradually scaling back the amount of the drug, adding another medication to help stabilize the nerve cells during detoxification or both.
  
• Stimulants (includes amphetamines, methamphetamine, cocaine, Ritalin and others). Side effects of withdrawal typically include depression, fatigue, anxiety and intense cravings. In some cases, signs and symptoms may include suicidal thoughts and suicide attempts, paranoia, and decreased contact with reality (acute psychosis). Treatment during withdrawal is usually limited to emotional support from your family, friends and doctor. Your doctor may recommend medications to treat paranoid psychosis or depression.
  
• Opioids (includes heroin, morphine, codeine, OxyContin and others). Withdrawal side effects of opioids can range from relatively minor to severe. On the minor end, they may include runny nose, sweating, yawning, anxiety and drug cravings. Severe reactions can include sleeplessness, depression, dilated pupils, rapid pulse, rapid breathing, high blood pressure, abdominal cramps, tremors, bone and muscle pain, vomiting, and diarrhea. Doctors may substitute an artificial opiate, such as methadone or buprenorphine (Subutex, others), to reduce the craving for heroin during recovery.

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Alcoholism

Alcoholism

Definition  :

Alcoholism is a chronic and often progressive disease that includes problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect (physical dependence), or having withdrawal symptoms when you rapidly decrease or stop drinking.

 If you have alcoholism, you can't consistently predict how much you'll drink, how long you'll drink, or what consequences will occur from your drinking.
It's possible to have a problem with alcohol, even when it has not progressed to the point of alcoholism. Problem drinking means you drink too much at times, causing repeated problems in your life, although you're not completely dependent on alcohol.

Binge drinking — a pattern of drinking where a male consumes five or more drinks in a row, or a female downs at least four drinks in a row — can lead to the same health risks and social problems associated with alcoholism.

The more you drink, the greater the risks. Binge drinking, which often occurs with teenagers and young adults, may lead to faster development of alcoholism.
If you have alcoholism or you have a problem with alcohol, you may not be able to cut back or quit without help. Denying that you have a problem is usually part of alcoholism and other types of excessive drinking.

Symptoms :
Alcoholism signs and symptoms include those below. You may:

• Be unable to limit the amount of alcohol you drink
• Feel a strong need or compulsion to drink
• Develop tolerance to alcohol so that you need more to feel its effects
• Drink alone or hide your drinking
• Experience physical withdrawal symptoms — such as nausea, sweating and shaking — when you don't drink
• Not remember conversations or commitments, sometimes referred to as a "black out"
• Make a ritual of having drinks at certain times and become annoyed when this ritual is disturbed or questioned
• Be irritable when your usual drinking time nears, especially if alcohol isn't available
• Keep alcohol in unlikely places at home, at work or in your car
• Gulp drinks, order doubles or become drunk intentionally to feel good, or drink to feel "normal"
• Have legal problems or problems with relationships, employment or finances due to drinking
• Lose interest in activities and hobbies that used to bring you pleasure

If you binge drink or have other problems with alcohol, you may have many of the signs and symptoms above, although you may not feel as much of a compulsion to drink compared with someone who has alcoholism. Also, you may not have physical withdrawal symptoms when you don't drink. But this pattern of drinking can still cause serious problems and lead to alcoholism. As with alcoholism, you may not be able to quit problem drinking without help.

What is considered one drink?
One standard drink is:

• 12 ounces (355 milliliters) of regular beer (about 5 percent alcohol)
• 8 to 9 ounces (237 to 266 milliliters) of malt liquor (about 7 percent alcohol)
• 5 ounces (148 milliliters) of wine (about 12 percent alcohol)
• 1.5 ounces (44 milliliters) of 80-proof hard liquor (about 40 percent alcohol)

What about my drinking?
If you've ever wondered whether your drinking crosses the line into problem drinking or alcoholism, ask yourself these questions:

• If you're a man, do you ever have five or more drinks in a day?
• If you're a woman, do you ever have four or more drinks in a day?
• Do you ever need a drink to get you started in the morning?
• Do you feel guilty about your drinking?
• Do you think you need to cut back on how much you drink?
• Are you annoyed when other people comment on or criticize your drinking habits?

If you answered yes to even one of these questions, you may have a problem with alcohol.

When to see a doctor
If you feel that you sometimes drink too much or your family is concerned about your drinking, talk with your doctor. See your doctor even if you don't think you have alcoholism, but you're concerned about your drinking or it's causing problems in your life. Other ways to get help include talking with a mental health provider or seeking help from a support group such as Alcoholics Anonymous.
Because denial is common, you may not feel like you have a problem with drinking or that you need help to stop. You might not recognize how much you drink or how many problems in your life are related to alcohol use. Listen to family members, friends or co-workers when they ask you to examine your drinking habits or to seek help.

Causes: 

Alcoholism is influenced by genetic, psychological, social and environmental factors that have an impact on how it affects your body and behavior.
The process of becoming addicted to alcohol occurs gradually, although some people have an abnormal response to alcohol from the time they start drinking. Over time, drinking too much may change the normal balance of chemicals and nerve tracks in your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in your craving alcohol to restore good feelings or remove negative ones.

Complications:

Alcohol depresses your central nervous system. In some people, the initial reaction may be stimulation. But as you continue to drink, you become sedated. Alcohol lowers your inhibitions and affects your thoughts, emotions and judgment.
Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death.

If you have problems with alcohol, you're more likely to also have problems with other substances.
Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, such as:

• Motor vehicle accidents and other types of accidents
• Domestic problems
• Poor performance at work or school
• Increased likelihood of committing violent crimes

Health problems caused by excessive drinking can include:

• Liver disease. Heavy drinking can cause alcoholic hepatitis — an inflammation of the liver. After years of heavy drinking, hepatitis may lead to irreversible destruction and scarring of liver tissue (cirrhosis).
  
• Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It also can interfere with absorption of B vitamins and other nutrients. Heavy drinking can damage your pancreas — which produces hormones that regulate your metabolism and enzymes that help digestion — and lead to inflammation of the pancreas (pancreatitis).
  
• Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke.
  
• Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level.
  
• Sexual function and menstruation. Excessive drinking can cause erectile dysfunction in men. In women, it can interrupt menstruation.
  
• Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamine).
  
• Birth defects. Alcohol use during pregnancy may cause fetal alcohol syndrome, resulting in giving birth to a child who has physical and developmental problems that last a lifetime.
  
• Bone loss. Alcohol may interfere with the production of new bone. This can lead to thinning bones (osteoporosis) and an increased risk of fractures.
  
• Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia and short-term memory loss.
  
• Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, making you more susceptible to illnesses.
  
• Increased risk of cancer. Long-term excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, colon and breast cancer. Even moderate drinking can increase the risk of breast cancer.

Alcohol use leads to serious consequences for many teens and young adults. In this age group:

• Alcohol-related motor vehicle accidents are a major cause of deaths.
• Alcohol is often a cause in other deaths, including drowning, suicides and homicides.
• Drinking makes it more likely they'll become sexually active, have sex more frequently, engage in risky, unprotected sex, and become victims of sexual abuse or date rape compared with those who don't drink.
• Alcohol use can lead to accidental injury, assault and property damage. 

Treatments and drugs:
 
Many people with alcoholism hesitate to get treatment because they don't recognize they have a problem. An intervention from loved ones can help some people recognize and accept that they need professional help. If you're concerned about a friend or family member who drinks too much, talk to a professional for advice on how to approach that person.

Various treatments may help. Depending on the circumstances, treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay.
The first step is to determine if you have a problem with alcohol. If you haven't lost control over your use of alcohol, treatment may involve reducing your drinking. If you have become addicted, simply cutting back is ineffective. Working to stop the use of alcohol to improve quality of life is the main treatment goal.
Treatment for alcoholism may include:

• Detoxification and withdrawal. Treatment for alcoholism may begin with a program of detoxification, which generally takes two to seven days. You may need to take sedating medications to prevent shaking, confusion or hallucinations (delirium tremens), or other withdrawal symptoms. Detoxification is usually done at an inpatient treatment center or a hospital.
  
• Learning skills and establishing a treatment plan. This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center.
  
• Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcoholism. You may benefit from couples or family therapy — family support can be an important part of the recovery process.
  
• Oral medications. A drug called disulfiram (Antabuse) may help to prevent you from drinking, although it won't cure alcoholism or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Naltrexone (Revia), a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate (Campral) may help you combat alcohol cravings. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick after taking a drink.
  
• Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol dependence to use consistently.
  
• Continuing support. Aftercare programs and support groups help people recovering from problem drinking or alcoholism to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group such as Alcoholics Anonymous.
  
• Treatment for psychological problems. Alcoholism commonly occurs along with other mental health disorders. You may need talk therapy (psychotherapy or psychological counseling), medications, or other treatment for depression, anxiety or another mental health condition, if you have any of these conditions.
  
• Medical treatment for other conditions. Common medical problems related to alcoholism include high blood pressure, high blood sugar, liver disease and heart disease. Many alcohol-related health problems improve significantly once you stop drinking.
  
• Spiritual practice. People who are involved with some type of regular spiritual practice may find it easier to maintain recovery from alcoholism or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery.

Residential treatment programs
For a serious alcohol problem, you may need a stay at a residential treatment facility. Many residential treatment programs include individual and group therapy, participation in alcoholism support groups such as Alcoholics Anonymous, educational lectures, family involvement, activity therapy, and working with counselors, professional staff and doctors experienced in treating alcoholism.

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ARDS

ARDS

Definition  :

Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. More fluid in your lungs means less oxygen can reach your bloodstream. This deprives your organs of the oxygen they need to function.

ARDS typically occurs in people who are already critically ill or who have significant injuries. Severe shortness of breath — the main symptom of ARDS — usually develops within a few hours to a few days after the original disease or trauma.

Many people who develop ARDS don't survive. The risk of death increases with age and severity of illness. Of the people who do survive ARDS, some recover completely while others experience lasting damage to their lungs.

Symptoms:

The signs and symptoms of ARDS can vary in intensity, depending on its cause and severity. They include:

• Severe shortness of breath
• Labored and unusually rapid breathing
• Low blood pressure
• Confusion and extreme tiredness

When to see a doctor
ARDS usually follows a major illness or injury, and most people who are affected are already hospitalized.

Causes:

The mechanical cause of ARDS is fluid leaked from the smallest blood vessels in the lungs into the tiny air sacs where blood is oxygenated. Normally, a protective membrane keeps this fluid in the vessels. Severe illness or injury, however, can cause inflammation that undermines the membrane's integrity, leading to the fluid leakage of ARDS.
The most common underlying causes of ARDS include:

• Sepsis. The most common cause of ARDS is sepsis, a serious and widespread infection of the bloodstream.
• Inhalation of harmful substances. Breathing high concentrations of smoke or chemical fumes can result in ARDS, as can inhaling (aspirating) vomit.
• Severe pneumonia. Severe cases of pneumonia usually affect all five lobes of the lungs.
• Head or chest injury. Accidents, such as falls or car crashes, can directly damage the lungs or the portion of the brain that controls breathing.

Complications:

ARDS is extremely serious, but thanks to improved treatments, more people are surviving it. However, many survivors end up with potentially serious — and sometimes lasting — complications, including:

• Pulmonary fibrosis. Scarring and thickening of the tissue between the air sacs can occur within a few weeks of the onset of ARDS. This stiffens your lungs, making it even more difficult for oxygen to flow from the air sacs into your bloodstream.
  
• Collapsed lung (pneumothorax). In most ARDS cases, a breathing machine called a ventilator is used to increase oxygen in the body and force fluid out of the lungs. However, the pressure and air volume of the ventilator can force gas to go through a small hole in the very outside of a lung and cause that lung to collapse. 

• Blood clots. Lying still in the hospital while you're on a ventilator can increase your risk of developing blood clots, particularly in the deep veins in your legs. If a clot forms in your leg, a portion of it can break off and travel to one of your lungs (pulmonary embolism) — where it blocks blood flow.

• Infections. Because the ventilator is attached directly to a tube inserted in your windpipe, this makes it much easier for germs to infect and further injure your lungs.

• Abnormal lung function. Many people with ARDS recover most of their lung function within several months to two years, but others may have breathing problems for the rest of their lives. Even people who do well usually have shortness of breath and fatigue and may need supplemental oxygen at home for a few months.

• Memory, cognitive and emotional problems. Sedatives and low levels of oxygen in the blood can lead to memory loss and cognitive problems after ARDS. In some cases, the effects may lessen over time, but in others, the damage may be permanent. Most ARDS survivors also report going through a period of depression, which is treatable.

Treatments and drugs:

The first goal in treating ARDS is to improve the levels of oxygen in your blood. Without oxygen, your organs can't function properly.
Oxygen
To get more oxygen into your bloodstream, your doctor will likely use:

• Supplemental oxygen. For milder symptoms or as a temporary measure, oxygen may be delivered through a mask that fits tightly over your nose and mouth.
• Mechanical ventilation. Most people with ARDS will need the help of a machine to breathe. A mechanical ventilator pushes air into your lungs and forces some of the fluid out of the air sacs.

Fluids
Carefully managing the amount of intravenous fluids is crucial. Too much fluid can increase fluid buildup in the lungs. Too little fluid can put a strain on your heart and other organs, and lead to shock.
Medication
People with ARDS usually are given medication to:

• Prevent and treat infections
• Relieve pain and discomfort
• Prevent clots in the legs and lungs
• Minimize gastric reflux

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Radiation sickness

Radiation sickness

Definition:

Radiation sickness is damage to your body caused by a large dose of radiation often received over a short period of time (acute). The amount of radiation absorbed by the body — the absorbed dose — determines how sick you'll be.
Radiation sickness is also called acute radiation sickness, acute radiation syndrome or radiation poisoning. Common exposures to low-dose radiation, such as X-ray or CT examinations, don't cause radiation sickness.

Although radiation sickness is serious and often fatal, it's rare. Since the atomic bombings of Hiroshima and Nagasaki, Japan, during World War II, most cases of radiation sickness have occurred after nuclear industrial accidents such as the 1986 fire that damaged the nuclear power plant at Chernobyl or the 2011 earthquake that damaged the nuclear power plant on the east coast of Japan.

Symptoms:

The severity of signs and symptoms of radiation sickness depends on how much radiation you've absorbed. How much you absorb depends on the strength of the radiated energy and the distance between you and the source of radiation. Signs and symptoms also are affected by the type of exposure — such as total or partial body and whether contamination is internal or external — and how sensitive to radiation the affected tissue is. For instance, the gastrointestinal system and bone marrow are highly sensitive to radiation.

Absorbed dose and duration of exposure
The absorbed dose of radiation is measured in a unit called a gray (Gy). Diagnostic tests that use radiation, such as an X-ray, result in a small dose of radiation — typically well below 0.1 Gy, focused on a few organs or small amount of tissue.
Signs and symptoms of radiation sickness usually appear when the entire body receives an absorbed dose of at least 1 Gy. Doses greater than 6 Gy to the whole body are generally not treatable and usually lead to death within two days to two weeks, depending on the dose and duration of the exposure.

Initial signs and symptoms
The initial signs and symptoms of treatable radiation sickness are usually nausea and vomiting. The amount of time between exposure and when these symptoms develop is an indicator of how much radiation a person has absorbed.
After the first round of signs and symptoms, a person with radiation sickness may have a brief period with no apparent illness, followed by the onset of new, more serious symptoms.
In general, the greater your radiation exposure, the more rapid and more severe your symptoms will be.

Early symptoms of radiation sickness*
	Mild exposure (1-2 Gy)	Moderate exposure (2-6 Gy)	Severe exposure (6-8 Gy)	Very severe exposure (8-10 Gy or higher)
Nausea and vomiting	Within 6 hours	Within 2 hours	Within 1 hour	Within 10 minutes
Diarrhea	--	Within 8 hours	Within 3 hours	Within 1 hour
Headache	--	Within 24 hours	Within 4 hours	Within 2 hours
Fever	--	Within 3 hours	Within 1 hour	Within 1 hour
Later symptoms of radiation sickness*
Dizziness and disorientation	--	--	Within 1 week	Immediate
Weakness, fatigue	Within 4 weeks	Within 1-4 weeks	Within 1 week	Immediate
Hair loss, bloody vomit and stools, infections, poor wound healing, low blood pressure	--	Within 1-4 weeks	Within 1 week	Immediate

* Adapted from Radiation exposure and contamination. The Merck Manuals: The Merck Manual for
Healthcare Professionals.

When to see a doctor
An accident or attack that causes radiation sickness would no doubt cause a lot of attention and public concern. If such an event occurs, monitor radio, television or online reports to learn about emergency instructions for your area.
If you know you've been exposed to radiation, seek emergency medical care


Causes:

Radiation is the energy released from atoms as either a wave or a tiny particle of matter. Radiation sickness is caused by exposure to a high dose of radiation, such as a high dose of radiation received during an industrial accident. Common exposures to low-dose radiation, such as X-ray examinations, don't cause radiation sickness.
Sources of high-dose radiation
Possible sources of high-dose radiation include the following:

• An accident at a nuclear industrial facility
• An attack on a nuclear industrial facility
• Detonation of a small radioactive device
• Detonation of a conventional explosive device that disperses radioactive material (dirty bomb)
• Detonation of a standard nuclear weapon

Radiation sickness occurs when high-energy radiation damages or destroys certain cells in your body. Regions of the body most vulnerable to high-energy radiation are cells in the lining of your intestinal tract, including your stomach, and the blood cell-producing cells of bone marrow.

Treatments and drugs:

The treatment goals for radiation sickness are to prevent further radioactive contamination; treat life-threatening injuries, such as from burns and trauma; reduce symptoms; and manage pain.

Decontamination
Decontamination is the removal of as much external radioactive particles as possible. Removing clothing and shoes eliminates about 90 percent of external contamination. Gently washing with water and soap removes additional radiation particles from the skin.
Decontamination prevents further distribution of radioactive materials and lowers the risk of internal contamination from inhalation, ingestion or open wounds.

Treatment for damaged bone marrow
A protein called granulocyte colony-stimulating factor, which promotes the growth of white blood cells, may counter the effect of radiation sickness on bone marrow. Treatment with this protein-based medication, which includes filgrastim (Neupogen) and pegfilgrastim (Neulasta), may increase white blood cell production and help prevent subsequent infections.
If you have severe damage to bone marrow, you may also receive transfusions of red blood cells or blood platelets.

Treatment for internal contamination
Some treatments may reduce damage to internal organs caused by radioactive particles. Medical personnel would use these treatments only if you've been exposed to a specific type of radiation. These treatments include the following:

• Potassium iodide. This is a nonradioactive form of iodine. Because iodine is essential for proper thyroid function, the thyroid becomes a "destination" for iodine in the body. If you have internal contamination with radioactive iodine (radioiodine), your thyroid will absorb radioiodine just as it would other forms of iodine. Treatment with potassium iodide may fill "vacancies" in the thyroid and prevent absorption of radioiodine. The radioiodine is eventually cleared from the body in urine. Potassium iodide isn't a cure-all and is most effective if taken within a day of exposure.
• Prussian blue. This type of dye binds to particles of radioactive elements known as cesium and thallium. The radioactive particles are then excreted in feces. This treatment speeds up the elimination of the radioactive particles and reduces the amount of radiation cells may absorb.
• Diethylenetriamine pentaacetic acid (DTPA). This substance binds to metals. DTPA binds to particles of the radioactive elements plutonium, americium and curium. The radioactive particles pass out of the body in urine, thereby reducing the amount of radiation absorbed.

Supportive treatment
If you have radiation sickness, you may receive additional medications or interventions to treat:

• Bacterial infections
• Headache
• Fever
• Diarrhea
• Nausea and vomiting
• Dehydration
• Burns

End-of-life care
A person who has absorbed large doses of radiation (6 Gy or greater) has little chance of recovery. Depending on the severity of illness, death can occur within two days or two weeks. People with a lethal radiation dose will receive medications to control pain, nausea, vomiting and diarrhea. They may also benefit from psychological or pastoral care.

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Sweet's syndrome

Sweet's syndrome

Definition:

Sweet's syndrome — also known as acute febrile neutrophilic dermatosis — is a rare skin condition marked by fever and painful skin lesions that appear mainly on your arms, neck, face and back.
The exact cause of Sweet's syndrome isn't always known. In some people, it's triggered by an infection, illness or certain medications. Sweet's syndrome can also occur with some types of cancer.

The most common treatment for Sweet's syndrome is corticosteroid pills, such as prednisone. Signs and symptoms often disappear just a few days after treatment begins, but recurrence is common.

Symptoms:

Sweet's syndrome is marked by an abrupt eruption of small red bumps on your arms, neck, face or back — often after a fever or upper respiratory infection. The bumps grow quickly in size, spreading into painful clusters up to an inch or so in diameter.

When to see a doctor
If you develop a painful, red rash that quickly grows in size, see your doctor for appropriate treatment.

Causes:

 In most cases, the cause of Sweet's syndrome isn't known. Sweet's syndrome is sometimes associated with cancer, most often leukemia. A few cases may be associated with a solid tumor, such as breast or colon cancer. Sweet's syndrome may also occur as a reaction to a medication — most commonly a type of drug that boosts production of white blood cells.

Complications:

There is a risk of the skin lesions becoming infected. Follow your doctor's recommendations for caring for the affected skin.
In cases where Sweet's syndrome is associated with cancer, the eruptions of the lesions may be the first sign of cancer either appearing or recurring.

Treatments and drugs:

In some cases, Sweet's syndrome resolves without treatment. But medications can speed the process dramatically. The most common medications used for Sweet's syndrome are corticosteroids, which come in a variety of forms, including:

• Pills. Oral corticosteroids, such as prednisone, work very well but will affect your entire body. Long-term use can cause weight gain and weakened bones.
• Creams or ointments. These preparations usually affect just the portion of skin where they're applied, but can cause thinning skin.
• Injections. Another option is to inject a small amount of corticosteroid right into each lesion. This may be less feasible for people who have a great number of lesions.

To avoid the side effects associated with long-term corticosteroid use, your doctor may suggest other types of oral medications, including:

• Dapsone
• Potassium iodide
• Colchicine
• Indomethacin
• Clofazimine
• Cyclosporine

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HIV/AIDS

HIV/AIDS

Definition:

AIDS is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease.

HIV is a sexually transmitted infection. It can also be spread by contact with infected blood, or from mother to child during pregnancy, childbirth or breast-feeding. It can take years before HIV weakens your immune system to the point that you have AIDS.

There's no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many developed nations. But HIV continues to decimate populations in Africa, Haiti and parts of Asia.

Symptoms:

The symptoms of HIV and AIDS vary, depending on the phase of infection.
Primary infection
The majority of people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible symptoms include:

• Fever
• Muscle soreness
• Rash
• Headache
• Sore throat
• Mouth or genital ulcers
• Swollen lymph glands, mainly on the neck
• Joint pain
• Night sweats
• Diarrhea

Although the symptoms of primary HIV infection may be mild enough to go unnoticed, the amount of virus in the blood stream (viral load) is particularly high at this time. As a result, HIV infection spreads more efficiently during primary infection than during the next stage of infection.

Clinical latent infection
In some people, persistent swelling of lymph nodes occurs during clinical latent HIV. Otherwise, there are no specific signs and symptoms. HIV remains in the body, however, as free virus and in infected white blood cells.
Clinical latent infection typically lasts eight to 10 years. A few people stay in this stage even longer, but others progress to more-severe disease much sooner.

Early symptomatic HIV infection
As the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic symptoms such as:

• Fever
• Fatigue
• Swollen lymph nodes — often one of the first signs of HIV infection
• Diarrhea
• Weight loss
• Cough and shortness of breath

Progression to AIDS
If you receive no treatment for your HIV infection, the disease typically progresses to AIDS in about 10 years. By the time AIDS develops, your immune system has been severely damaged, making you susceptible to opportunistic infections — diseases that wouldn't trouble a person with a healthy immune system. The signs and symptoms of some of these infections may include:

• Soaking night sweats
• Shaking chills or fever higher than 100 F (38 C) for several weeks
• Cough and shortness of breath
• Chronic diarrhea
• Persistent white spots or unusual lesions on your tongue or in your mouth
• Headaches
• Persistent, unexplained fatigue
• Blurred and distorted vision
• Weight loss
• Skin rashes or bumps

When to see a doctor
If you think you may have been infected with HIV or are at risk of contracting the virus, see a health care provider as soon as possible.

Causes:

Scientists believe a virus similar to HIV first occurred in some populations of chimps and monkeys in Africa, where they're hunted for food. Contact with an infected monkey's blood during butchering or cooking may have allowed the virus to cross into humans and become HIV.

How does HIV become AIDS?
HIV destroys CD4 cells — a specific type of white blood cell that plays a large role in helping your body fight disease. Your immune system weakens as more CD4 cells are killed. You can have an HIV infection for years before it progresses to AIDS.
People infected with HIV progress to AIDS when their CD4 count falls below 200 or they experience an AIDS-defining complication, such as:

• Pneumocystis pneumonia
• Cytomegalovirus
• Tuberculosis
• Toxoplasmosis
• Cryptosporidiosis

How HIV is transmitted
To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. You can't become infected through ordinary contact — hugging, kissing, dancing or shaking hands — with someone who has HIV or AIDS. HIV can't be transmitted through the air, water or via insect bites.
You can become infected with HIV in several ways, including:

• During sex. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. The virus can enter your body through mouth sores or small tears that sometimes develop in the rectum or vagina during sexual activity.
• Blood transfusions. In some cases, the virus may be transmitted through blood transfusions. American hospitals and blood banks now screen the blood supply for HIV antibodies, so this risk is very small.
• Sharing needles. HIV can be transmitted through needles and syringes contaminated with infected blood. Sharing intravenous drug paraphernalia puts you at high risk of HIV and other infectious diseases such as hepatitis.
• From mother to child. Infected mothers can infect their babies during pregnancy or delivery, or through breast-feeding. But if women receive treatment for HIV infection during pregnancy, the risk to their babies is significantly reduced.

Complications:

HIV infection weakens your immune system, making you highly susceptible to all sorts of infections and certain types of cancers.
Infections common to HIV/AIDS

• Tuberculosis (TB). In resource-poor nations, TB is the most common opportunistic infection associated with HIV and a leading cause of death among people living with AIDS. Millions of people are currently infected with both HIV and tuberculosis, and many experts consider the two diseases twin epidemics.

• Salmonellosis. You contract this bacterial infection from contaminated food or water. Symptoms include severe diarrhea, fever, chills, abdominal pain and, occasionally, vomiting. Although anyone exposed to salmonella bacteria can become sick, salmonellosis is far more common in people who are HIV-positive.

• Cytomegalovirus (CMV). This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. A healthy immune system inactivates the virus, and it remains dormant in your body. If your immune system weakens, the virus resurfaces — causing damage to your eyes, digestive tract, lungs or other organs.

• Candidiasis. Candidiasis is a common HIV-related infection. It causes inflammation and a thick white coating on the mucous membranes of your mouth, tongue, esophagus or vagina. Children may have especially severe symptoms in the mouth or esophagus, which can make eating painful and difficult.

• Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal meningitis is a common central nervous system infection associated with HIV, caused by a fungus that is present in soil. It may also be associated with bird or bat droppings.

• Toxoplasmosis. This potentially deadly infection is caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the parasites in their stools, and the parasites may then spread to other animals.

• Cryptosporidiosis. This infection is caused by an intestinal parasite that's commonly found in animals. You contract cryptosporidiosis when you ingest contaminated food or water. The parasite grows in your intestines and bile ducts, leading to severe, chronic diarrhea in people with AIDS.

Cancers common to HIV/AIDS

• Kaposi's sarcoma. Kaposi's sarcoma is a tumor of the blood vessel walls. Although rare in people not infected with HIV, it's common in HIV-positive people. Kaposi's sarcoma usually appears as pink, red or purple lesions on the skin and mouth. In people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect the internal organs, including the digestive tract and lungs.
• Lymphomas. This type of cancer originates in your white blood cells. Lymphomas usually begin in your lymph nodes. The most common early sign is painless swelling of the lymph nodes in your neck, armpit or groin.

Other complications

• Wasting syndrome. Aggressive treatment regimens have reduced the number of cases of wasting syndrome, but it does still affect many people with AIDS. It is defined as a loss of at least 10 percent of body weight and is often accompanied by diarrhea, chronic weakness and fever.

• Neurological complications. Although AIDS doesn't appear to infect the nerve cells, it can still cause neurological symptoms such as confusion, forgetfulness, depression, anxiety and trouble walking. One of the most common neurological complications is AIDS dementia complex, which leads to behavioral changes and diminished mental functioning.

• Kidney disease. HIV-associated nephropathy (HIV AN) is an inflammation of the tiny filters in your kidneys that remove excess fluid and wastes from your bloodstream and pass them to your urine. Because of a genetic predisposition, the risk of developing HIV AN is much higher in African Americans. Regardless of CD4 count, anti-retroviral therapy should be started in people diagnosed with HIV AN who are not already being treated. 

Treatments and drugs:

There's no cure for HIV/AIDS, but a variety of drugs can be used in combination to control the virus. Each of the classes of anti-HIV drugs blocks the virus in different ways. It's best to combine at least three drugs from two different classes to avoid creating strains of HIV that are immune to single drugs. The classes of anti-HIV drugs include:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune).
• Nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir).
• Protease inhibitors (PIs). PIs disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir).
• Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
• Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells.

When to start treatment
Current guidelines indicate that treatment should begin if:

• You have severe symptoms
• Your CD4 count is under 500
• You're pregnant
• You have HIV-related kidney disease
• You're being treated for hepatitis B

Treatment can be difficult
HIV treatment regimens may involve taking multiple pills at specific times every day for the rest of your life. Side effects can include:

• Nausea, vomiting or diarrhea
• Abnormal heartbeats
• Shortness of breath
• Skin rash
• Weakened bones
• Bone death, particularly in the hip joints

Co-diseases and co-treatments
Some health issues that are a natural part of aging may be more difficult to manage if you have HIV. Some medications that are common for age-related cardiovascular, metabolic and bone conditions, for example, may not interact well with anti-HIV medications. Talk to your doctor about other conditions you're receiving medication for. There are also known interactions between anti-HIV drugs and:

• Contraceptives and hormones for women
• Medications for the treatment of tuberculosis
• Drugs to treat hepatitis C

Treatment response
Your response to any treatment is measured by your viral load and CD4 counts. Viral load should be tested at the start of treatment and then every three to four months during therapy. CD4 counts should be checked every three to six months.

HIV treatment should reduce your viral load to the point that it's undetectable. That doesn't mean your HIV is gone. It just means that the test isn't sensitive enough to detect it. You can still transmit HIV to others when your viral load is undetectable.

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