Bone metastasis

Bone metastasis

Definition:
Bone metastasis occurs when cancer cells spread from their original site to a bone. Nearly all types of cancer can spread (metastasize) to the bones. But some types of cancer are particularly likely to spread to bone, including breast cancer and prostate cancer.

Bone metastasis can occur in any bone but more commonly occurs in the pelvis and spine. Bone metastasis may be the first sign that you have cancer, or bone metastasis may occur years after cancer treatment.

Bone metastasis can cause pain and broken bones. With rare exceptions, cancer that has spread to the bones can't be cured. Treatments can help reduce pain and other symptoms of bone metastases.


Symptoms:
Signs and symptoms of bone metastasis include:

• Bone pain
• Broken bones
• Urinary incontinence
• Bowel incontinence
• Weakness in the legs
• High levels of calcium in the blood (hypercalcemia), which can cause nausea, vomiting and confusion

When to see a doctor
If you experience persistent signs and symptoms that worry you, make an appointment with your doctor. If you've been treated for cancer in the past, tell your doctor about your medical history and that you're concerned about your signs and symptoms.


Causes:
Bone metastasis occurs when cancer cells break away from the original tumor and spread to the bones, where they begin to multiply. It's believed that cancer cells arrive in the bones by traveling through the blood vessels.

Doctors aren't sure what causes some cancers to spread. And it's not clear why some cancers travel to the bones rather than to other common sites for metastasis, such as the liver.

Treatments and drugs:

Treatments for bone metastasis include medications, radiation therapy and surgery. What treatments are best for you will depend on the specifics of your situation.
Medications
Medications used in people with bone metastasis include:

• Bone-building medications. Drugs commonly used to treat people with thinning bones (osteoporosis) may also help people with bone metastasis. These medications can strengthen bones and reduce the pain caused by bone metastasis, reducing the need for strong pain medications. Bone-building medications may also reduce your risk of developing new bone metastasis. These drugs can be administered every few weeks through a vein in your arm or through an injection. Bone-building medications can cause temporary bone pain and kidney problems. They increase your risk of a rare but serious deterioration of your jawbone (avascular osteonecrosis).
  
• Chemotherapy. If cancer has spread to multiple bones, your doctor may recommend chemotherapy. Chemotherapy travels throughout your body to fight cancer cells. Chemotherapy can be taken as a pill, administered through a vein or both. Side effects depend on the specific chemotherapy drugs you are given.
  
• Hormone therapy. For cancers that are sensitive to hormones in the body, treatment to suppress those hormones may be an option. Breast cancers and prostate cancers are often sensitive to hormone-blocking treatments. Hormone therapy can involve taking medications to lower natural hormone levels or medications that block the interaction between hormones and cancer cells. Another option is surgery to remove hormone-producing organs — in women, the ovaries, and in men, the testes.
  
• Pain medications. Pain medications may control the pain caused by bone metastasis. Pain medications may include over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others), or strong prescription pain relievers, such as morphine (Avinza, MS Contin, others). It may take time to determine what combination of pain medications works best for you. If you're taking medications but still experiencing pain, tell your doctor.

External radiation therapy
Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy may be an option if your bone metastasis is causing pain that isn't controlled with pain medications. Depending on your situation, radiation to the bone can be administered in one large dose or several smaller doses over many days. Side effects of radiation depend on the site being treated. In general, radiation therapy causes skin redness and fatigue.
Surgery
Surgical procedures can help stabilize a bone that is at risk of breaking or repair a broken bone.

• Surgery to stabilize the bone. If the bone is in danger of breaking due to bone metastasis, surgeons can stabilize the bone using metal plates, screws and nails (orthopedic fixation). Orthopedic fixation can relieve pain and improve function. Often, radiation therapy is given after you have healed from surgery.
  
• Surgery to inject a bone with cement. Bones that can't be easily reinforced with metal plates or screws, such as pelvic bones and bones in the spine, may benefit from bone cement. Doctors inject bone cement into a bone that is broken or damaged by bone metastasis. This procedure can reduce pain.
  
• Surgery to repair a broken bone. If bone metastasis has caused a bone to break, surgeons may work to repair the bone. This involves using metal plates, screws and nails to stabilize the bone. Joint replacement, such as a hip replacement, may be another option. In general, broken bones caused by bone metastasis aren't helped by placing a cast on the broken bone.

Heating and freezing cancer cells
Procedures to damage cancer cells with heat or cold may help control pain. These procedures may be an option if you have one or two areas of bone metastasis and aren't helped by other treatments.
During a procedure called radiofrequency ablation, a needle containing an electric probe is inserted into the bone tumor. Electricity passes through the probe and heats the surrounding tissue. The tissue is allowed to cool down, and the process is repeated. A similar procedure called cryoablation freezes the tumor and then allows it to thaw. The process is repeated multiple times.
Side effects can include damage to nearby structures, such as nerves, and damage to bones that can increase the risk of a broken bone.

Intravenous radiation
For people with multiple bone metastases, a form of radiation called radiopharmaceuticals can be given through a vein. Radiopharmaceuticals use low levels of radioactive material that has a strong attraction to bones. Once in your body, the particles travel to the areas of bone metastasis and release their radiation.

Radiopharmaceuticals can help control pain caused by bone metastasis. This treatment doesn't require a hospital stay, and you won't be radioactive after treatment. Side effects can include damage to the bone marrow, which can lead to low blood cell counts.

Clinical trials
Clinical trials are studies of new treatments and new ways of using existing treatments. Enrolling in a clinical trial gives you the chance to try the latest treatments. But a cure isn't guaranteed, and the side effects of new treatments may not be known. Discuss the available clinical trials with your doctor.

Physical therapy
A physical therapist can work with you to devise a plan that will help you increase your strength and improve your mobility. A physical therapist may suggest assistive devices to help you cope. Examples might include crutches or a walker to take weight off an affected bone while walking, a cane to improve balance, or a brace to stabilize the spine. A physical therapist may also suggest specific exercises to help you keep your strength up and reduce your pain.

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Bone cancer

Bone cancer

Definition:
Bone cancer is an uncommon cancer that begins in a bone. Bone cancer can begin in any bone in the body, but it most commonly affects the long bones that make up the arms and legs.

Several types of bone cancer exist. Some types of bone cancer occur primarily in children, while others affect mostly adults.

The term "bone cancer" doesn't include cancers that begin elsewhere in the body and spread (metastasize) to the bone. Instead, those cancers are named for where they began, such as breast cancer that has metastasized to the bone. Bone cancer also doesn't include blood cell cancers, such as multiple myeloma and leukemia, that begin in the bone marrow — the jelly-like material inside the bone where blood cells are made.


Symptoms:

Signs and symptoms of bone cancer include:

• Bone pain
• Swelling and tenderness near the affected area
• Broken bone
• Fatigue
• Unintended weight loss

When to see a doctor
Make an appointment with your doctor if you or your child develops signs and symptoms that worry you.


Causes:
It's not clear what causes most bone cancers. Doctors know bone cancer begins as an error in a cell's DNA. The error tells the cell to grow and divide in an uncontrolled way. These cells go on living, rather than dying at a set time. The accumulating mutated cells form a mass (tumor) that can invade nearby structures or spread to other areas of the body.

Types of bone cancer
Bone cancers are broken down into separate types based on the type of cell where the cancer began. The most common types of bone cancer include:

• Osteosarcoma. Osteosarcoma begins in the bone cells. Osteosarcoma occurs most often in children and young adults.
• Chondrosarcoma. Chondrosarcoma begins in cartilage cells that are commonly found on the ends of bones. Chondrosarcoma most commonly affects older adults.
• Ewing's sarcoma. It's not clear where in bone Ewing's sarcoma begins. Scientists believe Ewing's sarcoma may begin in nerve tissue within the bone. Ewing's sarcoma occurs most often in children and young adults.

Treatments and drugs:
The treatment options for your bone cancer are based on the type of cancer you have, the stage of the cancer, your overall health and your preferences. Bone cancer treatment typically involves surgery, chemotherapy, radiation or a combination of treatments.

Surgery
The goal of surgery is to remove the entire bone cancer. To accomplish this, doctors remove the tumor and a small portion of healthy tissue that surrounds it. Types of surgery used to treat bone cancer include:

• Surgery to remove a limb. Bone cancers that are large or located in a complicated point on the bone may require surgery to remove all or part of a limb (amputation). As other treatments have been developed, this procedure is becoming less common. You'll likely be fitted with an artificial limb after surgery and will go through training to learn to do everyday tasks using your new limb.
• Surgery to remove the cancer, but spare the limb. If a bone cancer can be separated from nerves and other tissue, the surgeon may be able to remove the bone cancer and spare the limb. Since some of the bone is removed with the cancer, the surgeon replaces the lost bone with some bone from another area of your body or with a special metal prosthesis.
• Surgery for cancer that doesn't affect the limbs. If bone cancer occurs in bones other than those of the arms and legs, surgeons may remove the bone and some surrounding tissue, such as in cancer that affects a rib, or may remove the cancer while preserving as much of the bone as possible, such as in cancer that affects the spine. Bone removed during surgery can be replaced with a piece of bone from another area of the body or with a special metal prosthesis.

Radiation therapy
Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. During radiation therapy, you lie on a table while a special machine moves around you and aims the energy beams at precise points on your body.
Radiation therapy may be used in people with bone cancer that can't be removed with surgery. Radiation therapy may also be used after surgery to kill any cancer cells that may be left behind. For people with advanced bone cancer, radiation therapy may help control signs and symptoms, such as pain.
Chemotherapy
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is most often given through a vein (intravenously). The chemotherapy medications travel throughout your body.
Chemotherapy alone or combined with radiation therapy is often used before surgery to shrink a bone cancer to a more manageable size that allows the surgeon to perform a limb-sparing surgery. Chemotherapy may also be used in people with bone cancer that has spread beyond the bone to other areas of the body.

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Boils and carbuncles

Boils and carbuncles.

Definition:
Boils and carbuncles are painful, pus-filled bumps that form under your skin when bacteria infect and inflame one or more of your hair follicles.

Boils (furuncles) usually start as red, tender lumps. The lumps quickly fill with pus, growing larger and more painful until they rupture and drain. A carbuncle is a cluster of boils that form a connected area of infection under the skin.

You can usually care for a single boil at home, but don't attempt to prick or squeeze it — that may spread the infection. Call your doctor if a boil or carbuncle is extremely painful, lasts longer than two weeks or occurs with a fever.

Symptoms:

Boils
Boils can occur anywhere on your skin, but appear mainly on your face, neck, armpits, buttocks or thighs — hair-bearing areas where you're most likely to sweat or experience friction. Signs and symptoms of a boil usually include:

• A painful, red bump that starts out about the size of a pea
• Red, swollen skin around the bump
• An increase in the size of the bump over a few days as it fills with pus (can sometimes reach the size of a golf ball)
• Development of a yellow-white tip that eventually ruptures and allows the pus to drain out.

Once the boil drains, the pain usually subsides. Small boils usually heal without scarring, but a large boil may leave a scar.

Carbuncles
A carbuncle is a cluster of boils that often occurs on the back of the neck, shoulders or thighs. Carbuncles:

• Cause a deeper and more severe infection than single boils do
• Develop and heal more slowly than single boils do
• Are likely to leave a scar

Signs and symptoms that may accompany carbuncles include:

• Feeling unwell in general
• Fever
• Chills

When to see a doctor
You usually can care for a single, small boil yourself. But see your doctor if you have:

• A boil on your face or spine
• A boil that worsens rapidly or is extremely painful
• Boils that are very large, haven't healed in two weeks or are accompanied by a fever
• Frequent boils
• A condition that suppresses your immune system, such as an organ transplant, corticosteroid use or an HIV infection
• Recently been hospitalized

Children and older adults who develop one or more boils also should receive medical care.

Causes:
Boils usually form when one or more hair follicles — the tube-shaped shafts from which hair grows — become infected with staph bacteria (Staphylococcus aureus). These bacteria, which normally inhabit your skin and sometimes your throat and nasal passages, are responsible for a number of serious diseases, including pneumonia and endocarditis — an infection of the lining of your heart. They're also a major cause of hospital-acquired infections.

Staph bacteria that cause boils generally enter through a cut, scratch or other break in your skin. As soon as this occurs, specialized white blood cells called neutrophils rush to the site to fight the infection. This leads to inflammation and eventually to the formation of pus — a mixture of old white blood cells, bacteria and dead skin cells.


Complications:
Complications of boils and carbuncles are generally few, but can be serious. They include:

• Blood poisoning. In some cases, bacteria from a boil or more commonly, a carbuncle, can enter your bloodstream and travel to other parts of your body. The spreading infection, commonly known as blood poisoning (sepsis), can lead to infections deep within your body, such as your heart (endocarditis) and bone (osteomyelitis). Blood poisoning itself — which is characterized by high fever, rapid breathing and elevated heart rate — can lead to septic shock, a life-threatening state of extremely low blood pressure.
• MRSA. Another potentially serious problem is the emergence of drug-resistant strains of Staphylococcus aureus. Up to half of the staph bacteria found in hospitals are resistant to many commonly used antibiotics, including methicillin. Methicillin-resistant staphylococcus aureus (MRSA) has led to the use of alternative antibiotics, such as vancomycin, but some strains of staph bacteria have become less susceptible to vancomycin, too. Although MRSA is often acquired in a hospital setting, it can be spread in the general community, as well.

Treatments and drugs:
You can generally treat small boils at home by applying warm compresses to relieve pain and promote natural drainage.
For larger boils and carbuncles, treatment usually includes draining the boil with an incision and sometimes taking antibiotics:

• Incision and drainage. Your doctor may drain a large boil or carbuncle by making a small incision in the tip. This relieves pain, speeds recovery and helps lessen scarring. Deep infections that can't be completely drained may be packed with sterile gauze so that pus can continue to drain.
• Antibiotics. Sometimes your doctor may prescribe antibiotics to help heal severe or recurrent infections, or infections that may be caused by MRSA.

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Burning mouth syndrome

Burning mouth syndrome

Definition:
Burning mouth syndrome causes chronic burning pain in your mouth. The pain from burning mouth syndrome may affect your tongue, gums, lips, inside of your cheeks, roof of your mouth, or widespread areas of your whole mouth. The pain can be severe, as if you scalded your mouth.

Unfortunately, the cause of burning mouth syndrome often can't be determined. Although that makes treatment more difficult, don't despair. By working closely with your health care team, you can usually get burning mouth syndrome under control.

Other names for burning mouth syndrome include scalded mouth syndrome, burning tongue syndrome, burning lips syndrome, glossodynia and stomatodynia.

Burning mouth syndrome:
Symptoms of burning mouth syndrome include:

• A burning sensation that may affect your tongue, lips, gums, palate, throat or whole mouth
• A tingling or numb sensation in your mouth or on the tip of your tongue
• Mouth pain that worsens as the day progresses
• A sensation of dry mouth
• Increased thirst
• Sore mouth
• Loss of taste
• Taste changes, such as a bitter or metallic taste

The pain from burning mouth syndrome typically has several different patterns. It may occur every day, with little pain when you wake but becoming worse as the day progresses. Or it may start as soon as you wake up and last all day. Or pain may come and go, and you may even have some entirely pain-free days.
Whatever pattern of mouth pain you have, burning mouth syndrome may last for years. In some cases, though, symptoms may suddenly go away on their own or become less frequent. Burning mouth syndrome usually doesn't cause any noticeable physical changes to your tongue or mouth.

When to see a doctor
If you have pain or soreness of your tongue, lips, gums or other areas of your mouth, see your doctor or dentist as soon as possible. They may need to work together to help pinpoint a cause and develop an effective treatment

Causes:
The cause of burning mouth syndrome can be classified as either primary or secondary.

Primary burning mouth syndrome
When the cause of burning mouth syndrome isn't known, the condition is called primary or idiopathic burning mouth syndrome. Some research suggests that primary burning mouth syndrome is related to problems with taste and sensory nerves of the peripheral or central nervous system.

Secondary burning mouth syndrome
Sometimes burning mouth syndrome is caused by an underlying medical condition, such as a nutritional deficiency. In these cases, it's called secondary burning mouth syndrome.
Underlying problems that may be linked to secondary burning mouth syndrome include:

• Dry mouth (xerostomia), which can be caused by various medications or health problems.
• Other oral conditions, such as oral yeast infection (thrush), oral lichen planus or geographic tongue.
• Psychological factors, such as anxiety, depression or excessive health worries.
• Nutritional deficiencies, such as lack of iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6) and cobalamin (vitamin B-12).
• Dentures. Dentures can place stress on some of the muscles and tissues of your mouth, causing mouth pain. The materials used in dentures also can irritate the tissues in your mouth.
• Nerve damage to nerves that control taste and pain in the tongue.
• Allergies or reactions to foods, food flavorings, other food additives, fragrances, dyes or other substances.
• Reflux of stomach acid (gastroesophageal reflux disease) that enters your mouth from your upper gastrointestinal tract.
• Certain medications, particularly high blood pressure medications called angiotensin-converting enzyme (ACE) inhibitors.
• Oral habits, such as tongue thrusting and teeth grinding (bruxism).
• Endocrine disorders, such as diabetes and underactive thyroid (hypothyroidism).
• Hormonal imbalances, such as those associated with menopause.
• Excessive mouth irritation, which may result from overbrushing of your tongue, overuse of mouthwashes or having too many acidic drinks.

Complications:
Complications that burning mouth syndrome may cause or be associated with are mainly related to pain and include:

• Difficulty sleeping
• Irritability
• Depression
• Anxiety
• Difficulty eating
• Decreased socializing
• Impaired relationships

Treatments and drugs:

There's no one sure way to treat primary burning mouth syndrome, and solid research on the most effective methods is lacking. Treatment depends on your particular signs and symptoms, as well as any underlying conditions that may be causing your mouth pain. That's why it's important to try to pinpoint the cause. Once any underlying causes are treated, your burning mouth syndrome symptoms should get better.

If a cause can't be found, treatment can be challenging. There's no known cure for primary burning mouth syndrome. You may need to try several treatment methods before finding one or a combination that is helpful in reducing your mouth pain. Treatment options may include:

• A lozenge-type form of the anticonvulsant medication clonazepam (Klonopin)
• Alpha-lipoic acid, a strong antioxidant produced naturally by the body
• Oral thrush medications
• Certain antidepressants
• B vitamins
• Cognitive behavioral therapy
• Specific oral rinses or mouthwashes
• Saliva replacement products
• Capsaicin, a pain reliever that comes from chili peppers

Surgery isn't recommended for burning mouth syndrome.

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Blood donation

Blood donation

Definition:
Blood donation is a voluntary procedure. You agree to have blood drawn so that it can be given to someone who needs a blood transfusion. Millions of people need blood transfusions each year. Some may need blood during surgery. Others depend on it after an accident or because they have a disease that requires blood components. Blood donation makes all of this possible.
There are several types of blood donation:

• Whole blood. This is the most common type of blood donation, during which approximately a pint of whole blood is given. The blood is then separated into its components — red cells, plasma, platelets.
• Platelets. This type of donation uses a process called apheresis. During apheresis, the donor is hooked up to a machine that collects the platelets and some of the plasma, and then returns the rest of the blood to the donor.
• Plasma. Plasma may be collected simultaneously with a platelet donation or it may be collected without collecting platelets during an apheresis donation.
• Double red cells. Double red cell donation is also done using apheresis. In this case, only the red cells are collected.

To be eligible to donate whole blood, platelets or plasma, you must be:

• In good health
• At least 17 years old — the minimum age varies by state with some states allowing 16-year-olds to donate with parent permission; there's no upper age limit
• At least 110 pounds
• Able to pass the physical and health history assessments

The eligibility requirements are slightly different for double red cell donation. Check with your local donor center for specifics.

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Blocked tear duct

Blocked tear duct

Definition:
When you have a blocked tear duct, your tears can't drain normally, leaving you with a watery, irritated eye. Blocked tear ducts are caused by a partial or complete obstruction in the tear drainage system.

As many as 20 percent of newborn babies have a blocked tear duct at birth, but it usually clears up on its own in the first year of life. Adults can get a blocked tear duct as a result of an infection, inflammation, an injury or a tumor. A blocked tear duct almost always is correctable, but the treatment depends on the cause and your age.

Symptoms:
Signs and symptoms may be caused by the blocked tear duct or from an infection that develops because of the blockage. Look for:

• Excessive tearing
• Watery eyes
• Recurrent eye inflammation (conjunctivitis)
• Recurrent eye infections (dacryocystitis)
• Painful swelling of the inside corner of the eye
• Eye mucus discharge
• Blurred vision
• Bloody tears

When to see a doctor
If your eye has been watery and leaking or is continually irritated or infected, make an appointment to see your doctor. Some blocked tear ducts are caused by tumors pressing on the tear drainage system, and quick identification of the tumor can give you more treatment options.

Causes:
Most of your tears come from your lacrimal glands, which are located above each eye. The tears flow down the surface of your eye to lubricate and protect it, and then drain into tiny holes (puncta) in the corners of your upper and lower eyelids. The tears then travel through the small canals in the lids (canaliculi) to a sac where the lids are attached to the side of the nose (lacrimal sac), then down a duct (the nasolacrimal duct) before emptying into your nose, where they evaporate or are reabsorbed. A blockage can occur at any point in the tear drainage system, from the puncta to your nose. When that happens, your tears don't drain properly, giving you watery eyes and increasing your risk of eye infections and inflammation.

Blocked tear ducts can be present at birth (congenital) or can occur at any other age. Causes include:

• Congenital blockage. As many as 20 percent of all newborns have a blocked tear duct. In these instances, the tear drainage system may not be fully developed or there may be a duct abnormality. A thin tissue membrane often remains over the opening that empties into the nose (nasolacrimal duct) in congenitally blocked tear ducts. This usually opens spontaneously during the first or second month of life.
• Abnormal development of the skull and face (craniofacial abnormalities). The presence of craniofacial abnormalities, including those in certain disorders such as Down syndrome, increases the likelihood of blockage of the tear ducts.
• Age-related changes. Older adults may experience age-related changes that can cause blocked tear ducts, including narrowing of the punctal openings.
• Eye infections or inflammation. Chronic infections and inflammation of your eyes, tear drainage system or nose can cause your tear ducts to become blocked.
• Facial injuries or trauma. An injury to your face can cause bone damage near the drainage system and disrupt the normal flow of tears through the ducts.
• Tumors. Nasal, sinus or lacrimal sac tumors can occur along the tear drainage system, blocking it as they grow larger.
• Cysts or stones. Sometimes, cysts and stones form in the tear drainage system, creating blockages.
• Topical medications. Rarely, long-term use of certain topical medications, such as those that treat glaucoma, can cause a blocked tear duct.
• Other medications. A blocked tear duct is a possible side effect of docetaxel (Taxotere), a commonly used chemotherapy medication for breast or lung cancer.

Complications:
Because your tears aren't draining the way they should, the tears that remain in the drainage system become stagnant, promoting growth of bacteria, viruses and fungi. These organisms can lead to recurrent eye infections and inflammation. Any part of the tear drainage system, including the clear membrane over your eye surface (conjunctiva), can become infected or inflamed because of a blocked tear duct. 

Treatments and drugs :

The cause of your blocked tear duct will determine which treatment is right for you. Sometimes, more than one treatment or procedure is needed before a blocked tear duct is completely corrected.
If an infection is suspected, your doctor will likely prescribe antibiotics.
If a tumor is causing your blocked tear duct, treatment will focus on the cause of the tumor. Surgery may be performed to remove the tumor, or your doctor may recommend using other treatments to shrink it.
Treatment options for non-tumor-blocked tear ducts vary from simple observation to surgery.

Conservative treatment
A high percentage of infants with congenital blocked tear duct improve on their own in the first several months of life, after the drainage system matures or the extra membrane involving the nasolacrimal duct opens up.

If your infant's blocked tear duct isn't opening on its own, your doctor may recommend that you use a special massage technique to help open up the membrane covering the lower opening into your baby's nose. Ask your doctor to show you how to perform this massage.

Conservative treatment may be recommended if the tear ducts become blocked from tissue swelling after facial injury. In most cases of blocked tear ducts after such facial trauma, the drainage system starts functioning again on its own a few months after the injury, and no further treatment is needed. Your doctor may recommend waiting three to six months after your injury before considering surgical intervention to open a blocked tear duct.

Minimally invasive treatment
Minimally invasive treatment options are used for infants and toddlers whose blocked tear ducts aren't opening on their own, or for adults who have a partially blocked duct or a partial narrowing of the puncta.

• Dilation, probing and irrigation. This technique works to open congenital blocked tear ducts in most infants. The procedure can be done using general anesthesia or using a restraint in very young babies. First, the doctor enlarges the punctal openings with a special dilation instrument, and then a thin probe is inserted through the puncta and into the tear drainage system. The doctor threads the probe all the way out through the nasal opening, sometimes causing a popping noise as the probe pierces through the extra membrane. The probe is removed, and the tear drainage system is flushed with a saline solution to clear out any remaining blockage.
  For adults with partially narrowed puncta, a similar procedure is done in the doctor's office. The tear ducts are flushed and irrigated while the puncta are dilated. If the problem is related solely to a partial narrowing of the punctal opening, this procedure will often provide temporary relief, at least. Antibiotics may be prescribed for any infections. If irrigation and dilation doesn't work, or if the beneficial effects of the dilation are only temporary, surgery may be necessary to open narrowed puncta. Sometimes, a small incision at the punctal opening may be all that's necessary.
  
• Balloon catheter dilation. This procedure opens tear drainage passages that are narrowed or blocked by scarring, inflammation and other acquired conditions. While you're under general anesthesia, a tube (catheter) with a deflated balloon on the tip is threaded through the lower nasolacrimal duct in your nose. The doctor then uses a pump to inflate and deflate the balloon a few times, sometimes moving it to different locations along the drainage system. This procedure is more effective for infants and toddlers, but also may be used in adults with partial blockage.
• Stenting or intubation. In this procedure, tiny silicone or polyurethane tubes are used to open up blockages and narrowing within the tear drainage system. The procedure, which is usually done under general anesthesia, involves having a thin tube threaded through one or both puncta in the corner of your eye, all the way through the tear drainage system and out through your nose. After the insertion, a small loop of tubing remains visible at the corner of your eye, but it's not usually bothersome. These tubes are generally left in for three to four months, and then removed. Possible complications include inflammation from the presence of the tube.

Surgery
Surgery is usually the treatment of choice for adults and older children with acquired blocked tear ducts. It's also effective in infants and toddlers with congenital blocked tear ducts, though it's typically used after other treatments have been tried.

The surgery used to treat most cases of blocked tear ducts (called dacryocystorhinostomy) reconstructs the passageway for tears to drain out through your nose normally again. First, you're given a general anesthetic, or a local anesthetic if it's performed as an outpatient procedure. The surgeon accesses your tear drainage system, and then creates a new, direct connection between your lacrimal sac and your nose. This new route bypasses the duct that empties into your nose (nasolacrimal duct), which is the most common site of blockage. Stents or intubation typically are placed in the new route while it heals, and then removed three or four months after surgery.
The steps in this procedure vary, depending on the exact location and extent of your blockage, as well as your surgeon's experience and preferences.

• External. An external dacryocystorhinostomy is a commonly used surgical method of opening a blocked tear duct. While you're under general anesthesia, your surgeon makes an incision on the side of your nose, near where the lacrimal sac is located. After connecting the lacrimal sac to your nasal cavity and placing a stent in the new passageway, the surgeon closes up the incision with a few stitches.
• Endoscopic or endonasal. The same bypass procedure can be performed using endoscopic instruments. Instead of making an incision, the surgeon uses a microscopic camera and other tiny instruments inserted through the nasal opening to your duct system. Sometimes, a fiber-optic light is inserted into your puncta to illuminate the surgical area. The benefits of this method are that there's no incision and no scar, and the recovery typically is faster and easier. The drawbacks are that it requires a surgeon with special training, and the success rates aren't as high as with the external procedure.
• Bypassing the entire lacrimal duct system. Depending on the type of blockage, your surgeon may recommend a reconstruction of your entire tear drainage system (called conjunctivodacryocystorhinostomy). Instead of creating a new channel from the lacrimal sac to your nose, the surgeon creates a new route from the inside corner of your eyes (puncta) to your nose, bypassing the tear drainage system altogether.

Following surgery for a blocked tear duct, you'll use a nasal decongestant spray as well as topical eyedrops to prevent infection and reduce postoperative inflammation. After three to six months, you'll return for removal of any stents used to keep the new channel open during the healing process.

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Blind loop syndrome

Blind loop syndrome

Definition:
Blind loop syndrome occurs when part of the small intestine becomes bypassed. The "blind loop" formed by the bypassed intestine means food can't move normally through the digestive tract. The slowly moving food and waste products become a breeding ground for bacteria, which can lead to a condition called bacterial overgrowth. As a result, nutrients may not be fully absorbed. Blind loop syndrome often causes diarrhea and may cause weight loss and malnutrition.

Blind loop syndrome — sometimes called stasis syndrome or stagnant loop syndrome — often occurs as a complication of stomach (abdominal) surgery. But blind loop syndrome can also result from structural problems and some diseases. Sometimes surgery is needed to correct the problem, but antibiotics are the most common treatment.


Symptoms:
Signs and symptoms of blind loop syndrome often include:

• Loss of appetite
• Abdominal pain
• Nausea
• Bloating
• An uncomfortable feeling of fullness after eating
• Diarrhea
• Unintentional weight loss

When to see a doctor
Bloating, nausea and diarrhea are signs and symptoms of many intestinal problems. See your doctor for a full evaluation — especially if you've had abdominal surgery — if you have:

• Persistent diarrhea
• Rapid, unintentional weight loss
• Abdominal pain lasting more than a few days

If you have severe abdominal pain, get immediate medical care.

Causes:
The small intestine is the longest section of your digestive tract, measuring about 20 feet (6.1 meters). The small intestine is where food mixes with digestive juices and nutrients are absorbed into your bloodstream.

Unlike your large intestine (colon), your small intestine normally has relatively few bacteria. But in blind loop syndrome, stagnant food in the bypassed small intestine becomes an ideal breeding ground for bacteria. The bacteria may produce toxins as well as block the absorption of nutrients. The greater the length of small bowel involved in the blind loop, the greater the chance of bacterial overgrowth.

What triggers blind loop syndrome
Blind loop syndrome can be caused by:

• Complications of abdominal surgery, including gastric bypass for extreme obesity and gastrectomy to treat peptic ulcers and stomach cancer
• Structural problems in and around your small intestine, including scar tissue (intestinal adhesions) on the outside of the bowel and small, bulging pouches of tissue that protrude through the intestinal wall (diverticulosis)
• Certain medical conditions, including Crohn's disease, radiation enteritis, scleroderma and diabetes, can slow movement (motility) of food and waste products through the small intestine

Complications:
A blind loop can cause escalating problems, including:

• Poor absorption of fats. Bacteria in your small intestine break down the bile salts needed to digest fats. As a result, your body can't fully absorb the fat-soluble vitamins A, D, E and K. Incomplete absorption of fats leads to diarrhea, weight loss and vitamin deficiency disorders.
• Damage to the intestinal lining. Toxins that are released when bacteria break down stagnant food harm the mucous lining (mucosa) of the small intestine. As a result, most nutrients, including carbohydrates and proteins, are poorly absorbed, leading to serious malnourishment.
• Vitamin B-12 deficiency. Bacteria in the small intestine absorb vitamin B-12, which is essential for the normal functioning of your nervous system and the production of blood cells and DNA. A severe B-12 deficiency can lead to weakness, fatigue, tingling and numbness in your hands and feet, and, in advanced cases, to mental confusion. Damage to your central nervous system resulting from a B-12 deficiency may be irreversible.
• Brittle bones (osteoporosis). Over time, damage to your intestine from abnormal bacterial growth causes poor calcium absorption, and eventually may lead to bone diseases, such as osteoporosis.
• Kidney stones. Poor calcium absorption may also result in kidney stones.

Treatments and drugs:
Whenever possible, doctors treat blind loop syndrome by dealing with the underlying problem — for example, by surgically repairing a postoperative blind loop, stricture or fistula. But the blind loop can't always be reversed. In that case, treatment focuses on correcting nutritional deficiencies and eliminating bacterial overgrowth.

Antibiotic therapy
For most people, the initial way to treat bacterial overgrowth is with antibiotics. Doctors may start this treatment even when test results are inconclusive. A short course of antibiotics often significantly reduces the number of abnormal bacteria. But bacteria can return when the antibiotic is discontinued, so treatment may need to be long term. Some people with a blind loop may go for long periods without needing antibiotics, while others may need them regularly.

Doctors may also switch among different drugs to help prevent bacterial resistance. Antibiotics wipe out most intestinal bacteria, both normal and abnormal. As a result, antibiotics can cause some of the very problems they're trying to cure, including diarrhea. Switching among different drugs can help avoid this problem.

Nutritional support
Correcting nutritional deficiencies is a crucial part of treating blind loop syndrome, particularly in people with severe weight loss. Malnutrition can be treated, but the damage it causes can't always be reversed.

These treatments may improve vitamin deficiencies, reduce intestinal distress and help with weight gain:

• Nutritional supplements. People with blind loop syndrome may need intramuscular injections of vitamin B-12 as well as oral vitamin, calcium and iron supplements.
• Lactose-free diet. Damage to the small intestine may cause you to lose the ability to digest milk sugar (lactose). In that case, it's important to avoid most lactose-containing products, or use lactase preparations that help digest milk sugar. Some people may tolerate yogurt because the bacteria used in the culturing process naturally break down lactose.
• Medium-chain triglycerides. Most dietary fats consist of a long chain of fat molecules (triglycerides). Medium-chain triglycerides, found in coconut oil, are more easily digested by some people with blind loop syndrome. Medium-chain triglycerides are sometimes prescribed as a dietary supplement for people with severe blind loop syndrome resulting in short bowel syndrome.

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