Bipolar disorder

Bipolar disorder

Definition  :

Bipolar disorder — sometimes called manic-depressive disorder — is associated with mood swings that range from the lows of depression to the highs of mania. When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities.

When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year, or as often as several times a day. In some cases, bipolar disorder causes symptoms of depression and mania at the same time.

Although bipolar disorder is a disruptive, long-term condition, you can keep your moods in check by following a treatment plan. In most cases, bipolar disorder can be controlled with medications and psychological counseling (psychotherapy).

Symptoms:

Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:

• Bipolar I disorder. Mood swings with bipolar I cause significant difficulty in your job, school or relationships. Manic episodes can be severe and dangerous.
  
• Bipolar II disorder. Bipolar II is less severe than bipolar I. You may have an elevated mood, irritability and some changes in your functioning, but generally you can carry on with your normal daily routine. Instead of full-blown mania, you have hypomania — a less severe form of mania. In bipolar II, periods of depression typically last longer than periods of hypomania.
  
• Cyclothymic disorder. Cyclothymic disorder, also known as cyclothymia, is a mild form of bipolar disorder. With cyclothymia, hypomania and depression can be disruptive, but the highs and lows are not as severe as they are with other types of bipolar disorder.

Bipolar disorder symptoms reflect a range of moods.

The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people, manic symptoms are the main concern. Symptoms of depression and symptoms of mania or hypomania may also occur together. This is known as a mixed episode.

Manic phase of bipolar disorder
Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:

• Euphoria
• Inflated self-esteem
• Poor judgment
• Rapid speech
• Racing thoughts
• Aggressive behavior
• Agitation or irritation
• Increased physical activity
• Risky behavior
• Spending sprees or unwise financial choices
• Increased drive to perform or achieve goals
• Increased sex drive
• Decreased need for sleep
• Easily distracted
• Careless or dangerous use of drugs or alcohol
• Frequent absences from work or school
• Delusions or a break from reality (psychosis)
• Poor performance at work or school

Depressive phase of bipolar disorder
Signs and symptoms of the depressive phase of bipolar disorder can include:

• Sadness
• Hopelessness
• Suicidal thoughts or behavior
• Anxiety
• Guilt
• Sleep problems
• Low appetite or increased appetite
• Fatigue
• Loss of interest in activities once considered enjoyable
• Problems concentrating
• Irritability
• Chronic pain without a known cause
• Frequent absences from work or school
• Poor performance at work or school

Other signs and symptoms of bipolar disorder
Signs and symptoms of bipolar disorder can also include:

• Seasonal changes in mood. As with seasonal affective disorder (SAD), some people with bipolar disorder have moods that change with the seasons. Some people become manic or hypomanic in the spring or summer and then become depressed in the fall or winter. For other people, this cycle is reversed — they become depressed in the spring or summer and manic or hypomanic in the fall or winter.
   
• Rapid cycling bipolar disorder. Some people with bipolar disorder have rapid mood shifts. This is defined as having four or more mood swings within a single year. However, in some people mood shifts occur much more quickly, sometimes within just hours.
  
• Psychosis. Severe episodes of either mania or depression may result in psychosis, a detachment from reality. Symptoms of psychosis may include false but strongly held beliefs (delusions) and hearing or seeing things that aren't there (hallucinations).

Symptoms in children and adolescents
Instead of clear-cut depression and mania or hypomania, the most prominent signs of bipolar disorder in children and adolescents can include explosive temper, rapid mood shifts, reckless behavior and aggression. In some cases, these shifts occur within hours or less — for example, a child may have intense periods of giddiness and silliness, long bouts of crying and outbursts of explosive anger all in one day.

When to see a doctor
If you have any symptoms of depression or mania, see your doctor or mental health provider. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health provider with experience in bipolar disorder can help you get your symptoms under control.

Many people with bipolar disorder don't get the treatment they need. Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones. And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.

If you're reluctant to seek treatment, confide in a friend or loved one, a health care professional, a faith leader or someone else you trust. They may be able to help you take the first steps to successful treatment.

If you have suicidal thoughts
Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:

• Contact a family member or friend.
• Seek help from your doctor, a mental health provider or other health care professional.
• Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.
• Contact a minister, spiritual leader or someone in your faith community.

When to get emergency help
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.

Causes:

The exact cause of bipolar disorder is unknown, but several factors seem to be involved in causing and triggering bipolar episodes:

• Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
• Neurotransmitters. An imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder and other mood disorders.
• Hormones. Imbalanced hormones may be involved in causing or triggering bipolar disorder.
• Inherited traits. Bipolar disorder is more common in people who have a blood relative (such as a sibling or parent) with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.
• Environment. Stress, abuse, significant loss or other traumatic experiences may play a role in bipolar disorder.

Complications:


Left untreated, bipolar disorder can result in serious problems that affect every area of your life. These can include:

• Problems related to substance and alcohol abuse
• Legal problems
• Financial problems
• Relationship troubles
• Isolation and loneliness
• Poor work or school performance
• Frequent absences from work or school
• Suicide

Treatments and drugs:


Bipolar disorder requires lifelong treatment, even during periods when you feel better. Treatment is usually guided by a psychiatrist skilled in treating the condition. You may have a treatment team that also includes psychologists, social workers and psychiatric nurses. The primary treatments for bipolar disorder include medications; individual, group or family psychological counseling (psychotherapy); or education and support groups.

• Hospitalization. Your doctor may have you hospitalized if you are behaving dangerously, you feel suicidal or you become detached from reality (psychotic).
  
• Initial treatment. Often, you'll need to begin taking medications to balance your moods right away. Once your symptoms are under control, you'll work with your doctor to find the best long-term treatment.
  
• Continued treatment. Maintenance treatment is used to manage bipolar disorder on a long-term basis. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.
  
• Substance abuse treatment. If you have problems with alcohol or drugs, you'll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.

Medications
A number of medications are used to treat bipolar disorder. If one doesn't work well for you, there are a number of others to try. Your doctor may suggest combining medications for maximum effect. Medications for bipolar disorder include those that prevent the extreme highs and lows that can occur with bipolar disorder (mood stabilizers) and medications that help with depression or anxiety.
Medications for bipolar disorder include:

• Lithium. Lithium (Lithobid, others) is effective at stabilizing mood and preventing the extreme highs and lows of certain categories of bipolar disorder and has been used for many years. Periodic blood tests are required, since lithium can cause thyroid and kidney problems. Common side effects include restlessness, dry mouth and digestive issues.
  
• Anticonvulsants. These mood-stabilizing medications include valproic acid (Depakene, Stavzor), divalproex (Depakote) and lamotrigine (Lamictal). The medication asenapine (Saphris) may be helpful in treating mixed episodes. Depending on the medication you take, side effects can vary. Common side effects include weight gain, dizziness and drowsiness. Rarely, certain anticonvulsants cause more serious problems, such as skin rashes, blood disorders or liver problems.
  
• Antipsychotics. Certain antipsychotic medications, such as aripiprazole (Abilify), olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel), may help people who don't benefit from anticonvulsants. The only antipsychotic that's specifically approved by the U.S. Food and Drug Administration (FDA) for treating bipolar disorder is quetiapine. However, doctors can still prescribe other medications for bipolar disorder. This is known as off-label use. Side effects depend on the medication, but can include weight gain, sleepiness, tremors, blurred vision and rapid heartbeat. Weight gain in children is a significant concern. Antipsychotic use may also affect memory and attention and cause involuntary facial or body movements.
  
• Antidepressants. Depending on your symptoms, your doctor may recommend you take an antidepressant. In some people with bipolar disorder, antidepressants can trigger manic episodes, but may be OK if taken along with a mood stabilizer. The most common antidepressant side effects include reduced sexual desire and problems reaching orgasm. Older antidepressants, which include tricyclics and MAO inhibitors, can cause a number of potentially dangerous side effects and require careful monitoring.
  
• Symbyax. This medication combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the FDA specifically for the treatment of bipolar disorder. Side effects can include weight gain, drowsiness and increased appetite. This medication may also cause sexual problems similar to those caused by antidepressants.
  
• Benzodiazepines. These anti-anxiety medications may help with anxiety and improve sleep. Examples include clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Niravam, Xanax). Benzodiazepines are generally used for relieving anxiety only on a short-term basis. Side effects can include drowsiness, reduced muscle coordination, and problems with balance and memory.

Finding the right medication
Finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. This can take months or longer, and medications may need to be adjusted as your symptoms change. Side effects improve as you find the right medications and doses that work for you, and your body adjusts to the medications.

Medications and pregnancy
A number of medications for bipolar disorder can be associated with birth defects.

• Use effective birth control (contraception) to prevent pregnancy. Discuss birth control options with your doctor, as birth control medications may lose effectiveness when taken along with certain bipolar disorder medications.
• If you plan to become pregnant, meet with your doctor to discuss your treatment options.
• Discuss breast-feeding with your doctor, as some bipolar medications can pass through breast milk to your infant.

Psychotherapy
Psychotherapy is another vital part of bipolar disorder treatment. Several types of therapy may be helpful. These include:

• Cognitive behavioral therapy. This is a common form of individual therapy for bipolar disorder. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. It can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
  
• Psychoeducation. Counseling to help you learn about bipolar disorder (psychoeducation) can help you and your loved ones understand bipolar disorder. Knowing what's going on can help you get the best support and treatment, and help you and your loved ones recognize warning signs of mood swings.
  
• Family therapy. Family therapy involves seeing a psychologist or other mental health provider along with your family members. Family therapy can help identify and reduce stress within your family. It can help your family learn how to communicate better, solve problems and resolve conflicts.
  
• Group therapy. Group therapy provides a forum to communicate with and learn from others in a similar situation. It may also help build better relationship skills.
  
• Other therapies. Other therapies that have been studied with some evidence of success include early identification and therapy for worsening symptoms (prodrome detection) and therapy to identify and resolve problems with your daily routine and interpersonal relationships (interpersonal and social rhythm therapy). Ask your doctor if any of these options may be appropriate for you.

Transcranial magnetic stimulation
This treatment applies rapid pulses of a magnetic field to the head. It's not clear exactly how this helps, but it appears to have an antidepressant effect. However, not everyone is helped by this therapy, and it's not yet clear who is a good candidate for this type of treatment. More research is needed. The most serious potential side effect is a seizure.

Electroconvulsive therapy (ECT)
Electroconvulsive therapy can be effective for people who have episodes of severe depression or feel suicidal or people who haven't seen improvements in their symptoms despite other treatment. With ECT, electrical currents are passed through your brain. Researchers don't fully understand how ECT works. But it's thought that the electric shock causes changes in brain chemistry that leads to improvements in your mood. ECT may be an option if you have mania or severe depression when you're pregnant and cannot take your regular medications. ECT can cause temporary memory loss and confusion.

Hospitalization
In some cases, people with bipolar disorder benefit from hospitalization. Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic episode or a deep depression. Partial hospitalization or day treatment programs also are options to consider. These programs provide the support and counseling you need while you get symptoms under control.

Treatment in children and adolescents
Children and adolescents with bipolar disorder are prescribed the same types of medications as those used in adults. However, there's little research on the safety and effectiveness of bipolar medications in children, so treatment decisions are based on adult research. Treatments are generally decided on a case-by-case basis, depending on exact symptoms, medication side effects and other factors. As with adults, ECT may be an option for adolescents with severe bipolar I symptoms or for whom medications don't work.

Most children diagnosed with bipolar disorder require counseling as part of initial treatment and to keep symptoms from returning. Psychotherapy — along with working with teachers and school counselors — can help children develop coping skills, address learning difficulties and resolve social problems. It can also help strengthen family bonds and communication. Psychotherapy may also be necessary to resolve substance abuse problems, common in older children with bipolar disorder.

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Binge-eating disorder

Binge-eating disorder

Definition  :

Binge-eating disorder is a serious eating disorder in which you frequently consume unusually large amounts of food. Almost everyone overeats on occasion, such as having seconds or thirds of a holiday meal. But for some people, overeating crosses the line to binge-eating disorder and it becomes a regular occurrence, usually done in secret.

When you have binge-eating disorder, you may be deeply embarrassed about gorging and vow to stop. But you feel such a compulsion that you can't resist the urges and continue binge eating. If you have binge-eating disorder, treatment can help.

Symptoms:

You may have no obvious physical signs or symptoms when you have binge-eating disorder. You may be overweight or obese, or you may be at a normal weight. However, you likely have numerous behavioral and emotional signs and symptoms, such as:

• Eating unusually large amounts of food
• Eating even when you're full or not hungry
• Eating rapidly during binge episodes
• Eating until you're uncomfortably full
• Frequently eating alone
• Feeling that your eating behavior is out of control
• Feeling depressed, disgusted, ashamed, guilty or upset about your eating
• Experiencing depression and anxiety
• Feeling isolated and having difficulty talking about your feelings
• Frequently dieting, possibly without weight loss
• Losing and gaining weight repeatedly, also called yo-yo dieting

After a binge, you may try to diet or eat normal meals. But restricting your eating may simply lead to more binge eating, creating a vicious cycle.

When to see a doctor
If you have any symptoms of binge-eating disorder, seek medical help as soon as possible. Binge-eating disorder usually doesn't get better by itself, and it may get worse if left untreated.

Talk to your primary care doctor or a mental health provider about your binge-eating symptoms and feelings. If you're reluctant to seek treatment, talk to someone you trust about what you're going through. A friend, loved one, teacher or faith leader can help you take the first steps to successful treatment of binge-eating disorder.

Helping a loved one who has symptoms
A person with binge-eating disorder can become an expert at hiding behavior, making it hard for others to detect the problem. If you have a loved one you think may have symptoms of binge-eating disorder, have an open and honest discussion about your concerns. You can offer encouragement and support and help your loved one find a qualified doctor or mental health provider and make an appointment. You may even offer to go along.

Causes:

 The causes of binge-eating disorder are unknown. But family history, biological factors, long-term dieting and psychological issues increase your risk.


Complications:

You may develop psychological and physical problems related to binge eating. Some of these complications arise from being overweight due to frequent bingeing. Other complications may occur because of unhealthy yo-yo eating habits — bingeing followed by harsh dieting. In addition, food consumed during a binge is often high in fat and low in protein and other nutrients, which could lead to health problems.

Complications that may be caused by, or linked with, binge-eating disorder include:

• Depression
• Suicidal thoughts
• Insomnia
• Obesity
• High blood pressure
• Type 2 diabetes
• High cholesterol
• Gallbladder disease and other digestive problems
• Heart disease
• Some types of cancer
• Joint pain
• Muscle pain
• Headache
• Menstrual problems

Treatments and drugs:

The goals for treatment of binge-eating disorder are to reduce eating binges, to improve your emotional well-being and, when necessary, to lose weight. Because binge eating is so entwined with shame, poor self-image, self-disgust and other negative emotions, treatment needs to address these and other psychological issues. By getting help for binge eating, you can learn how to properly lose weight and keep it off.

There are four main types of treatment for binge-eating disorder.

Psychotherapy
Psychotherapy, whether in individual or group sessions, can help teach you how to exchange unhealthy habits for healthy ones and reduce bingeing episodes. Examples of psychotherapy include:

• Cognitive behavioral therapy (CBT). CBT may help you cope better with issues that can trigger binge-eating episodes, such as negative feelings about your body or a depressed mood. It may also give you a better sense of control over your behavior and eating patterns. If you're overweight, you may need weight-loss counseling in addition to CBT.
  
• Interpersonal psychotherapy. Interpersonal psychotherapy focuses on your current relationships with other people. The goal is to improve your interpersonal skills — how you relate to others, including family, friends and colleagues. This may help reduce binge eating that's triggered by poor relationships and unhealthy communication skills.
  
• Dialectical behavior therapy. This form of therapy can help you learn behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others, all of which can reduce the desire to binge eat.

Medications
There's no medication specifically designed to treat binge-eating disorder. But, several types of medication may help reduce symptoms, especially when combined with psychotherapy. Examples include:

• Antidepressants. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may be helpful. It's not clear how these can reduce binge eating, but it may relate to how they affect certain brain chemicals associated with mood.
  
• The anticonvulsant topiramate (Topamax). Normally used to control seizures, topiramate has also been found to reduce binge-eating episodes. However, potentially it can cause serious side effects, so discuss these risks with your doctor.

Behavioral weight-loss programs
Many people with binge-eating disorder have a long history of failed attempts to lose weight on their own. However, weight-loss programs typically aren't recommended until the binge-eating disorder is treated because very low calorie diets may trigger more binge-eating episodes.

When appropriate, weight-loss programs are generally done under medical supervision to ensure that your nutritional requirements are met. Weight-loss programs that address binge triggers can be especially helpful when you're also getting cognitive behavioral therapy.

Self-help strategies
Some people with binge-eating disorder find self-help books, videos, Internet programs or support groups effective. Some eating disorder programs offer self-help manuals that you can use on your own or with guidance from mental health experts. However, you still may need professional treatment with psychotherapy or medications.

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Bile reflux

Bile reflux

Definition  :

Bile reflux occurs when bile — a digestive liquid produced in your liver — backs up (refluxes) into your stomach and esophagus (the tube that connects your mouth and stomach). Bile reflux may accompany acid reflux, the medical term for the backwash of stomach acids into your esophagus.

Whether bile is important in reflux is controversial. Bile is often implicated as a cause of reflux when people respond incompletely or not at all to powerful acid-suppressant medications. But there is little evidence pinpointing the effects of bile reflux in people. Studies in lab animals indicate that over time, bile reflux may have serious consequences, potentially increasing your risk of esophageal cancer.

Unlike acid reflux, bile reflux usually can't be completely controlled by changes in diet or lifestyle. Instead, bile reflux is most often managed with medications or, in severe cases, with surgery.

Symptoms:

Bile reflux can be difficult to distinguish from acid reflux. The signs and symptoms are similar, and the two conditions may occur at the same time. It isn't clear what role bile plays in reflux conditions.
Bile reflux signs and symptoms include:

• Upper abdominal pain that may be severe
• Frequent heartburn — a burning sensation in your chest that sometimes spreads to your throat, along with a sour taste in your mouth
• Nausea
• Vomiting a greenish-yellow fluid (bile)
• Occasionally, a cough or hoarseness
• Unintended weight loss

When to see a doctor
Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you're losing weight without trying.
If you've been diagnosed with gastroesophageal reflux disease (GERD) but aren't getting adequate relief from your medications, call your doctor. You may need additional treatment for bile reflux.

Causes:

Bile is a greenish-yellow fluid that is essential for digesting fats and for eliminating worn-out red blood cells and certain toxins from your body. Bile is produced in your liver and stored in your gallbladder.
Eating a meal that contains even a small amount of fat signals your gallbladder to release bile, which flows through two small tubes (cystic duct and common bile duct) into the upper part of your small intestine (duodenum).

Bile reflux into the stomach
At the same time that bile flows into the duodenum, food enters your small intestine through the pyloric valve, a heavy ring of muscle located at the outlet of your stomach. The pyloric valve usually opens only slightly — enough to release about an eighth of an ounce (about 3.5 milliliters) of liquefied food at a time, but not enough to allow digestive juices to reflux into the stomach. In many cases of bile reflux, the valve doesn't close properly, and bile washes back into the stomach.

Bile reflux into the esophagus
Bile and stomach acid can reflux into the esophagus when another muscular valve, the lower esophageal sphincter, malfunctions. The lower esophageal sphincter separates the esophagus and stomach. The valve normally opens just long enough to allow food to pass into the stomach. But if the valve weakens or relaxes abnormally, bile can wash back into the esophagus.


What leads to bile reflux?
Bile reflux may be caused by:

• Surgery complications. Most damage to the pyloric valve occurs as a complication of gastric surgery, including total removal of the stomach (gastrectomy) and gastric bypass surgery for weight loss.
  
• Peptic ulcers. A peptic ulcer can block the pyloric valve so that it doesn't open enough to allow the stomach to empty as quickly as it should. Stagnant food in the stomach can lead to increased gastric pressure that refluxes bile and stomach acid into the esophagus.
  
• Gallbladder surgery (cholecystectomy). People who have had their gallbladders removed have significantly more bile reflux than do people who haven't had this surgery.

Complications:

Sticky mucous coats and protects the lining of your stomach from the corrosive effects of stomach acid. The esophagus lacks this protection, so acid and bile reflux can seriously damage esophageal tissue. The combination of bile and acid reflux increases the risk of complications, including:

• GERD. Occasional heartburn usually isn't a concern. But frequent or continual heartburn is the most common symptom of GERD, a potentially serious problem that causes irritation and inflammation of esophageal tissue (esophagitis). GERD is most often due to excess acid. Although bile has been implicated, its importance in reflux is controversial.
  
• Barrett's esophagus. This serious condition can occur when long-term exposure to stomach acid, or to acid and bile, damages tissue in the lower esophagus. The damaged esophageal cells (metaplasia) have an increased risk of becoming cancerous. Animal studies have also linked bile reflux to the occurrence of Barrett's esophagus.
  
• Esophageal cancer. This serious form of cancer may not be diagnosed until it's quite advanced. The possible link between bile and acid reflux and esophageal cancer remains controversial, but many experts think a direct connection exists. In animal studies, bile reflux alone has been shown to cause cancer of the esophagus. 

Treatments and drugs:


Although treatments for acid reflux can be very effective, medications for bile reflux may not be helpful for many people. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
Medications

• Bile acid sequestrants. These medications, which disrupt the circulation of bile, may be helpful for some people with bile reflux. Side effects, such as bloating, may be severe.
  
• Ursodeoxycholic acid. This medication helps promote bile flow. It may lessen the frequency and severity of your symptoms.
  
• Prokinetic agents. These medications can help your stomach empty more rapidly and help tighten the lower esophageal sphincter. These medications have several side effects, including fatigue, depression, anxiety and other neurological problems.
  
• Proton pump inhibitors. These medications are often prescribed to block acid production, but they don't have a clear role in treating bile reflux.

Surgical treatments
Doctors may recommend surgery if medications fail to reduce severe symptoms, or there are precancerous changes in your esophagus. Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor.
The options include:

• Diversion surgery (Roux-en-Y). This procedure may be recommended for people who have had previous gastric surgery with pylorus removal (Billroth I or Billroth II). In Roux-en-Y, surgeons make a new connection for bile drainage farther down in the small intestine, diverting bile away from the stomach.
  
• Anti-reflux surgery (fundoplication). The part of the stomach closest to the esophagus (fundus) is wrapped and then sewn around the lower esophageal sphincter. This procedure strengthens the valve and can reduce acid reflux. There is little evidence about the surgery's effectiveness for bile reflux.

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Bell's palsy

Bell's palsy

Definition  :

Bell's palsy causes sudden weakness in your facial muscles. This makes half of your face appear to droop. Your smile is one-sided, and your eye on that side resists closing.

Bell's palsy, also known as facial palsy, can occur at any age. The exact cause is unknown, but it's believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of your face. It may be a reaction that occurs after a viral infection.

For most people, Bell's palsy is temporary. Symptoms usually start to improve within a few weeks, with complete recovery in about six months. A small number of people continue to have some Bell's
palsy symptoms for life. Rarely, Bell's palsy can recur.

Symptoms:

Signs and symptoms of Bell's palsy come on suddenly, and may include:

• Rapid onset of mild weakness to total paralysis on one side of your face — occurring within hours to days — making it difficult to smile or close your eye on the affected side
• Facial droop and difficulty making facial expressions
• Pain around the jaw or in or behind your ear on the affected side
• Increased sensitivity to sound on the affected side
• Headache
• A decrease in your ability to taste
• Changes in the amount of tears and saliva you produce

In rare cases, Bell's palsy can affect the nerves on both sides of your face.

When to see a doctor
Seek immediate medical help if you experience any type of paralysis because you may be having a stroke. Bell's palsy is not caused by a stroke. See your doctor if you experience facial weakness or drooping, to determine the underlying cause and severity of the illness.


Causes:

Although the exact reason Bell's palsy occurs isn't clear, it's often linked to exposure to a viral infection. Viruses that have been linked to Bell's palsy include the virus that causes:

• Cold sores and genital herpes (herpes simplex)
• Chickenpox and shingles (herpes zoster)
• Mononucleosis (Epstein-Barr)
• Cytomegalovirus infections
• Respiratory illnesses (adenovirus)
• German measles (rubella)
• Mumps (mumps virus)
• Flu (influenza B)
• Hand-foot-and-mouth disease (coxsackievirus)

With Bell's palsy, the nerve that controls your facial muscles, which passes through a narrow corridor of bone on its way to your face, becomes inflamed and swollen — usually related to a viral infection. Besides facial muscles, the nerve affects tears, saliva, taste and a small bone in the middle of your ear.

Complications:

Although a mild case of Bell's palsy normally disappears within a month, recovery from a case involving total paralysis varies. Complications may include:

• Irreversible damage to your facial nerve
• Misdirected regrowth of nerve fibers, resulting in involuntary contraction of certain muscles when you're trying to move others (synkinesis) — for example, when you smile, the eye on the affected side may close
• Partial or complete blindness of the eye that won't close, due to excessive dryness and scratching of the cornea, the clear protective covering of the eye

Treatments and drugs:

Most people with Bell's palsy recover fully — with or without treatment. There's no one-size-fits-all treatment for Bell's palsy, but your doctor may suggest medications or physical therapy to help speed your recovery. Surgery is rarely an option for Bell's palsy.
Medications
Commonly used medications to treat Bell's palsy include:

• Corticosteroids, such as prednisone, are powerful anti-inflammatory agents. If they can reduce the swelling of the facial nerve, it will fit more comfortably within the bony corridor that surrounds it. Corticosteroids may work best if they're started within several days of when your symptoms started.
  
• Antiviral drugs, such as acyclovir (Zovirax) or valacyclovir (Valtrex), may stop the progression of the infection if a virus is known to have caused it. This treatment may be offered only if your facial paralysis is severe.

Physical therapy
Paralyzed muscles can shrink and shorten, causing permanent contractures. A physical therapist can teach you how to massage and exercise your facial muscles to help prevent this from occurring.

Surgery
In the past, decompression surgery was used to relieve the pressure on the facial nerve by opening the bony passage that the nerve passes through. Today, decompression surgery isn't recommended. Facial nerve injury and permanent hearing loss are possible risks associated with this surgery.
In rare cases, plastic surgery may be needed to correct lasting facial nerve problems.

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Behcet's disease

Behcet's disease

Definition  :

Behcet's (beh-CHETS) disease, also called Behcet's syndrome, is a rare disorder that causes chronic inflammation in blood vessels throughout your body. The exact cause of Behcet's is unknown, but it may be an autoimmune disorder, which means the body's immune system mistakenly attacks some of its own healthy cells. Both genetic and environmental factors may be responsible for Behcet's disease.

The inflammation of Behcet's disease leads to numerous symptoms that may initially seem unrelated. The signs and symptoms of Behcet's disease — which may include mouth sores, eye inflammation, skin rashes and lesions, and genital sores — vary from person to person and may come and go on their own.

Treatment aims to reduce the signs and symptoms of Behcet's disease and to prevent serious complications, such as blindness.

Symptoms:

Behcet's disease symptoms vary from person to person. Behcet's disease may disappear and recur on its own. The signs and symptoms that you may experience depend on which parts of your body are affected by the inflammation of Behcet's disease. Areas commonly affected by Behcet's disease include:

• Mouth. Painful mouth sores, identical to canker sores, are the most common sign of Behcet's disease. Sores begin as raised, round lesions in the mouth that quickly turn into painful ulcers. The sores heal usually in seven to 21 days, though they do recur.
  
• Skin. Skin lesions may occur in people with Behcet's disease. Skin problems can vary. Some people may develop acne-like sores on their bodies. Others may develop red, raised and tender nodules on their skin, especially on the lower legs.
  
• Genitals. People with Behcet's disease may develop sores on their genitals. The sores commonly occur on the scrotum or the vulva. Sores appear as red, ulcerated lesions. The genital sores are usually painful and may leave scars.
  
• Eyes. Behcet's disease may cause inflammation in the eye — a condition called uveitis (u-ve-I-tis). In people with Behcet's disease, uveitis causes redness, pain and blurred vision in one or both eyes and may come and go. Inflammation that occurs in the blood vessels of the retina is a serious complication of the disorder.
  
• Joints. Joint swelling and pain often affect the knees in people with Behcet's disease. The ankles, elbows or wrists also may be involved. Signs and symptoms may last one to three weeks and go away on their own.
  
• Vascular system. Inflammation in veins and large arteries may occur in Behcet's disease, causing redness, pain and swelling in the arms or legs when a blood clot results. In fact, many of the signs and symptoms of Behcet's are believed to be caused by inflammation of the blood vessels (vasculitis). Inflammation in the large arteries can lead to complications, such as aneurysms and narrowing or blockage of the vessel.
  
• Digestive system. Behcet's disease may cause a variety of signs and symptoms that affect the digestive system, including abdominal pain, diarrhea or bleeding.
  
• Brain. Behcet's disease may cause inflammation in the brain and nervous system that leads to headache, fever, disorientation, poor balance or stroke.

When to see a doctor
Make an appointment with your doctor if you notice any unusual signs and symptoms that might indicate Behcet's disease. If you've been diagnosed with Behcet's disease, see your doctor if you notice any new signs and symptoms.


Causes:

 Doctors don't know what causes Behcet's disease. However, a combination of genetic and environmental factors likely plays a role. Several genes have been found to be associated with the disease. Some researchers believe a virus or bacterium may trigger Behcet's disease in people who have certain genes that make them susceptible to Behcet's.


Complications:

Behcet's disease typically comes and goes in unpredictable cycles. Symptoms of the disease may become less severe after about 20 years.

Though treatment can't cure Behcet's disease, it often can control signs and symptoms and reduce the risk of complications. For instance, untreated uveitis can lead to decreased vision or even blindness. People with eye signs and symptoms of Behcet's disease should be carefully monitored by an eye doctor because treatment can help prevent this complication. Other complications of Behcet's disease depend on the specific set of signs and symptoms you're experiencing.


Treatments and drugs:

No cure exists for Behcet's disease. If your signs and symptoms of Behcet's disease are mild, your doctor may offer medications to control temporary flares in pain and inflammation. You may not need to take medication between flares. But if your signs and symptoms are more severe, your doctor may advise systemic medications to control the signs and symptoms of Behcet's disease throughout your body, in addition to medications for the temporary flares. Several factors, including your age and sex, may influence the specific treatment your doctor recommends.

Treatments for individual signs and symptoms of Behcet's disease
Behcet's disease may come and go on its own in periods of flares and remissions. Your doctor works to control any signs and symptoms you experience during flares with medications such as:

• Skin creams, gels and ointments. Topical medicines are applied directly to skin and genital sores in order to reduce inflammation and pain. These types of medications usually contain a corticosteroid drug that reduces inflammation or an anesthetic to relieve pain.
  
• Mouth rinses. Special mouthwashes that contain corticosteroids and other agents to reduce the pain of mouth sores may ease your discomfort.
  
• Eyedrops. Eyedrops containing corticosteroids or other anti-inflammatory medicines can relieve pain and redness in your eyes if inflammation is mild.

Systemic treatments for Behcet's disease
Severe cases of Behcet's disease require treatments to control damage from the disease between flares. If you have moderate to severe Behcet's disease, your doctor may prescribe:

• Corticosteroids to control inflammation. Corticosteroids, such as prednisone, in combination with other medications may reduce the inflammation caused by Behcet's disease. The signs and symptoms of Behcet's disease tend to recur when corticosteroids are used alone, so doctors often prescribe them with another medication to suppress the activity of your immune system (immunosuppressives). Side effects of corticosteroids include weight gain, persistent heartburn, high blood pressure and bone thinning (osteoporosis).
  
• Medications that suppress your immune system. Immunosuppressive drugs suppress your immune system, which overreacts in Behcet's disease. By stopping your immune system from attacking normal, healthy tissues in your body, immunosuppressive drugs reduce the inflammation that your immune system causes. Immunosuppressive drugs that may play a role in controlling Behcet's disease include azathioprine (Imuran, Azasan), cyclosporine (Sandimmune) and cyclophosphamide (Cytoxan). Since these medications suppress the actions of your immune system, they may increase your risk of infection. Other possible side effects include liver and kidney problems, low blood counts and high blood pressure.
  
• Medication that regulates your immune system. Interferon alfa-2b (Intron A) regulates the activity of your immune system to control inflammation. It may help control skin sores, joint pain and eye inflammation in people with Behcet's disease. Side effects include flu-like signs and symptoms, such as muscle pain and fatigue. Interferon alfa-2b may be combined with other medications. More recently, small studies have suggested that medications that block a substance called tumor necrosis factor (TNF), such as infliximab (Remicade) and etanercept (Enbrel), may be effective in treating some of the manifestations of Behcet's.

Other drugs that have been used to treat Behcet's disease include colchicine and methotrexate.

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Bee stings

Bee stings

Definition:

 Bee stings are a common outdoor nuisance. In most cases, bee stings are just annoying and home treatment is all that's necessary to ease the pain of bee stings. But if you're allergic to bee stings or you get stung numerous times, you may have a more serious reaction that requires emergency treatment. You can take several steps to avoid bee stings — as well as hornet and wasp stings — and find out how to treat them if you do get stung.

Symptoms  :

Bee stings can produce different reactions, ranging from temporary pain and discomfort to a severe allergic reaction. Having one type of reaction doesn't mean you'll always have the same reaction every time you're stung.

Minor reaction
Most of the time, signs and symptoms of a bee sting are minor and include:

• Instant, sharp burning pain at the sting site
• A red welt at the sting area
• A small, white spot where the stinger punctured the skin
• Slight swelling around the sting area

In most people, swelling and pain go away within a few hours.
Large local reaction
About 10 percent of people who get stung by a bee or other insect have a bit stronger reaction (large local reaction), with signs and symptoms such as:

• Extreme redness
• Swelling at the site of the sting that gradually enlarges over the next day or two

Large local reactions tend to resolve over five to 10 days. Having a large local reaction doesn't mean you'll have a severe allergic reaction the next time you're stung. But some people develop similar large local reactions each time they're stung. If this happens to you, talk to your doctor about treatment and prevention.

Severe allergic reaction (anaphylaxis)
A severe allergic reaction (anaphylaxis) to bee stings is potentially life-threatening and requires emergency treatment. About 3 percent of people who are stung by a bee or other insect quickly develop anaphylaxis. Signs and symptoms of anaphylaxis include:

• Skin reactions in parts of the body other than the sting area, including hives and itching and flushed or pale skin (almost always present with anaphylaxis)
• Difficulty breathing
• Swelling of the throat and tongue
• A weak and rapid pulse
• Nausea, vomiting or diarrhea
• Dizziness or fainting
• Loss of consciousness

People who have a severe allergic reaction to a bee sting have a 30 to 60 percent chance of anaphylaxis the next time they're stung. Talk to your doctor or an allergy specialist about prevention measures such as immunotherapy to avoid a similar reaction in case you get stung again.

Multiple bee stings
Generally, insects such as bees and wasps aren't aggressive and only sting in self-defense. In most cases, this results in one or perhaps a few stings. However, in some cases a person will disrupt a hive or swarm of bees and get stung multiple times. Some types of bees — such as Africanized honeybees — are more likely than are other bees to swarm, stinging in a group.
If you get stung more than a dozen times, the accumulation of venom may induce a toxic reaction and make you feel quite sick. Signs and symptoms include:

• Nausea, vomiting or diarrhea
• Headache
• Vertigo
• Feeling faint or fainting
• Convulsions
• Fever

Multiple stings can be a medical emergency in children, older adults, and people who have heart or breathing problems.
When to see a doctor
In most cases, bee stings don't require a visit to your doctor. In more-severe cases:
Call 911 or other emergency services if:

• You're having a serious reaction to a bee sting that suggests anaphylaxis, even if it's just one or two signs or symptoms.
  If you were prescribed an emergency epinephrine autoinjector (EpiPen, Twinject), use it right away as your doctor directed.
  

Seek prompt medical care if:

• You've been swarmed by bees and have multiple stings.

Make an appointment to see your doctor if:

• Bee sting symptoms don't go away within a few days.
• You've had other symptoms of an allergic response to a bee sting.

Causes:

 Bee sting venom contains proteins that affect skin cells and the immune system, causing pain and swelling around the sting area. In people with a bee sting allergy, bee venom can trigger a more serious immune system reaction.


Complications:

Possible, though uncommon, complications of bee and other insect stings include:

• Anaphylaxis. A severe allergic reaction is the most dangerous complication of a bee or other insect sting. A rapid fall in blood pressure can lead to loss of consciousness, and can sometimes be fatal. Anaphylaxis requires an emergency shot of epinephrine and a trip to the emergency room.
• Toxic reaction to multiple stings can be dangerous, especially in children. Because children are smaller than adults, fewer stings can create high levels of venom in the bloodstream. Complications of massive poisoning by venom (envenomation) include heart problems, rapid muscle tissue damage (rhabdomyolysis) and kidney failure.
• Infection at the site of a sting. As with other cases when the skin is broken, a sting site may become infected. Scratching a sting site can increase your risk of infection.

Treatments and drugs:

For most bee stings, home treatment is enough. Multiple stings or an allergic reaction, on the other hand, can be a medical emergency that requires immediate treatment.

Treatment for minor reactions
When a bee stings, it jabs a barbed stinger into the skin. Removing the stinger and its attached venom sac right away will keep more venom from being released.

• Remove the stinger as soon as you can, as it takes only seconds for all of the venom to enter your body. Scrape the stinger out with the edge of a credit card or a fingernail, or use a pair of tweezers. Avoid squeezing the attached venom sac, which can release more venom.
• Wash the sting area with soap and water.
• Apply cold compresses to relieve pain and ease swelling.

Treatment for large local reactions
The following steps may help ease the swelling and itching often associated with large local reactions:

• Remove the stinger as soon as possible.
• Wash the area with soap and water.
• Apply cold compresses.
• Apply hydrocortisone cream or calamine lotion to ease redness, itching or swelling.
• If itching or swelling is bothersome, take an oral antihistamine that contains diphenhydramine (Benadryl) or chlorpheniramine (Chlor-Trimeton).
• Avoid scratching the sting area. This will worsen itching and swelling — and increase your risk of infection.

Emergency treatment for allergic reactions
During an anaphylactic attack, an emergency medical team may perform cardiopulmonary resuscitation (CPR) if you stop breathing or your heart stops beating. You may be given medications including:

• Epinephrine (adrenaline) to reduce your body's allergic response
• Oxygen, to help compensate for restricted breathing
• Intravenous (IV) antihistamines and cortisone to reduce inflammation of your air passages and improve breathing
• A beta agonist (such as albuterol) to relieve breathing symptoms

Epinephrine autoinjector
If you're allergic to bee stings, your doctor will likely prescribe an emergency epinephrine autoinjector (EpiPen, Twinject). You'll need to carry it with you at all times. An autoinjector is a combined syringe and concealed needle that injects a single dose of medication when pressed against your thigh. Always be sure to replace epinephrine before its expiration date, or it may not work properly.

Be sure you know how to use the autoinjector. Also, make sure the people closest to you know how to administer the drug — if they're with you in an anaphylactic emergency, they could save your life. Medical personnel called in to respond to a severe anaphylactic reaction also may give you an epinephrine injection or another medication.

You might also consider wearing an alert bracelet that identifies your allergy to bee or other insect stings.

Allergy shots
Bee and other insect stings are a common cause of anaphylaxis. If you've had a serious reaction to a bee sting or you've been swarmed by bees, your doctor will likely refer you to an allergy specialist (allergist) for allergy shots (immunotherapy). These shots are generally given on a regular basis for a few years and can reduce or completely eliminate your allergic response to bee venom.

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Bedbugs

Bedbugs

Definition:

Bedbugs bite the exposed skin of sleeping humans to feed on their blood. Decades ago, bedbugs were eradicated from most developed nations using DDT — a pesticide that's since been banned because it's so toxic.

Spurred perhaps by increases in international travel, bedbugs are becoming a problem once again. The risk of encountering bedbugs increases if you spend time in places with high turnovers of nighttime guests — such as hotels, hospitals or homeless shelters.

Bedbugs are reddish brown, oval and flat, about the size of an apple seed. During the day, they hide in the cracks and crevices of beds, box springs, headboards and bed frames. If you have bedbugs in your home, professional extermination is recommended.

Symptoms:

It can be difficult to distinguish bedbug bites from other insect bites. In general, the sites of bedbug bites usually are:

• Red, often with a darker red spot in the middle
• Itchy
• Arranged in a rough line or in a cluster
• Located on the face, neck, arms and hands

Some people have no reaction at all to bedbug bites, while others experience an allergic reaction that can include severe itching, blisters or hives.
When to see a doctor
If you experience allergic reactions or severe skin reactions to your bedbug bites, see your doctor for professional treatment.


Causes:

The resurgence of bedbugs in developed countries may be linked to:

• Increased international travel
• Changes in pest control practices
• Insecticide resistance

Where do they hide?
During the day, bedbugs hide in the cracks and crevices of:

• Mattresses
• Box springs
• Bed frames
• Headboards

They also can be found:

• Under peeling paint and loose wallpaper
• Under carpeting near baseboards
• In upholstered furniture seams
• Under light switch plates or electrical outlets

How do they spread?
Bedbugs don't usually stay on their human hosts after their meal, but they might take refuge in clothes or luggage left nearby on the floor. If you're traveling and bedbugs get into your luggage, you might bring them home.

While bedbugs may hitchhike on your belongings, they can also crawl about as fast as a ladybug. So they can easily travel between floors and rooms in hotels or apartment complexes.

Some varieties of bedbugs prefer to feed on birds or bats, so they may take up residence in your attics or eaves. If their preferred prey migrates south, these bedbugs will settle for feeding on the humans in the house.

Sign of uncleanliness?
Bedbugs don't care if their environment is clean or dirty. All they need is a warm host and plenty of hiding places. Even pristine homes and hotels can harbor bedbugs.

Treatments and drugs:


The itchy red spots associated with bedbug bites usually disappear on their own within a week or two. You might speed your recovery by using:

• A skin cream containing hydrocortisone
• An oral antihistamine, such as diphenhydramine (Benadryl)

If you develop a skin infection from scratching bedbug bites, your doctor may prescribe an antibiotic.

Treating your home
Once your symptoms are treated, you must tackle the underlying infestation. This can be difficult because bedbugs hide so well and can live for months without eating. Your best bet may be to hire a professional exterminator, who may use a combination of pesticides and nonchemical treatments.
Nonchemical treatments may include:

• Vacuuming. A thorough vacuuming of cracks and crevices can physically remove bedbugs from an area. But vacuum cleaners can't reach all hiding places.
  
• Hot water. Washing clothes and other items in water at least 120 F (49 C) can kill bedbugs.
  
• Clothes dryer. Placing wet or dry items in a clothes dryer set at medium to high heat for 20 minutes will kill bedbugs and their eggs.
  
• Freezing. Bedbugs are also vulnerable to temperatures below 32 F (0 C), but you'd need to leave the items outdoors or in the freezer for several days.

Some professional exterminators use portable devices to raise the temperature of a room to a lethal temperature. All stages of bedbugs can be killed at 122 F (50 C). In some cases, you may have to throw out heavily infested items such as mattresses or couches.

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Bed-wetting

Bed-wetting

Definition:

Soggy sheets and pajamas — and an embarrassed child — are a familiar scene in many homes. But don't despair. Bed-wetting isn't a sign of toilet training gone bad. It's often just a normal part of a child's development.

Bed-wetting is also known as nighttime incontinence or nocturnal enuresis. Generally, bed-wetting before age 6 or 7 isn't cause for concern. At this age, your child may still be developing nighttime bladder control.

If bed-wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help reduce bed-wetting.

Symptoms:

Bed-wetting is involuntary urination while asleep.
Most kids are fully toilet trained by age 4, but there's really no target date for developing complete bladder control. By age 5, bed-wetting remains a problem for only about 15 percent of children. Between 8 and 11 years of age, fewer than 5 percent of youngsters are still wetting the bed.

When to see a doctor
Most children outgrow bed-wetting on their own — but some need a little help. In other cases, bed-wetting may be a sign of an underlying condition that needs medical attention.
Consult your child's doctor if:

• Your child still wets the bed after age 6 or 7
• Your child starts to wet the bed after a period of being dry at night
• The bed-wetting is accompanied by painful urination, unusual thirst, pink urine or snoring

Causes:

No one knows for sure what causes bed-wetting, but various factors may play a role.

• A small bladder. Your child's bladder may not be developed enough to hold urine produced during the night.
• Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not wake your child — especially if your child is a deep sleeper.
• A hormone imbalance. During childhood, some kids don't produce enough anti-diuretic hormone (ADH) to slow nighttime urine production.
• Stress. Stressful events — such as becoming a big brother or sister, starting a new school, or sleeping away from home — may trigger bed-wetting.
• Urinary tract infection. A urinary tract infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination, bloody urine and pain during urination.
• Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep — often because of inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat, and daytime drowsiness.
• Diabetes. For a child who's usually dry at night, bed-wetting may be the first sign of diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite.
• Chronic constipation. A lack of regular bowel movements may make it so your child's bladder can't hold much urine, which can cause bed-wetting at night.
• A structural problem in the urinary tract or nervous system. Rarely, bed-wetting is related to a defect in the child's neurological system or urinary system.

Complications:

Although frustrating, bed-wetting without a physical cause doesn't pose any health risks. The guilt and embarrassment a child feels about wetting the bed can lead to low self-esteem, however.
Rashes on the bottom and genital area may be an issue as well — especially if your child sleeps in wet underwear. To prevent a rash, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a petroleum ointment at bedtime.

Treatments and drugs:

Most children outgrow bed-wetting on their own. If there's a family history of bed-wetting, your child will probably stop bed-wetting around the age the parent stopped bed-wetting.
Generally, your child will be your doctor's guide to the level of necessary treatment. If your child isn't especially bothered or embarrassed by an occasional wet night, home remedies may be the ideal treatment. However, if your grade schooler is terrified about wetting the bed during a sleepover, he or she may be more motivated to try additional treatments.

Moisture alarms
These small, battery-operated devices — available without a prescription at most pharmacies — connect to a moisture-sensitive pad on your child's pajamas or bedding. When the pad senses wetness, the alarm goes off. Ideally, the moisture alarm sounds just as your child begins to urinate — in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm.

If you try a moisture alarm, give it plenty of time. It often takes at least two weeks to see any type of response and up to 12 weeks to enjoy dry nights. Moisture alarms are highly effective, carry a low risk of relapse or side effects, and may provide a better long-term solution than medication does.

Medication
As a last resort, your child's doctor may prescribe medication to stop bed-wetting. Various types of medication can:

• Slow nighttime urine production. The drug desmopressin acetate (DDAVP) boosts levels of a natural hormone (anti-diuretic hormone, or ADH) that forces the body to make less urine at night. Although DDAVP has few side effects, the most serious is the potential for seizures. This can happen if your child drinks too much when taking the medication. For this reason, don't use this medication on nights when your child drinks a lot of fluids. Additionally, don't give your child this medication if he or she has a headache, has vomited or feels nauseous.
  
• Calm the bladder. If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan) or hyoscyamine (Levsin) may help reduce bladder contractions and increase bladder capacity. Side effects may include dry mouth and facial flushing.
  
• Change a child's sleeping and waking pattern. The antidepressant imipramine (Tofranil) may provide bed-wetting relief by changing a child's sleeping and waking pattern. The medication may also increase the amount of time a child can hold urine or reduce the amount of urine produced. Imipramine has been associated with mood changes and sleep problems. Caution is essential when using this medication, because an overdose could be fatal. Because of the serious nature of these side effects, this medication is generally recommended only when other treatments have failed.

Sometimes a combination of medications is most effective. There are no guarantees, however, and medication doesn't cure the problem. Bed-wetting typically resumes when the medication is stopped.

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Body dysmorphic disorder

Body dysmorphic disorder

Definition:

Body dysmorphic disorder is a type of chronic mental illness in which you can't stop thinking about a flaw with your appearance — a flaw that is either minor or imagined. But to you, your appearance seems so shameful that you don't want to be seen by anyone. Body dysmorphic disorder has sometimes been called "imagined ugliness."

When you have body dysmorphic disorder, you intensely obsess over your appearance and body image, often for many hours a day. You may seek out numerous cosmetic procedures to try to "fix" your perceived flaws, but never will be satisfied. Body dysmorphic disorder is also known as dysmorphophobia, the fear of having a deformity.

Treatment of body dysmorphic disorder may include medication and cognitive behavioral therapy.

Symptoms:

Signs and symptoms of body dysmorphic disorder include:

• Preoccupation with your physical appearance
• Strong belief that you have an abnormality or defect in your appearance that makes you ugly
• Frequent examination of yourself in the mirror or, conversely, avoidance of mirrors altogether
• Belief that others take special notice of your appearance in a negative way
• The need to seek reassurance about your appearance from others
• Frequent cosmetic procedures with little satisfaction
• Excessive grooming, such as hair plucking
• Extreme self-consciousness
• Refusal to appear in pictures
• Skin picking
• Comparison of your appearance with that of others
• Avoidance of social situations
• The need to wear excessive makeup or clothing to camouflage perceived flaws

You may obsess over any part of your body, but common features people may obsess about include:

• Nose
• Hair
• Skin
• Complexion
• Wrinkles
• Acne and blemishes
• Baldness
• Breast size
• Muscle size
• Genitalia

The body feature you focus on may change over time. You may be so convinced about your perceived flaws that you become delusional, imagining something about your body that's not true, no matter how much someone tries to convince you otherwise.

When to see a doctor
Shame and embarrassment about your appearance may keep you from seeking treatment for body dysmorphic disorder. But if you have any signs or symptoms of body dysmorphic disorder, see your doctor, mental health provider or other health professional. Body dysmorphic disorder usually doesn't get better on its own, and if untreated, it may get worse over time and lead to suicidal thoughts and behavior.

Causes:

It's not known specifically what causes body dysmorphic disorder. Like many other mental illnesses, body dysmorphic disorder may result from a combination of causes:

• Brain chemical differences. Some evidence suggests that naturally occurring brain chemicals called neurotransmitters, which are linked to mood, may play a role in causing body dysmorphic disorder.
  
• Structural brain differences. In people who have body dysmorphic disorder, certain areas of the brain may not have developed properly.
  
• Genes. Some studies show that body dysmorphic disorder is more common in people whose biological family members also have the condition, indicating that there may be a gene or genes associated with this disorder.
  
• Environment. Your environment, life experiences and culture may contribute to body dysmorphic disorder, especially if they involve negative experiences about your body or self-image.

Complications:

Complications that body dysmorphic disorder may cause or be associated with include:

• Suicidal thoughts or behavior
• Repeated hospitalizations
• Depression and other mood disorders
• Anxiety disorders
• Obsessive-compulsive disorder
• Eating disorders
• Social phobia
• Substance abuse
• Low self-esteem
• Social isolation
• Difficulty attending work or school
• Lack of close relationships
• Unnecessary medical procedures, especially cosmetic surgery
• The need to stay housebound

Treatments and drugs:

Treatment of body dysmorphic disorder can be difficult, especially if you aren't a willing and active participant in your care. But effective treatment can be successful.

Treatment options: Cognitive behavioral therapy and medications
The two main treatments for body dysmorphic disorder are:

• Cognitive behavioral therapy
• Medications, such as selective serotonin reuptake inhibitors (SSRIs)

Often, treatment involves a combination of cognitive behavioral therapy and medications.

Cognitive behavioral therapy for body dysmorphic disorder
Cognitive behavioral therapy focuses on teaching you healthy behaviors, such as being social and avoiding obsessive behaviors, such as mirror checking. Therapy can help you learn about your condition and your feelings, thoughts, mood and behavior. Using the insights and knowledge you gain in psychotherapy, you can learn to stop automatic negative thoughts and to see yourself in a more realistic and positive way. You can also learn healthy ways to handle urges or rituals, such as mirror checking or skin picking.

You and your therapist can talk about which type of therapy is right for you, your goals for therapy, and other issues, such as the number of sessions and the length of treatment.

Medications for body dysmorphic disorder
There are no medications specifically approved by the Food and Drug Administration (FDA) to treat body dysmorphic disorder. However, psychiatric medications used to treat other conditions, such as depression, can be prescribed for body dysmorphic disorder off-label — that is, even if they haven't been specifically FDA approved for that use.

Because body dysmorphic disorder is thought to be caused in part by problems related to the brain chemical serotonin, the medications prescribed most commonly are selective serotonin reuptake inhibitors (SSRIs). SSRIs appear to be more effective than other antidepressant medications for body dysmorphic disorder.

SSRIs may help control your obsessions and repetitive behaviors. In general, treatment of body dysmorphic disorder requires higher doses of these medications than does depression. You can gradually increase your dose to make sure you can tolerate the medication and possible side effects, such as weight gain or a change in sexual desire.

It may take as long as 12 weeks for noticeable improvement in your symptoms. You may need to try two or more medications before finding one that works well for you and has the fewest side effects. And you may need to try other types of antidepressants or medications if the main choices aren't effective enough.

In some cases, you may benefit from taking medications in addition to your primary antidepressant medication. For instance, your doctor may recommend that you take an antipsychotic medication in addition to an SSRI if you have delusions related to body dysmorphic disorder.

The risk of relapse is typically high once you stop taking a medication for body dysmorphic disorder. You may need to continue to take a medication indefinitely, especially if you've had suicidal thoughts or behavior in the past.

Hospitalization
In some cases, your body dysmorphic disorder symptoms may be so severe that you require psychiatric hospitalization. Psychiatric hospitalization is generally recommended only when you aren't able to care for yourself properly or when you're in immediate danger of harming yourself or someone else. Psychiatric hospitalization options include 24-hour inpatient care, partial or day hospitalization, or residential treatment, which offers a supportive place to live.

Cosmetic procedures
While it may seem that a procedure to "fix" your perceived flaw is a good option, cosmetic surgery, dentistry or other approaches usually don't relieve the stress and shame of body dysmorphic disorder. You may not get the results you hoped for, or you may simply begin obsessing about another aspect of your appearance and seek out more cosmetic procedures. Cosmetic procedures don't treat your underlying condition — they are only temporary fixes, at best.

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Basal cell carcinoma

Basal cell carcinoma

Definition:

Basal cell carcinoma is a type of skin cancer. Basal cell carcinoma begins in the basal cells — a type of cell within the skin that produces new skin cells as old ones die off.
Basal cell carcinoma often appears as a waxy bump, though it can take other forms. Basal cell carcinoma occurs most often on areas of the skin that are often exposed to the sun, such as your face and neck.

Most basal cell carcinomas are thought to be caused by long-term exposure to ultraviolet (UV) radiation from sunlight. Avoiding the sun and using sunscreen may help protect against basal cell carcinoma.

Symptoms:

Basal cell carcinomas usually develop on sun-exposed parts of your body, especially your head and neck. A much smaller number occur on the trunk and legs. Yet basal cell carcinomas can also occur on parts of your body that are rarely exposed to sunlight.

Although a general warning sign of skin cancer is a sore that won't heal or that repeatedly bleeds and scabs over, basal cell cancer may look like:

• A pearly white or waxy bump, often with visible blood vessels on your face, ears or neck. The bump may bleed, develop a crust or form a depression in the center. In darker skinned people, this type of cancer is usually brown or black.
  
• A flat, scaly, brown or flesh-colored patch on your back or chest. Over time, these patches can grow quite large.
  
• More rarely, a white, waxy scar. This type of basal cell carcinoma is easy to overlook, but it may be a sign of a particularly invasive and disfiguring cancer called morpheaform basal cell carcinoma.

When to see a doctor
Some basal cell carcinomas may be difficult to distinguish from ordinary sores. See your dermatologist if you have:

• A skin sore that bleeds easily or doesn't heal in about two weeks
• A sore that repeatedly crusts or oozes
• Visible blood vessels in or around a sore
• A scar in an area where you haven't injured yourself

Causes:

Basal cell carcinoma occurs when one of the skin's basal cells develops a mutation in its DNA. Basal cells are found at the bottom of the epidermis — the outermost layer of skin. Basal cells produce new skin cells. As new skin cells are produced, they push older cells toward the skin's surface, where the old cells die and are sloughed off.

The process of creating new skin cells is controlled by a basal cell's DNA. A mutation in the DNA causes a basal cell to multiply rapidly and continue growing when it would normally die. Eventually the accumulating abnormal cells may form a cancerous tumor.

Ultraviolet light and other causes
Much of the damage to DNA in basal cells is thought to result from ultraviolet (UV) radiation found in sunlight and in commercial tanning lamps and tanning beds. But sun exposure doesn't explain skin cancers that develop on skin not ordinarily exposed to sunlight. This indicates that other factors may contribute to your risk of skin cancer, such as being exposed to toxic substances or having a condition that weakens your immune system.


Complications:

Complications of basal cell carcinoma can include:

• A risk of recurrence. Basal cell carcinomas commonly recur. Even after successful treatment, they may recur, often in the same place.
  
• An increased risk of other types of skin cancer. A history of basal cell carcinoma may also increase the chance of developing other types of skin cancer, such as squamous cell carcinoma and melanoma.
  
• Cancer that spreads beyond the skin. Rare, aggressive forms of basal cell carcinoma can invade and destroy nearby muscles, nerves and bone. Very rarely, basal cell carcinoma can spread to other areas of the body.

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Barrett's esophagus

Barrett's esophagus

Definition:

Barrett's esophagus is a condition in which the cells of your lower esophagus become damaged, usually from repeated exposure to stomach acid. The damage causes changes to the color and composition of the esophagus cells.

Barrett's esophagus is most often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett's esophagus.

A diagnosis of Barrett's esophagus can be concerning because it increases the risk of developing esophageal cancer. Although the risk of esophageal cancer is small, monitoring of Barrett's esophagus focuses on periodic exams to find precancerous esophagus cells. If precancerous cells are discovered, they can be treated to prevent esophageal cancer.


Symptoms:

Barrett's esophagus signs and symptoms are usually related to acid reflux and may include:

• Frequent heartburn
• Difficulty swallowing food
• Chest pain
• Upper abdominal pain
• Dry cough

Many people with Barrett's esophagus have no signs or symptoms.
When to see a doctor
If you've had long-term trouble with heartburn and acid reflux, discuss this with your doctor and ask about your risk of Barrett's esophagus.
Seek immediate medical attention if you:

• Have chest pain
• Have difficulty swallowing
• Are vomiting red blood or blood that looks like coffee grounds
• Are passing black, tarry or bloody stools

Causes:

The exact cause of Barrett's esophagus isn't known. Most people with Barrett's esophagus have long-standing GERD. It's thought that GERD causes stomach contents to wash back into the esophagus, causing damage to the esophagus. As the esophagus tries to heal itself, the cells can change to the type of cells found in Barrett's esophagus.

Still, some people diagnosed with Barrett's esophagus have never experienced heartburn or acid reflux. It's not clear what causes Barrett's esophagus in these cases.

Complications:

Increased risk of esophageal cancer
People with Barrett's esophagus have an increased risk of esophageal cancer. Still, the risk is small, especially in people whose lab test results show no precancerous changes (dysplasia) in their esophagus cells. The overwhelming majority of people with Barrett's esophagus will never develop esophageal cancer.

Studies of people with Barrett's esophagus show most think their risk of esophageal cancer is much higher than it really is. This causes needless worry and anxiety.
If you're worried about your risk of esophageal cancer, ask your doctor to explain your chances of developing the disease. Also ask what you can do to reduce your risk. This may help you feel more in control of your health.


Treatments and drugs:

Your treatment options for Barrett's esophagus depend on whether high-grade or low-grade dysplasia is found in the cells of your esophagus, your overall health and your own preferences.
Treatment for people with no dysplasia or low-grade dysplasia
If a biopsy reveals that your cells have no dysplasia or that your cells have low-grade dysplasia, your doctor may suggest:

• Periodic endoscopy exams to monitor the cells in your esophagus. How often you undergo endoscopy exams will depend on your situation. Typically, if your biopsies show no dysplasia, you'll have a follow-up endoscopy one year later. If your doctor again detects no dysplasia, your doctor will likely recommend endoscopy exams every three years. If low-grade dysplasia is detected, your doctor may recommend GERD treatments and another endoscopy in six months or a year. If you're determined to have high-grade dysplasia, then your doctor may offer other treatment options.
  
  Sometimes when endoscopy is repeated, no evidence of Barrett's esophagus is detected. This may not mean that the condition has gone away. The affected portion of the esophagus could be very small, and it may have been missed during the endoscopy. For this reason, your doctor will still recommend follow-up endoscopy exams.
  
  
• Continued treatment for GERD. If you're still struggling with chronic heartburn and acid reflux, your doctor will work to find prescription medications that help you control your signs and symptoms. Surgery to tighten the sphincter that controls the flow of stomach acid may be an option to treat GERD. One such procedure is called Nissen fundoplication. Treating acid reflux can reduce your signs and symptoms, but it doesn't treat the underlying Barrett's esophagus.

Treatment for people with high-grade dysplasia
High-grade dysplasia is thought to be a precursor to esophageal cancer. For this reason, doctors sometimes recommend more-invasive treatments, such as:

• Surgery to remove the esophagus. During an esophagectomy, the surgeon removes most of your esophagus and attaches your stomach to the remaining portion. Surgery carries a risk of significant complications, such as bleeding, infection and leaking from the area where the esophagus and stomach are joined. When esophagectomy is performed by an experienced surgeon, there's a reduced risk of complications. Still, because of the potential complications of this major operation, other treatments are usually preferred over surgery. One advantage to surgery is that it reduces the need for periodic endoscopy exams in the future.
  
• Removing damaged cells with an endoscope. Endoscopic mucosal resection is used to remove areas of damaged cells using an endoscope. Your doctor guides the endoscope down your throat and into your esophagus. Special surgical tools are passed through the tube. The tools allow your doctor to cut away the superficial layers of the esophagus and remove damaged cells. Endoscopic mucosal resection carries a risk of complications, such as bleeding, rupture and narrowing of the esophagus.
  
• Using heat to remove abnormal esophageal tissue. Radiofrequency ablation involves inserting a balloon filled with electrodes in the esophagus. The balloon emits a short burst of energy that destroys the damaged esophageal tissue. Radiofrequency ablation carries a risk of narrowing of the esophagus, bleeding and chest pain.
  
• Using cold to destroy abnormal esophagus cells. Cryotherapy involves using an endoscope to apply a cold liquid or gas to the abnormal cells in the esophagus. The cells are allowed to warm up and then are frozen again. The cycle of freezing and thawing damages the cells. Cryotherapy carries a risk of chest pain, narrowing of the esophagus and tearing of the esophagus.
  
• Destroying damaged cells by making them sensitive to light. Before this procedure, called photodynamic therapy (PDT), you receive a special medication through a vein in your arm. The medication makes certain cells, including the damaged cells in your esophagus, sensitive to light. During PDT, your doctor uses an endoscope to guide a special light down your throat and into your esophagus. The light reacts with medication in the cells and causes the damaged cells to die. PDT makes you sensitive to sunlight and requires diligent avoidance of sunlight after the procedure. Complications of PDT can include narrowing of the esophagus, chest pain and nausea.

If you undergo treatment other than surgery to remove your esophagus, there's a chance that Barrett's esophagus can recur. For this reason, your doctor may recommend continuing to take acid-reducing medications and having periodic endoscopy exams.

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