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.

Read more...

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.

Read more...

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.

Read more...

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.

Read more...

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.

Read more...

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.

Read more...

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.

Read more...

Blepharitis

Blepharitis

Definition:
Blepharitis (blef-uh-RI-tis) is inflammation that affects the eyelids. Blepharitis usually involves the part of the eyelid where the eyelashes grow.

Blepharitis commonly occurs when tiny oil glands located near the base of the eyelashes malfunction. This leads to inflamed, irritated and itchy eyelids. Several diseases and conditions can cause blepharitis.
Blepharitis is often a chronic condition that is difficult to treat. Blepharitis can be uncomfortable and may be unattractive,
but it usually doesn't cause permanent damage to your eyesight.


Symptoms:
Blepharitis symptoms and signs include:

• Watery eyes
• Red eyes
• A gritty, burning sensation in the eye
• Eyelids that appear greasy
• Itchy eyelids
• Red, swollen eyelids
• Flaking of the skin around the eyes
• Crusted eyelashes upon awakening
• Eyelid sticking
• More frequent blinking
• Sensitivity to light
• Eyelashes that grow abnormally (misdirected eyelashes)
• Loss of eyelashes

When to see a doctor
If you have blepharitis symptoms and signs that don't seem to be improving despite good hygiene — regular cleaning and care of the affected area — make an appointment with your doctor.


Causes:
The exact cause of blepharitis isn't clear. Factors associated with the development of blepharitis include:

• Seborrheic dermatitis — dandruff of the scalp and eyebrows
• A bacterial infection
• Malfunctioning oil glands in your eyelid
• Rosacea — a skin condition characterized by facial redness
• Allergies, including allergic reactions to eye medications, contact lens solutions or eye makeup
• Eyelash mites or lice
• Certain medication — the severe acne medication isotretinoin (Amnesteem, Claravis, Sotret) can lead to an increase in bacteria on the eyelids and can affect tear production

Blepharitis may be caused by a combination of factors.


Complications:
 If you have blepharitis, you may also experience:

• Eyelash problems. Blepharitis can cause your eyelashes to fall out or grow abnormally (misdirected eyelashes).
• Eyelid skin problems. Scarring may occur on your eyelids in response to long-term blepharitis.
• Excess tearing or dry eyes. Abnormal oily secretions and other debris shed from the eyelid, such as flaking associated with dandruff, can accumulate in your tear film — the water, oil and mucus solution that forms tears. Abnormal tear film interferes with the healthy lubrication of your eyelids. This can irritate your eyes and cause dry eyes or excessive tearing.
• Difficulty wearing contact lenses. Because blepharitis can affect the amount of lubrication in your eyes, wearing contact lenses may be uncomfortable.
• Sty. A sty is an infection that develops near the base of the eyelashes. The result is a painful lump on the edge (usually on the outside part) of your eyelid. A sty is usually most visible on the surface of the eyelid.
• Chalazion. A chalazion occurs when there's a blockage in one of the small oil glands at the margin of the eyelid, just behind the eyelashes. The gland can become infected with bacteria, which causes a red, swollen eyelid. Unlike a sty, a chalazion tends to be most prominent on the inside of the eyelid.
• Chronic pink eye. Blepharitis can lead to recurrent bouts of pink eye (conjunctivitis).
• Injury to the cornea. Constant irritation from inflamed eyelids or misdirected eyelashes may cause a sore (ulcer) to develop on your cornea. Insufficient tearing could predispose you to a corneal infection

Treatments and drugs:
Treatment for blepharitis can include:

• Cleaning the affected area regularly. Cleaning your eyelids with a warm washcloth can help control signs and symptoms. Self-care measures may be the only treatment necessary for most cases of blepharitis.
• Antibiotics. Eyedrops containing antibiotics applied to your eyelids may help control blepharitis caused by a bacterial infection. In certain cases, antibiotics are administered in cream, ointment or pill form.
• Steroid eyedrops or ointments. Eyedrops or ointments containing steroids can help control inflammation in your eyes and your eyelids.
• Artificial tears. Lubricating eyedrops or artificial tears, which are available over-the-counter, may help relieve dry eyes.
• Treating underlying conditions. Blepharitis caused by seborrheic dermatitis, rosacea or other diseases may be controlled by treating the underlying disease.

Blepharitis rarely disappears completely. Even with successful treatment, relapses are common.

Read more...

Blastocystis hominis infection

Blastocystis hominis infection

Definition:

Blastocystis hominis (B. hominis) is a microscopic parasite sometimes found in the stools of healthy people as well as in the stools of those who have diarrhea, abdominal pain or other gastrointestinal problems. Infection with B. hominis is called blastocystosis.

Researchers don't yet fully understand the role that B. hominis plays in causing an infection. Certain subtypes of this parasite may be more likely to cause infection, or may pose a risk only when combined with other types of infection. In some cases, the parasite simply resides in the digestive tract without causing harm.

There are no proven treatments for Blastocystis, and the infection usually clears up on its own. However, if signs and symptoms don't improve, your doctor may recommend trying medications.


Symptoms:

Signs and symptoms that might be associated with blastocystis include:

• Diarrhea
• Nausea
• Abdominal cramps
• Bloating
• Excessive gas (flatulence)
• Anal itching
• Fatigue

When to see a doctor
See your doctor if you have signs and symptoms associated with blastocystis, such as diarrhea, cramps and fatigue that last longer than three days.


Causes:

Once thought to be a harmless yeast, B. hominis is a parasite, a microscopic single-celled organism (protozoan). It behaves like a tiny animal — hunting and gathering other microbes for food. Many protozoa inhabit your gastrointestinal tract and are harmless; others cause disease.

Whether B. hominis is the type of protozoa that causes disease is controversial. While many people who carry B. hominis have no signs or symptoms, others have diarrhea and other gastrointestinal problems. Because B. hominis often appears with other organisms, experts aren't sure whether B. hominis causes disease on its own.

It's possible that some people are susceptible to illness caused by B. hominis infection, while others carry the parasite without signs or symptoms.

Many types of protozoa get into the intestinal tract through oral-fecal contact, such as occurs when a person doesn't wash his or her hands thoroughly after using the toilet before preparing food. No one knows for certain how B. hominis is transmitted, but experts suspect it's through oral-fecal contact. Experts do know that the incidence of infection associated with B. hominis increases in places with inadequate sanitation and poor personal hygiene.

Complications:

 If you have diarrhea associated with B. hominis, it's likely to be self-limiting. However, anytime you have diarrhea, you lose vital fluids, salts and minerals, which can lead to dehydration. Children are especially vulnerable to dehydration.


Treatments and drugs:

If you have blastocystis without signs or symptoms, then you don't need treatment. Mild signs and symptoms may improve on their own within a few days.

Potential medications for treating blastocystis include the antibiotic metronidazole (Flagyl), the combination medication sulfamethoxazole and trimethoprim (Bactrim, Septra, others), and the antiprotozoal medication iodoquinol (Yodoxin, others). However, keep in mind that response to medication for B. hominis infection varies greatly from person to person. And, because the symptoms you're having might be unrelated to blastocystis, it's also possible that any improvement may be due to the medication's effect on another organism.

Read more...

Bladder cancer

Bladder cancer

Definition:

Bladder cancer is a type of cancer that begins in your bladder — a balloon-shaped organ in your pelvic area that stores urine. Bladder cancer begins most often in the cells that line the inside of the bladder. Bladder cancer typically affects older adults, though it can occur at any age.

The great majority of bladder cancers are diagnosed at an early stage — when bladder cancer is highly treatable. However, even early-stage bladder cancer is likely to recur. For this reason, bladder cancer survivors often undergo follow-up tests to look for bladder cancer recurrence for years after treatment.


Symptoms:

Bladder cancer signs and symptoms may include:

• Blood in urine (hematuria) — urine may appear dark yellow, bright red or cola colored. Or urine may appear normal, but blood may be detected in a microscopic examination of the urine
• Frequent urination
• Painful urination
• Back pain
• Pelvic pain

When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you, such as blood in your urine.

Causes:

It's not always clear what causes bladder cancer. Bladder cancer has been linked to smoking, a parasitic infection, radiation and chemical exposure.

Bladder cancer develops when cells in the bladder begin to grow abnormally. Rather than grow and divide in an orderly way, these cells develop mutations that cause them to grow out of control and not die. These abnormal cells form a tumor.

Types of bladder cancer
Different types of cells in your bladder can become cancerous. The type of bladder cell where cancer begins determines the type of bladder cancer. Your bladder cancer type determines which treatments may work best for you. Types of bladder cancer include:

• Transitional cell carcinoma. Transitional cell carcinoma occurs in the cells that line the inside of your bladder. Transitional cells expand when your bladder is full and contract when your bladder is empty. These same cells line the inside of your ureters and your urethra, and tumors can form in those places as well. Transitional cell carcinoma is the most common type of bladder cancer in the United States.
• Squamous cell carcinoma. Squamous cells appear in your bladder in response to infection and irritation. Over time they can become cancerous. Squamous cell bladder cancer is rare in the United States. It's more common in parts of the world where a certain parasitic infection (schistosomiasis) is a prevalent cause of bladder infections.
• Adenocarcinoma. Adenocarcinoma begins in cells that make up mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is rare in the United States.

Some bladder cancers include more than one type of cell.


Complications:

Bladder cancer often recurs. Because of this, bladder cancer survivors often undergo follow-up testing for years after successful treatment. What tests you'll undergo and how often will depend on your type of bladder cancer and your treatment, among other factors.

Ask your doctor to create a follow-up plan for you. In general, doctors recommend a test to examine the inside of your urethra and bladder (cystoscopy) every three to six months for the first few years after bladder cancer treatment. Then you may undergo cystoscopy every year. Your doctor may recommend other tests at various intervals as well.

People with aggressive cancers may undergo more frequent screening. Those with less aggressive cancers may undergo screening tests less often.


Treatments and drugs:

Your treatment options for bladder cancer depend on a number of factors, including the type and stage of the cancer, your overall health, and your treatment preferences. Discuss your options with your doctor to determine what treatments are best for you.

Surgical procedures
The types of surgical procedures available to you may be based on factors such as the stage of your bladder cancer, your overall health and your preferences.

Surgery for early-stage bladder cancer
If your cancer is very small and hasn't invaded the wall of your bladder, your doctor may recommend:

• Surgery to remove the tumor. Transurethral resection (TUR) is often used to remove bladder cancers that are confined to the inner layers of the bladder. During TUR, your doctor passes a small wire loop through a cystoscope and into your bladder. The loop is used to burn away cancer cells with an electric current. In some cases, a high-energy laser may be used instead of electric current. TUR may cause painful or bloody urination for a few days following the procedure.
  
• Surgery to remove the tumor and a small portion of the bladder. During segmental cystectomy, sometimes called partial cystectomy, the surgeon removes only the portion of the bladder that contains cancer cells. Segmental cystectomy may be an option if your cancer is limited to one area of the bladder that can easily be removed without harming bladder function.
  Surgery carries a risk of bleeding and infection. You may experience more frequent urination after segmental cystectomy, since the operation reduces the size of your bladder. Over time, this may improve.
  

Surgery for invasive bladder cancer
If your cancer has invaded the deeper layers of the bladder wall, you may consider:

• Surgery to remove the entire bladder. A radical cystectomy is an operation to remove the entire bladder, as well as surrounding lymph nodes. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy involves removal of the uterus, ovaries and part of the vagina.
  
  Cystectomy carries a risk of infection and bleeding. In men, removal of the prostate and seminal vesicles may cause erectile dysfunction. But in many cases, your surgeon can attempt to spare the nerves necessary for an erection. In women, removal of the ovaries causes infertility and premature menopause.
  
  
• Surgery to create a new way for urine to leave your body. Immediately after your radical cystectomy, your surgeon works to create a new way for you to expel urine. Several options exist. Which option is best for you depends on your situation and your preferences. Your surgeon may create a tube (urinary conduit) using a piece of your intestine. The tube runs from your kidneys to the outside of your body, where your urine drains into a pouch (urostomy bag) you wear on your abdomen.
  
  In another procedure, your surgeon may use a section of intestine to create a small reservoir for urine inside your body (cutaneous continent urinary diversion). You can drain urine from the reservoir through a hole in your abdomen using a catheter a few times each day.
  
  In select cases, your surgeon may create a bladder-like reservoir out of a piece of your intestine (neobladder). This reservoir sits inside your body and is attached to your urethra, which allows you to urinate normally. You may need to use a catheter to drain all the urine from your neobladder.
  

Biological therapy (immunotherapy)
Biological therapy, sometimes called immunotherapy, works by signaling your body's immune system to help fight cancer cells. Biological therapy for bladder cancer is typically administered through your urethra and directly into the bladder (intravesical therapy).
Biological therapy drugs used to treat bladder cancer include:

• An immune-stimulating bacterium. Bacille Calmette-Guerin (BCG) is a bacterium used in tuberculosis vaccines. BCG can cause bladder irritation and blood in your urine. Some people feel as if they have the flu after treatment with BCG.
  
• A synthetic version of an immune system protein. Interferon is a protein that your immune system makes to help your body fight infections. A synthetic version of interferon, called interferon alfa-2b (Intron A), may be used to treat bladder cancer. Interferon alfa-2b is sometimes used in combination with BCG. Interferon alfa-2b can cause flu-like symptoms.

Biological therapy can be administered after TUR to reduce the risk that cancer will recur.

Chemotherapy
Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment for bladder cancer usually involves two or more chemotherapy drugs used in combination. Drugs can be given through a vein in your arm (intravenously), or they can be administered directly to your bladder by passing a tube through your urethra (intravesical therapy).

Chemotherapy may be used to kill cancer cells that might remain after surgery. It may also be used before surgery. In this case, chemotherapy may shrink a tumor enough to allow the surgeon to perform a less invasive surgery. Chemotherapy is sometimes combined with radiation therapy.

Radiation therapy
Radiation therapy is used infrequently in people with bladder cancer. Radiation therapy uses high-energy beams aimed at your cancer to destroy the cancer cells. Radiation therapy for bladder cancer usually comes from a machine that moves around your body, directing the energy beams to precise points.

Radiation therapy can be used after surgery to kill cancer cells that might remain. Radiation therapy is sometimes combined with chemotherapy.

Read more...

Bladder stones

Bladder stones

Definition:

Bladder stones are usually small masses of minerals that form in your bladder. Bladder stones develop when urine in your bladder becomes concentrated, causing minerals in your urine to crystallize. Concentrated, stagnant urine is often the result of not being able to completely empty your bladder. This may be due to an enlarged prostate, nerve damage or recurring urinary tract infections.

Bladder stones don't always cause signs or symptoms and may be discovered during tests for other problems. When symptoms do occur, they can range from abdominal pain to blood in your urine.
Small bladder stones sometimes pass on their own, but you may need to have others removed by your doctor. Left untreated, bladder stones can cause infections and other complications.

Symptoms:

Some people with bladder stones have no problems — even when their stones are large. But if a stone irritates the bladder wall or blocks the flow of urine, signs and symptoms can develop. These include:

• Lower abdominal pain
• In men, pain or discomfort in the penis
• Painful urination
• Frequent urination, especially during the night
• Difficulty urinating or interruption of urine flow
• Blood in your urine
• Cloudy or abnormally dark-colored urine

Causes:

Bladder stones generally begin when your bladder doesn't empty completely. The urine that's left in your bladder can form crystals that eventually become bladder stones. In most cases, an underlying condition affects your bladder's ability to empty completely.
The most common conditions that cause bladder stones include:

• Prostate gland enlargement. An enlarged prostate, or benign prostatic hyperplasia (BPH), can be a cause of bladder stones in men. As the prostate enlarges, it can compress the urethra and interrupt urine flow, causing urine to remain in your bladder.
  
• Damaged nerves (neurogenic bladder). Normally, nerves carry messages from your brain to your bladder muscles, directing your bladder muscles to tighten or release. If these nerves are damaged — from a stroke, spinal cord injury or other health problem — your bladder may not empty completely.
  
• Weakened bladder wall. Bladder diverticula are weakened areas in the bladder wall that bulge outward in pouches, and allow urine to collect.

Other conditions that can cause bladder stones include:

• Inflammation. Bladder stones can develop if your bladder becomes inflamed. Urinary tract infections and radiation therapy to your pelvic area can both cause bladder inflammation.
  
• Medical devices. Occasionally, catheters — slender tubes inserted through the urethra to help urine drain from your bladder — can cause bladder stones. So can objects that accidentally migrate to your bladder, such as a contraceptive device or stent. Mineral crystals, which later become stones, tend to form on the surface of these devices.
  
• Kidney stones. Stones that form in your kidneys are not the same as bladder stones. They develop in different ways and often for different reasons. But small kidney stones occasionally travel down the ureters into your bladder and if not expelled, can grow into bladder stones.

Complications:

Bladder stones that aren't removed — even those that don't cause symptoms — can lead to complications, such as:

• Chronic bladder dysfunction. Left untreated, bladder stones can cause long-term urinary problems, such as pain or frequent urination. Bladder stones can also lodge in the opening where urine exits the bladder into the urethra and block the passage of urine from your body.
• Urinary tract infections. Recurring bacterial infections in your urinary tract may be caused by bladder stones. 

Treatments and drugs:

Generally, bladder stones should be removed. If the stone is small, your doctor may recommend that you drink an increased amount of water each day to help the stone pass. However, because bladder stones are usually caused by the inability to empty the bladder completely, spontaneous passage of the stones is unlikely. Almost all cases require removal of the stones.

Breaking stones apart
Bladder stones are often removed during a procedure called a cystolitholapaxy. A small tube with a camera at the end (cystoscope) is inserted through your urethra and into your bladder to view the stone. Your doctor then uses a laser, ultrasound or mechanical device to break the stone into small pieces and flushes the pieces from your bladder.

You'll likely have regional or general anesthesia prior to the procedure to make you comfortable. Complications from a cystolitholapaxy aren't common, but urinary tract infections, fever, a tear in your bladder and bleeding can occur. Your doctor may give you antibiotics before the procedure to reduce the risk of infections. About a month after the cystolitholapaxy, your doctor will likely check to make sure that no stone fragments remain in your bladder.

Surgical removal
Occasionally, bladder stones that are large or too hard to break up are removed through open surgery. In these cases, your doctor makes an incision in your bladder and directly removes the stones. Any underlying condition causing the stones, such as an enlarged prostate, may be corrected at the same time.

Read more...

Black, hairy tongue

Black, hairy tongue

Definition:

Black, hairy tongue is a temporary, harmless (benign), painless oral condition that gives your tongue a dark, furry appearance. The distinct look of black, hairy tongue usually results from an overgrowth of bacteria in the mouth.

Although black, hairy tongue may look alarming, it doesn't cause any health problems. Black, hairy tongue usually resolves without medical treatment.

Symptoms:

Signs and symptoms of black, hairy tongue include:

• Black, yellow or brown discoloration of the tongue
• A hairy or furry appearance of the tongue
• Altered taste or metallic taste in mouth
• Bad breath (halitosis)
• Gagging sensation in some people

When to see a doctor
Though unattractive, black, hairy tongue is usually a temporary, harmless condition. See your doctor if:

• You're concerned about the appearance of your tongue
• Your signs and symptoms persist for more than 10 days

Causes:

Black, hairy tongue typically results when projections on the tongue called papillae grow longer (elongate) and don't shed like normal. This makes the tongue look hairy. Debris, bacteria or other organisms can collect on the papillae and result in black, yellow or brown discoloration.
The cause of black, hairy tongue can't always be determined. However, potential causes include:

• Changes in the normal bacteria or yeast content of the mouth following antibiotic use
• Poor oral hygiene
• Breathing through your mouth
• Medications containing bismuth, such as Pepto-Bismol
• Regular use of mouthwashes containing oxidizing agents, such as peroxide, or astringent agents, such as witch hazel or menthol
• Heavy tobacco use

Treatments and drugs:

Black, hairy tongue typically doesn't require medical treatment. Though unattractive, it's a temporary, harmless condition.

Practicing good oral hygiene and eliminating factors that potentially contribute to the condition — such as tobacco use or medications that contain bismuth — help resolve black, hairy tongue. Talk to your doctor or dentist before discontinuing a prescribed medication.

Read more...

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.

Read more...