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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Baker's cyst

Baker's cyst

Definition:

A Baker's cyst is a fluid-filled cyst that causes a bulge and a feeling of tightness behind your knee. The pain can get worse when you fully flex or extend your knee or when you're active.

A Baker's cyst, also called a popliteal (pop-LIT-e-ul) cyst, is usually the result of a problem with your knee joint, such as arthritis or a cartilage tear. Both conditions can cause your knee to produce too much fluid, which can lead to a Baker's cyst.

Although a Baker's cyst may cause swelling and make you uncomfortable, treating the probable underlying problem usually provides relief.


Symptoms:

In some cases, a Baker's cyst causes no pain, and you may not even notice it. If you do experience signs and symptoms, you may notice:

• Swelling behind your knee, and sometimes in your leg
• Knee pain
• Stiffness

Your symptoms may be worse after you've been active, or even if you've just been standing for a long time.
When to see a doctor
If you're experiencing pain and swelling behind your knee, see your doctor to determine the cause. Though unlikely, a bulge behind your knee may be a sign of a more serious condition rather than a fluid-filled cyst.

Causes:

A lubricating fluid called synovial (sih-NO-vee-ul) fluid helps your leg swing smoothly and reduces friction between the moving parts of your knee.

But, sometimes the knee produces too much synovial fluid, resulting in buildup of fluid in an area on the back of your knee (popliteal bursa), causing a Baker's cyst. This can happen because of:

• Inflammation of the knee joint, such as occurs with various types of arthritis
• A knee injury, such as a cartilage tear

Complications:


Rarely, a Baker's cyst bursts and synovial fluid leaks into the calf region, causing:

• Sharp pain in your knee
• Swelling
• Sometimes, redness of your calf or a feeling of water running down your calf

These signs and symptoms closely resemble those of a blood clot in a vein in your leg. If you have swelling and redness of your calf, you'll need prompt medical evaluation to rule out a more serious cause of your symptoms.

Treatments and drugs:

Many times, no treatment is required and a Baker's cyst will disappear on its own.
If the cyst is very large and causes a lot of pain, your doctor may use the following treatments:

• Medication. Your doctor may inject a corticosteroid medication, such as cortisone, into your knee to reduce inflammation. This may relieve pain, but it doesn't always prevent recurrence of the cyst.
  
• Fluid drainage. Your doctor may drain the fluid from the knee joint using a needle. This is called needle aspiration and is often performed under ultrasound guidance.
  
• Physical therapy. Icing, a compression wrap and crutches may help reduce pain and swelling. Gentle range-of-motion and strengthening exercises for the muscles around your knee also may help to reduce your symptoms and preserve knee function.

Typically though, doctors treat the underlying cause rather than the Baker's cyst itself.
If your doctor determines that a cartilage tear is causing the overproduction of synovial fluid, he or she may recommend surgery to remove or repair the torn cartilage.

Baker's cysts associated with osteoarthritis may stay swollen even if you're receiving arthritis treatment. You and your doctor may discuss surgery to remove the cyst if it doesn't resolve and it affects your joint movement. Baker's cyst removal may be an option for a cyst that repeatedly refills after you have it drained with a needle.

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Bad breath

Bad breath

Definition:

Bad breath, also called halitosis, can be embarrassing and in some cases may even cause anxiety. It's no wonder that store shelves are overflowing with gum, mints, mouthwashes and other products designed to fight bad breath. But many of these products are only temporary measures because they don't address the cause of the problem.

Certain foods, health conditions and habits are among the causes of bad breath. In many cases, you can improve bad breath with consistent proper dental hygiene. If simple self-care techniques don't solve the problem, see your dentist or physician to be sure a more serious condition isn't causing your bad breath.

Symptoms:

Bad breath odors vary, depending on the source or the underlying cause. Some people worry too much about their breath even though they have little or no mouth odor, while others have bad breath and don't know it. Because it's difficult to assess how your own breath smells, ask a close friend or relative to confirm your bad-breath questions.

When to see a doctor
If you have bad breath, review your oral hygiene habits. Try making lifestyle changes, such as brushing your teeth and tongue after eating, using dental floss, and drinking plenty of water.
If your bad breath persists after making such changes, see your dentist. If your dentist suspects a more serious condition is causing your bad breath, he or she may refer you to a physician to find the cause of the odor.


Causes:

Most bad breath starts in your mouth, and there are many possible causes. They include:

• Food. The breakdown of food particles in and around your teeth can increase bacteria and cause a foul odor. Eating certain foods, such as onions, garlic, and other vegetables and spices, also can cause bad breath. After you digest these foods, they enter your bloodstream, are carried to your lungs and affect your breath.
  
• Tobacco products. Smoking causes its own unpleasant mouth odor. Smokers and oral tobacco users are also more likely to have gum disease, another source of bad breath.
  
• Poor dental hygiene. If you don't brush and floss daily, food particles remain in your mouth, causing bad breath. A colorless, sticky film of bacteria (plaque) forms on your teeth and if not brushed away, plaque can irritate your gums (gingivitis) and eventually form plaque-filled pockets between your teeth and gums (periodontitis). The uneven surface of the tongue also can trap bacteria that produce odors. And dentures that aren't cleaned regularly or don't fit properly can harbor odor-causing bacteria and food particles.
  
• Dry mouth. Saliva helps cleanse your mouth, removing particles that may cause bad odors. A condition called dry mouth — also known as xerostomia (zeer-o-STOE-me-ah) — can contribute to bad breath because production of saliva is decreased. Dry mouth naturally occurs during sleep, leading to "morning breath," and is made worse if you sleep with your mouth open. Some medications can lead to a chronic dry mouth, as can a problem with your salivary glands and some diseases.
  
• Infections in your mouth. Bad breath can be caused by surgical wounds after oral surgery, such as tooth removal, or as a result of tooth decay, gum disease or mouth sores.
  
• Other mouth, nose and throat conditions. Bad breath can occasionally stem from small stones that form in the tonsils and are covered with bacteria that produce odorous chemicals. Infections or chronic inflammation in the nose, sinuses or throat, which can contribute to postnasal drip, also can cause bad breath.
  
• Medications. Some medications can indirectly produce bad breath by contributing to dry mouth. Others can be broken down in the body to release chemicals that can be carried on your breath.
  
• Other causes. Diseases, such as some cancers, and conditions such as metabolic disorders, can cause a distinctive breath odor as a result of chemicals they produce. Chronic reflux of stomach acids (gastroesophageal reflux disease) can be associated with bad breath. Bad breath in young children may be caused by a foreign body, such as a small toy or piece of food, lodged in a nostril.

Treatments and drugs:

To reduce bad breath, help avoid cavities and lower your risk of gum disease, consistently practice good oral hygiene. Further treatment for bad breath can vary, depending on the cause. If your bad breath is thought to be caused by an underlying health condition, your dentist will likely refer you to your primary care physician.
For causes related to oral health, your dentist will work with you to help you better control that condition. Dental measures may include:

• Mouth rinses and toothpastes. If your bad breath is due to a buildup of bacteria (plaque) on your teeth, your dentist may recommend a mouth rinse that kills the bacteria. Mouth rinses containing cetylpyridinium chloride and those with chlorhexidine can prevent production of odors that cause bad breath. Your dentist may also recommend a toothpaste that contains an antibacterial agent to kill the bacteria that cause plaque buildup.
  
• Treatment of dental disease. If your dentist discovers that you have gum disease, you may be referred to a gum specialist (periodontist). Gum disease can cause the gums to pull away from the teeth, leaving deep pockets that accumulate odor-causing bacteria. Sometimes these bacteria can be removed only by professional cleaning. Your dentist might also recommend replacing faulty tooth restorations, which can be a breeding ground for bacteria.

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Broken heart syndrome

Broken heart syndrome

Definition:

Add caption

Broken heart syndrome is a temporary heart condition brought on by stressful situations, such as the death of a loved one. People with broken heart syndrome may have sudden chest pain or think they're having a heart attack.

These broken heart syndrome symptoms may be brought on by the heart's reaction to a surge of stress hormones. In broken heart syndrome, a part of your heart temporarily enlarges and doesn't pump well, while the remainder of the heart functions normally or with even more forceful contractions.

The condition was originally called takotsubo cardiomyopathy. Today, it's also referred to as stress cardiomyopathy, stress-induced cardiomyopathy or apical ballooning syndrome.
The symptoms of broken heart syndrome are treatable, and the condition usually reverses itself in about a week.

Causes:


The exact cause of broken heart syndrome is unclear. It's thought that a surge of stress hormones, such as adrenaline, might temporarily damage the hearts of some people. How these hormones might hurt the heart or whether something else is responsible isn't completely clear. A temporary constriction of the large or small arteries of the heart may play a role.
Broken heart syndrome is often preceded by an intense physical or emotional event. Some potential triggers of broken heart syndrome are:

• News of an unexpected death of a loved one
• A frightening medical diagnosis
• Domestic abuse
• Losing a lot of money
• A surprise party
• Having to perform publicly
• Physical stressors, such as an asthma attack, infection, a car accident or major surgery

How is broken heart syndrome different from a heart attack?
Most heart attacks are caused by a complete or near complete blockage of a heart artery. This blockage is due to a blood clot forming at the site of narrowing from fatty buildup (atherosclerosis) in the wall of the artery. In broken heart syndrome, the heart arteries are not blocked, although blood flow in the arteries of the heart may be reduced.

Complications:

In rare cases, broken heart syndrome is fatal. However, most who experience broken heart syndrome quickly recover and don't have long-lasting effects.
Other complications of broken heart syndrome include:

• Disruptions in your heartbeat
• A fast or slow heartbeat
• Backup of fluid into your lungs (pulmonary edema)

It's also possible that you may have broken heart syndrome again if you have another stressful event.

Treatments and drugs:

There are no standard treatment guidelines for treating broken heart syndrome. Treatment is similar to treatment for a heart attack until the diagnosis is clear. Most people stay in the hospital while they recover.

Once it's clear that broken heart syndrome is the cause of your symptoms, your doctor will likely prescribe heart medications for you to take while you're in the hospital, such as angiotensin-converting enzyme (ACE) inhibitors, beta blockers or diuretics. These medications help reduce the workload on your heart while you recover and may help prevent further attacks. Many patients make a full recovery within one to two months. Ask your doctor how long you will need to continue taking these medications once you recover.

Procedures that are often used to treat a heart attack, such as balloon angioplasty and stent placement, or even surgery, are not helpful in treating broken heart syndrome. These procedures treat blocked arteries, which are not the cause of broken heart syndrome. However, coronary angiography is often used to diagnose exactly what's the cause of the chest pain.

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