Antibiotic-associated diarrhea

Antibiotic-associated diarrhea

Definition:

Antibiotic-associated diarrhea describes frequent, watery bowel movements (diarrhea) that occur in response to medications used to treat bacterial infections (antibiotics).

Most often, antibiotic-associated diarrhea is mild and clears up shortly after stopping the antibiotic. But in some cases, antibiotic-associated diarrhea leads to colitis, an inflammation of your colon, or a more serious form of colitis called pseudomembranous colitis. Both can cause abdominal pain, fever and bloody diarrhea.

Mild antibiotic-associated diarrhea may not require treatment. More serious antibiotic-associated diarrhea may require stopping or switching antibiotic medications.

Symptoms:

Antibiotic-associated diarrhea can cause signs and symptoms that range from mild to severe.

Common signs and symptoms
For most people, antibiotic-associated diarrhea causes mild signs and symptoms, such as:

• Loose stools
• More frequent bowel movements

Antibiotic-associated diarrhea is likely to begin about five to 10 days after starting antibiotic therapy. Sometimes, however, diarrhea and other symptoms may not appear for days or even weeks after you've finished antibiotic treatment.

More serious signs and symptoms
Some people experience a more serious form of antibiotic-associated diarrhea. When the overgrowth of harmful bacteria is severe, you may have signs and symptoms of colitis or pseudomembranous colitis, such as:

• Frequent, watery diarrhea
• Abdominal pain and cramping
• Fever
• Pus in your stool
• Bloody stools
• Nausea

When to see a doctor
Call your doctor right away if you experience signs and symptoms of serious antibiotic-associated diarrhea. These signs and symptoms are common to a number of conditions, so your doctor may recommend tests to determine the cause.

Causes:

Antibiotic-associated diarrhea occurs when antibacterial medications (antibiotics) upset the balance of good and bad bacteria in your gastrointestinal tract.

The antibiotics most likely to cause diarrhea
Nearly all antibiotics can cause antibiotic-associated diarrhea, colitis or pseudomembranous colitis. The antibiotics most commonly linked to antibiotic-associated diarrhea include:

• Cephalosporins, such as cefixime (Suprax) and cefpodoxime (Vantin)
• Clindamycin (Cleocin)
• Erythromycin (Erythrocin, E.E.S., others)
• Penicillins, such as amoxicillin (Larotid, Moxatag, others) and ampicillin
• Quinolones, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin)
• Tetracyclines, such as doxycycline (Vibramycin, Periostat, others) and minocycline (Minocin, Solodyn, others)

How antibiotics cause diarrhea
Your digestive tract is a complex ecosystem that's home to millions of microorganisms (intestinal flora), including hundreds of species of bacteria. Many of these bacteria are beneficial, performing essential functions. But some of the bacteria that normally inhabit your intestinal tract are potentially dangerous. The bad bacteria are usually kept in check by beneficial bacteria unless the delicate balance between the two is disturbed by illness, medications or other factors.

Antibiotics can be especially disruptive to intestinal flora because they destroy beneficial bacteria along with harmful ones. Without enough "good" microorganisms, "bad" bacteria that are resistant to the antibiotic you received grow out of control, producing toxins that can damage the bowel wall and trigger inflammation.

Clostridium difficile causes most serious antibiotic-associated diarrhea
The bacterium responsible for almost all cases of pseudomembranous colitis and many instances of severe antibiotic-associated diarrhea is C. difficile. Most people acquire a C. difficile infection during a stay in a hospital or nursing home after they've received antibiotics.


Complications:

The most severe form of antibiotic-associated diarrhea, pseudomembranous colitis, can lead to life-threatening complications, including:

• Dehydration. Severe diarrhea can lead to excessive loss of fluids and electrolytes — essential substances such as sodium and potassium. Extreme fluid loss can cause serious complications. Signs and symptoms of dehydration include a very dry mouth, intense thirst, little or no urination, and extreme weakness.
  
• A hole in your bowel (bowel perforation). Extensive damage to the lining of your large intestine can lead to a perforation in the wall of your intestine.
  
• Toxic megacolon. In this condition, your colon becomes unable to expel gas and stool, causing it to become greatly distended (megacolon). Signs and symptoms of toxic megacolon include abdominal pain and swelling, fever, and weakness. Toxic megacolon is a serious complication that can lead to infection or a ruptured colon. Toxic megacolon requires aggressive treatment, usually with medications. 

Treatments and drugs:

Treatment for antibiotic-associated diarrhea depends on the severity of your signs and symptoms.

Treatments to cope with mild antibiotic-associated diarrhea
If you have mild diarrhea, your symptoms may clear up within a few days after your antibiotic treatment ends. In some cases your doctor may advise you to stop your antibiotic therapy until your diarrhea subsides. In the meantime, your doctor may recommend home care techniques to help you cope with diarrhea until it resolves on its own.

Treatment to fight bad bacteria in severe antibiotic-associated diarrhea
If you experience colitis or pseudomembranous colitis, your doctor may recommend antibiotics to kill the bad bacteria causing your antibiotic-associated diarrhea. For many people, this antibiotic targeted at the bad bacteria will clear up signs and symptoms. For those with pseudomembranous colitis, diarrhea symptoms may return and require repeated treatment.

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Anthrax

Anthrax

Definition:

Anthrax is a serious illness caused by a spore-forming bacterium, Bacillus anthracis. Although anthrax affects mainly livestock and wild game, humans can become infected through direct or indirect contact with sick animals. Normally, anthrax isn't transmitted from person to person, but in rare cases, anthrax skin lesions may be contagious.

Most often, anthrax bacteria enter your body through a wound in your skin. You can also become infected by eating contaminated meat or inhaling the spores. Signs and symptoms, which depend on the way you're infected, can range from skin sores to nausea and vomiting or shock.
Prompt treatment with antibiotics can cure most anthrax infections contracted through the skin or contaminated meat. Inhaled anthrax is more difficult to treat and can be fatal.

Symptoms:

There are three types of anthrax, each with different signs and symptoms. In most cases, symptoms develop within seven days of exposure to the bacteria.
Cutaneous anthrax
This form of anthrax enters your body through a cut or other sore on your skin. It's by far the most common form of the disease. It's also the mildest — with appropriate treatment, cutaneous anthrax is seldom fatal. Signs and symptoms of cutaneous anthrax include:

• A raised, itchy bump resembling an insect bite that quickly develops into a painless sore with a black center
• Swelling in the sore and nearby lymph glands

Gastrointestinal anthrax
You contract this form of anthrax by eating undercooked meat from an infected animal. Signs and symptoms include:

• Nausea
• Vomiting, which is often bloody in the later stages of the disease
• Loss of appetite
• Fever
• Severe, bloody diarrhea in the later stages of the disease
• Sore throat and difficulty swallowing
• Swollen neck

Inhalation (pulmonary) anthrax
Inhalation anthrax develops when you breathe in anthrax spores. It's the most deadly form of the disease, and even with treatment it is often fatal. Initial signs and symptoms of inhalation anthrax include:

• Flu-like symptoms, such as sore throat, mild fever, fatigue and muscle aches, which may last a few hours or days
• Mild chest discomfort

As the disease progresses, you may experience:

• High fever
• Trouble breathing
• Shock
• Meningitis — a potentially life-threatening inflammation of the brain and spinal cord

When to see a doctor
Many common illnesses start with symptoms that resemble the flu. Anthrax is rare in the developed world, and the chances that your sore throat and aching muscles are due to anthrax are extremely small.
If you think you may have been exposed — for example, if you work in an environment where anthrax is likely to occur — see a doctor immediately for evaluation and care. If you develop signs and symptoms of the disorder after exposure to animals or animal products in parts of the world where anthrax is common, seek prompt medical attention. Early diagnosis and treatment are crucial.


Causes:

Anthrax spores are formed by anthrax bacteria that occur naturally in soil in most parts of the world. The spores can remain dormant for years until they find their way into a host — usually wild or domestic livestock, such as sheep, cattle, horses, goats and camels. Although rare in the United States, anthrax is still common throughout the developing world, such as in Iran, Iraq, Turkey, Pakistan and sub-Saharan Africa.

Most human cases of anthrax occur as a result of exposure to infected animals or their meat or hides. In the United States, a few people have developed anthrax while making traditional African drums from the skins of infected animals.

One of the few known instances of non-animal transmission occurred in the United States in 2001 when 22 people developed anthrax after being exposed to spores sent through the mail. Five of those who were infected died.

Complications:

The most serious complication of anthrax is a fatal inflammation of the membranes and fluid covering the brain and spinal cord, leading to massive bleeding (hemorrhagic meningitis).


Treatments and drugs:

The standard treatment for anthrax is a 60-day course of an antibiotic, such as ciprofloxacin or doxycycline. Which single antibiotic or combination of antibiotics will be most effective for you depends on the type of anthrax you have, your age, overall health and other factors. Treatment is most effective when started as soon as possible.
Although some cases of anthrax respond to antibiotics, advanced inhalation anthrax may not. By the later stages of the disease, the bacteria have often produced more toxins than drugs can eliminate.

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Anorgasmia in women

Anorgasmia in women

Definition  :

Anorgasmia is the medical term for regular difficulty reaching orgasm after ample sexual stimulation, causing you personal distress. Anorgasmia is actually a common occurrence, affecting more women than you might think.

Orgasms vary in intensity, and women vary in the frequency of their orgasms and the amount of stimulation necessary to trigger an orgasm. In fact, fewer than a third of women consistently have orgasms with sexual activity. Plus, orgasms often change with age, medical issues or medications you're taking.

If you're happy with the climax of your sexual activities, there's no need for concern. However, if you're bothered by lack of orgasm or the intensity of your orgasms, talk to your doctor about anorgasmia. Lifestyle changes and sex therapy may help.

Symptoms:

An orgasm is a feeling of intense physical pleasure and release of tension, accompanied by involuntary, rhythmic contractions of your pelvic floor muscles. But it doesn't always look — or sound — like that famous scene from "When Harry Met Sally." Some women actually feel pelvic contractions or a quivering of the uterus during orgasm, but some don't. Some women describe fireworks all over the body, while others describe the feeling as a tingle.

By definition, the major symptoms of anorgasmia are inability to experience orgasm or long delays in reaching orgasm. But there are different types of anorgasmia:

• Primary anorgasmia. This means you've never experienced an orgasm.
• Secondary anorgasmia. This means you used to have orgasms, but now experience difficulty reaching climax.
• Situational anorgasmia. This means you are able to orgasm only during certain circumstances, such as during oral sex or masturbation. This is very common in women. In fact, most women experience orgasm only from stimulation of the clitoris.
• General anorgasmia. This means you aren't able to orgasm in any situation or with any partner.

When to see a doctor
Talk to your doctor if you have questions about orgasm or concerns about your ability to reach orgasm. You may find that your sexual experiences are normal. Or your doctor may recommend strategies to reduce your anxiety and increase your satisfaction.

Causes:

Despite what you see in the movies, orgasm is no simple, sure thing. This pleasurable peak is actually a complex reaction to many physical, emotional and psychological factors. If you're experiencing trouble in any of these areas, it can affect your ability to orgasm.
Physical causes
A wide range of illnesses, physical changes and medications can interfere with orgasm:

• Medical diseases. Any illness can affect this part of the human sexual response cycle, including diabetes and neurological diseases, such as multiple sclerosis.
• Gynecologic issues. Orgasm may be affected by gynecologic surgeries, such as hysterectomy or cancer surgeries. In addition, lack of orgasm often goes hand in hand with other sexual concerns, such as uncomfortable or painful intercourse.
• Medications. Many prescription and over-the-counter medications can interfere with orgasm, including blood pressure medications, antihistamines and antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs).
• Alcohol and drugs. Too much alcohol can cramp your ability to climax; the same is true of street drugs.
• The aging process. As you age, normal changes in your anatomy, hormones, neurological system and circulatory system can affect your sexuality. A tapering of estrogen levels during the transition to menopause can decrease sensations in the clitoris, nipples and skin; blood flow to the vagina and clitoris also may be impeded, which can delay or stop orgasm entirely.

Psychological causes
Many psychological factors play a role in your ability to orgasm, including:

• Mental health problems, such as anxiety or depression
• Performance anxiety
• Stress and financial pressures
• Cultural and religious beliefs
• Fear of pregnancy or sexually transmitted diseases
• Embarrassment
• Guilt about enjoying sexual experiences

Relationship issues
Many couples who are experiencing problems outside of the bedroom will also experience problems in the bedroom. These overarching issues may include:

• Lack of connection with your partner
• Unresolved conflicts or fights
• Poor communication of sexual needs and preferences
• Infidelity or breach of trust

Treatments and drugs:

It can be difficult to treat anorgasmia. Your treatment plan will depend on the underlying cause of your symptoms, but your doctor may recommend a combination of lifestyle changes, therapy and medication.

Lifestyle changes and therapy
For most women, a key part of treatment includes addressing relationship issues and everyday stressors. Understanding your body and trying different types of sexual stimulation also can help.

• Understand your body better. Understanding your own anatomy and how you like to be touched can lead to better sexual satisfaction. If you need a refresher course on your genital anatomy, ask your doctor for a diagram or get out a mirror and look. Then take some time to explore your own body. Masturbating or using a vibrator can help you discover what type of touching feels best to you, and then you can share that information with your partner. If you're uncomfortable with self-exploration, try exploring your body with your partner.
• Increase sexual stimulation. Many women who've never had an orgasm aren't getting enough effective sexual stimulation. Most women need direct or indirect stimulation of the clitoris in order to orgasm, but not all women realize this. Switching sexual positions can produce more clitoral stimulation during intercourse; some positions also allow for you or your partner to gently touch your clitoris during sex. Using a vibrator during sex also can help trigger an orgasm.
• Seek couples counseling. Conflicts and disagreements in your relationship can affect your ability to orgasm. A counselor can help you work through disagreements and tensions and get your sex life back on track.
• Try sex therapy. Sex therapists are therapists who specialize in treating sexual concerns. You may be embarrassed or nervous about seeing a sex therapist, but sex therapists can be very helpful in treating anorgasmia. Therapy often includes sex education, help with communication skills, and behavioral exercises that you and your partner try at home.
  
  For example, you and your partner may be asked to practice "sensate focus" exercises, a specific set of body-touching exercises that teach you how to touch and pleasure your partner without focusing on orgasm. Or you and your partner may learn how to combine a situation in which you reach orgasm — such as clitoral stimulation — with a situation in which you desire to reach orgasm, such as intercourse. By using these techniques and others, you may learn to view orgasm as one pleasurable part of sexual intimacy, not the whole goal of every sexual encounter.
  

Medical treatments
Hormone therapies aren't a guaranteed fix for anorgasmia. But they can help. So can treating underlying medical conditions.

• Treating underlying conditions. If a medical condition is hindering your ability to orgasm, treating the underlying cause may resolve your problem. Changing or modifying medications known to inhibit orgasm also may eliminate your symptoms.
• Estrogen therapy. Systemic estrogen therapy — by pill, patch or gel — can have a positive effect on brain function and mood factors that affect sexual response. Local estrogen therapy — in the form of a vaginal cream or a slow-releasing suppository or ring that you place in your vagina — can increase blood flow to the vagina and help improve desire. In some cases, your doctor may prescribe a combination of estrogen and progesterone.
• Testosterone therapy. Male hormones, such as testosterone, play an important role in female sexual function, even though testosterone occurs in much lower amounts in a woman. As a result, testosterone may help increase orgasm, especially if estrogen and progesterone aren't helping. However, replacing testosterone in women is controversial and it's not approved by the Food and Drug Administration for sexual dysfunction in women. Plus, it can cause negative side effects, including acne, excess body hair (hirsutism), and mood or personality changes. Testosterone seems most effective for women with low testosterone levels as a result of surgical removal of the ovaries (oophorectomy). If you choose to use this therapy, your doctor will closely monitor your symptoms to make sure you're not experiencing negative side effects.

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Anorexia nervosa

Anorexia nervosa

Definition:

Anorexia nervosa is an eating disorder that causes people to obsess about their weight and the food they eat. People with anorexia nervosa attempt to maintain a weight that's far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively.

Anorexia (an-oh-REK-see-uh) nervosa isn't really about food. It's an unhealthy way to try to cope with emotional problems. When you have anorexia nervosa, you often equate thinness with self-worth.
Anorexia nervosa can be difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of anorexia's serious complications.


Symptoms:

Some people with anorexia lose weight mainly through severely restricting the amount of food they eat. They may also try to lose weight by exercising excessively. Others with anorexia binge and purge, similar to bulimia. They control calorie intake by vomiting after eating or by misusing laxatives, diuretics or enemas.

No matter how weight loss is achieved, anorexia has a number of physical, emotional and behavioral signs and symptoms.

Physical anorexia symptoms
Physical signs and symptoms of anorexia include:

• Extreme weight loss
• Thin appearance
• Abnormal blood counts
• Fatigue
• Insomnia
• Dizziness or fainting
• A bluish discoloration of the fingers
• Hair that thins, breaks or falls out
• Soft, downy hair covering the body
• Absence of menstruation
• Constipation
• Dry skin
• Intolerance of cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration
• Osteoporosis
• Swelling of arms or legs

Emotional and behavioral anorexia symptoms
Emotional and behavioral characteristics associated with anorexia include:

• Refusal to eat
• Denial of hunger
• Afraid of gaining weight
• Lying about how much food has been eaten
• Excessive exercise
• Flat mood (lack of emotion)
• Social withdrawal
• Irritability
• Preoccupation with food
• Reduced interest in sex
• Depressed mood
• Possible use of laxatives, diet aids or herbal products

When to see doctor
Anorexia, like other eating disorders, can take over your life. You may think about food all the time, spend hours agonizing over options in the grocery store and exercise to exhaustion. You also may have a host of physical problems that make you feel generally miserable, such as dizziness, constipation,
fatigue and frequently feeling cold. You may feel irritable, angry, moody, sad, anxious and hopeless.

You might visit pro-anorexia websites, refer to the disease as your "friend," cover up in layers of heavy clothing, and try to get by on a menu of lettuce, carrots, popcorn and diet soda.

If you're experiencing any of these problems, or if you think you may have an eating disorder, get help. If you're hiding your anorexia from loved ones, try to find a confidant you can talk to about what's going on.

Anorexia red flags to watch for
It may be hard to notice signs and symptoms of anorexia because people with anorexia often go to great lengths to disguise their thinness, eating habits or physical problems.
If you're concerned that a loved one may have anorexia, watch for these possible red flags:

• Skipping meals
• Making excuses for not eating
• Eating only a few certain "safe" foods, usually those low in fat and calories
• Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing
• Cooking elaborate meals for others but refusing to eat
• Repeated weighing of themselves
• Frequent checking in the mirror for perceived flaws
• Complaining about being fat
• Not wanting to eat in public

Unfortunately, many people with anorexia don't want treatment, at least initially. Their desire to remain thin overrides concerns about their health. If you have a loved one you're worried about, urge her or him to talk to a doctor.

Causes:

The exact cause of anorexia nervosa is unknown. As with many diseases, it's probably a combination of biological, psychological and environmental factors.

• Biological. There may be genetic changes that make some people more vulnerable to developing anorexia. However, it's not clear specifically how your genes could cause anorexia. It may be that some people have a genetic tendency toward perfectionism, sensitivity and perseverance, all traits associated with anorexia. There's also some evidence that serotonin — one of the brain chemicals involved in depression — may play a role in anorexia.
  
• Psychological. Some emotional characteristics may contribute to anorexia. Young women may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which means they may never think they're thin enough.
  
• Environmental. Modern Western culture emphasizes thinness. The media are splashed with images of thin models and actors. Success and worth are often equated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls.

Complications:

Anorexia can have numerous complications. At its most severe, it can be fatal. Death may occur suddenly — even when someone is not severely underweight. This may result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body.
Complications of anorexia include:

• Death
• Anemia
• Heart problems, such as mitral valve prolapse, abnormal heart rhythms and heart failure
• Bone loss, increasing risk of fractures later in life
• In females, absence of a period
• In males, decreased testosterone
• Gastrointestinal problems, such as constipation, bloating or nausea
• Electrolyte abnormalities, such as low blood potassium, sodium and chloride
• Kidney problems

If a person with anorexia becomes severely malnourished, every organ in the body can be damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even when the anorexia is under control.
In addition to the host of physical complications, people with anorexia also commonly have other mental disorders as well. They may include:

• Depression
• Anxiety disorders
• Personality disorders
• Obsessive-compulsive disorders
• Drug abuse

Treatments and drugs:

When you have anorexia, you may need several types of treatment. If your life is in immediate danger, you may need treatment in a hospital emergency room for such issues as a heart rhythm disturbance, dehydration, electrolyte imbalances or psychiatric problems.
Here's a look at what's commonly involved in treating people with anorexia:

Medical care
Because of the host of complications anorexia causes, you may need frequent monitoring of vital signs, hydration level and electrolytes, as well as related physical conditions. In severe cases, people with anorexia may initially require feeding through a tube that's placed in their nose and goes to the stomach (nasogastric tube). A primary care doctor may be the one who coordinates care with the other health care professionals involved. Sometimes, though, it's the mental health provider who coordinates care.

Restoring a healthy weight
The first goal of treatment is getting back to a healthy weight. You can't recover from an eating disorder without restoring an appropriate weight and learning proper nutrition. A psychologist can work with you to develop behavioral strategies to help you return to a healthy weight. A dietitian can offer guidance on a healthy diet, including providing specific meal plans and calorie requirements that will help you meet your weight goals. Your family will also likely be involved in helping you maintain healthy-eating habits.

Psychotherapy
Individual, family-based and group therapy may all be beneficial.

• Individual therapy. This type of therapy can help you deal with the behavior and thoughts that contribute to anorexia. You can gain a healthier self-esteem and learn positive ways to cope with distress and other strong feelings. A type of talk therapy called cognitive behavioral therapy (CBT) is commonly used. Therapy may be done in day treatment programs, but in some cases, may be part of treatment in a psychiatric hospital.
  
• Family-based therapy. This therapy begins with the assumption that the person with the eating disorder is no longer capable of making sound decisions regarding his or her health and needs help from the family. An important part of family-based therapy is that the family is involved in making sure that healthy-eating patterns are followed. This type of therapy can help resolve family conflicts and muster support from concerned family members. Family-based therapy can be especially important for children with anorexia who still live at home.
  
• Group therapy. This type of therapy gives you a way to connect to others facing eating disorders. And informal support groups may sometimes be helpful. However, be careful with informal groups that aren't led by a mental health professional. For some people with anorexia, support groups might result in competitions to be the thinnest person there.

Medications
There are no medications specifically designed to treat anorexia because they haven't been found to work very well. However, antidepressants or other psychiatric medications can help treat other mental disorders you may also have, such as depression or anxiety.

Hospitalization
In cases of medical complications, psychiatric emergencies, severe malnutrition or continued refusal to eat, hospitalization may be needed. Hospitalization may be on a medical or psychiatric ward. Some clinics specialize in treating people with eating disorders. Some may offer day programs or residential programs, rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time. Also, even after hospitalization ends, ongoing therapy and nutrition education are highly important to continued recovery.

Treatment challenges in anorexia
Some cases of anorexia are much more severe than others. Less severe cases may take less time for treatment and recovery. One of the biggest challenges in treating anorexia is that people may not want treatment, may think they don't need it or may be concerned about weight gain. And, some people with anorexia don't see it as an illness, but instead promote it as a lifestyle choice.

Even if you do want to get better, the pull of anorexia can be difficult to overcome. Anorexia is often an ongoing, lifelong battle. Although symptoms may subside, you remain vulnerable and may have a relapse during periods of high stress or during triggering situations. For example, anorexia symptoms may go away during pregnancy only to return once your baby has been delivered. Ongoing therapy or periodic appointments during times of stress may be helpful.

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Ankylosing spondylitis

Ankylosing spondylitis

Definition:

Ankylosing spondylitis is an inflammatory disease that can cause some of the vertebrae in your spine to fuse together. This fusing makes the spine less flexible and can result in a hunched-forward posture. A severe case of ankylosing spondylitis can make it impossible for you to lift your head high enough to see forward.

Ankylosing spondylitis affects men more often than women. Signs and symptoms of ankylosing spondylitis typically begin in early adulthood. Inflammation also can occur in other parts of your body — such as your eyes and bowels.
There is no cure for ankylosing spondylitis, but treatments can decrease your pain and lessen your symptoms.


Symptoms:

Early signs and symptoms of ankylosing spondylitis may include pain and stiffness in your lower back and hips, especially in the morning and after periods of inactivity.
These symptoms may come on so gradually that you don't notice them at first. Over time, symptoms may worsen, improve or stop completely at irregular intervals.
The areas most commonly affected are:

• The joint between the base of your spine and your pelvis
• The vertebrae in your lower back
• The places where your tendons and ligaments attach to bones, mainly in your spine, but sometimes along the back of your heel
• The cartilage between your breastbone and ribs
• Your hip and shoulder joints

When to see a doctor
See your doctor if you have chronic pain and stiffness in your lower back and hips, or if deep breathing makes your chest hurt. Seek immediate medical advice if you develop eye pain, light sensitivity or blurred vision.

Causes:

Ankylosing spondylitis has no known specific cause, though genetic factors seem to be involved. In particular, people who have a gene called HLA-B27 are at significantly increased risk of developing ankylosing spondylitis.

As ankylosing spondylitis worsens and the inflammation persists, new bone forms as part of the body's attempt to heal. This new bone gradually bridges the gap between vertebrae and eventually fuses sections of vertebrae together. Those parts of your spine become stiff and inflexible. Fusion can also stiffen your rib cage, restricting your lung capacity and function.

Complications:

Ankylosing spondylitis doesn't follow a set course. The severity of symptoms and development of complications vary widely from person to person. Complications may include:

• Eye inflammation (uveitis). One of the most common complications of ankylosing spondylitis, uveitis can cause rapid-onset eye pain, sensitivity to light and blurred vision. See your doctor right away if you develop these symptoms.
  
• Compression fractures. Some people experience a thinning of their bones during the early stages of ankylosing spondylitis. Weakened vertebrae may crumble, increasing the severity of your stooped posture. Vertebral fractures sometimes can damage the spinal cord and the nerves that pass through the spine.
  
• Difficulty breathing. If ankylosing spondylitis affects your ribs, the fused bones can't move when you breathe — making it difficult to fully inflate your lungs.
  
• Heart problems. Ankylosing spondylitis can cause problems with your aorta, the largest artery in your body. The inflamed aorta can enlarge to the point that it distorts the shape of the aortic valve in the heart, which impairs its function.

Treatments and drugs:

The goal of treatment is to relieve your pain and stiffness, and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage to your joints.

Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen (Aleve, Naprosyn) and indomethacin (Indocin) — are the medications doctors most commonly use to treat ankylosing spondylitis. They can relieve your inflammation, pain and stiffness. However, these medications also can cause gastrointestinal bleeding.

If NSAIDs aren't helpful, your doctor may suggest tumor necrosis factor (TNF) blockers. TNF is a cell protein that acts as an inflammatory agent in rheumatoid arthritis. TNF blockers target this protein to help reduce pain, stiffness, and tender or swollen joints. They are administered by injecting the medication under the skin or through an intravenous line.
Examples of TNF blockers include:

• Adalimumab (Humira)
• Etanercept (Enbrel)
• Infliximab (Remicade)
• Golimumab (Simponi)

TNF blockers can reactivate latent tuberculosis and may cause certain neurological problems.

Therapy
Physical therapy can provide a number of benefits, from pain relief to improved physical strength and flexibility. Your doctor may recommend that you meet with a physical therapist to provide you with specific exercises designed for your needs.

Range-of-motion and stretching exercises can help maintain flexibility in your joints and preserve good posture. In addition, specific breathing exercises can help to sustain and enhance your lung capacity.
As your condition worsens, your upper body may begin to stoop forward. Proper sleep and walking positions and abdominal and back exercises can help maintain your upright posture. Even if portions of your spine eventually fuse, you'll be able to get around and perform daily functions more easily if your spine fuses in an upright position.

Surgery
Most people with ankylosing spondylitis don't need surgery. However, your doctor may recommend surgery if you have severe pain or joint damage, or if a hip joint is so damaged that it needs to be replaced.

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Anhidrosis

Anhidrosis 

Definition:

Anhidrosis is the inability to sweat normally. When you don't perspire, your body can't cool itself, which can lead to overheating and sometimes to heatstroke — a potentially fatal condition.

Anhidrosis — sometimes called hypohidrosis — can be difficult to diagnose. Mild anhidrosis often goes unrecognized, and dozens of factors can cause the condition, including skin trauma and certain diseases and medications. You can inherit anhidrosis or develop it later in life.
Treatment of anhidrosis involves addressing the underlying cause, if one can be found.

Symptoms:

Signs and symptoms of anhidrosis include:

• Little or no perspiration
• Dizziness
• Muscle cramps or weakness
• Flushing
• Feeling hot

A lack of perspiration can occur:

• Over most of your body
• In a single area
• In scattered patches

Unaffected areas may try to compensate by producing more perspiration, so it's possible to sweat profusely on one part of your body and very little or not at all on another. Anhidrosis that affects a large portion of your body prevents proper cooling, so vigorous exercise, hard physical work and hot weather can cause heat cramps, heat exhaustion or even heatstroke.

Anhidrosis can develop on its own or as one of several signs and symptoms of another disorder, such as diabetes, neuropathy or psoriasis.

When to see a doctor
If you barely sweat, even when it's hot or you're working or exercising strenuously, talk to your doctor. Talk to your doctor if you notice you're sweating less than usual. Because anhidrosis increases your risk of heatstroke, seek medical care if you develop any signs or symptoms of a heat-related illness, such as:

• Weakness
• Nausea
• Dizziness
• Rapid heartbeat
• Goose pimples on the skin, despite warm temperatures

Causes:

Anhidrosis occurs when your sweat glands stop working, and this can happen for a number of reasons.
Nerve damage
Your autonomic nervous system regulates involuntary actions, such as digestion, heartbeat, blood pressure and body temperature. Injuries to your nerves that control this system can affect the functioning of your sweat glands.
Many illnesses can damage your autonomic nerves, including:

• Ross syndrome, a peripheral nerve disorder
• Diabetes
• Alcoholism
• Parkinson's disease
• Multiple system atrophy, a progressive, neurodegenerative disorder
• Amyloidosis, caused by a buildup of substances called amyloid proteins in your organs
• Sjogren's syndrome, which causes dry eyes and mouth
• Small cell lung cancer
• Rare metabolic disorders, such as Fabry disease
• Horner syndrome, which damages nerves in your face and eye

Skin damage

• Clogged ducts. Skin diseases or conditions that block sweat ducts (poral occlusion) are the most common cause of anhidrosis.
• Skin injuries. Physical injury to your skin, especially from severe burns, can permanently damage your sweat glands.

Certain medications

• Many prescription medications — including some for heart and blood pressure, bladder control, nausea and psychiatric conditions — can reduce sweating.
• Perspiration usually returns to normal when the medications are stopped.
• If you develop anhidrosis after starting a new medication, let your doctor know.

Genetic factors

• Some genetic disorders cause sweat glands to malfunction.
• Hypohidrotic ectodermal dysplasia, an inherited disorder, causes the body to develop with few, if any, sweat glands.

Dehydration
This occurs when your body doesn't have enough fluids to carry out its normal functions. In the most serious cases, dehydration can interfere with your ability to sweat.
Dehydration may be caused by:

• An intense bout of diarrhea and vomiting
• A very high fever
• Excessive sweating without replacing lost fluids
• Increased urination — often as a result of undiagnosed or uncontrolled diabetes mellitus or diabetes insipidus
• Alcohol and certain medications, such as diuretics, antihistamines, blood pressure medications and some psychiatric drugs

Complications:

 Heat-related illnesses are the most serious complications of anhidrosis. Children are especially vulnerable because their core temperatures rise faster than adults, and they dissipate heat less efficiently. All children should be monitored closely for overheating, but extra precautions should be taken when a child has anhidrosis.
Heat-related problems include:

• Heat cramps. These muscle spasms, which can tighten muscles in your legs, arms, abdomen and back, are generally more painful and prolonged than are typical nighttime leg cramps.
  
• Heat exhaustion. Symptoms, such as weakness, nausea and a rapid heartbeat, usually begin after strenuous exercise. Anyone with heat exhaustion should be monitored carefully because symptoms can quickly become worse.
  
• Heatstroke. This life-threatening condition occurs when your body temperature reaches 104 F (40 C) or higher. If not treated immediately, heatstroke can cause hallucinations, loss of consciousness, coma and even death.

Treatments and drugs:

Treatment isn't always necessary
Anhidrosis that affects a small part of your body usually isn't a problem and doesn't need treatment. But large areas of decreased perspiration can be life-threatening. Treatments may be available for the condition that's causing the anhidrosis.

Treating heat-related problems
Overheating needs prompt treatment to prevent symptoms from becoming worse.

Heat cramps
To relieve cramping:

• Rest and cool down.
• Drink cool fruit juice or a sports drink that contains electrolytes.
• Get medical care if cramps become worse or don't go away in about an hour.
• Wait at least several hours before returning to strenuous activity.

Heat exhaustion
When someone develops symptoms of heat exhaustion, such as nausea, dizziness and a rapid heartbeat, act quickly:

• Move the person into a shady or air-conditioned space, and elevate his or her legs slightly.
• Loosen the person's clothing, and remove any heavy pieces of clothing.
• Have the person drink cool, not iced, water or a sports drink that contains electrolytes.
• Spray or sponge the person with cool water.
• If symptoms don't improve quickly, call 911 or emergency medical help.

Heatstroke
Heatstroke requires immediate medical care. This condition can be fatal if left untreated. Until help arrives:

• Move the person into the shade or an air-conditioned space.
• Start the cooling process by spraying the skin with water or wrapping the person in wet towels or sheets, and use a fan or newspaper to increase air circulation.

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Angelman syndrome

Angelman syndrome

Definition:

Angelman syndrome is a genetic disorder that causes developmental disabilities and neurological problems, such as difficulty speaking, balancing and walking and, in some cases, seizures. Frequent smiles and outbursts of laughter are common for people with Angelman syndrome, and many have happy, excitable personalities.

Angelman syndrome usually isn't detected until parents begin to notice developmental delays when a baby is about 6 to 12 months old. Seizures often begin when a child is between 2 and 3 years old.
People with Angelman syndrome tend to live a normal life span, but they may become less excitable with age. Other signs and symptoms remain. Treatment for Angelman syndrome focuses on managing the child's medical and developmental problems.

Symptoms:

Characteristic Angelman syndrome signs and symptoms include:

• Developmental delays, such as lack of crawling or babbling at 6 to 12 months, and intellectual disability
• Lack of or minimal speech
• Inability to walk, move or balance well (ataxia)
• Trembling movement of arms and legs
• Frequent smiling and laughter
• Happy, excitable personality

People who have Angelman syndrome may also have other signs and symptoms, including:

• Seizures, usually beginning between 2 and 3 years of age
• Stiff or jerky movements
• Small head size, with flatness in the back of the head (microbrachycephaly)
• Crossing of the eyes (strabismus)
• Tongue thrusting
• Walking with arms up in the air
• Light pigmentation in hair, skin and eyes (hypopigmentation)

When to see a doctor
Most babies with Angelman syndrome don't show signs or symptoms of the disorder when they're born. The first signs of Angelman syndrome are usually developmental delays, such as lack of crawling or babbling, between 6 and 12 months.
If your child seems to have developmental delays, or if your child has other signs or symptoms of Angelman syndrome, make an appointment to talk with your child's doctor.

Causes:

Angelman syndrome is a genetic disorder. It's most often caused by problems with a gene located on chromosome 15 called the ubiquitin-protein ligase E3A (UBE3A) gene.
Genes are segments of DNA that provide the blueprints for all of your characteristics. You receive your genes, which occur in pairs, from your parents. One copy comes from your mother (maternal copy), and the other copy comes from your father (paternal copy).

A missing or defective gene
Both genes in a pair usually are active. This means that your cells use information from both the maternal copy and the paternal copy of each gene pair. But in a small number of genes, only one copy of a gene pair is active. The activity of each gene copy depends on whether it was passed from your mother or from your father. This parent-specific gene activity is called imprinting. In these genes, when the copy that's usually active is missing or defective, it causes problems in the functions and characteristics controlled by that gene.

Normally, only the maternal copy of the UBE3A gene is active in the brain, caused by what's known as genomic imprinting. Most cases of Angelman syndrome occur when part of the maternal chromosome 15, which contains this gene, is missing or damaged. In a small number of cases, Angelman syndrome is caused when two paternal copies of the gene are inherited, instead of one paternal and one maternal copy (paternal uniparental disomy).

Complications:

Complications associated with Angelman syndrome include:

• Feeding difficulties. Some infants with Angelman syndrome have problems feeding during the first few months of life because of an inability to coordinate sucking and swallowing. If your child has difficulty feeding, your pediatrician may recommend a high-calorie formula to help your baby gain weight.
  
• Hyperactivity. Many young children with Angelman syndrome have increased motor activity. They may move quickly from one activity to another, often keeping their hands or a toy in their mouths. Their attention span may be very short. Hyperactivity often decreases with age in children with Angelman syndrome, and medication usually isn't necessary.
  
• Sleep disorders. It's common for people with Angelman syndrome to have abnormal sleep-wake patterns and to need less sleep than normal. In some cases, sleep difficulties may improve with age. Medication and behavior therapy may help control sleep disorders.
  
• Curving of the spine (scoliosis). Some people with Angelman syndrome develop this abnormal side-to-side spinal curvature over time.
  
• Obesity. Older children with Angelman syndrome tend to have large appetites, which lead to obesity.

Treatments and drugs:

Because there isn't a way to repair chromosome defects, there's no cure for Angelman syndrome. Treatment focuses on managing the medical and developmental problems that the chromosome defects cause.
A team of health care professionals will likely work with you to manage your child's condition. Depending on your child's signs and symptoms, treatment for Angelman syndrome may involve the following:

• Anti-seizure medication. Medication may be necessary to control seizures caused by Angelman syndrome.
  
• Physical therapy. Children with Angelman syndrome may learn to walk better and overcome other movement problems with the help of physical therapy.
  
• Communication therapy. Although people with Angelman syndrome usually don't develop verbal language beyond simple sentences, communication therapy can be helpful. Nonverbal language skills may be developed through sign language and picture communication.
  
• Behavior therapy. Behavior therapy can help children with Angelman syndrome overcome hyperactivity and a short attention span, which can aid in developmental progress. Although the level of development people with Angelman syndrome can achieve varies widely, many are outgoing and are able to build relationships with friends and family.

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