Asthma

Asthma is a lung condition that affects 23 million Americans, including 6 million kids. People with asthma may cough, wheeze, or have trouble breathing.

Is Your Child's Asthma Under Control? Take Our Assessment

 If your child has asthma, it can seem like you’re fighting an invisible enemy. Youngsters with asthma often seem perfectly healthy, just like any other kid. But things most children can shrug off—a simple cold or a bout of exercise—can land the asthmatic child in the hospital if the respiratory disease is not well controlled by medication.
What’s so maddening, as a parent, is not knowing if you have a lid on asthma. When that trigger comes—be it mold, pollen, dust, a cold, or pet cat—will your child’s asthma escalate out of control?
The bottom line is, it’s hard to tell—but not impossible. Your child may be coughing at night, but there are ways to tell how much coughing is too much. And, sure, your child may need to use a rescue inhaler, but if he or she needs it too often, it’s an indicator that he or she could be edging into the danger zone.
If your child is ages 5 to 11, you can use this assessment tool to help determine if his or her asthma is under control. (This tool, which was adapted from asthma guidelines issued by the National Heart, Lung, and Blood Institute, in 2007, is not designed to replace a consultation with a doctor. Nor should it be used for children under age 5 or 12 and older.)
1 .  My child has asthma symptoms such as coughing or wheezing:
A. No more than two days each week and never more than once a day (+1 point)
B. Several times a day on at least two days a week, or more than two days each week (+2 points)
C. Throughout the day (+3 points)
2 .  My child has coughing or has wheezing that wakes him or her up at night:
A. Once a month or less (+1 point)
B. Twice a month or more (+2 points)
C. Twice a week or more (+3 points)
3 .  My child needs to use his or her rescue inhaler or nebulizer:
A. Two days a week or less (+1 point)
B. More than two days each week (+2 points)
C. Several times per day (+3 points)
4 .  When it comes to my child’s daily life, asthma symptoms:
A. Never limit his or her activities (+1 point)
B. Cause some limitation (+2 points)
C. Extremely limit activity (+3 points)
5 .  My child has had asthma symptoms so severe he or she needs a course of oral corticosteroids:
A. One time per year or not at all (+1 point)
B. More than twice per year (+3 points)
If your score is 5 points:
Based on symptoms alone, experts would consider your child’s asthma to be under control. You should make sure your child continues to take medication carefully and correctly, and be sure to see your doctor within one to six months.   Another way to measure asthma control is to check peak flow, which can be done at home with a peak flow meter. If peak flow is more than 80% of your child’s personal best, asthma is under control. If it’s 80% or less, asthma is not well controlled.
If your score is 6 points or more:
Based on symptoms alone, your score suggests that your child’s asthma is not as well controlled as it could be. Talk with your doctor as soon as possible to see if your child is taking the right amount and type of medication.   Another way to measure asthma control is to check peak flow, which can be done at home with a peak flow meter. If peak flow is more than 80% of your child’s personal best, asthma is under control. If it’s 80% or less, asthma is not well controlled.

Why You Need to Take Asthma Medicine, Even if You Feel Fine

Carolyn M. Kercsmar, MD, the director of the asthma center at Cincinnati Children’s Hospital Medical Center, recently had a 10-year-old patient who decided, on his own, to stop taking his asthma medicine—crucial maintenance steroids he was supposed to take regularly.
His reasoning: He felt fine and hadn’t had any asthma attacks for a while, so why bother? Dr. Kercsmar performed a series of tests, and it was clear his lung function was compromised, even though he didn’t have any coughing, wheezing, shortness of breath, or other signs of asthma. She made sure he knew that he needed to start his asthma medication again.
“We were to come into pollen season, which could have triggered his asthma symptoms, possibly leading to an emergency room visit or hospitalization,” she says.
Generally, asthma can be categorized into two classes: intermittent asthma, in which symptoms occur less than three times a week, and chronic asthma.
People with intermittent asthma can often get by using only a short-acting or “rescue” inhaler when symptoms develop. Those with more chronic asthma and more frequent flare-ups (like Dr. Kercsmar’s 10-year-old patient) need to take a maintenance medication to reduce inflammation between attacks. “The goal of asthma treatment is to prevent, prevent, prevent,” Dr. Kercsmar says.
Unfortunately, patients failing to take their maintenance medication is an all-too-common scenario. People may take medication incorrectly, in an erratic stop-and-start fashion, or just flat out skip it. It’s not that people with asthma are trying to dupe their doc. Asthma can be a sneaky foe. Most people feel perfectly fine, until they very quickly don’t. All it takes is a rise in pollen counts, a common cold, a chance encounter with a cat, a change in temperature, or a bout of exercise to send a patient into the danger zone. The problem? It’s hard to predict when that will happen.
“It can be hours, days, weeks, or months, so it’s pretty easy for patients to be lulled into a false sense of security,” says Dr. Kercsmar. “It’s an incredibly variable disease that can be punctuated by flare-ups, but the time between flare-ups can be variable.”

Why you may be on a symptom roller coaster
Even patients with the best of intentions may have a hard time taking medications day in and day out, sometimes several times a day, when they feel just dandy. The temptation is to think, “Why not just skip it today since I feel fine?”

“This is a chronic problem that I encounter with many asthmatics,” says Len Horovitz, MD, a pulmonary specialist with Lenox Hill Hospital, in New York City. “Once patients are well controlled on medications, a part of their psyche thinks they’ve been cured and they no longer need medication.”

As a result, patients end up on a “roller coaster,” says Mark H. Moss, MD, an associate professor of medicine and pediatrics at the University of Wisconsin School of Medicine and Public Health. “They have very few symptoms when they take their medicine, but then the symptoms reemerge when they stop taking it.”

But skipping medications, even when you don’t have any symptoms, could mean more flare-ups and worsened asthma down the line.

“It’s important to continue to use anti-inflammatory maintenance medications because there’s an inflammation process that’s occurring within your lungs,” says Amber Watts, PharmD, an assistant professor of pharmacy practice at Texas A&M Health Science Center Rangel College of Pharmacy, in Kingsville. “The steroids in these medications help prevent that inflammation and reduce the chances of an exacerbation. It’s not going to completely prevent an exacerbation, but it does decrease the risk.”
What’s a steroid?
Asthma is a chronic condition that is thought to be driven by inflammation in the airways. That inflammation is pretty much always there, only producing symptoms when a certain threshold is reached; that threshold, as well as individual triggers, is different for each person.
“It’s like having a charcoal fire burning all the time and more fuel comes along, like wind or oxygen, then you have a raging inferno and get symptomatic,” Dr. Kercsmar says.
Anti-inflammatory medications such as corticosteroids (commonly called steroids, but in a different class of drug from anabolic steroids, which are sometimes abused by athletes), leukotriene pathway modifier drugs, and IgE blockers dampen down this ever-burning “charcoal fire.”
When a person has an asthma attack, the lining of the airway swells, secretes more mucus, and, most dramatically, constricts the muscles in the airways. This calls for a different treatment: A person uses a rescue inhaler or nebulizer to administer bronchodilator drugs (such as albuterol) to open the tight airways.
“That works primarily to relax the muscles. It essentially has no effect on inflammation,” says Dr. Kercsmar. And it acts within minutes to provide relief.
Even without maintenance medications, some patients will go weeks or even months without a problem. But doctors can’t always tell which patients fall into this category.

Skipping a child’s medication now may mean stronger drugs later
It is especially important for children and teens to take medicine as directed.
“Through childhood, asthma may periodically become more severe or improve, and that does complicate things because parents may perceive that a child’s asthma is ‘cured,’” says Dr. Moss. “They could continue for months or potentially even years like this only to have the asthma worsen as they get older.”
Often a remission occurs during adolescence, but there is no cure for asthma, and the condition will likely reappear in adulthood, only more chronic, explains Dr. Moss.
Sometimes medications can be stopped or the dose lowered, but a doctor needs to make that decision, Dr. Moss says.
Unexpected triggers such as a cold, allergy, chemical irritant, or air pollution can quickly bring the asthma from the back burner to the front burner, Dr. Horovitz says.
“Not taking maintenance medications makes patients vulnerable,” he says.
Parents can be scared off by the fact that maintenance drugs have a steroid component, thinking it will affect their child’s development, Watts says. But since patients are inhaling the steroids—rather than swallowing them in a liquid—it’s much less likely. While corticosteroids can stunt growth slightly, it’s unlikely with inhaled steroids. But if your child’s asthma is so bad that he or she is at risk for hospitalization, doctors may have no choice but to put him or her on the much stronger oral corticosteroids—at least temporarily—to get the asthma under control. (You can read more about asthma drug safety here.)
Patients should also remember to rinse their mouth after taking inhaled corticosteroids, so as to avoid developing thrush, a yeast infection of the throat, Watts warns.
“Whether you have a child with asthma or have it as an adult, you shouldn’t skip your maintenance medications. You should always take them as prescribed every day and, if you notice more symptoms or a difference in breathing, then you should definitely call a physician so that he or she can adjust your medication,” Watts says. 

Lead writer: Amanda Gardner

Asthma Symptoms

While asthma symptoms seem straightforward—coughing, wheezing, and shortness of breath—it’s not always easy for doctors to definitively diagnose the condition. It can be hard to determine if a chronic cough is asthma, a lingering respiratory ailment, or something else. Symptoms like wheezing can come and go, or coughing may only occur at specific times, such as at night or with exposure to pollen or other triggers.
To learn more about the symptoms of asthma in children, check out the following information from our A–Z Health Library. Asthma symptoms in adults are very similar to those in children.

Symptoms of asthma can be mild or severe. Your child may have no symptoms; severe, daily symptoms; or something in between. How often your child has symptoms can also change. Symptoms of asthma may include:

• Wheezing, a whistling noise of varying loudness that occurs when the airways of the lungs (bronchial tubes ) narrow.
• Coughing, which is the only symptom for some children.
• Chest tightness.
• Shortness of breath, which is rapid, shallow breathing or difficulty breathing.
• Sleep disturbance.
• Tiring quickly during exercise.

If your child has only one or two of these symptoms, it does not necessarily mean he or she has asthma. The more of these symptoms your child has, the more likely it is that he or she has asthma.
An asthma attack occurs when your child's symptoms suddenly increase. Factors that can lead to an asthma attack or make one worse include:

• Having a cold or another type of respiratory illness, especially one caused by a virus, such as influenza.
• Exercising (exercise-induced asthma), especially if the air is cold and dry.
• Exposure to triggers, such as cigarette smoke, air pollution, dust mites, or animal dander.
• Changes in hormones, such as during the start of a girl's menstrual blood flow at puberty.
• Taking medicines, such as aspirin (aspirin-induced asthma) or nonsteroidal anti-inflammatory drugs.

Most asthma attacks result from a failure to successfully control asthma with medicines. By strictly following the doctor's recommendations and taking all medicines correctly, it is possible in most cases to prevent these attacks from occurring. While some asthma attacks occur very suddenly, many get worse gradually over a period of several days.
Many children have symptoms that become worse at night (nocturnal asthma). In all people, lung function changes throughout the day and night. In children with asthma, this often is very noticeable, especially at night, and nighttime cough and shortness of breath occur frequently. In general, waking at night because of shortness of breath or cough indicates poorly controlled asthma.
It can be difficult to know how severe your child's asthma attack is. Symptoms are used to classify asthma by severity. Talk with your doctor about how to evaluate your child's symptoms.
Symptoms are also used along with peak expiratory flow to help define the green, yellow, and red zones of your child's asthma action plan. You use this to decide on treatment during an asthma attack.
Other conditions with symptoms similar to asthma include sinusitis and vocal cord dysfunction.

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Arrhythmia

Arrhythmia is an irregular heartbeat caused by abnormal electrical impulses in the heart. Scary as it sounds—heart beating too slowly, too quickly, or skipping a beat—arrhythmia is not uncommon and often harmless. Some arrhythmias, however, can increase the risk of stroke, blood clots, and cardiac arrest, and are more serious for those with heart failure or heart disease. Arrhythmia symptoms can include dizziness, lightheadedness, or shortness of breath.

What Causes Arrhythmia?

The heart doesn't contract all at once. Instead, each section waits for its cue: an electrical signal that starts at the top of the right atrium and runs downward through the ventricles. As long as nothing disturbs that signal, the heart will beat at a mostly steady, healthy pace.
Damage to the heart—whether from an infection, an inherited condition, or a heart attack—can interfere with the electrical signal and throw the heart off its rhythm. This is arrythmia.

Almost any part of the heart is capable of starting the electricity that drives the beat, and the heart muscle may also immediately jury-rig a new source of electrical signals. These new signals may keep the heart beating, but they disrupt the normal pace or rhythm.
A racing heartbeat—ventricular tachycardia, it turns out—sent Shannon Schroeder, 37, of Poulsbo, Wash., to the emergency room. It's a good thing she went.

An echocardiogram showed that the walls of her left ventricle were thicker than they should be, and the muscle showed telltale damage of an earlier silent heart attack. The damage had weakened her heart and harmed the electric circuitry that maintains a normal rhythm.
Stimulants—including caffeine, nicotine, and drugs—can also cause brief arrhythmias. They're usually harmless, but there are case reports of people dying from ventricular fibrillation after overdosing on controlled substances.

Lead writer: Chris Woolston

7 Symptoms of Arrhythmia

Here are signs you must see a doctor: If strange heartbeats are accompanied by other symptoms of heart trouble, including fainting or near-fainting, breathlessness, or chest pain. Or if your arrhythmia lasts longer than 30 seconds. Also if you're a heart attack survivor or if you have heart failure, any change in rhythm is cause to seek medical help.
Read on for possible symptoms of a common type of arrhythmia, atrial fibrillation (a racing, irregular heartbeat). For symptoms of another type of arrhythmia, bradycardia (a slower than normal heartbeat), visit our A-Z Health Library. 

How Medications Treat Arrhythmia

Treating an arrhythmia with medication is like putting out a campfire with a squirt gun. Drugs can control abnormal heartbeats and the fainting, light-headedness, and breathlessness that can go along with them, but they merely dent the problem, says Dan Roden, MD, a professor of medicine at the Vanderbilt University School of Medicine. "Medications don't work as well as we'd like, and many have side effects ranging from fatigue to organ damage," he says.
Still, some of the medications are used to manage arrhythmia. Here's an overview.

• Blood thinners such as Coumadin can help prevent the blood clots that result from atrial fibrillation.
• Anti-arrhythmic drugs such as Betapace and Cordarone can encourage a normal rhythm in the heart. Unfortunately Cordarone may cause many side effects ranging from fatigue to uncontrollable tremor to liver and lung disease. Doctors typically don't prescribe it unless other medications have failed.
• Beta-blockers such as Coreg and Lopressor can slow the heart rate in patients with atrial fibrillation.
• Calcium channel blockers such as Cardizem and Norvasc also help slow the rate and are especially effective for treating tachycardias.

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Appendicitis

Appendicitis occurs when the appendix—a finger-shaped organ connected to the end of the large intestine—becomes infected. Symptoms of appendicitis include abdominal pain, often starting near the belly button. The pain may move down to the lower right side of the abdomen. Appendicitis is the leading cause of emergency abdominal surgery (appendix surgery is called an appendectomy) and is most likely to strike people between the ages of 10 and 30—although it can occur at any age.

Appendicitis is one of the causes of serious belly pain. It happens when the appendix, a part of the large intestine, becomes infected and inflamed.
Appendicitis is most common in people between the ages of 10 and 30, although it can occur at any age. Common symptoms of appendicitis include:

• Pain in the belly. The pain may begin around the belly button.
• Pain in the belly that gets stronger and moves below the belly button to the lower right side.
• Pain that does not go away and gets worse when the person moves, walks, or coughs.
• Pain in any part of the belly or on the side.
• Nausea, throwing up, and not wanting to eat.
• Constipation, back pain, and a slight fever.
• A general feeling of being sick, and a pain that is hard to describe.

If the inflamed appendix is not surgically removed and the infection gets worse, the wall of the appendix can break open (rupture). This spreads infection into the belly area, causing peritonitis. Peritonitis is a serious condition that, in rare cases, can lead to death.

Symptoms

The main symptom of appendicitis is belly (abdominal) pain. The pain can feel like indigestion or like you need to have a bowel movement or pass gas. Many people feel the first pain near the belly button. Then it moves to the lower right side of the belly. But the pain can be in different parts of your belly or even on your side. The pain may get worse if you move, walk, or cough. You may also have a fever or feel sick to your stomach.

Many people who have had appendicitis say the pain is hard to describe. It may not feel like any pain you have had before. It may not even be a very bad pain, but you may feel like something is wrong. If you have moderate belly pain that does not go away after 4 hours, call your doctor. If you have severe belly pain, call your doctor right away.
You may have appendicitis if:

• You have pain in your belly. The pain may begin around your belly button.
• The pain in your belly gets stronger and moves below your belly button on your right side (the lower right quadrant ). This is the most common place to feel pain when you have appendicitis.
• The pain does not go away and gets worse when you move, walk, or cough.
• You have pain in any part of your belly or on your side.
• You feel nauseated or throw up a few times. You also may not feel like eating.
• You have constipation, back pain, a slight fever, or a swollen abdomen.

Some people do not have the symptoms listed above. Older people, children younger than 2 years, and pregnant women may not have pain in the lower right part of the belly. Other people feel pain in the side because their appendix is in a different position than normal.
Pain in the abdomen is very common. For more information, see the topics Abdominal Pain, Age 12 and Older, and Abdominal Pain, Age 11 and Younger.
There are also many conditions with symptoms similar to appendicitis. But because appendicitis can become serious in a short amount of time, call your doctor right away if you have any of the symptoms listed above. Treatment is much easier if the appendix has not ruptured. In most people, the appendix does not rupture until they have felt sick for at least 24 hours.

Treatment Overview

The only treatment for appendicitis is surgery to remove the appendix (appendectomy). The goal is to remove the appendix before it ruptures and spreads infection to the abdomen (peritonitis).
If your doctor is not sure if you have appendicitis, you may have to wait for several hours at home or in the hospital before a decision about surgery is made. Your doctor may send you home and have you come back in 6 or 8 hours to be rechecked.
Surgery to remove the appendix can be done one of two ways—laparoscopic or traditional. Experts do not agree on which surgery is best. It often depends on what your surgeon prefers. Laparoscopic surgery uses three or four small cuts or incisions, and traditional appendectomy uses one larger incision. Most people feel better immediately after surgery. Some people can even go home the same day.
If your appendix has burst and there is infection in your abdomen, you may have to stay in the hospital longer. Your treatment will include intravenous (IV) fluids and antibiotics. Surgery for a burst appendix may be more complicated. If you have a burst appendix, a radiologist may place a drain in your belly to help remove some of the infection before you have surgery to remove it. In this case, the appendix will be taken out a few weeks later. After you have your appendix removed, the doctor may leave the incision (cut) open to heal from the inside to the outside. You may also have a drain placed within the wound to help drain the infection.
You will also have to stay in the hospital longer if you have health problems that get worse after surgery.
Sometimes a doctor will recommend surgery even if he or she is not sure you have appendicitis. Surgery can eliminate the chances of a ruptured appendix. If you have surgery and your appendix is normal, your appendix will still be removed so that it will not cause future problems.

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Anxiety

Anxiety can be a good thing—in small amounts. A little bit of anxiety can prompt you to study for a big test or get to work on time. Too much anxiety, however, can damage your physical or emotional health. Feeling extreme fear or worry that’s out of proportion to the actual risk can be a problem, particularly if it interferes with daily life. There are many types of anxiety disorders, including obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder (PTSD).

Anxiety

Feeling worried or nervous is a normal part of everyday life. Everyone frets or feels anxious from time to time. Mild to moderate anxiety can help you focus your attention, energy, and motivation. If anxiety is severe, you may have feelings of helplessness, confusion, and extreme worry that are out of proportion with the actual seriousness or likelihood of the feared event. Overwhelming anxiety that interferes with daily life is not normal. This type of anxiety may be a symptom of another problem, such as depression.

Anxiety can cause physical and emotional symptoms. A specific situation or fear can cause some or all of these symptoms for a short time. When the situation passes, the symptoms usually go away.

Physical symptoms of anxiety include:

• Trembling, twitching, or shaking.
• Feeling of fullness in the throat or chest.
• Breathlessness or rapid heartbeat.
• Lightheadedness or dizziness.
• Sweating or cold, clammy hands.
• Feeling jumpy.
• Muscle tension, aches, or soreness (myalgias).
• Extreme tiredness.
• Sleep problems, such as the inability to fall asleep or stay asleep, early waking, or restlessness (not feeling rested when you wake up).

Anxiety affects the part of the brain that helps control how you communicate. This makes it more difficult to express yourself creatively or function effectively in relationships. Emotional symptoms of anxiety include:

• Restlessness, irritability, or feeling on edge or keyed up.
• Worrying too much.
• Fearing that something bad is going to happen; feeling doomed.
• Inability to concentrate; feeling like your mind goes blank.

Anxiety disorders

Anxiety disorders occur when people have both physical and emotional symptoms. Anxiety disorders interfere with how a person gets along with others and affect daily activities. Women are twice as likely as men to have problems with anxiety disorders. Examples of anxiety disorders include panic attacks, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD).

Often the cause of anxiety disorders is not known. Many people with an anxiety disorder say they have felt nervous and anxious all their lives. This problem can occur at any age. Children who have at least one parent with the diagnosis of depression are more than twice as likely to have an anxiety disorder than other children.

Anxiety disorders often occur with other problems, such as:

• Mental health problems, such as depression or substance abuse.
• A physical problem, such as heart or lung disease. A complete medical examination may be needed before an anxiety disorder can be diagnosed.

Panic attacks

A panic attack is a sudden feeling of extreme anxiety or intense fear without a clear cause or when there is no danger. Panic attacks are common. They sometimes occur in otherwise normal, healthy people and will usually last for several minutes.

Symptoms include feelings of dying or losing control of yourself, rapid breathing (hyperventilation), and a racing heart. You may feel dizzy, sweaty, or shaky. Other symptoms include trouble breathing, chest pain or tightness, and an irregular heartbeat. These symptoms come on suddenly and without warning.

Sometimes symptoms of a panic attack are so intense that the person fears he or she is having a heart attack. Many of the symptoms of a panic attack can occur with other illnesses, such as hyperthyroidism, coronary artery disease, or chronic obstructive pulmonary disease (COPD). A complete medical examination may be needed before an anxiety disorder can be diagnosed.

People who have repeated unexpected panic attacks and worry about the attacks are said to have a panic disorder.

Phobias

Phobias are extreme and irrational fears that interfere with daily life. People with phobias have fears that are out of proportion to real danger. And although these people are aware that their fears are not rational, they are not able to control them.

Phobias are common and are sometimes present with other conditions, such as panic disorder or Tourette's disorder. Most people deal with phobias by avoiding the situation or object that causes them to feel panic (avoidance behavior).

A phobic disorder occurs when the avoidance behavior becomes so extreme that it interferes with your ability to participate in your daily activities. There are three main types of phobic disorders:

• Fear of being alone or in public places where help might not be available or escape is impossible (agoraphobia)
• Fear of situations where the individual might be exposed to criticism by others (social phobia)
• Fear of specific things (specific phobia)

Use the Check Your Symptoms section to decide if and when you should see a doctor.

Head-to-Toe Solutions for Stress

Stress effects

By Kate Ledger
From Health magazine
Worrying about being able to pay the bills? The babysitter canceled—again? Situations like these are the modern-day equivalent of being attacked by a saber-toothed tiger, and our bodies rev up to face the threats, says Paul J. Rosch, MD, president of the American Institute of Stress. Chronic stress can lead to a whole host of physical and emotional problems. Plus, women often have stronger stress reactions than men, says David Rakel, MD, director of integrative medicine at the University of Wisconsin, maybe because the area where emotions are processed in our brains is larger. Even more of a reason to ID your stress and learn to let it go.
Headaches
Researchers once blamed tension headaches on tight muscles in the face and neck. But now they think that stress-induced fluctuations in neurotransmitters—like serotonin and endorphins—also activate pain pathways in the brain, leading to headaches. In either case, ouch!
Just 10 minutes a day of mindful relaxation—like deep breathing or meditation—can ease the muscle tension that can trigger a headache, says Lisa Corbin, MD, medical director of the Integrative Medicine Program at the University of Colorado Hospital. Try this: Sit in a quiet place, and close your eyes. Take a deep breath through your nose, and let it fill your abdomen; hold it for 5 seconds, then exhale. Studies have shown that simple, deep-breathing exercises like this reduce blood pressure and promote a sense of well-being.

Breakouts

A bad day really can go straight to your face: Chronic-stress hormones can increase oil production in skin glands. The result can be blemishes or full-blown acne.
The Chinese tradition of drinking hot water with lemon helps detoxify your skin, says Susan Ciminelli, founder of Susan Ciminelli Day Spa in New York City. Also try slowly rubbing a dry loofah up your body, starting from the ankles. This helps blood circulate and is invigorating and calming, Ciminelli says.

Stiff neck

Sometimes that pain in the neck from the office goes home with you in the form of sore, stiff muscles. After tensing up all day, trigger points within the muscles can go into tiny spasms and cause intense neck cramps, integrative-medicine expert David Rakel, MD, says.
Massage—from hot stones to ischemic-compression therapy, during which trigger points are probed—can help relax tight muscles in your neck or upper back, says Dr. Rakel. Or try Kneipp hydrotherapy: Sit in bathwater that’s as cold as you can tolerate, then warm up the water; alternate between cold and hot three to four times while soaking. You can also take a cold shower or splash cold water on sore muscles for 10 to 60 seconds; the dramatic change in temperature may constrict and open blood vessels, removing toxins like lactic acid and improving blood supply and lymph flow, Dr. Rakel says. A recent study also showed that cold-water therapy can reduce fibromyalgia pain.

Fatigue

If you can’t stop yawning, it’s probably because you’ve spent hours in bed ruminating  instead of sleeping. “There are wake-promoting regions of the brain that get stimulated by anxious thoughts,” says psychologist Stephanie Silberman, PhD, a diplomate of the American Board of Sleep Medicine and author of The Insomnia Workbook. Too many restless nights, and your days will be shot—memory is impaired and you may feel more irritable and moody.
If stress is keeping you awake, practice “thought stopping,” says Silberman. "Picture an actual stop sign every time you start worrying."
Progressive muscle-relaxation is another anti-insomnia technique: Beginning at your toes, tighten the muscles in that area, hold for 5 seconds, then release; continue with each muscle group, going up the length of your body. Breathe calmly throughout the exercise.
Period problems and infertility
Bad cramps? No period? The reproductive system is ground zero for stress in many women, says Anne Nedrow, MD, medical director of women’s primary care and integrative medicine at Oregon Health and Sciences University’s Center for Women’s Health. “Sometimes it starts when young women go off to college and have excessive bleeding or don’t bleed at all,” she says. There’s also a strong mind-body connection that can interfere with fertility and sexual function, Dr. Nedrow says.
Acupuncture can help regulate periods, diminish pain, and improve pregnancy and birth rates in women having in vitro fertilization. “It’s thought to unblock certain energy pathways,” says Dr. Nedrow.
Weight gain Stress could be causing that upward tick in the numbers on your scale. Some studies suggest that our stressed-out bodies are becoming immune to the continuous secretion of adrenaline. Instead of burning more calories, our hyped-up systems produce more cortisol, a stress hormone that encourages the storage of fat. Add to that the fact that “some women overeat in times of stress,” says Los Angeles–based registered dietitian Deborah A. Klein, author of the forthcoming book The 200 Foods That Will Save Your Life. The stress-plus-increased-eating combo is like putting out a welcome mat for fat.
Weight gain
Stress could be causing that upward tick in the numbers on your scale. Some studies suggest that our stressed-out bodies are becoming immune to the continuous secretion of adrenaline. Instead of burning more calories, our hyped-up systems produce more cortisol, a stress hormone that encourages the storage of fat. Add to that the fact that “some women overeat in times of stress,” says Los Angeles–based registered dietitian Deborah A. Klein, author of the forthcoming book The 200 Foods That Will Save Your Life. The stress-plus-increased-eating combo is like putting out a welcome mat for fat.
Instead of snacking on junk food the next time you’re under pressure, take a good brisk walk. Studies say exercise relieves stress and burns calories.
Replacing high-fat snacks with healthier options can help you relax too, Klein says. Carbohydrate-rich foods like yams increase serotonin in the brain, which promotes good feelings. And whole grains, bananas, avocados, chicken, spinach, and broccoli all contain vitamin B, which can boost your sense of well-being.Health buster
Stress weakens the immune system and worsens chronic conditions like asthma, high blood pressure, and diabetes, says Robin Molella, MD, a preventive medicine specialist at the Mayo Clinic, in Rochester, Minn.
Laughing your way through shows like I Love Lucy or Saturday Night Live may hike your body’s natural disease-fighting cells or relieve tightness in your chest. Even “fake” laughter has been shown in brain scans to work, Dr. Molella says.
Sore shoulders
Your too-heavy purse could, indeed, be causing your sore shoulders—but hunching over the computer or phone could also be the culprit. This position wreaks havoc on your posture and makes your head jut forward, creating an SOS situation for shoulder and back muscles.
Relax your shoulders and open your chest with a classic yoga stretch, says Jessica Bellofatto, owner of YogaShanti in Sag Harbor, N.Y. Stand with right arm raised over your head, bend arm so elbow is pointing upward and right hand reaches behind your head. Extend left arm sideways, then lower it and reach upward behind your back; try to touch fingers together (as shown). Repeat stretch with left arm on top.
Bloating
Your body's response to stress may cause it to divert blood away from normal digestive processes in the abdomen to large muscle groups elsewhere. The result? An upset tummy, painful bloating, diarrhea, constipation, even irritable bowel syndrome, women’s-health specialist Anne Nedrow, MD, says.
Placing a hot-water bottle on top of your belly may relax the smooth-muscle tissue of the bowel and eliminate pain, distention, or bloating, says Dr. Nedrow. Eating more foods with plenty of fiber—such as a handful of almonds, peanuts or soy nuts, or a steamed artichoke with vinaigrette dressing—may also help.
Sore feet
We walk too fast, we pace, we cram our feet into high heels and shoes a size too small—no wonder 8 out of 10 women say their feet hurt. The really bad news: Sore feet make it harder to stand up to the stresses attacking the rest of your body.
In the right hands (a reflexologist’s, to be exact), a foot rub can actually help heal a variety of stress disorders, from migraines to back pain, research shows. Rub under the base of the toes to calm the head, the ball of the foot to relax the chest, and the middle of the foot to soothe the abdominal area, says reflexologist Mara Nicandro, director of Therapeutic Massage of Texas.

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Anorexia nervosa

Anorexia nervosa is a serious, life-threatening eating disorder. People with anorexia nervosa fear weight gain and may obsessively diet and exercise, even to the point of starvation. About 1% of the population has anorexia nervosa, and it’s more common in women than men.

Who is affected by anorexia nervosa

Although anorexia nervosa is not common, affecting only 5 to 10 people out of every 100,000 people, it is a growing problem.¹ Anorexia nervosa is more common in industrialized countries, where lack of food is not generally a problem and thinness is prized.

You are more likely to develop anorexia nervosa if you:²

• Are female. Although males can develop anorexia, it is rare. For every 10 females who develop anorexia, approximately 1 male does.
• Are a white adolescent from a Western society, although people all over the world from all races and age groups develop anorexia.
• Participate in sports or work in a profession that requires a certain body type. Examples include:
  • Athletes (such as runners, wrestlers, figure skaters, swimmers, gymnasts, or jockeys).
  • Models.
  • Ballet dancers.
  • Actors.
• Have a sister, brother, or parent who has anorexia.

Other conditions that can occur with anorexia nervosa

It is not clear whether other mental health disorders occur before or as a result of anorexia nervosa. Treatment can be difficult when a person has anorexia along with other mental health disorders. Some of the most common mental health disorders that can be present with anorexia include:¹

• Depression, which occurs in up to 50 out of 100 people who have anorexia.
• Irrational fears (phobias), including social anxiety disorder.
• Obsessive-compulsive disorder.
• Obsessive-compulsive personality disorder, marked by a drive for perfectionism, orderliness, and control.
• Panic disorder or panic attacks.
• Post-traumatic stress disorder.
• Substance abuse, which can increase the risk of death in those who also have anorexia.
• Body dysmorphic disorder, which is an imagined belief that there is a defect in your body or your physical appearance even though none exists, such as seeing yourself as fat when you are thin.

Anorexia: Developing trust in the people who are helping you

Sometimes people who have anorexia find it difficult to trust the family, friends, health professionals, and other caring people who are trying to help them. There are many reasons for this, ranging from anxiety about losing control and gaining weight to confused thinking because of malnutrition. And, it can be hard to trust a whole new way of eating, exercising, and taking care of yourself.
If you are diagnosed with an eating disorder, it may take some time to develop trust in the people who are trying to help. However, you can do it with practice.

• Listen to what others are saying about healthy eating. Avoid looking for ways to argue back.
• Ask to read some information that supports what others say about food.
• Learn about what is included in a balanced diet. Then discuss what you have learned with the people who are trying to help.
• Let people know how you are feeling. Listen to how others are feeling.
• Try to concentrate on one goal at a time. This helps to keep things simple.
• Accept support and feedback from other people.
• Focus on your breathing to calm yourself when you start to feel anxious.

 (Suu tam)

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Anemia

Anemia is caused by a lack of red blood cells or hemoglobin, the oxygen-carrying protein found in red blood cells. Anemia is most often due to a deficiency in iron, a key component of hemoglobin. (That’s why it is often treated with iron supplements). Anemia can be triggered by blood loss, a folic acid or vitamin B12 deficiency, sickle cell disease, and a genetic disorder called thalassemia, among other causes. In the U.S., 2% to 5% of women and 1% of men have iron deficiency anemia. 

Tips for preventing anemia

 Anemia occurs when there are too few red blood cells in the blood. A complete blood count (CBC) can determine whether anemia is present.

Women who have heavy and prolonged periods may develop anemia, because the body cannot produce blood as fast as it is being lost. Your body needs iron to make new blood cells. The recommended dietary allowance (RDA) is 18 mg. You may need to increase your iron intake to 20 mg a day if your periods are heavy or prolonged.

Your diet is the best source of iron. It is better for you to eat a balanced diet than it is to take dietary supplements. Red meats, shellfish, eggs, beans, and green leafy vegetables are the best sources of iron.

Other good sources of iron include:

• Clams [canned drained, 3 oz (85.1 g)]
• Oysters [3.5 oz (99.2 g)]
• Shrimp [3.5 oz (99.2 g)]
• Beef liver [3 oz (85.1 g)]
• Lean beef [3 oz (85.1 g)]
• Lentils (uncooked, 1 cup)
• Green peas (uncooked, 1 cup)
• Spinach (uncooked, 1 cup)
• Raisins (1 cup)
• Prunes (10)
• Enriched wheat bread (1 slice)
• Egg (1)
• Iron-enriched cereals (1 cup, read label for exact amounts)

Cooking in iron cookware will add small amounts of iron to the food.

Vitamin C improves the absorption of iron. Be sure your diet includes 250 mg of vitamin C a day.

Consider using a nonprescription iron supplement (such as ferrous sulfate) or a multivitamin if you are unable to meet your need for iron through your diet. For more information about iron, see the topic Healthy Eating.

You may become constipated when you are taking an iron supplement. To avoid constipation:

• Increase dietary fiber.
• Eat plenty of fruits.
• Drink at least 2 to 4 extra glasses of water a day.

Iron Deficiency Anemia 

What is iron deficiency anemia?

Iron deficiency anemia occurs when your body doesn't have enough iron.

Iron is important because it helps you get enough oxygen throughout your body. Your body uses iron to make hemoglobin. Hemoglobin is a part of your red blood cells. Hemoglobin carries oxygen through your body. If you do not have enough iron, your body makes fewer and smaller red blood cells . Then your body has less hemoglobin, and you cannot get enough oxygen.

What causes iron deficiency anemia?

Iron deficiency anemia is caused by low levels of iron in the body. You might have low iron levels because you:

• Have heavy menstrual bleeding.
• Are not getting enough iron in food. This can happen in people who need a lot of iron, such as small children, teens, and pregnant women.
• Have bleeding inside your body. This bleeding may be caused by problems such as ulcers, hemorrhoids, or cancer. This bleeding can also happen with regular aspirin use. Bleeding inside the body is the most common cause of iron deficiency anemia in men and in women after menopause.
• Cannot absorb iron well in your body. This problem may occur if you have celiac disease or if you have had part of your stomach or small intestine removed.

What are the symptoms?

You may not notice the symptoms of anemia, because it develops slowly and the symptoms may be mild. In fact, you may not notice them until your anemia gets worse. As anemia gets worse, you may:

• Feel weak and tire out more easily.
• Feel dizzy.
• Be grumpy or cranky.
• Have headaches.
• Look very pale.
• Feel short of breath.
• Have trouble concentrating.

Babies and small children who have anemia may:

• Be fussy.
• Have a short attention span.
• Grow more slowly than normal.
• Develop skills, such as walking and talking, later than normal.

Anemia in children must be treated so that mental and behavior problems do not last long.

How is iron deficiency anemia diagnosed?

If you think you have anemia, see your doctor. Your doctor will do a physical exam and ask you questions about your medical history and your symptoms. Your doctor will take some of your blood to run tests. These tests may include a complete blood count to look at your red blood cells and an iron test that shows how much iron is in your blood.

Your doctor may also do tests to find out what is causing your anemia.

How is it treated?

Your doctor will probably have you take iron supplement pills to treat your anemia. Most people begin to feel better after a few days of taking iron pills. But do not stop taking the pills even if you feel better. You will need to keep taking the pills for several months to build up the iron in your body.

If your doctor finds an exact cause of your anemia, such as a bleeding ulcer, your doctor will also treat that problem.

If you think you have anemia, do not try to treat yourself. Do not take iron pills on your own without seeing your doctor first. If you take iron pills without talking with your doctor first, the pills may cause you to have too much iron in your blood, or even iron poisoning. Your low iron level may be caused by a serious problem, such as a bleeding ulcer or colon cancer. These other problems need different treatment than iron pills.

You can get the most benefit from iron pills if you take them with vitamin C or drink orange juice. Do not take your iron pills with milk, caffeine, foods with high fiber, or antacids.

Can you prevent iron deficiency anemia?

You can prevent anemia by eating the right amount of iron every day. Iron-rich foods include meats, eggs, and whole-grain or iron-fortified foods. You can also get iron from many other foods, including peas, beans, oatmeal, prunes, and figs.

You can prevent anemia in babies and children by feeding them enough iron. To make sure they get enough iron:¹

• Breast-feed your baby for at least a year or as long after as you and your child desire. Introduce iron-enriched solid foods at 6 months of age to complement the breast milk. Iron-fortified cereals are a good source of iron.
• After 6 months of age, give your child 2 to 3 servings of iron-rich foods a day.
• For babies who were weaned from the breast or the bottle before 12 months of age, give iron-fortified formula, not cow's milk or goat's milk. Cow and goat milks are low in iron.

If you are pregnant, you can prevent anemia by taking prenatal vitamins. Your doctor will give you prenatal vitamins that include iron. Your doctor will also test your blood to see if you are anemic. If you are anemic, you will take a higher-dose iron pill.

Blood transfusions for sickle cell disease

During a blood transfusion, a person (the recipient) receives healthy blood from another person (the donor). The donated blood is carefully screened for diseases before it is used. Before receiving a blood transfusion, the recipient's blood is analyzed closely (using blood type) to make sure the donor blood is a close match to the recipient's.

Blood is transfused into an arm vein slowly over 1 to 4 hours (except in an emergency when blood is transfused more quickly).

Blood transfusions can:

• Treat a sudden or short-term condition related to sickle cell disease.
• Treat severe complications of sickle cell disease.
• Prevent complications of sickle cell disease.
• Lower the risk of stroke in infants and children.

Blood transfusions aren't usually used to treat uncomplicated painful events or mild to moderate anemia.

What To Expect After Treatment

Following a blood transfusion, doctors keep a close watch on the person for any negative reactions.

• A transfusion reaction, resulting from mismatched blood type, may occur immediately or days later (5 to 20 days after transfusion). An acute transfusion reaction ranges from mild (fever, chills, and rash) to severe (shock, severe anemia, painful event, and death).
• A person receiving repeat blood transfusions may develop antibodies to the donor blood (called alloimmunization). Alloimmunization makes repeated transfusions more difficult. It occurs in about 1 out of 4 people with sickle cell disease who get frequent transfusions.¹

Hospital staff will also check for iron buildup in the body (iron overload). This can develop when a person gets many transfusions.

Why It Is Done

A blood transfusion lowers the amount of hemoglobin S red blood cells in the body. When there are fewer sickled hemoglobin S cells in the bloodstream, they are less likely to build up and block blood vessels.

Blood transfusion also increases the number of normal red blood cells in the body, increasing the supply of oxygen to the body.

Anemia

Some sudden complications of sickle cell disease cause the body's red blood cell count to drop to life-threatening levels (severe anemia). When severe, these conditions (including splenic sequestration, acute chest syndrome, and aplastic crisis) can be fatal if not treated with blood transfusions.

Chronic severe anemia from kidney failure may need treatment with periodic blood transfusions.

Surgery

After having general anesthesia and surgery, people with sickle cell disease are at risk for sickling-related problems and acute chest syndrome. Blood transfusions before surgery can prevent or treat these complications.

Red blood cell sickling-related complications (vaso-occlusion)

Blood transfusions can treat acute chest syndrome and leg ulcers.

Frequent blood transfusions may help prevent strokes in children who already had a stroke or are at high risk for a first stroke.²

How Well It Works

Blood transfusion is currently the single most effective and proven treatment for some severe complications of sickle cell disease.³

Blood transfusions reduce the risk of some complications of sickle cell disease and improve symptoms of severe anemia. Using repeat blood transfusions for 3 to 5 years can reduce the number of repeat strokes in children who have had a stroke.

Risks

A person receiving many blood transfusions will gradually collect too much iron in the body (iron overload). Very high levels of iron can lead to hemochromatosis, which can be fatal if untreated.

After 10 to 20 blood transfusions, iron chelation treatment can help rid the body of excess iron.

Donated blood is carefully screened for diseases before it is used. But it's remotely possible that donor blood may be contaminated with an infectious disease (such as HIV or hepatitis).

What To Think About

If you have repeated blood transfusions, you'll have routine testing for iron buildup in your body.

Though blood transfusions are an effective treatment for sickle cell disease complications, they are only used selectively. The risks of hemochromatosis and alloimmunization from repeat transfusions makes this procedure more suitable for severe and high-risk conditions.

Doctors and researchers continue to weigh the benefits against the risks of preventive blood transfusions. Repeat blood transfusion treatment for 3 to 5 years can reduce the number of repeat strokes in children who have sickle cell disease. It helps prevent a second stroke in most children. But some children who get repeat transfusions will still have a second stroke.

Complete the special treatment information form (PDF) (What is a PDF document?) to help you understand this treatment.

References

Citations

1. Steinberg MH (2008). Sickle cell disease and associated hemoglobinopathies. In L Goldman, D Ausiello, eds., Cecil Medicine, 23rd ed., pp. 1217–1226. Philadelphia: Saunders Elsevier.
2. Benz EJ (2008). Disorders of hemoglobin. In AS Fauci et al., eds., Harrison's Principles of Internal Medicine, 17th ed., pp. 635–643. New York: McGraw-Hill Medical.
3. Wang WC (2004). Sickle cell anemia and other sickling syndromes. In JP Greer et al., eds., Wintrobe's Clinical Hematology, 11th ed., pp. 1264–1311. Philadelphia: Lippincott Williams and Wilkins.

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Alzheimers

Alzheimer’s disease, the most common type of dementia, damages parts of the brain involved in memory, intelligence, judgment, language, and behavior. Almost half of people afflicted with Alzheimer’s are between 75 and 85, although a rare, inherited form of the disease can affect people in their 40s. While the loss of cognitive ability is irreversible, the rate of disease progression varies by individual.

 

Is It Alzheimer’s? Probably Not
 If you forget to pick up your dry cleaning once or twice, it’s unlikely that dementia is around the corner (although your favorite silk dress may be). Letting a few errands slip isn’t a sure sign of the disease. Really important symptoms include loss of control over speech, trouble completing simple tasks like balancing a checkbook, and confusion about where you are. In fact, your memory losses may simply be due to a shortage of vitamin B12. According to Harvard research, a deficiency can produce symptoms similar to dementia and Alzheimer’s. There’s plenty of the vitamin in meats, chicken, fish, dairy products, and fortified breakfast cereal.
Still worried? Consider talking to a therapist if you’re superanxious about memory loss. A study by the Rush Alzheimer’s Disease Center in Chicago found that people plagued by worry, anxiety, or depression are more prone to developing a condition that’s a precursor to Alzheimer’s. 

How Is Depression in the Elderly Different From Dementia?

There's no single test that can differentiate depression from dementia. But some behavior clues may help the doctor make an educated assessment.
"Alzheimer's disease and depression are probably related in ways we don't understand," says Brent Forester, MD, director of the mood disorders divison in the geriatric psychiatry research program at McLean Hospital in Belmont, Mass. "Forty to 50% of people with Alzheimer's disease get depression, but depression also may be a risk factor for Alzheimer's."

Here is how geriatric psychiatrists tell the two conditions apart.

• Memory: People who are depressed may have trouble concentrating. They may even suffer occasional memory lapses, which can make their mood worse. But people with Alzheimer's disease consistently have trouble storing new information, such as the recent visit of a close relative or what they ate for dinner. They may not remember eating dinner at all.
• Orientation: Most people who are depressed generally know with whom they're speaking, what time and day it is, and where they are. People with dementia tend to be confused about some or all of this.
• Language use: Depressed people use language properly, although they may speak slowly at times. People who are demented because of Alzheimer's disease or strokes often have lots of language problems. Particularly hard: remembering the names of common objects such as "pen" or "lamp" or "birthday cake."
• Use of familiar objects: Again, not a problem for people with depression. Someone with dementia may not recall how to get a pullover sweater on, for example. This is called apraxia—trouble remembering how to perform previously learned and routine motor activities.
• Negativity: Depressed people have a general tendency to put a negative spin on events. For example, if asked to take a test designed to screen for depression or Alzheimer's, they may jump to the conclusion that they did quite badly, and they often overestimate the problem. In contrast, someone with dementia may try to fabricate some story or excuse for a memory lapse or poor performance on a memory test.

Lead writer: Mary Pinkowish

Areas of the brain affected by Alzheimer's and other dementias

 

  

llustration copyright 2000 Nucleus Communications, Inc. All rights reserved. http://www.nucleusinc.com

Alzheimer's disease is a progressive condition that damages areas of the brain involved in memory, intelligence, judgment, language, and behavior. It is the most common form of mental decline, or dementia, in older adults.

 (Suu tam)

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