Constipation

Constipation

WHAT IS CONSTIPATION?
Constipation is passage of small amounts of hard, dry bowel movements, usually fewer than three times a week. People who are constipated may find it difficult and painful to have a bowel movement. Other symptoms of constipation include feeling bloated, uncomfortable, and sluggish. Many people think they are constipated when, in fact, their bowel movements are regular. For example, some people believe they are constipated, or irregular, if they do not have a bowel movement every day. However, there is no right number of daily or weekly bowel movements. Normal may be three times a day or three times a week depending on the person. In addition, some people naturally have firmer stools than others. At one time or another almost everyone gets constipated. Poor diet and lack of exercise are usually the causes. In most cases, constipation is temporary and not serious. Understanding causes, prevention, and treatment will help most people find relief.

Bowel habits are affected by diet. The average Singaporean diet includes 12 to 20 grams of fibre per day, and is below the recommended 25 to 30 grams of fiber. Exercise is also beneficial to proper function of the colon.

About 80 percent of people suffer from constipation at some time during their lives, and brief periods of constipation are normal. Not passing motion does not result in poisons remaining inside your body. Widespread beliefs, such as the assumption that everyone should have a movement at least once each day, have led to overuse and abuse of laxatives.
Eating foods high in fibre, including bran, shredded wheat, whole grain breads and certain fruits and vegetables will help provide the 25 to 30 grams of fibre per day recommended for proper bowel function.

Constipation is a very common problem in infants and children and is frequently seen by both pediatricians and family doctors. Most of the time, reassurance, dietary changes, and laxatives are effective treatment for both the patient and family.Constipation can occur at any age and the evaluation and treatment may be different depending on the child's age. The newborn infant should have his/her first stool within the first 24 hours after birth. Failure to pass stool by 48 hours of life may signify a more serious condition such as Hirschsprung's disease, meconium ileus due to cystic fibrosis, or hypothyroidism and further evaluation of the infant is needed.Constipation is usually diagnosed when an infant or child has hard stools or has difficulty stooling. This condition can be quite distressing for the family but is usually easy to treat. Infants are noted to strain excessively and have difficulty passing stools, even though their stools are of normal consistency. The difficulty in passing stool is thought to represent a delay in maturation of intestinal motility and is self-resolving; use of glycerin suppositories may be helpful. The frequency of bowel movements in infants varies considerably, and an infant who has soft, pain-free, but infrequent stools is not constipated and does not need further evaluation. As the child gets older, constipation can be due to a large number of factors including anal fissure, diet lacking in fiber and fluids, overuse of laxatives, family or behavior problems, and (rarely) ectopic anus. Constipation in children can also present, paradoxically, as watery diarrhea and incontinence due to overflow around impacted stool, a condition called encopresis.

More often than not, however, constipation is purely a functional problem unrelated to an underlying disease. Most individuals with uncontrolled constipation develop a variety of symptoms:
Large bowel pain.
Rectal discomfort.
Abdominal fullness.
Bloating
Nausea
Anorexia.
A general feeling of malaise.
These individuals feel as if they never completely evacuate their bowels. Severe chronic constipation may be accompanied by fecal impaction

What Causes Constipation?
Several factors may act together and cause constipation. This include inadequate fibre and water intake, a sedentary lifestyle, and environmental changes. Constipation may be aggravated by travel, pregnancy, or change in diet. In some people, repeatedly ignoring the urge to pass motion may result in constipation.

More serious causes of constipation include growths or areas of narrowing in the colon, so it is wise to seek the advice of a doctor when constipation persists. Uncommonly, constipation may be due to a nervous or endocrine disorders, including thyroid disease, multiple sclerosis, Parkinson's disease, stroke, and spinal cord injuries.

Can Medication Cause Constipation?
Yes, many medications, including pain killers, antidepressants, tranquilizers, and other psychiatric medications, blood pressure medication, diuretics, iron supplements, calcium supplements, and aluminum containing antacids can cause or worsen constipation. Do check with your doctor if you have constipation after being started on a new medication.

When Should I See A Doctor About Constipation?
Most of the time, the cause of constipation is not serious. But, in rare cases, chronic constipation may be a sign of an obstruction or abnormality in the colon. You should seek medical advice if there is a persistent change in your bowel habit for more than 3 weeks - this may either be an increase or decrease in frequency, size of stool or an increased difficulty in passing. The important factor is the change - if you have been passing one time every three days and now pass one time a day, this is not normal. If blood appears in the stool, consult your doctor right away. Your doctor can evaluate you to determine the cause of your constipation and rule out any underlying disorder.
Your doctor may ask you questions like these:
-How long have you had symptoms?
-Have you any medical problems, and if yes, what medications are you on?
-What is your diet like?
-What is your daily activity like?
-How often do you need use laxatives or enemas?
-How Can The Cause Of Constipation Be Determined?

There are many possible causes of constipation. It is important to find the cause and treat them specifically. Repeatedly taking laxatives may help but it does not treat the cause.
Your doctor will want to check for any anatomic causes, such as growths or areas of narrowing in the colon. Examination of the anus and rectum is usually the first step, since it is relatively simple and may show the cause of the problem. Examination of the intestine with either a colonoscopy or barium x-ray study may also be required. This is to look for conditions such as such as polyps, cancers, or diverticular disease, which may cause constipation. If this is found, then the underlying condition can be treated.

Other test may be needed to identify specific problems with the movement of your intestines. A "marker studies" in which the patient swallows a capsule containing markers that show up on x-rays taken several days later, provide clues to disorders in the movement of the intestines. Other physiologic tests check the function of the anus and rectum. These include testing the reflexes of anal muscles that control bowel movements using a small plastic catheter, or x-ray testing to evaluate function of the anus and rectum during defecation.
In many cases, no specific anatomic or functional causes are identified and the cause of constipation is said to be nonspecific.

How Is Constipation Treated?
Most patients with constipation are successfully treated by a few simple steps. Eat well balanced, regularly scheduled meals to promote normal bowel function. If you have not been consuming much roughage, take additional fibre in your diet. Ensure that you drink enough fluids to help keep the stools soft. Try to drink at least 8 to 10 glasses of liquid each day in the form of juice, milk, coffee, tea, soup, water or other fluids. An increase in activity will also help the bowel move.

High fibre diet, in addition to relief of constipation, may help to lower cholesterol levels, reduce the risk of developing colon polyps and cancer, and help prevent symptomatic hemorrhoids.

Fibre supplements takes time (up to weeks) for the full effect to take place. However, they are not harmful to the body. Laxatives stimulate the colon to work more rapidly. Continuous use of laxatives can cause the colon to stretch and weaken and, eventually the colon may not work right without them. Thus, laxatives, enemas or suppositories, although it provides rapid relief, is harmful in the long term, and you should avoid long term usage unless recommended and monitored by your doctor.

A change in lifestyle may also help. Having a specific time each day to have a bowel movement may be helpful. In some cases, bio-feedback may help to retrain poorly functioning anal sphincter muscles.

In rare circumstances are surgical procedures necessary to treat constipation. Your doctor can discuss these options with you in greater detail to determine the best treatment for you.

Depression

Depression

Everyone has felt sad at one time or another. Usually it is due to a disappointment, frustration or losing someone. Such sadness is normal. Time heals, the mood lifts and people continue to get on with their lives.
But in some people, depression can be so severe that it dominates their lives, preventing them from coping as they are used to. Depression of this degree is an illness and needs treatment.

WHAT ARE THE SYMPTOMS OF DEPRESSION?
The following are the most common symptoms of depression. If you experience 5 or more of these symptoms for 2 weeks or longer, you are probably depressed.
- Persistent sadness or feeling down or gloomy
- A loss of interest in activities previously enjoyed, such as socializing with friends and family, most of the day, nearly every day.
- Loss of appetite and loss of weight.
- Insomnia. For some people, on the contrary, they find that they are sleeping more than normal.
- Feeling restless and agitated more easily.
- Feeling tired and having little energy.
- Unable to concentrate and think clearly and thereby becoming indecisive.
- Feeling of worthlessness and guilt
- Recurrent thoughts of death

HOW COMMON IS DEPRESSION?
Depression has been called the “common cold of mental health problem”. The World Health Organization (WHO) recently ranked depression as the leading cause of morbidity in developing nations in the next century. Lifetime occurrence rate is between 3% to 6%, and it is twice as common in women as it is in men. It commonly begin in people aged between 20 and 40 years, although it can occur in children or older people. Research has shown that it is commoner in people with a family history of depression.

YOU ARE NOT TO BLAME?
The common misconception is that depression is a moral weakness or a character flaw. Many a time, people have told depressed people to just ‘snap out of it’. Depression is a medical illness with biological roots. It cannot be wiled or wished away.

WHAT ARE THE CAUSES OF DEPRESSION?
Some types of depression run in families, indicating hereditary or genetic factors. In some families, major depression seems to occur generation after generation.
Studies have also suggested some biological component in depression. It may be associated with having too little or too much chemical in the brain. Certain medications have mood altering properties. Antidepressant medication act by altering and normalizing the biochemical imbalances in the brain.

Life events such as loss of job, retirement, divorce, death of a loved one or moving to a new house can precipitate a depressive illness. Social circumstances also play a part. If we are alone, have few or no friends, suffer from a chronic illness, then we may be more vulnerable to depression. People with life threatening or long-term physical illness such as cancer, stroke, arthritis or heart disease are also more vulnerable to depression.

Personality may also play a part in depression. Some of us are more vulnerable than others because of the individual make-up or early life experiences.

Every often, a combination of genetic, psychological and environmental factors is involved in the onset of depression.

The good news is that whatever the cause, depression is treatable.

HOW CAN DEPRESSION BE TREATED?
Treatment consists of drug (antidepressant medication) and non-drug therapy. Usually a combined treatment is best: medication to gain relatively quick relief and psychotherapy to learn more effective ways to deal with life stresses.

ANTIDEPRESSANT MEDICATION?
All antidepressant medications are equally effective but they have different side effects. The most often used antidepressants include tricyclics, monoamine oxidase inhibitors, lithium and selective serotonin inhibitos (SSRI)
Be patient when you take the medication. Antidepressant medications do not begin working the day you take them but your mood will improve after one to two weeks. However, you may notice some improvement on the first day, especially in your sleep and feeling less tense and anxious. They are not addictive.
You can eat a normal diet (if not, your doctor will tell you). The medications are compatible with painkillers, antibiotics and contraceptives. However, you should avoid alcohol as the medication and alcohol combined can make you too drowsy.
Do not stop the medication once you start to feel better as you may relapse into depression again. You should discuss this with your doctor and let him advise you when to stop.
Like all medications, antidepressants have some side effects, though these are usually mild and tend to wear off as treatment goes on.

Some side effects of antidepressant medication:
- Dry mouth
- Constipation
- Dizziness
- Drowsiness
- Nausea and stomach discomfort

NON-DRUG THERAPY
1. PSYCHOTHERAPY
Psychotherapy involves talking things through with a trained counsellor or therapist. Talking to someone who can really listen and understand you without passing judgement can be a tremendous relief. You learn how to solve problems and cope with life stresses better.

2. EXERCISE
Exercise not only improves your health but it also gives you a sense of accomplishment. Endorphins (‘feel good’hormones) are released during exercise and this can elevate your mood.

3. RELAXATION THERAPY
This involves deep breathing exercises and progressive muscle relaxation.

4. SUPPORT GROUPS
Support groups offer fellowship and you get to hear first hand accounts of how other with depression, like you, have learn to cope. Presently SAMH, IMH and the Behavioural Medicine Clinic at IMH run support groups. The group at IMH is a psychoeducation group, i.e. you learn about the depressive illness and methods of coping.

5. ELECTROCONVULSIVE THERAPY (ECT)
ECT is only indicated for those with severe depression who have not responded to treatment or are highly suicidal. It involves giving a light general anaesthetic and an electric current is passed through the brain for few seconds. The whole procedure takes only about 15 minutes and the patient is only aware of having gone to sleep.

HOW TO HELP YOURSELF?
- Don’t bottle things up. Try to talk to someone close to you. It helps to have a good cry and talk things through.
- Don’t set yourself unrealistic or difficult goals. Do what you can.
- Do something – do some light activities or get out of the house for some exercise and some fresh air. It helps to take your mind off things.
- Eat a balanced diet, although you may not feel like eating.
- Do not drown your sorrows in alcohol. Alcohol actually depresses the mood. It may give immediate relief but this is temporary and you end up more depressed. It is also bad for your health.
- Don’t despair: remind yourself that many other people have suffered from depression and have becomes better. You will eventually come out of it, just like they did.

LIVING WITH A DEPRESSED PERSON – HOW CAN YOU HELP?
- Get him to see a doctor so that he can be diagnosed and treated.
- Offer emotional support. Spend time and encourage him to open up. Offer a listening ear.
- Encourage him to continue with treatment. Reassure him that he will get better.
- If the depressed person has mentioned not wanting to live or suicide, it is important to tell his therapist.

Pimples

Most people get pimples at some time in their life - that's just the way it is. Whether you're a teenager, young adult, or even advanced in years, pimples will likely make an appearance. And if you're like most people, you'll reach for your over-the-counter pimple cream, dab it on your pimples and wait for them to go away. But that's just treating the symptom after it appears, rather than preventing the outbreak of pimples in the first place.

You see, by the time a pimple appears on your skin, it has been forming under the skin for about two weeks. Using over-the-counter pimple treatments on existing pimples does little to prevent or treat new pimples forming under the skin. These pimple products mainly use salicylic acid or benzoyl peroxide to treat pimples you see, which is fine, but have little effect on what causes pimples to form in the first place.

What Causes Pimples?
A number of things contribute to the formation of pimples. The main factor is the abnormal flaking of cells inside a hair follicle, which leads to the formation of a plug. This plug can grow and even rupture the hair follicle. A ruptured hair follicle dumps its load of oil and debris into the skin, which leads to swelling, redness and pimples.

Bacteria that normally live on the skin also play a role in causing pimples. The bacteria, known as P. acnes, produce substances that cause redness and inflammation. They also make enzymes which turn the sebum from oil glands in the skin into irritants which can make the inflammation worse, resulting in the formation of pimples.




Another factor in the creation of pimples is the presence of androgens, which are male hormones found in both men and women, although their levels are higher in males. These androgens enlarge the sebaceous glands in the skin and cause them to increase their production of sebum. This increased sebum forms plugs and feed the bacteria which causes pimples to grow.

While over-the-counter treatments containing benozyl peroxide, salicylic acid, or glycolic acid may be helpful in treating occasional outbreaks of pimples or mild cases of acne, they do little to treat and prevent these underlying causes of pimples and acne.





WHEN TO SEE YOUR DOCTOR

* Over-the-counter acne medicines aren't helping.
* Your pimples are forming scars after they heal.

What Your Symptom Is Telling You
Acne usually begins in adolescence, when hormones start to rage. Along with producing major bodily changes like the appearance of a beard or breasts, those hormones can also produce enough oil to keep J. R. Ewing in business for life. With the extra, thicker oil supply, the tiny ducts leading from the oil glands to the surface of the skin can become narrowed or clogged.
Sometimes, oil gets caught at a pore's opening, and when it hits the air, it oxidizes and turns dark, forming a blackhead. Those irritating dark spots are not from inadequate cleansing, dermatologists say. You could wash your face six times a day and still be prone to blackheads. When oil can't escape a plugged-up pore, a small white cyst, known as a whitehead, may form. Either a blackhead or a whitehead can become infected, producing the inflammation and redness of an acne pimple.

But the raging hormones of youth aren't the only cause of problem complexion. External oils on your skin—greasy cleansers, hair products or cosmetics, or even oils you encounter at work—may cause pimples. Stress plays a part, too. Some researchers say that chemicals released by the skin during stress can worsen inflammation.

Acne in adults is essentially the same as the plague of adolescents. Older skin tends to react a little differently, producing deeper lesions and fewer whiteheads and blackheads.
Another kind of acne is unique to adults. It's called rosacea or "the curse of the Celts." This is a skin condition common among rosy-cheeked people of Scotch-Irish descent. These people have a tendency to flush easily, and the increased blood flow to the skin overstimulates oil glands. Over time, this condition can produce acnelike pimples.

Symptom Relief
There's a lot you can do on your own to clear up pimples.
1. Use the right OTCs.
Over-the-counter preparations can be a big help with acne, if you know which ones to use, dermatologists say. Oxy-5, Oxy-10 and Clearasil contain benzoyl peroxide, which fights infection and promotes drying, says Ralph Coskey, M.D., a clinical professor of dermatology at Wayne State University School of Medicine in Detroit.
Clearasil contains salicylic acid and sulfur to both cover and dry up the pimple, says Tor Shwayder, M.D., a pediatric dermatologist at Henry Ford Hospital in Detroit.
2. Handle with care.
Gentle cleaning is the watchword for acne. Twice a day, cleanse your skin with an antibacterial soap like Dial or Safeguard and an ordinary washcloth, says Stephen Webster, M.D., a dermatologist in Lacrosse, Wisconsin. "Don't use abrasive scrubs," says Dr. Coskey. "They can make acne worse."
Also avoid astringents, advises Thomas D. Griffin, M.D., a dermatologist at the Graduate Hospital in Philadelphia. Astringents can be irritating, causing the follicles to swell and leading to further breakouts.
3. Soak, but don't pick.
Warm compresses can ease acne inflammation, says. Dr. Shwayder. Dip a washcloth in warm water, wring it out and apply it to the affected area for 20 minutes twice a day. Avoid the temptation to pick at the lesions, which can cause scarring.
4. Use nonclogging makeup.
Use only cosmetics labeled "noncomedogenic," which won't clog pores, advises Dr. Griffin.
5. Soothe your stress.
Removing the sources of stress from your life—along with daily relaxation techniques and exercise—will ease the stress that can aggravate acne, says George Murphy, M.D., a dermatologist at the University of Pennsylvania School of Medicine in Philadelphia. "Studies show that stress may be part of your skin problem," he advises.
6. Don't touch.
Touching your face frequently only encourages inflammation, says Dr. Griffin. Try to become aware of it and leave this nervous habit behind.






Help from the Doctor
Fortunately, even the worst case of acne can be temporary. Here's how your dermatologist can help.
1. Open the pores.
A form of vitamin A called tretinoin (Retin-A) has gotten a lot of press for its ability to reduce wrinkles. But the primary mission of Retin-A is to treat acne by peeling away the buildup of skin in clogged pores. Your doctor can prescribe Retin-A for as long as you're troubled with acne. At first your skin may be irritated, but your doctor can adjust the dose to the concentration that's right for you.
Another side effect of Retin-A is increased sensitivity to the sun, says Dr. Webster. If you're using Retin-A, apply a nongreasy sunscreen with an SPF (sun protection factor) of 30 every time you go outdoors, he says. "Check labels. You should look for a gel-type sunscreen that contains alcohol."
2. Kill bacteria.
For persistent acne, dermatologists often prescribe benzoyl peroxide medicines to be applied to the skin. Benzoyl peroxide cuts down bacterial activity in the pores, and also produces a mild amount of peeling, says Dr. Webster.
3. Ask about antibiotics.
Your doctor may also prescribe antibiotic creams or lotions to cut down on skin bacteria, says Dr. Webster. The normal bacteria in your skin break oil down into fatty acids, which may cause inflammation. For more severe lesions, your doctor may prescribe oral antibiotics, he says.
4. Peel pimples away.
Fruit acids called alpha-hydroxy acids are effective new weapons in the acne-fighting arsenal, says Dr. Griffin. "A light chemical peel gives fairly quick control over acne," he says. "It may take two or three light peels, repeated monthly."
Your dermatologist will apply a diluted solution of glycolic acid in the office, he says. You will feel stinging and burning for about 30 minutes and experience some initial redness and swelling. If you have the peel done on a Friday, by Monday you'll have only mild flaking, which makeup can cover.
5. Zap them with zinc.
Prescription zinc creams, sometimes mixed with an antibiotic such as erythromycin, may slow the inflammatory process and aid in healing, says Dr. Shwayder.
6. Approach Accutane with caution.
Accutane is a powerful prescription drug for severe cystic acne that doesn't respond to any other treatment, says Dr. Coskey. But Accutane can cause birth defects and must be used with extreme caution in women of child-bearing age. If you're a woman using Accutane, your doctor will require that you use a reliable method of birth control and that you be tested regularly for pregnancy. Other side effects often associated with Accutane are extremely dry skin, nosebleeds, dry eyes, muscle aches and elevated triglycerides and cholesterol.
Accutane therapy lasts for 16 to 20 weeks, and is 80 percent effective for severe acne, says Dr. Coskey.

Cancer

What is cancer?
Throughout our lives, healthy cells in our bodies divide and replace themselves in a controlled sequence. Sometimes, however, a cell begins to reproduce abnormally for no apparent reason. A tumour or lump is a cluster of these abnormal cells. Often a cell from this lump or tumour spreads to another part of the body and begins reproduction there. Eventually this abnormal tissue interferes with the ability of the body and its cells, organs and other structures to perform their normal function, and illness or death may result.






Tumour formation
Most cancers form tumours. Malignant or cancerous tumours crowd out the healthy cells in the body, interfere with body functions, draw nutrients from body tissues and form new tumours in other parts of the body. The spread of cancerous cells is a process called metastasis.
The term 'cancer' is actually applied to more than 100 diseases that affect nearly every part of the body. All can be potentially life-threatening. They all have different causes, cause different symptoms, and vary in aggressiveness (the speed at which they spread). However, most types of cancer fall into 4 main categories.
Carcinomas—these are the most commonly diagnosed cancers that affect the skin, mucous membranes, lungs, breasts, pancreas and other organs and glands.
Leukaemias—these are cancers of the blood and blood-forming tissues and do not form solid tumours.
Sarcomas—these are cancers that affect the bones, muscle and connective tissue and include many of the rarer forms of cancer.
Lymphomas—these are cancers that affect the lymphatic system.

What causes cancer?
At present it is not known what exactly causes some cells to produce cancerous cells. For a healthy cell to turn malignant, its genetic code must be changed or reprogrammed for constant, uncontrolled cell division. Substances that either start or promote the process are called carcinogens, and there are many types.

What are the symptoms?
Cancers appear in many different ways. Most often they are noticed as a lump or growth in some part of the body. This is the case with tumours that form on the outlines of organs. When the cancerous growth is not physically identifiable, there may be other revealing symptoms depending on the form of cancer and the affected organ.
Cancer in the brain may have symptoms like headache, vomiting, difficulty in walking, paralysis and memory problems. Tumours of the intestine can present problems in bowel movements and pain in the stomach. Lung cancers may be manifested by difficulty in breathing and cough. Cancers of the breast are detected as a painless lump. There may also be some deformity of one or both breasts in some cases.
Some malignant tumours are manifested by abnormal bleeding from the affected organ. For example, cancer of the intestine may result in loss of blood in stools. Similarly, lung cancer may be detected when the patient passes blood in the sputum. Pain, as popularly believed, is not a common symptom of cancer. It only occurs in some cases where a nerve is pressed due to rapid enlargement of a tumour.
Other symptoms that may be common to all forms of cancer are a lack of appetite, unexplained loss of weight, general feeling of weakness and fatigue and increased proneness to infections.


Environmental factors
Environmental factors and diet are now thought to be 2 of the major causes of cancer. For example, people exposed to cigarette smoke have significantly higher rates of lung cancer than other people. Smoking is also linked to cancer of the head and neck areas, bladder, kidney, stomach, cervix and pancreas, as well as some leukaemias. Another environmental factor is overexposure to sunlight, causing several types of skin cancers. Many substances in the environment have been identified as carcinogens but, generally, high levels or long-term exposure are needed to cause cancer. These types of environmental carcinogens include various chemicals, gases and other substances found in the air, water and food.


Diet and nutrition
A diet that is high in fat and low in fibre is associated with a greater risk of colorectal cancer and is now considered a factor in several other cancers. Other dietary habits associated with cancer include over-consumption of alcohol, fat and foods that have been smoked, cured, pickled or charred.

Age and genetics
The risk for most cancers increases with age. Inherited, or familial, predisposition is also considered a risk factor, although the influence will vary from case to case.
All these factors may contribute to cancer; however, cancer is not actually caused by any single factor. Cancer most commonly is caused by a multiple of factors including age, inherited predisposition, general health and exposure to carcinogens. As such, everyone’s cancer risk profile is complex and unique.

How is it diagnosed?
In case blood is passed in stools or cough, the patient should see a doctor. For confirmation, a biopsy of the affected organ is done. In this procedure, a small part of the tissue is taken for laboratory testing to detect the presence of cancerous cells.
In case of cancer of the lungs, liver, stomach or intestine, an X-ray or ultrasound of the area may be taken. CT scans of the organs may also be done for diagnosis. The diagnosis is always made keeping in mind the patient’s previous medical history.

What is the treatment?
Treatment is most effective if the cancer is detected early. Chemotherapy is the most common method of treatment for cancer that has spread to other parts of the body. In this procedure, the malignant cells are destroyed with the help of powerful chemicals like methotrexate and vincristine which are given intra-venously i.e. directly injected into the veins. This procedure requires a hospital stay for the duration of therapy. It is also associated with various side effects like loss of hair, nausea, vomiting, loss of appetite and weakness for some days.
For a tumour that has not spread, radiotherapy or radiation, or surgery may be done. In the former, the cells are destroyed with the help of strong radio active waves. The exact position of the tumour is marked and the area is exposed to radiation under strictly controlled conditions. This treatment is given in breaks and in pre-determined doses.
Tumours that develop in organs under hormonal control like the breast, thyroid or prostate, may also be treated with endocrine therapy. In this treatment, either the source of the hormone is removed or anti-hormone drugs are given. This treatment scores over chemotherapy because it usually has less severe side effects. But the doctor decides the best course of treatment depending on the diagnosis of the form of cancer.

TUBERCULOSIS

What is tuberculosis?
Tuberculosis is a disease caused by a bacteria called mycobacterium tuberculosis. This germ enters the body through the air (usually that which has been coughed out by someone who is an infectious case of tuberculosis) that you breathe and causes an infection usually in the lungs.
Can tuberculosis affect other parts of the body?
It may also infect other parts of the body, including the lymph-nodes, the covering of the heart known as the pericardium, the bones and joints, the liver, brain and the intestines.




What are the symptoms of tuberculosis?
Persistent cough, sometimes this may be productive of blood stained sputum, fever with shaking chills, night sweats, loss of appetite, loss of weight, easy fatiguability may be seen in patients with tuberculosis.

How do I know whether I have tuberculosis (lungs)?
A screening chest x-ray can be done. Though a normal x-ray does not exclude tuberculosis, there is a much lower likelihood of having active lung tuberculosis if the chest x-ray is normal.

Is there a test for tuberculosis?
Besides an abnormal chest x-ray that may suggest possible active tuberculosis, sputum tests need to be done to confirm it. If the patient cannot produce sputum, a laryngeal swab (a swab taken from part of the throat) may be taken. Sometimes bronchoscopy is performed to confirm the diagnosis. This involves obtaining a specimen via a flexible endoscope used to examine the airways. These specimens are specially stained and examined under the microscope for the tuberculosis germ, as well as sent for cultures (may take several weeks). In some cases, both the smears and cultures are negative but the patient responds to treatment with medication for tuberculosis with resolution of his symptoms and an improvement in chest x-rays done serially.

Can tuberculosis be cured?
Active tuberculosis can be treated very effectively with a combination of appropriate drugs. Treatment may take up to 6 months or more, but as long as they are taken as prescribed, the disease usually be cured.

Read More about Tuberculosis

Heart Palpitation

Heart Palpitation

Palpitation of the heart is the name given to attacks that come on by day or night, often suddenly. The person who has the attack suddenly flushes up ; there is distress in the chest, and the heart becomes exceedingly rapid. True palpitation is always of this character, though slight disturbances with intermittences of the pulse and fluttering of the heart may happen in less well-defined attacks. Sometimes the person describes a feeling as if the heart turned over in the chest.

Palpitation is often a sign of serious disease; again, it may happen in persons who are upset by indiscretions of diet, abuses of tea or tobacco, or in those who are enfeebled by lack of exercise or other debilitating conditions. Palpitation of a troublesome kind is often seen in people who have hardening of the arteries, and when these attacks are accompanied by wind on the stomach and indigestion, the' true cause may be overlooked, but the attacks are never overcome till the hardening of the arteries is treated.

A person who is subject to attacks of palpitation should build up his general health in every way, and having found the cause of these attacks should seek to have it removed.

There are some cases, however, in which there does not appear to be any discoverable, under-lying cause. This seems to happen most often in families in which nervous tendencies are a characteristic; it also seems more apt to occur in people with low blood pressure. The attacks often terminate suddenly, and a curious fact is that during the attack the pulse is frequently exactly twice as rapid as it is in the intervals.

There is no satisfactory treatment for an attack of palpitation; sometimes the attack yields to a certain treatment; another time, when the same treatment is tried, the attack continues. Among the things to be tried are the drinking of cold water, deep respirations, changes of position from standing up to lying down, lowering the head, etc. emetics, bromide of ammonia, bicarbonate of soda, or an ice bag over the heart.

If the attacks can be traced to other conditions, of course, these are to be treated. Such palpitation may occur after typhoid fever, in which case particular care should be exercised, and the heart should be examined later to see if any permanent damage has remained from the fever. When palpitation occurs after an attack of diphtheria, it may be serious.

In heart disease proper a rapid pulse is frequently observed. Persons who are subject to palpitation learn by experience what helps the most. The attacks seldom last more than a few hours, and it is better to remain perfectly quiet and wait for the attack to pass off. These attacks are not ordinarily dangerous tho, of course, they are alarming.

Any one who has charge of the nursing of a patient with palpitation of the heart must learn to reassure the sufferer and patiently apply the various remedies already suggested ; but a physician should always be summoned unless one has already given instructions.

The important thing to learn about palpitation is that it must not be allowed to interfere with attention to the general health of the patient.

What is a Heart Palpitation?
Heart palpitations are sensations that feel like pounding or racing. Sometimes it feels like your heart skipped or stopped beats. Palpitations can be felt in your chest, throat, or neck.
If you have heart palpitations, you should contact your doctor to make sure it is not caused by a serious condition. Your doctor will perform tests to determine the cause and whether the heart palpitations are treatable or not.
Heart palpitations are also called:
-Heartbeat sensations
-Irregular heartbeat
-Palpitations
-Rapid heart rate
-Racing heart
-Tachycardia

What Causes Heart Palpitations?
There are many causes of heart palpitations. The most common causes are:
-Exercise
-Anxiety
-Stress
-Heart Disease
-Caffeine, nicotine, cocaine, diet pills
-Fever
-Hyperventilation
-Overactive thyroid
-Anemia
-Low levels of oxygen in your blood
-Medications
-Mitral valve prolapse

Can Heart Palpitations be Prevented?
Whether or not heart palpitations can be prevented will depend on the cause. Reducing stress and anxiety can help lessen your heart palpitations.

Emergency Symptoms
Call your doctor immediately if:
-You have fainted or someone you are with loses consciousness.
-You have shortness of breath, chest pain, unusual sweating, dizziness, or lightheadedness.
-You feel frequent extra heartbeats
-You have risk factors for heart disease like high cholesterol, diabetes, or high blood pressure.
-You have new or different heart palpitations.
-Your pulse is more than 100 beats per minute (without exercise).

Insomnia

Insomnia

There are four major types of Insomnia.
1. Difficulty falling asleep
2. No problem falling asleep but difficulty staying asleep (many awakenings)
3. Waking up too early
4. Sleep State Misperception

How much sleep does a person need?
Enough to feel alert during the day. Typically 7 to 9 hours (varies from person to person) of good quality sleep.

What can cause Insomnia?
Many things can cause insomnia. Insomnia is not a disorder it is a complaint. The goal is to find the underlying problem causing the complaint. Almost any sleep disorder can present themselves as insomnia including circadian disorders, sleep apnea, restless legs, and the list goes on. So ruling out a sleep disorder can be important. Medications, herbs and caffeine can cause insomnia. Most medications will report the possible side effect of insomnia and sleepiness. The same medication can cause both since we all react to medications differently. Life events can cause insomnia but it is usually temporary. Anxiety about falling asleep can also be responsible, however, if the anxiety is due to a long history of insomnia, the anxiety is probably not the problem and you need to find out what is the underlying cause. Once sleep is restored to normal the anxiety will usually go away. Physical problems such as pain can be the underlying cause. There is also the possibility of mental problems, and a good sleep doctor that works with insomnia can rule this in or out sometimes without an all night sleep study. This problem can be treated using many different techniques.

Three basic types of Insomnia
1. Transient insomnia - lasting for a few nights
2. Short-term insomnia - two or four weeks of poor sleep
3. Chronic insomnia - poor sleep that happens most nights and last a month or longer

Transient and short-term insomnia generally occur in people who are temporarily experiencing one or more of the following:
• stress
• environmental noise
• extreme temperatures change in the surrounding environment
• sleep/wake schedule problems such as those due to jet lag
• medication side effects

Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, restless legs syndrome, Parkinson's disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur with shift work or other nighttime activity schedules; and chronic stress.

In addition, the following behaviors have been shown to perpetuate insomnia in some people: • poor sleep hygiene in general
• expecting to have difficulty sleeping and worrying about it
• ingesting excessive amounts of caffeine
• drinking alcohol before bedtime
• smoking cigarettes before bedtime
• excessive napping in the afternoon or evening
• irregular or continually disrupted sleep/wake schedule

Difficulty sleeping is only one of the symptoms. Daytime symptoms include:
-Sleepiness
-Anxiety
-Impaired concentration
-Impaired memory
-Irritability

Treatment for transient and short-term insomnia
Transient and short-term insomnia may not require treatment since episodes last only a few days at a time. For example, if insomnia is due to a temporary change in the sleep/wake schedule, as with jet lag, the person's biological clock will often get back to normal on its own. However, for some people who experience daytime sleepiness and impaired performance as a result of transient insomnia, the use of short-acting sleeping pills may improve sleep and next-day alertness. As with all drugs, there are potential side effects. The use of over-the-counter sleep medicines is not usually recommended for the treatment of insomnia.

Treatment for chronic insomnia consists of:
First, diagnosing and treating underlying medical or psychological problems.
Identifying behaviors that may worsen insomnia and stopping (or reducing) them.
Possibly using sleeping pills, although the long-term use of sleeping pills for chronic insomnia is controversial.

A patient taking any sleeping pill should be under the supervision of a physician to closely evaluate effectiveness and minimize side effects. In general, these drugs are prescribed at the lowest dose and for the shortest duration needed to relieve the sleep-related symptoms. For some of these medicines, the dose must be gradually lowered as the medicine is discontinued because, if stopped abruptly, it can cause insomnia to occur again for a night or two.

Trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, reconditioning, and bright light.

Relaxation Therapy. There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person's mind is able to stop "racing," the muscles can relax, and restful sleep can occur. It usually takes much practice to learn these techniques and to achieve effective relaxation.
Sleep Restriction. Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night's sleep is achieved.
Reconditioning. Another treatment that may help some people with insomnia is to recondition them to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex (some experts even say using the bed for sex call cause performance anxiety which could lead to insomnia). As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy, and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person's body will be conditioned to associate the bed and bedtime with sleep.
Bright Light. If you are having trouble getting to sleep early enough at night it will help to wake up at the same time every morning and try to get as much bright light in the morning as possible. This will help reset the internal clock to an earlier time at night for sleep. If you are having trouble staying awake in the evening and waking up too early in the morning then try to get bright light in the evening. This will help rest the internal clock to go to sleep later and wake up later. You may want to avoid early morning light using this method until you have stabilized your sleeping pattern.

Sleep State Misperception
Many people will sleep most of the night and believe they didn't sleep at all. Sleep State Misperception can cause anxiety which increases the symptoms. All night sleep recordings show normal sleep, but the next morning the patient will report not sleeping. Seeing their sleep data and education can help with this problem.
If you feel you are not sleeping at all during the night but are not sleepy the next day you may have this complaint.

If insomnia is effecting the quality of life, talking to your physician is advised. The subject will not usually be brought up unless your bring it up. For chromic insomnia a sleep specialist may be needed.

Bipolar Disorder (Part 3)

Bipolar Disorder

Thyroid Function
People with bipolar disorder often have abnormal thyroid gland function. Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are carefully monitored by a physician.
People with rapid cycling tend to have co-occurring thyroid problems and may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation.

Medication Side Effects
Before starting a new medication for bipolar disorder, always talk with your psychiatrist and/or pharmacist about possible side effects. Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth. Be sure to tell the doctor about all side effects you notice during treatment. He or she may be able to change the dose or offer a different medication to relieve them. Your medication should not be changed or stopped without the psychiatrist's guidance.

Psychosocial Treatments
As an addition to medication, psychosocial treatments—including certain forms of psychotherapy (or "talk" therapy)—are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas. A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient's progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.

Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy, and a newer technique, interpersonal and social rhythm therapy. NIMH researchers are studying how these interventions compare to one another when added to medication treatment for bipolar disorder.

-Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.
-Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for family members.
-Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person's symptoms.
-Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
-As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.

Other Treatments
1. In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.
2. Herbal or natural supplements, such as St. John's wort (Hypericum perforatum), have not been well studied, and little is known about their effects on bipolar disorder. Because the FDA does not regulate their production, different brands of these supplements can contain different amounts of active ingredient. Before trying herbal or natural supplements, it is important to discuss them with your doctor. There is evidence that St. John's wort can reduce the effectiveness of certain medications. In addition, like prescription antidepressants, St. John's wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken.
3. Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder.

Do Other Illnesses Co-occur with Bipolar Disorder?
Alcohol and drug abuse are very common among people with bipolar disorder. Research findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms, mood symptoms either brought on or perpetuated by substance abuse, and risk factors that may influence the occurrence of both bipolar disorder and substance use disorders. Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan.
Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with bipolar disorder. Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder, or they may require separate treatment.

How Can Individuals and Families Get Help for Bipolar Disorder?
Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.

People with bipolar disorder may need help to get help.
1. Often people with bipolar disorder do not realize how impaired they are, or they blame their problems on some cause other than mental illness.
2. A person with bipolar disorder may need strong encouragement from family and friends to seek treatment. Family physicians can play an important role in providing referral to a mental health professional.
3. Sometimes a family member or friend may need to take the person with bipolar disorder for proper mental health evaluation and treatment.
4. A person who is in the midst of a severe episode may need to be hospitalized for his or her own protection and for much-needed treatment. There may be times when the person must be hospitalized against his or her wishes.
5. Ongoing encouragement and support are needed after a person obtains treatment, because it may take a while to find the best treatment plan for each individual.
6. In some cases, individuals with bipolar disorder may agree, when the disorder is under good control, to a preferred course of action in the event of a future manic or depressive relapse.
7. Like other serious illnesses, bipolar disorder is also hard on spouses, family members, friends, and employers.
8. Family members of someone with bipolar disorder often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during depression, and the lasting consequences of these behaviors.
9. Many people with bipolar disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA).

Bipolar Disorder (Part 2)

Bipolar Disorder

What Is the Course of Bipolar Disorder?
Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.

The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated. Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared. But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.

Can Children and Adolescents Have Bipolar Disorder?
Both children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness.
Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day. Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.

Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, or other types of mental disorders more common among adults such as major depression or schizophrenia. Drug abuse also may lead to such symptoms.

For any illness, however, effective treatment depends on appropriate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional. Any child or adolescent who has suicidal feelings, talks about suicide, or attempts suicide should be taken seriously and should receive immediate help from a mental health specialist.

What Causes Bipolar Disorder?
Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder—rather, many factors act together to produce the illness.

Because bipolar disorder tends to run in families, researchers have been searching for specific genes—the microscopic "building blocks" of DNA inside all cells that influence how the body and mind work and grow—passed down through generations that may increase a person's chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.

In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene. It appears likely that many different genes act together, and in combination with other factors of the person or the person's environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries and to new and better treatments for bipolar disorder.

Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses. New brain-imaging techniques allow researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures. These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.

How Is Bipolar Disorder Treated?
Most people with bipolar disorder—even those with the most severe forms—can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.
In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.
In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.

Medications
Medications for bipolar disorder are prescribed by psychiatrists—medical doctors (M.D.) with expertise in the diagnosis and treatment of mental disorders. While primary care physicians who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.

Medications known as "mood stabilizers" usually are prescribed to help control bipolar disorder. Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years). Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.
1. Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
2. Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania.
3. Newer anticonvulsant medications, including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood cycles.
4. Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect.
5. Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine also are used. Researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents. There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20. Therefore, young female patients taking valproate should be monitored carefully by a physician.
6. Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant. Therefore, the benefits and risks of all available treatment options should be discussed with a clinician skilled in this area. New treatments with reduced risks during pregnancy and lactation are under study.

Treatment of Bipolar Depression
Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication. Therefore, "mood-stabilizing" medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today. However, research studies continue to evaluate the potential mood-stabilizing effects of newer medications.
-Atypical antipsychotic medications, including clozapine (Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), and ziprasidone (Geodon®), are being studied as possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants. Other research has supported the efficacy of olanzapine for acute mania, an indication that has recently received FDA approval. Olanzapine may also help relieve psychotic depression.
-If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem (Ambien®), are sometimes used instead.
-Changes to the treatment plan may be needed at various times during the course of bipolar disorder to manage the illness most effectively. A psychiatrist should guide any changes in type or dose of medication.
-Be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements you may be taking. This is important because certain medications and supplements taken together may cause adverse reactions.
-To reduce the chance of relapse or of developing a new episode, it is important to stick to the treatment plan. Talk to your doctor if you have any concerns about the medications.

Bipolar Disorder (manic-depressive illness) Part 1

Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

More than 2 million American adults,1 or about 1 percent of the population age 18 and older in any given year,2 have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.
Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide.

Symptoms of Bipolar Disorder
Bipolar disorder causes dramatic mood swings—from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include:
-Increased energy, activity, and restlessness
-Excessively "high," overly good, euphoric mood
-Extreme irritability
-Racing thoughts and talking very fast, jumping from one idea to another
-Distractibility, can't concentrate well
-Little sleep needed
-Unrealistic beliefs in one's abilities and powers
-Poor judgment
-Spending sprees
-A lasting period of behavior that is different from usual
-Increased sexual drive
-Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
-Provocative, intrusive, or aggressive behavior
-Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:
-Lasting sad, anxious, or empty mood
-Feelings of hopelessness or pessimism
-Feelings of guilt, worthlessness, or helplessness
-Loss of interest or pleasure in activities once enjoyed, including sex
-Decreased energy, a feeling of fatigue or of being "slowed down"
-Difficulty concentrating, remembering, making decisions
-Restlessness or irritability
-Sleeping too much, or can't sleep
-Change in appetite and/or unintended weight loss or gain
-Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
-Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.
A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.
Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.
It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

Bipolar disorder may appear to be a problem other than mental illness—for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.




Diagnosis of Bipolar Disorder
Like other mental illnesses, bipolar disorder cannot yet be identified physiologically—for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history.

Mental Illness

About Mental Illness

Mental illnesses include such disorders as schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic and other severe anxiety disorders, autism and pervasive developmental disorders, attention deficit/hyperactivity disorder, borderline personality disorder, and other severe and persistent mental illnesses that affect the brain.

These disorders can profoundly disrupt a person's thinking, feeling, moods, ability to relate to others and capacity for coping with the demands of life.

Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing.

Mental illnesses are treatable. Most people with serious mental illness need medication to help control symptoms, but also rely on supportive counseling, self-help groups, assistance with housing, vocational rehabilitation, income assistance and other community services in order to achieve their highest level of recovery.

Here are some important facts about mental illness and recovery:

1. Mental illnesses are biologically based brain disorders. They cannot be overcome through "will power" and are not related to a person's "character" or intelligence.
2. Mental disorders fall along a continuum of severity. The most serious and disabling conditions affect five to ten million adults (2.6 – 5.4%) and three to five million children ages five to seventeen (5 – 9%) in the United States.
3. Mental disorders are the leading cause of disability (lost years of productive life) in the North America, Europe and, increasingly, in the world. By 2020, Major Depressive illness will be the leading cause of disability in the world for women and children.
4. Mental illnesses strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable.
5. Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives; The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States.
6. The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports;
7. Early identification and treatment is of vital importance; By getting people the treatment they need early, recovery is accelerated and the brain is protected from further harm related to the course of illness.
8. Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is time to take these barriers down.

Colds and the Flu

Colds and the Flu

Colds and flu are caused by viruses. Flu is short for "influenza." True flu is a virus that affects your upper respiratory and lower system – your nose, throat, breathing tube, and lungs. "Stomach flu" is upset stomach and diarrhea caused by a virus in the stomach and intestines. This is not true flu or influenza.Flu symptoms come on suddenly and affect the body all over. Cold symptoms mostly affect you above the neck. A cold typically goes away in 10-14 days with or without treatment.

How Do I Know If I Have the Flu?
Flu generally strikes 1 to 3 days after exposure to the virus. The onset of flu often seems sudden: people describe feeling like they've "been hit by a truck." Common flu symptoms include sudden onset, fever and chills, cough, muscle and joint pain, headache, fatigue and weakness. Some people also get a stuffy nose and sore throat.

Differentiating Between the Flu and a Cold
Both the flu and a cold are viral infections and can cause symptoms such as coughing and sore throat. A cold is a minor viral infection of the nose and throat. The flu, however, is usually more severe, with higher fevers and the addition of aches and pains.


Signs and Symptoms - Flu/Cold
Fever, chills - Usual; can be a high fever ; Low fever, if any
Headache - Usual; Rare
General aches and pains - Usual, often severe, affect the body all over ; Mild, if any
Fatigue, weakness - Can last up to 2 to 3 weeks ; Mild , if any
Runny, stuffy nose - Sometimes ; Common
Sneezing - Sometimes ; Usual
Sore throat - Sometimes ; Common
Cough - Common,can be come severe; Mild to moderate,hacking cough
Extreme exhaustion - Early and prominent ; Never
Chest discomfort - Common ; Mild to moderate
Myalgia (muscle aches and pains) - Usual, often severe; Slight

What Should I Do If I Get the Flu?
Rest is important to help you get better. Plus if you stay home, there's less risk that you'll give the flu to other people. Flu continues to be contagious for 3 or 4 days after symptoms appear. You should also drink plenty of fluids. Hot liquids may relieve the feeling of congestion. A pain reliever, such as acetaminophen, can be taken for aches and fever.Doctor may prescribe an antiviral medication, which must be taken within 1 to 2 days of the time the first symptoms appear, to reduce the duration of fever and other flu-related symptoms. Antibiotics are not indicated unless there is a secondary bacterial infection.

Ways to treat your cold/flu symptoms
Stay home and rest, especially while you have a fever.
Stop smoking and avoid secondhand smoke, which can make cold symptoms worse.
Drink plenty of fluids like water, fruit juices and clear soups. Fluids help loosen mucus. Fluids are also important if you have a fever because fever can dry up your body's fluids, which can lead to dehydration.
Do not drink alcohol.
Gargle with warm salt water a few times a day to relieve a sore throat. Throat sprays or lozenges may also help relieve the pain.
Use saline (salt water) nose drops to help loosen mucus and moisten the tender skin in your nose.

Should I Take Medicine For a Cold or the Flu?
No medicine can cure a cold or the flu. Medicine can, however, help relieve your cold/flu symptoms.

Prevention
Wash your hands often. Keep them away from your nose, eyes, and mouth.
Try not to touch people or their things when they have a cold or the flu.
Get regular exercise. Eat well.
Get adequate rest. Plan this in your busy schedule.
Get a flu shot each fall if you have chronic illness, like asthma, or other lung diseases, heart diseases, or diabetes.

Should I Call My Doctor?
In most cases, you don't need to see your doctor when you have a cold or the flu. However, if you have any of the symptoms below, seek medical advice.
A cold that lasts for more than 10 days
Earache or drainage from your ear
Severe pain in your face or forehead
Temperature above 102° F
Shortness of breath
Hoarseness, sore throat or a cough that won't go away