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ANEMIA, FOLIC-ACID DEFICIENCY

September 15, 2011 in Health Library

General Information

DEFINITION–Anemia caused by a deficiency of folic acid. It is often accompanied by iron-deficiency anemia.

BODY PARTS INVOLVED–Blood cells, which transport oxygen to all body parts.

SEX OR AGE MOST AFFECTED–Both sexes, but most common in women over 30.

SIGNS & SYMPTOMS

  • Fatigue and weakness.
  • Red, sore tongue.
  • Paleness.
  • Shortness of breath.
  • Nausea, vomiting and diarrhea (rare).

CAUSES

  • Complication of pregnancy, when the body needs 8 times more folic acid than usual.
  • Inadequate intake or absorption of foods with a high folic-acid content, such as meat, poultry, fish, cheese, milk, eggs, green vegetables, yeast and mushrooms.
  • Alcoholism.
  • Overcooking foods, which destroys folic acid.
  • Deficiency of vitamin B-12 or vitamin C.

RISK INCREASES WITH

  • Adults over 60, especially those who have poor diets.
  • Pregnancy.
  • Illness, such as tropical sprue, psoriasis, acne rosacea, eczema or dermatitis herpetiformis.
  • Fad diets or general poor nutrition, especially vitamin-C deficiency.
  • Surgical removal of the stomach.
  • Smoking, which decreases vitamin-C absorption. Vitamin C is necessary for folic-acid absorption.
  • Use of certain drugs, such as oral contraceptives, anticonvulsants, methotrexate, triamterene or sulfasalazine.

HOW TO PREVENT

  • Don’t drink alcohol.
  • Have regular medical checkups during pregnancy. Take prenatal vitamin supplements, if they are prescribed.
  • Eat well. Include fresh vegetables, meat and other animal proteins. Avoid fad diets. Don’t overcook food.
  • Don’t smoke. Smoking increases vitamin requirements.

What To Expect

DIAGNOSTIC MEASURES–

  • Your own observation of symptoms.
  • Medical history and physical exam by a doctor.
  • Laboratory blood studies and possibly a Schilling test to measure vitamin B-12 levels and a therapeutic trial of vitamin B-12.

APPROPRIATE HEALTH CARE

  • Self-care after diagnosis.
  • Doctor’s treatment.

POSSIBLE COMPLICATIONS

  • Infertility.
  • Increased susceptibility to infection.
  • Congestive heart failure (severe cases only).

PROBABLE OUTCOME–Usually curable in 3 weeks with an adequate folic-acid intake.

How To Treat

GENERAL MEASURES–

  • If you smoke, stop smoking.
  • If you take oral contraceptives, consider using another form of contraception.

MEDICATION–Your doctor may prescribe:

  • Folic-acid supplements.
  • Iron supplements to take orally.

ACTIVITY–Anemia causes fatigue. Schedule regular rest periods until you are able to resume normal activity.

DIET–No special diet. Eat foods daily that are high in folic acid. The liver can store folic acid for a limited time only. Foods include asparagus spears, beef liver, broccoli spears, collards (cooked), mushrooms, oatmeal, peanut butter, red beans, wheat germ.

Call Your Doctor If

  • You have symptoms of anemia.
  • Symptoms don’t improve in 2 weeks, despite treatment.
  • Symptoms of infection (fever, chills and muscle aches) occur during treatment.

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ALTITUDE ILLNESS

September 12, 2011 in Health Library

General Information

DEFINITION–

Any of several illnesses associated with higher than usual altitudes. Illnesses are of several types, including:

  • Acute mountain sickness (AMS).
  • High altitude pulmonary edema (HAPE).
  • High altitude cerebral edema (HACE).
  • High altitude retinal hemorrhage (HARH).
  • Subacute and chronic mountain sickness (CMS). This illness is a complication that represents failure to recover from AMS over a long period of time.

BODY PARTS INVOLVED–These illnesses affect most body systems, especially the brain, heart, lungs, gastrointestinal tract, circulatory system and electrolytes. SEX AND AGE MOST AFFECTED–Young adults of both sexes.

SIGNS & SYMPTOMS

> AMS: headache, nausea, vomiting, shortness of breath, sleep disturbances.

> HAPE: shortness of breath, cough, weakness, headache, coma.

> HACE: severe headache, staggering gait, hallucinations, stupor. These indicate swelling of the brain. Death will occur with descent.

> HARH: visual disturbances, including spots before the eyes. Blood clots and bleeding into the retina occur in 50% of those who go above 17,000 feet.

> CMS: shortness of breath, fatigue, bloated face and body, congestive heart failure after years of living at high altitude (rare).

CAUSES–

Insufficient oxygen at high altitudes. Following are the altitudes at which each type of illness can occur:

  • AMS–7,000 to 8,000 feet or higher.
  • HAPE–9,000 to 10,000 feet.
  • HACE–10,000 to 12,000 feet.
  • HARH–17,000 feet.

RISK INCREASES WITH

  • Lack of conditioning.
  • Faster and higher ascent.
  • Previous episodes of altitude illness.
  • Chronic illness of any sort, particularly cardiovascular and lung diseases.
  • Excess alcohol consumption or use of mind-altering drugs, including narcotics and tranquilizers.

HOW TO PREVENT

  • Acclimatization as you ascend; descend if troubling symptoms appear.
  • Obtain maximum physical conditioning.
  • Talk to your doctor about preventive drugs.

What To Expect

DIAGNOSTIC MEASURES–

  • Medical history and physical exam by a doctor.
  • Laboratory blood studies and urinalysis.
  • ECG (See Glossary) and chest x-rays (sometimes).

APPROPRIATE HEALTH CARE

  • Self-care.
  • Doctor’s treatment.
  • Hospitalization (severe cases).

POSSIBLE COMPLICATIONS–Respiratory distress syndrome; brain, eye, heart and lung damage.

PROBABLE OUTCOME–Complete recovery in 1-3 days.

How To Treat

GENERAL MEASURES–

  • In most cases, rest, mild pain relievers, avoidance of alcohol and adequate hydration will control symptoms.
  • For some patients, a descent to a lower altitude will be necessary.

MEDICATION–Your doctor may prescribe:

  • Pain relievers for headache.
  • Antibiotics if infection is present.
  • Dexamethasone or acetazolamide for more severe symptoms.
  • Supplemental oxygen if required.

ACTIVITY–

  • If any altitude illness occurs, decrease activity to a level at which symptoms disappear.
  • Resume routine activities gradually upon returning to normal altitude.

DIET–Increase fluid intake, avoid alcohol, eat small meals.

Call Your Doctor If

  • You have symptoms of any altitude illness.
  • New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

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ACNE ROSACEA

September 9, 2011 in Health Library

General Information

DEFINITION–Chronic inflammation of skin of the face. Severe nose involvement, mostly in men, is called rhinophyma.

BODY PARTS INVOLVED–Face, especially the nose, and surrounding areas.

SEX OR AGE MOST AFFECTED–Adults; it is more common in women, but more severe in men.

SIGNS & SYMPTOMS

  • Flushing of the nose, cheeks and forehead that may last a few minutes or hours. In most cases, the flushing becomes permanent.
  • Facial tenderness.
  • Papules (small raised bumps) and pustules (small, white blisters with pus) on the affected skin (sometimes).
  • Unsightly red, thickened skin (excess tissue) on the nose and cheeks. Small blood vessels are visible on the skin surface.

CAUSES

  • Unknown. Some evidence suggests an underlying vascular disorder. Another factor may be a microscopic mite called Demodex folliculorum (a normal resident in human skin) that is more numerous on the skin of people with rosacea.
  • The condition is worsened by stress (worry and anxiety), hot drinks, spicy foods, smoking, alcohol, exposure to temperature extremes, excessive sunlight and cosmetics or skin products containing alcohol (or other irritating ingredients).

RISK INCREASES WITH

  • People who flush easily.
  • Fair complexion.
  • Family history of acne rosacea.
  • Overuse of corticosteroid creams or ointments in treatment of other skin disorders.

HOW TO PREVENT–No specific preventive measures.

What To Expect

DIAGNOSTIC MEASURES–

  • Your own observation of symptoms.
  • Medical history and physical exam by a doctor. There is no specific test to diagnose the disorder.

APPROPRIATE HEALTH CARE

  • Self-care after diagnosis.
  • Doctor’s treatment with medications.
  • Steroid-induced rosacea is treated first by stopping the steroid drug.
  • Destruction of large vessels with electric needle or a laser.
  • Excess tissue removal with electric needle or a laser; or sometimes with a scalpel or rapidly rotating wire brush. The nose may be red for up to a year and then assumes a normal color.
  • Psychotherapy or counseling, if disfigurement causes distress.

POSSIBLE COMPLICATIONS

  • Psychological distress caused by an unsightly appearance.
  • More likely to suffer from migraines.
  • Autoimmune eye disorders (rare).

PROBABLE OUTCOME–Symptoms can be controlled with treatment. Acne rosacea is a disease of remissions and frequent flare-ups.

How To Treat

GENERAL MEASURES–

  • Seek care early if you notice evidence of acne rosacea.
  • Use water-based cosmetics instead of oil-based products.
  • See How to Cope With Stress in Appendix.

MEDICATION–

  • Your doctor may prescribe: Oral antibiotics, such as tetracycline or erythromycin. Topical antibiotics. Topical antiprotozoal and antibacterial medications, such as metronidazole. Isotretinoin (Accutane), an oral drug, may succeed where other measures fail.
  • Don’t use cortisone preparations, including non-prescription medicines, without doctor’s approval.

ACTIVITY–No restrictions except to avoid factors that may cause a flare-up (see Causes).

DIET–No special diet. Avoid spicy foods, alcohol or anything that causes the face to flush.

Call Your Doctor If

You have symptoms of acne rosacea. This condition can be helped with treatment.

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