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ANXIETY

September 16, 2011 in Health Library

 

General Information

 

DEFINITION–A vague, uncomfortable feeling of fear, dread or danger from an unknown source. For some it may be a one time episode; other persons become constantly anxious about everything. A certain amount of anxiety is normal and helps improve our performance and allows people to avoid dangerous situations. Several types of anxiety are recognized including acute situational anxiety (which is usually short-term), generalized anxiety disorder and adjustment disorder. (See also Panic Disorder, Post Traumatic Stress Disorder, Phobias, and Obsessive-Compulsive Disorder in Illness section). Generalized anxiety is defined as unrealistic or excessive anxiety for 6 months or longer. Anxiety is the most common mental health problem in the U.S.

 

BODY PARTS INVOLVED–Central nervous system; endocrine system.

 

SEX OR AGE MOST AFFECTED–Females more than males, and mainly in adults ages 20-45.

 

SIGNS & SYMPTOMS

 

  • Feeling that something undesirable or harmful is about to happen (edginess and apprehension).
  • Dry mouth; swallowing difficulty; hoarseness.
  • Rapid breathing and heartbeat, palpitations.
  • Twitching or trembling.
  • Muscle tension; headaches; backache.
  • Sweating.
  • Difficulty in concentrating.
  • Dizziness or faintness.
  • Nausea; diarrhea; weight loss.
  • Sleeplessness.
  • Irritability.
  • Fatigue.
  • Nightmares.
  • Memory problems.
  • Sexual impotence.

 

CAUSES–Activation of the body’s defense mechanisms for fight or flight. Excess adrenalin is discharged from the adrenal glands, and adrenalin breakdown products (catecholamines) eventually affect various parts of the body. Attempts to avoid the anxiety leads to more anxiety.

 

RISK INCREASES WITH

 

  • Stress from any source (such as social or financial problems).
  • Family history of neurosis.
  • Fatigue or overwork.
  • Recurrence of situations that have been previously stressful or harmful.
  • Medical illness.
  • Unrealistic perfectionism.
  • Withdrawal from drugs or alcohol.

 

HOW TO PREVENT

 

  • Practice relaxation techniques or meditation.
  • Consider lifestyle changes to reduce stress. See How to Cope with Stress in Appendix.

 

 

What To Expect

 

DIAGNOSTIC MEASURES–

 

  • Your own observation of symptoms.
  • Medical history and physical exam by a doctor.
  • Laboratory studies to rule out medical conditions that produce anxiety, such as hyperthyroidism, anemia, hypoglycemia, diabetes.

 

APPROPRIATE HEALTH CARE

 

  • Self-care.
  • Doctor’s treatment.
  • Psychotherapy or counseling.

 

POSSIBLE COMPLICATIONS

 

  • Impaired social and occupational functioning.
  • A sudden increase in anxiety may lead to panic and violent escape behavior.
  • Dependence on drugs.
  • Heart arrhythmias.

 

PROBABLE OUTCOME–Generalized anxiety can be controlled with treatment. Overcoming anxiety often results in a richer, more satisfying life.

 

 

How To Treat

 

GENERAL MEASURES–

 

  • Obtain therapy to understand the specific but unconscious threat or source of stress.
  • Learn techniques, including biofeedback and relaxation therapy, to reduce muscle tension.
  • Follow a regular energetic fitness routine using aerobic exercise if possible.
  • See Resources for Additional Information.

 

MEDICATION–Your doctor may prescribe:

 

  • Antianxiety drugs for a short-term basis.
  • Antidepressants for panic-disorders.

 

ACTIVITY–Stay active. Physical exertion helps reduce anxiety.

 

DIET–No special diet. Avoid caffeine and other stimulants and alcohol.

 

 

Call Your Doctor If

 

  • You have symptoms of anxiety and self-treatment has failed.
  • You have a sudden feeling of panic.

 

  • New, unexplained symptoms develop. Drugs used in treatment may produce side effects.


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ANKYLOSING SPONDYLITIS

September 15, 2011 in Health Library

General Information

DEFINITION–A chronic, progressive, rheumatic disease of the joints, accompanied by inflammation and stiffening. It is characterized by a “bent forward” posture caused by stiffening of the spine and support structures.

BODY PARTS INVOLVED–Sacroiliac region; hip joints; lumbar, thoracic and cervical spines.

SEX OR AGE MOST AFFECTED–Within families, males and females are affected equally. In the general population, males are affected 4-5 times more frequently than females, and onset is usually late teens or early twenties.

SIGNS & SYMPTOMS

Early stages:

  • Recurrent episodes of low backache. Pain can also occur along the sciatic nerve.
  • Stiffness that is worse in the morning.

Later stages:

  • Progressive worsening of symptoms. Pain often spreads from the low back to the middle back or higher in the neck. Joints in the arms, legs, feet and hands are sometimes affected.
  • Anemia; muscle stiffness; fatigue; weight loss; iritis (in about 25% of patients).

CAUSES–Unknown, but it may be caused by genetic changes or autoimmune disorder.

RISK INCREASES WITH–Family history of ankylosing spondylitis. Occurs more frequently in North American Indians and in white popula-tion of North America and Western Europe.

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.
  • Laboratory blood studies.
  • X-rays of the spine.

APPROPRIATE HEALTH CARE

  • Self-care after diagnosis.
  • Doctor’s treatment.
  • Surgery to replace a damaged hip or to insert bone grafts in the spine (advanced stages only).

POSSIBLE COMPLICATIONS

  • Congestive heart failure.
  • Eye inflammation, rarely causing blindness.
  • Amyloidosis.
  • Heart-valve disease.
  • Gastrointestinal disease.
  • Lung disease.
  • Nerve compression causing numbness in arms or legs.
  • Permanent disability and immobilization.

PROBABLE OUTCOME–This disease is currently considered incurable. Symptoms progress unpredictably with mild or moderate flares and periods of total remission. With treatment, symptoms can be relieved or controlled and most patients can lead normal, productive lives. Occasionally, the disease is severe and incapacitating due to deformities.

How To Treat

GENERAL MEASURES–

  • Therapy includes exercises for breathing techniques, maintaining proper posture and building up muscle groups (to oppose the direction of possible deformities). Patient compliance with therapy is important.
  • Psychological counseling may be recommended.
  • Sleep on your back on a firm mattress. Use a small pillow or none at all.
  • Take hot baths or use heat compresses before exercising or to relieve pain. Have regular massages, if possible.
  • Additional information available from the Arthritis Foundation (800)283-7800.

MEDICATION–Your doctor may prescribe:

  • Nonsteroidal anti-inflammatory drugs. Don’t take narcotics for pain; they are addictive.
  • Stronger pain medications and muscle relaxants for short periods of time.
  • Sulfasalazine, vitamin D and immunosuppressive therapy.

ACTIVITY–Stay as active as your strength allows:

  • Exercise to maintain good posture and retain as much upright carriage as possible. Back braces don’t help.
  • Swim regularly, if possible. Your buoyancy in water will allow you to move stiff, painful areas more easily.
  • Avoid activity that puts stress on the back and avoid contact sports (too much risk of spinal injury).

DIET–No special diet.

Call Your Doctor If

  • You or your child have symptoms of ankylosing spondylitis.
  • The following occurs during treatment: A fever occurs. Increasing pain and disability, despite measures outlined above.

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ANEMIA, IRON-DEFICIENCY

September 15, 2011 in Conditions, Health Library

General Information

DEFINITION–A decreased number of circulating blood cells, or insufficient hemoglobin in the cells. Anemia is a symptom of other disorders. For proper treatment, the cause must be found.

BODY PARTS INVOLVED–Blood, which affects all body cells.

SEX OR AGE MOST AFFECTED–Both sexes; all ages.

SIGNS & SYMPTOMS-Initially, there may be no symptoms.

Signs of pronounced anemia include:

  • Tiredness and weakness.
  • Paleness, especially in the hands and lining of the lower eyelids.

Less common signs include:

  • Tongue inflammation.
  • Fainting.
  • Breathlessness.
  • Rapid heartbeat.
  • Unusual quietness or withdrawal in a child.
  • Appetite loss.
  • Abdominal discomfort.
  • Cravings for ice, paint or dirt.
  • Susceptibility to infection.

CAUSES–

Decreased absorption of iron or increased need for iron. Causes in infants and children include:

  • Poor nutrition. Between 6 months and 2 years of age, children may consume large quantities of milk, to the exclusion of iron-containing foods.
  • Premature birth. Premature babies often have low stores of iron at birth. Causes in adolescents and adults:
  • Rapid growth spurts.
  • Heavy menstrual bleeding.
  • Pregnancy.
  • Malabsorption.
  • Gastrointestinal disease with bleeding, including cancer.

RISK INCREASES WITH

  • Poverty.
  • Adults over 60.
  • Recent illness, such as an ulcer, diverticulitis, colitis, hemorrhoids or gastrointestinal tumors.

HOW TO PREVENT–Maintain an adequate iron intake through a well-balanced diet or iron supplements. Provide iron-fortified formula for bottle-fed infants.

What To Expect

DIAGNOSTIC MEASURES–

  • Your own observation of symptoms.
  • Medical history and physical exam by a doctor.
  • Laboratory blood studies of serum iron, total iron-binding capacity and ferritin levels.

APPROPRIATE HEALTH CARE

  • Doctor’s treatment.
  • Self-care.
  • Blood transfusions in rare instances.

POSSIBLE COMPLICATIONS–Failure to diagnose a bleeding malignancy.

PROBABLE OUTCOME–Usually curable with iron supplements if the underlying cause can be identified and cured.

How To Treat

GENERAL MEASURES–

  • The most important part of treatment for iron-deficiency anemia is to correct the underlying cause. Iron deficiency can be treated well with iron supplements.
  • Avoid risk of infections.

MEDICATION–Your doctor may prescribe iron supplements:

  • Take iron on an empty stomach (at least 1/2 hour before meals) for best absorption. If it upsets your stomach, you may take it with a small amount of food (except milk).
  • If you take other medications, wait at least 2 hours after taking iron before taking them. Antacids and tetracyclines especially interfere with iron absorption.
  • Because liquid iron supplements may discolor the teeth, a child should drink any liquid iron preparation through a straw. Iron supplements may also cause black bowel movements, diarrhea or constipation.
  • Continue iron supplements until 2 to 3 months after blood tests return to normal.
  • Too much iron is dangerous. A bottle of iron tablets can poison a child. Keep iron supplements out of the reach of children.

ACTIVITY–No restrictions. You may need to pace activities until symptoms of fatigue are gone.

DIET–

  • Adults should limit milk to 1 pint a day. It interferes with iron absorption.
  • Eat protein- and iron-containing foods, including meat, beans and leafy green vegetables.
  • Increase dietary fiber to prevent constipation.

Call Your Doctor If

  • You have symptoms of anemia.
  • Nausea, vomiting, severe diarrhea or constipation occur during treatment.

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ANEMIA, HEMOLYTIC

September 15, 2011 in Health Library

General Information

DEFINITION–Anemia due to the premature destruction of red blood cells (a process known as hemolysis). Bone marrow cannot produce red blood cells fast enough to compensate for those being destroyed. These anemias can be acquired (develop over time) or congenital (present at birth).

BODY PARTS INVOLVED–Blood; bone marrow; spleen.

SEX OR AGE MOST AFFECTED–Both sexes; all ages.

SIGNS & SYMPTOMS

  • Fatigue.
  • Shortness of breath.
  • Irregular heartbeat.
  • Jaundice (yellow skin and eyes, dark urine).
  • Enlarged spleen.

CAUSES

  • Inherited disorder, such as hereditary spherocytosis, G6PD deficiency, sickle-cell anemia or thalassemia. One inherited variety, favism, is common in Greece; hemolysis occurs after eating a type of bean.
  • Antibodies produced by the body to fight infections, that for unknown reason attack red blood cells. This response is sometimes triggered by blood transfusions.
  • Use of medications, including non-prescription drugs, that damage red blood cells.

RISK INCREASES WITH

  • Family history of hemolytic anemia.
  • Use of any medication.

HOW TO PREVENT

  • Don’t take any medicine that has previously triggered hemolytic anemia.
  • Seek genetic counseling before having children if you have a family history of hemolytic anemia (inherited forms).
  • Some types may be preventable by avoidance of the drugs or foods that precipitate hemolysis.

What To Expect

DIAGNOSTIC MEASURES–

  • Your own observation of symptoms.
  • Medical history and physical exam by a doctor.
  • Laboratory blood studies, including blood count, examination of bone marrow, and measurement with radioactive chromium of red cell survival.

APPROPRIATE HEALTH CARE

  • Doctor’s treatment.
  • Hospitalization for transfusions during a hemolytic crisis.
  • Surgery to remove an enlarged spleen (sometimes).
  • Treatment is individualized depending on the specific hemolytic problem.

POSSIBLE COMPLICATIONS

  • Excessive spleen enlargement, which increases destruction of red blood cells.
  • Pain, shock and serious illness caused by hemolysis (red blood cell destruction).
  • Gallstones.

PROBABLE OUTCOME–

  • If hemolytic anemia is acquired, it can usually be cured when the cause, such as a drug, is removed. Sometimes the spleen is removed surgically.
  • If hemolytic anemia is inherited, it is currently considered incurable. However, symptoms can be relieved or controlled. Scientific research into causes and treatment continues, so there is hope for increasingly effective treatment and cure.

How To Treat

GENERAL MEASURES—-If removal of the spleen is required, see Spleen Removal in Surgery section for an explanation of surgery and postoperative care.

MEDICATION–Your doctor may prescribe:

  • Immunosuppressive drugs to control the antibody response.
  • Medication to reduce pain. For minor discomfort, you may use non-prescription drugs such as acetaminophen.

ACTIVITY–After treatment, resume normal activities as soon as possible.

DIET–No special diet.

Call Your Doctor If

  • You have symptoms of hemolytic anemia.
  • The following occurs during treatment: Fever. Cough. Sore throat. Swollen joints. Muscle aches. Bloody urine. Signs of infection in any part of the body (redness, pain, swelling, fever).
  • New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

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AGRANULOCYTOSIS

September 9, 2011 in Health Library

General Information

DEFINITION–Reduction in the normal number of circulating white blood cells (granulocytes or neutrophils) in the bloodstream. These cells are the first to attack bacterial infections.

BODY PARTS INVOLVED–Blood; bone marrow.

SEX OR AGE MOST AFFECTED–Both sexes; all ages.

SIGNS & SYMPTOMS

  • Fever.
  • Aching.
  • Sore throat.
  • Ulcers (especially in the mouth and throat), which do not produce pus.
  • Any sign of infection in someone who has had agranulocytosis in the past. This may signal a recurrence.

CAUSES–Increased destruction or impaired production of granulocytes (white blood cells). The most common reason for this is an adverse reaction to medications, including: anticancer drugs; anticonvulsants; antihistamines; antithyroid drugs; arsenic; chloramphenicol; Dibenzyline; gold salts; indomethacin; nitrofurantoin; nitrous oxide; phenothiazines; phenylbutazone; procainamide; sulfonamides; synthetic penicillins; and thiazide diuretics.

RISK INCREASES WITH–Genetic factors. A rare form, infantile genetic agranulocytosis, is inherited.

HOW TO PREVENT

  • See your doctor if you have one infection after another (especially if you take medications).
  • Prevent recurrences by avoiding any suspect medicine or drug that may have triggered agranulocytosis previously.

What To Expect

DIAGNOSTIC MEASURES–

  • Your own observation of symptoms.
  • Medical history and physical exam by a doctor.
  • Laboratory studies of blood and bone marrow, and cultures of blood, nose, throat and urine.

APPROPRIATE HEALTH CARE

  • Doctor’s treatment.
  • Possible hospitalization for intensive treatment during the active phase, with strict reverse isolation techniques (See Glossary) and transfusions of white blood cells (sometimes).
  • Self-care after diagnosis and hospitalization.

> Dangerous, sometimes fatal infections (bacterial, fungal, viral or others)–

even with vigorous treatment.

  • May be an early sign of leukemia or aplastic anemia.

PROBABLE OUTCOME–Depending on cause, usually curable with intensive treatment.

How To Treat

GENERAL MEASURES—-Hospitalization may be necessary during the acute phase. The following may be helpful after hospitalization:

  • Be extra careful about personal cleanliness.
  • Keep the mouth clean by rinsing frequently with warm salt water (1 teaspoon salt to 8 oz. water) or gargling with hydrogen peroxide.
  • Pay particular attention to oral hygiene. Brush teeth gently with a very soft brush, avoiding irritation of the gums.
  • Avoid contact with harmful materials, such as cleaning chemicals, glue, insecticide, fertilizer and paint remover.

MEDICATION–Your doctor may:

  • Prescribe intravenous and oral antibiotics if the white blood cell count is very low.
  • Prescribe lithium to stimulate bone marrow to produce more granulocytes.
  • Stop prescribing any drug that is suspected of causing agranulocytosis.

ACTIVITY–Rest in bed during the acute stage. Resume normal activities gradually after symptoms subside.

DIET–No restrictions.

Call Your Doctor If

  • You have symptoms of agranulocytosis.
  • The following occurs after treatment: Any sign of infection, especially fever. Swelling of the feet and ankles. Painful urination or decreased urine output in 1 day.
  • New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

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