Hair loss (ALOPECIA) , Causes , symptoms, treatment

      DEFINITION

Hair loss can affect just your scalp or your entire body. It can be the result of heredity, hormonal changes, medical conditions or medications. Anyone — men, women and children — can experience hair loss.

Baldness typically refers to excessive hair loss from your scalp. Hereditary hair loss with age is the most common cause of baldness. Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the treatments available to prevent further hair loss and to restore growth.

Before pursuing hair loss treatment, talk with your doctor about the cause of the hair loss and the best treatment options.

SYMPTOMS

Hair loss can appear in many different ways, depending on what's causing it. It can come on suddenly or gradually and affect just your scalp or your whole body. Some types of hair loss are temporary, and others are permanent.

Signs and symptoms of hair loss may include:

• Gradual thinning on top of head. This is the most common type of hair loss, affecting both men and women as they age. In men, hair often begins to recede from the forehead in a line that resembles the letter M. Women typically retain the hairline on the forehead but have a broadening of the part in their hair.
• Circular or patchy bald spots. Some people experience smooth, coin-sized bald spots. This type of hair loss usually affects just the scalp, but it sometimes also occurs in beards or eyebrows. In some cases, your skin may become itchy or painful before the hair falls out.
• Sudden loosening of hair. A physical or emotional shock can cause hair to loosen. Handfuls of hair may come out when combing or washing your hair or even after gentle tugging. This type of hair loss usually causes overall hair thinning and not bald patches.
• Full-body hair loss. Some conditions and medical treatments, such as chemotherapy for cancer, can result in the loss of hair all over your body. The hair usually grows back.
• Patches of scaling that spread over the scalp. This is a sign of ringworm. It may be accompanied by broken hair, redness, swelling and, at times, oozing.

When to see a doctor

See your doctor if your child or you are distressed by hair loss and want to pursue treatment. Also talk to your doctor if you notice sudden or patchy hair loss or more than usual hair loss when combing or washing your or your child's hair. Sudden hair loss can signal an underlying medical condition that requires treatment.

CAUSES

Most people normally shed 50 to 100 hairs a day. This usually doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair loss occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue.

The exact cause of hair loss may not be fully understood, but it's usually related to one or more of the following factors:

• Family history (heredity)
• Hormonal changes
• Medical conditions
• Medications

Family history (heredity)

The most common cause of hair loss is a hereditary condition called male-pattern baldness or female-pattern baldness. It usually occurs gradually and in predictable patterns — a receding hairline and bald spots in men and thinning hair in women.

Heredity also affects the age at which you begin to lose hair, the rate of hair loss and the extent of baldness. Pattern baldness is most common in men and can begin as early as puberty. This type of hair loss may involve both hair thinning and miniaturization (hair becomes soft, fine and short).

Hormonal changes and medical conditions

A variety of conditions can cause hair loss, including:

• Hormonal changes. Hormonal changes and imbalances can cause temporary hair loss. This could be due to pregnancy, childbirth or the onset of menopause. Hormone levels are also affected by the thyroid gland, so thyroid problems may cause hair loss.
• Patchy hair loss. This type of nonscarring hair loss is called alopecia areata (al-o-PEE-she-uh ar-e-A-tuh). It occurs when the body's immune system attacks hair follicles — causing sudden hair loss that leaves smooth, roundish bald patches on the skin.
• Scalp infections. Infections, such as ringworm, can invade the hair and skin of your scalp, leading to scaly patches and hair loss. Once infections are treated, hair generally grows back.
• Other skin disorders. Diseases that cause scarring alopecia may result in permanent loss at the scarred areas. These conditions include lichen planus, some types of lupus and sarcoidosis.
• Hair-pulling disorder. This condition, also called trichotillomania (trik-o-til-o-MAY-nee-uh), causes people to have an irresistible urge to pull out their hair, whether it's from the scalp, the eyebrows or other areas of the body.

Medications

Hair loss can be caused by drugs used for cancer, arthritis, depression, heart problems, high blood pressure and birth control. Intake of too much vitamin A may cause hair loss as well.

Other causes of hair loss

Hair loss can also result from:

• Radiation therapy to the head. The hair may not grow back the same as it was before.
• A trigger event. Many people experience a general thinning of hair several months after a physical or emotional shock. This type of hair loss is temporary. Examples of trigger events include sudden or excessive weight loss, a high fever, surgery, or a death in the family.
• Certain hairstyles and treatments.Excessive hairstyling or hairstyles that pull your hair tight, such as pigtails or cornrows, can cause traction alopecia. Hot oil hair treatments and permanents can cause inflammation of hair follicles that leads to hair loss. If scarring occurs, hair loss could be permanent.

RISK FACTORS

A number of factors can increase your risk of hair loss, including:

• Family history
• Age
• Poor nutrition
• Certain medical conditions, such as diabetes and lupus
• Stress

PREPARING FOR YOUR APPOINTMENT

You're likely to first bring your concerns to the attention of your family doctor. He or she may refer you to a doctor who specializes in the treatment of skin problems (dermatologist).

What you can do

• List key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements that you're taking.
• List questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For hair loss, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Are there other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• Will my hair grow back? How long will it take?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Do you have any brochures or other printed material that I can take home with me?
• What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing hair loss?
• Has your hair loss been continuous or occasional?
• Have you noticed poor hair growth? hair breakage? hair shedding?
• Has your hair loss been patchy or overall?
• Have you had a similar problem in the past?
• Has anyone in your immediate family experienced hair loss?
• What medications or supplements do you take regularly?
• What, if anything, seems to improve your hair loss?
• What, if anything, appears to worsen your hair loss?

TESTS AND DIAGNOSIS

Before making a diagnosis, your doctor will likely give you a physical exam and ask about your medical history and family history. He or she may also perform tests, such as the following:

• Blood test. This may help uncover medical conditions related to hair loss, such as thyroid disease.
• Pull test. Your doctor gently pulls several dozen hairs to see how many come out. This helps determine the stage of the shedding process.
• Scalp biopsy. Your doctor scrapes samples from the skin or from a few hairs plucked from the scalp to examine the hair roots. This can help determine whether an infection is causing hair loss.
• Light microscopy. Your doctor uses a special instrument to examine hairs trimmed at their bases. Microscopy helps uncover possible disorders of the hair shaft.

TREATMENTS AND DRUGS

Effective treatments for some types of hair loss are available. But some hair loss is permanent. With some conditions, such as patchy alopecia, hair may regrow without treatment within a year.

Treatments for hair loss include medications, surgery, laser therapy, and wigs or hairpieces. Your doctor may suggest a combination of these approaches in order to get the best results.

The goals of treatment are to promote hair growth, slow hair loss or hide hair loss.

Medication

If your hair loss is caused by an underlying disease, treatment for that disease will be necessary. This may include drugs to reduce inflammation and suppress your immune system, such as prednisone. If a certain medication is causing the hair loss, your doctor may advise you to stop using it for at least three months.

Medications are available to treat pattern baldness. Two medications approved by the Food and Drug Administration (FDA) to treat hair loss are:

• Minoxidil (Rogaine). Minoxidil is an over-the-counter liquid or foam that you rub into your scalp twice a day to grow hair and to prevent further hair loss. It may be used by men and women. With this treatment, some people experience hair regrowth, a slower rate of hair loss or both. The effect peaks at 16 weeks and you need to keep applying the medication to retain benefits.
  Possible side effects include scalp irritation, unwanted hair growth on the adjacent skin of the face and hands, and rapid heart rate (tachycardia).
• Finasteride (Propecia). This prescription drug is available only to men. It's taken daily in pill form. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. You need to keep taking it to retain benefits.
  Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer. Women who are or may be pregnant need to avoid touching crushed or broken tablets.

Surgery

In the most common type of permanent hair loss, only the top of the head is affected. Hair transplant or restoration surgery can make the most of the hair you have left.

During this procedure, your surgeon removes tiny plugs of skin, each containing a few hairs, from the back or sides of your scalp. He or she then implants the plugs into the bald sections of your scalp. You may be asked to take a hair loss medication before and after surgery to improve results.

Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring.

Laser therapy

A low-level laser device is available to treat men and women with pattern baldness. It has been cleared by the FDA. A study of 128 male and 141 female subjects indicated the device resulted in an overall improvement of hair loss condition and thickness among those who used the device. The researchers said no side effects were noted but that further study is needed to consider the long-term effects of this therapy.

Wigs and hairpieces

You may want to try a wig or a hairpiece as an alternative to medical treatment or if you don't respond to treatment. It can be used to cover either permanent or temporary hair loss. Quality, natural-looking wigs and hairpieces are available.

If your hair loss is due to a medical condition, the cost of a wig may be covered by insurance. You'll need a prescription for the wig from your doctor.

LIFESTYLE AND HOME REMEDIES

These tips may help you avoid preventable types of hair loss:

• Eat a nutritionally balanced diet.
• Avoid tight hairstyles, such as braids, buns or ponytails.
• Avoid compulsively twisting, rubbing or pulling your hair.
• Treat your hair gently when washing and brushing. A wide-toothed comb may help prevent pulling out hair.
• Avoid harsh treatments such as hot rollers, curling irons, hot oil treatments and permanents.

ALTERNATIVE MEDICINE

If you are otherwise well-nourished, taking nutritional supplements has not been shown to be helpful.

Some studies report that the patchy hair loss caused by alopecia areata may be helped by lavender oil combined with oils from thyme, rosemary and cedar wood. Further study is needed.

Conjoined twins, how twins are joined

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DEFINITION

Conjoined twins are two babies that are born physically connected to each other.

Conjoined twins develop when an early embryo partially separates to form two individuals. Although two fetuses will develop from this embryo, they will remain physically connected — most often at the chest, pelvis or buttocks. Conjoined twins may also share one or more internal organs.

Most conjoined twins are stillborn or die shortly after birth. Some surviving conjoined twins can be surgically separated. The success of surgery to separate conjoined twins depends on where the twins are joined and how many and which organs are shared, as well as on the experience and skill of the surgical team.

SYMPTOMS

There aren't any specific signs and symptoms that indicate a woman is carrying conjoined twins. As with other twin pregnancies, the uterus may grow more rapidly than expected, and mothers of twins may also have more fatigue, nausea and vomiting early in the pregnancy.

How twins are joined

Conjoined twins are usually classified according to where they're joined, and there are many ways that conjoined twins may be connected. Some of the more common ways include:

• Joined at the chest. One of the most common of conjoined twins, thoracopagus twins are joined at the chest. They often have a shared heart and may also share one liver and upper intestine.
• Joined near the bellybutton.Omphalopagus twins are joined near the bellybutton. Many omphalopagus twins share the liver, and some share the lower part of the small intestine (ileum) and colon. They generally do not, however, share a heart.
• Joined at the base of the spine.Pygopagus twins are joined at the base of the spine and commonly face away from one another. Some pygopagus twins share the lower gastrointestinal tract, and a few share the genital and urinary organs.
• Joined at the pelvis. Ischiopagus twins are joined at the pelvis. Many ischiopagus twins share the lower gastrointestinal tract, as well as the liver and genital and urinary tract organs. Each twin may have two legs or in some cases, one pair of legs and even a fused leg, though that's uncommon.
• Joined at the head. Craniopagus twins are joined at the head. Craniopagus twins share a portion of the skull, and possibly brain tissue. This sharing may involve the cerebral cortex — the part of the brain that plays a central role in memory, language and perception.

In rare cases, twins may be asymmetrically conjoined, with one twin smaller and less fully formed than the other (parasitic twins).

CAUSES

Identical twins (monozygotic twins) occur when a single fertilized egg splits and develops into two individuals. Eight to 12 days after conception, the embryonic layers that will split to form monozygotic twins begin to develop into specific organs and structures. It's believed that when the embryo splits later than this — usually between 13 and 15 days after conception — separation stops before the process is complete, and the resulting twins are conjoined.

An alternative theory suggests that two separate embryos may somehow fuse together in early development.

What might cause either scenario to occur is unknown.

RISK FACTORS

Because conjoined twins are so rare, and the cause isn't clear, it's unknown what might make some couples more likely to have conjoined twins. It is known, however, that conjoined twins occur more often in Latin America than they do in the United States or Europe. However, most risk factors for twins only apply to those arising from two separate eggs.

COMPLICATIONS

Most conjoined twins die in the womb (stillborn) or soon after birth.

Conjoined twins must be delivered by cesarean section. About 40 to 60 percent of conjoined twins are stillborn. Of conjoined twins born alive, less than half survive long enough to be candidates for separation surgery.

TESTS AND DIAGNOSIS

Conjoined twins can be diagnosed using standard ultrasound as early as the first trimester. More-detailed ultrasounds and echocardiograms can be used about halfway through pregnancy to better determine the extent of the twins' connection and functioning of their organs. False-positive results can occur before 10 weeks, however, when identical twins who share an amniotic sac (monoamniotic twins) may appear conjoined.

If an ultrasound detects conjoined twins, a magnetic resonance imaging (MRI) scan may be done. It can provide greater detail about where the conjoined twins are connected and which organs they share.

TREATMENTS AND DRUGS

Treatment of conjoined twins depends on their unique circumstances — their health, where they're joined, and whether they share organs or other vital structures.

If you're carrying conjoined twins, you will be very closely monitored throughout your pregnancy. You will be best served by a team of doctors who work to learn as much as possible about your twins' anatomy, functional capabilities and prognosis after birth. Having this information can help your doctors form a treatment plan for your twins.

A surgical delivery (C-section) is planned ahead of time, often two to four weeks before the due date.

After your conjoined twins are born, you and your doctors must decide whether separation surgery should be attempted. An emergency separation may be needed if one of the twins dies, develops a life-threatening condition or threatens the survival of the other twin. More often, however, separation surgery is an elective procedure done two to four months after birth. Recent advances in prenatal imaging, critical care and anesthetic care have improved outcomes in separation surgery.

Many factors weigh heavily in the decision to pursue separation surgery, such as:

• Do the twins share vital organs?
• Are the twins healthy enough to withstand separation surgery?
• What are the odds of successful separation?
• What type of reconstructive surgery might be needed for each twin after successful separation?
• What issues would the twins face if left conjoined?

If the circumstances are grave and separation surgery isn't possible or you decide not to pursue the surgery, comfort care — such as nutrition, fluids, human touch and pain relief — is provided as needed.

COPING AND SUPPORT

Few things are harder than to learn that your unborn child has a life-threatening condition. In the case of conjoined twins, this is doubly difficult — not only because there are two babies involved but also because the children who survive may face tremendous obstacles. Parents in these situations must grapple with very difficult decisions.

Because conjoined twins are rare, it may be difficult to find resources for conjoined twins or their families. But there are a number of organizations that support parents who have lost children or who have children with grave physical conditions. Your medical team can put you in touch with some of these groups as well as with medical social workers and counselors.

Pet allergy

basicbiology2.blogspot.com

DEFINITION

Pet allergy is an allergic reaction to proteins found in an animal's skin cells, saliva or urine. Signs of pet allergy include those common to hay fever, such as sneezing and runny nose. Some people may also experience signs of asthma, such as wheezing and difficulty breathing.

Most often, pet allergy is triggered by exposure to the dead flakes of skin (dander) a pet sheds. Any animal with fur can be a source of pet allergy, but pet allergies are most commonly associated with cats, dogs, rodents and horses.

If you have a pet allergy, the best strategy is to avoid or reduce exposure to the animal as much as possible. Medications or other treatments may be necessary to relieve symptoms and manage asthma.

SYMPTOMS

Pet allergy signs and symptoms caused by inflammation of nasal passages include:

• Sneezing
• Runny nose
• Itchy, red or watery eyes
• Nasal congestion
• Itchy nose, roof of mouth or throat
• Postnasal drip
• Cough
• Facial pressure and pain
• Frequent awakening
• Swollen, blue-colored skin under your eyes
• In a child, frequent upward rubbing of the nose

If your pet allergy contributes to asthma, you may also experience:

• Difficulty breathing
• Chest tightness or pain
• Audible whistling or wheezing sound when exhaling
• Trouble sleeping caused by shortness of breath, coughing or wheezing

Skin symptoms

Some people with pet allergy may also experience skin symptoms. Allergic dermatitis is an immune system reaction that causes skin inflammation. Direct contact with an allergy-causing pet may trigger allergic dermatitis signs and symptoms, which may include:

• Raised, red patches of skin (hives)
• Eczema
• Itchy skin

When to see a doctor

Some signs and symptoms of pet allergy, such as a runny nose or sneezing, are similar to those of the common cold. Sometimes it's difficult to know whether you have a cold or an allergy. If symptoms persist for more than one week, you might have an allergy.

If your signs and symptoms are severe — such as severe nasal congestion, difficulty sleeping or wheezing — call your doctor. Seek emergency care if wheezing or shortness of breath rapidly worsens or if you are short of breath with minimal activity.

CAUSES

Allergies occur when your immune system reacts to a foreign substance such as pollen, mold or pet dander.

Your immune system produces proteins known as antibodies. These antibodies protect you from unwanted invaders that could make you sick or cause an infection. When you have allergies, your immune system makes antibodies that identify your particular allergen as something harmful, even though it isn't. When you inhale the allergen or come into contact with it, your immune system responds and produces an inflammatory response in your nasal passages or lungs. Prolonged or regular exposure to the allergen can cause the ongoing (chronic) inflammation associated with asthma.

Cats and dogs

Allergens from cats and dogs are found in skin cells the animals shed (dander), as well as in their saliva, urine and sweat and on their fur. Dander is a particular problem because it is very small and can remain airborne for long periods of time with the slightest bit of air circulation. It also collects easily in upholstered furniture and sticks to your clothes.

Pet saliva can stick to carpets, bedding, furniture and clothing. Dried saliva can become airborne.

So-called hypoallergenic cats and dogs may shed less fur than shedding types, but no breed is truly hypoallergenic.

Rodents and rabbits

Rodent pets include mice, gerbils, hamsters and guinea pigs. Allergens from rodents are usually present in hair, dander, saliva and urine. Dust from litter or sawdust in the bottom of cages may contribute to airborne allergens from rodents.

Rabbit allergens are present in dander, hair and saliva.

Other pets

Pet allergy is rarely caused by animals that don't have fur, such as fish and reptiles.

RISK FACTORS

Pet allergies are common. However, you're more likely to develop a pet allergy if allergies or asthma runs in your family.

Being exposed to pets at an early age may have an impact on your risk of pet allergies. Some studies have found that children who live with a dog in the first year of life may have better resistance to upper respiratory infections during childhood than kids who don't have a dog at that age.

COMPLICATIONS

Sinus infections

Ongoing (chronic) inflammation of tissues in the nasal passages caused by pet allergy can obstruct your sinuses, the hollow cavities connected to your nasal passages. These obstructions may make you more likely to develop bacterial infections of the sinuses, such as sinusitis.

Asthma

People with asthma and pet allergy often have difficulty managing asthma symptoms. They may be at risk of asthma attacks that require immediate medical treatment or emergency care.

PREPARING FOR YOUR APPOINTMENT

If you're experiencing runny nose, sneezing, wheezing, shortness of breath or other symptoms that may be related to an allergy, you'll most likely start by seeing your family doctor or general practitioner. Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to prepare for your appointment.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to allergy-like symptoms.
• Write down your family's history of allergy and asthma, including specific types of allergies if you know them.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Ask if you should stop any medications,for example, antihistamines that would alter the results of an allergy skin test.

Preparing a list of questions will help you make the most of your time together. For symptoms that may be related to pet allergy, some basic questions to ask your doctor include:

• What is the most likely cause of my signs and symptoms?
• Are there any other possible causes?
• Will I need any allergy tests?
• Should I see an allergy specialist?
• What is the best treatment?
• I have other health conditions. How can I best manage these conditions together?
• If I have a pet allergy, can I keep my pet?
• What changes can I make at home to reduce my symptoms?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Are symptoms worse at certain times of day?
• Are the symptoms worse in the bedroom or other rooms of the house?
• Do you have pets, and do they go into bedrooms?
• What kind of self-care techniques have you used, and have they helped?
• What, if anything, appears to worsen your symptoms?

Issues if you have asthma

If you've already been diagnosed with asthmaand are having difficulty managing the disease, your doctor may talk to you about the possibility of allergies. Although allergies are a major contributing factor to asthma, the influence of allergy on asthma isn't always obvious.

The impact of a pollen allergy may be noticeable because the allergy is seasonal. For example, you may have more difficulty managing your asthma for a short time during the summer.

Pet allergy, on the other hand, may be due to a pet that you're exposed to throughout the year. Even if you don't have a pet, you may be exposed to pet allergens in other people's homes or that have been transported on people's clothes at work or school. Therefore, you may not recognize allergy as a factor possibly complicating your asthma when, in fact, it may be a primary cause.

What you can do in the meantime

If you suspect that you may have a pet allergy, take steps to reduce your exposure to your pets. Keep pets out of your bedroom and off upholstered furniture, and wash your hands immediately after touching pets.

TESTS AND DIAGNOSIS

Your doctor may suspect a pet allergy based on symptoms, an examination of your nose and your answers to his or her questions. He or she may use a lighted instrument to look at the condition of the lining of your nose. If you have a pet allergy, the lining of the nasal passage may be swollen or appear pale or bluish.

Allergy skin test

Your doctor may suggest an allergy skin test to determine exactly what you're allergic to. You may be referred to an allergy specialist (allergist) for this test.

In this test, tiny amounts of purified allergen extracts — including extracts with animal proteins — are pricked into your skin's surface. This is usually carried out on the forearm, but it may be done on the upper back.

Your doctor or nurse observes your skin for signs of allergic reactions after 15 minutes. If you're allergic to cats, for example, you'll develop a red, itchy bump where the cat extract was pricked into your skin. The most common side effects of these skin tests are itching and redness. These side effects usually go away within 30 minutes.

Blood test

In some cases, a skin test can't be performed because of the presence of a skin condition or because of interactions with certain medications. As an alternative, your doctor may order a blood test that screens your blood for specific allergy-causing antibodies to various common allergens, including various animals. This test may also indicate how sensitive you are to an allergen.

TREATMENTS AND DRUGS

The first line of treatment for controlling pet allergy is avoiding the allergy-causing animal as much as possible. When you minimize your exposure to pet allergens, you should expect to have allergic reactions that are less often or less severe. However, it's often difficult or impossible to eliminate completely your exposure to animal allergens. Even if you don't have a pet, you may unexpectedly encounter pet allergens transported on other people's clothes.

In addition to avoiding pet allergens, you may need medications to control symptoms.

Allergy medications

Your doctor may direct you to take one of the following medications to improve nasal allergy symptoms:

• Antihistamines reduce the production of an immune system chemical that is active in an allergic reaction, and they help relieve itching, sneezing and runny nose. Prescription antihistamines taken as a nasal spray include azelastine (Astelin, Astepro) and olopatadine (Patanase). Over-the-counter (OTC) antihistamine tablets include fexofenadine (Allegra Allergy), loratadine (Claritin, Alavert) and cetirizine (Zyrtec Allergy); OTC antihistamine syrups are available for children. Prescription antihistamine tablets, such as levocetirizine (Xyzal) and desloratadine (Clarinex), are other options.
• Corticosteroids delivered as a nasal spray can reduce inflammation and control symptoms of hay fever. These drugs include fluticasone (Flonase), mometasone furoate (Nasonex), triamcinolone (Nasacort AQ) and ciclesonide (Omnaris). Nasal corticosteroids provide a low dose of the drug and have a much lower risk of side effects than do oral corticosteroids.
• Decongestants can help shrink swollen tissues in your nasal passages and make it easier to breathe through your nose. Some over-the-counter allergy tablets combine an antihistamine with a decongestant. Oral decongestants can increase blood pressure and shouldn't be taken if you have high blood pressure, glaucoma or cardiovascular disease. In men with an enlarged prostate, the drug can worsen the condition. Talk to your doctor about whether you can safely take a decongestant.
  Over-the-counter decongestants taken as a nasal spray may briefly reduce allergy symptoms. If you use a decongestant spray for more than three days in a row, it can contribute to congestion.
• Cromolyn sodium prevents the release of an immune system chemical and may reduce symptoms. You need to use this over-the-counter nasal spray several times a day, and it's most effective when used before signs and symptoms develop. Cromolyn sodium doesn't have serious side effects.
• Leukotriene modifiers block the action of certain immune system chemicals. Your doctor may prescribe this prescription tablet, montelukast (Singulair), if you can't tolerate corticosteroid nasal sprays or an antihistamine nasal spray. Possible side effects of montelukast include upper respiratory infection, headache and fever. Less common side effects include behavior or mood changes, such as anxiousness or depression.

Other treatments

• Immunotherapy. You can "train" your immune system not to be sensitive to an allergen. This is done through a series of allergy shots called immunotherapy. One to two weekly shots expose you to very small doses of the allergen, in this case, the animal protein that causes an allergic reaction. The dose is gradually increased, usually during a three- to six-month period. Maintenance shots are needed every four weeks for three to five years. Immunotherapy is usually used when other simple treatments aren't satisfactory.
• Nasal irrigation. You can use a neti pot or a specially designed squeeze bottle to flush thickened mucus and irritants from your sinuses with a prepared saltwater (saline) rinse. If you're preparing the saline solution yourself, use water that's contaminant-free — distilled, sterile, previously boiled and cooled, or filtered with a filter that has an absolute pore size of 1 micron or smaller. Be sure to rinse the irrigation device after each use with contaminant-free water, and leave open to air-dry.

LIFESTYLE AND HOME REMEDIES

If you don't have a pet but are considering adopting or buying one, make sure you don't have pet allergies before making the commitment.

Touch me not / child abuse awareness .

basicbiology2.blogspot.com

 

DEFINITION

Any intentional harm or mistreatment to a child under 18 years old is considered child abuse. Child abuse takes many forms, which often occur at the same time.

• Physical abuse. Physical child abuse occurs when a child is purposefully physically injured.
• Sexual abuse. Sexual child abuse is any sexual activity with a child, such as fondling, oral-genital contact, intercourse or exposure to child pornography.
• Emotional abuse. Emotional child abuse means injuring a child's self-esteem or emotional well-being. It includes verbal and emotional assault — such as continually belittling or berating a child — as well as isolating, ignoring or rejecting a child.
• Neglect. Child neglect is failure to provide adequate food, shelter, affection, supervision, education or medical care.

Most child abuse is inflicted by someone the child knows and trusts, often a parent or other relative. If you suspect child abuse, report the abuse to the proper authorities.

SYMPTOMS

A child who's being abused may feel guilty, ashamed or confused. He or she may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. In fact, the child may have an apparent fear of parents, adult caregivers or family friends. That's why it's vital to watch for red flags, such as:

• Withdrawal from friends or usual activities
• Changes in behavior — such as aggression, anger, hostility or hyperactivity — or changes in school performance
• Depression, anxiety or a sudden loss of self-confidence
• An apparent lack of supervision
• Frequent absences from school or reluctance to ride the school bus
• Reluctance to leave school activities, as if he or she doesn't want to go home
• Attempts at running away
• Rebellious or defiant behavior
• Attempts at suicide

Specific signs and symptoms depend on the type of abuse. Keep in mind that warning signs are just that — warning signs. The presence of warning signs doesn't necessarily mean that a child is being abused.

Physical abuse signs and symptoms

• Unexplained injuries, such as bruises, fractures or burns
• Injuries that don't match the given explanation
• Untreated medical or dental problems

Sexual abuse signs and symptoms

• Sexual behavior or knowledge that's inappropriate for the child's age
• Pregnancy or a sexually transmitted infection
• Blood in the child's underwear
• Statements that he or she was sexually abused
• Trouble walking or sitting
• Abuse of other children sexually

Emotional abuse signs and symptoms

• Delayed or inappropriate emotional development
• Loss of self-confidence or self-esteem
• Social withdrawal
• Depression
• Headaches or stomachaches with no medical cause
• Avoidance of certain situations, such as refusing to go to school or ride the bus
• Desperately seeks affection

Neglect signs and symptoms

• Poor growth or weight gain
• Poor hygiene
• Lack of clothing or supplies to meet physical needs
• Taking food or money without permission
• Eating a lot in one sitting or hiding food for later
• Poor record of school attendance
• Lack of appropriate attention for medical, dental or psychological problems, even though the parents have been notified
• Emotional swings that are inappropriate or out of context to the situation
• Indifference

Parental behavior

Sometimes a parent's demeanor or behavior sends red flags about child abuse. Warning signs include a parent who:

• Shows little concern for the child
• Appears unable to recognize physical or emotional distress in the child
• Denies that any problems exist at home or school, or blames the child for the problems
• Consistently blames, belittles or berates the child and describes the child with negative terms, such as "worthless" or "evil"
• Expects the child to provide him or her with attention and care and seems jealous of other family members getting attention from the child
• Uses harsh physical discipline or asks teachers to do so
• Demands an inappropriate level of physical or academic performance
• Severely limits the child's contact with others
• Offers conflicting or unconvincing explanations for a child's injuries or no explanation at all

Although most child health experts condemn the use of violence in any form, some people still use corporal punishment (such as spanking) as a way to discipline their children. Corporal punishment has limited effectiveness in deterring behavior and is associated with aggressive behavior in the child. Any corporal punishment may leave emotional scars.

Parental behaviors that cause pain or physical injury — even when done in the name of discipline — could be child abuse.

When to see a doctor

If you're concerned that your child or another child has been abused, seek help immediately. The sooner you get help and support for the child, the better the child's chance of recovery.

If the child needs immediate medical attention, call 911 or your local emergency number. Depending on the situation, contact the child's doctor, a local child protective agency, the police department, or a hotline such as Childhelp National Child Abuse Hotline (800-422-4453).

Keep in mind that health care professionals are legally required to report all suspected cases of child abuse to the appropriate county or state authorities.

RISK FACTORS

Child abuse occurs across all social and economic levels and ethnic groups. Factors that may increase a person's risk of becoming abusive include:

• A history of being abused or neglected as a child
• Physical or mental illness, such as depression or post-traumatic stress disorder (PTSD)
• Family crisis or stress, including domestic violence and other marital conflicts, single parenting, or young children in the family, especially several children under age 5
• A child in the family who is developmentally or physically disabled
• Financial stress or unemployment
• Social or extended family isolation
• Poor understanding of child development and parenting skills
• Alcoholism or other forms of substance abuse

COMPLICATIONS

Some children overcome the physical and psychological effects of child abuse, particularly those with strong social support who can adapt and cope with bad experiences. For many others, however, child abuse has lifelong consequences. For example, child abuse may result in physical, behavioral, emotional and mental issues. Examples include:

Physical issues

• Death
• Physical disabilities and health problems
• Learning disabilities
• Attention-deficit/hyperactivity disorder (ADHD)
• Substance abuse

Behavioral issues

• Delinquent or violent behavior
• Abuse of others
• Withdrawal
• Suicide attempts
• Frequent, casual sex with many different partners (sexual promiscuity) or teen pregnancy

Emotional issues

• Low self-esteem
• Difficulty establishing or maintaining relationships
• Challenges with intimacy and trust
• An unhealthy view of parenthood that may perpetuate the cycle of abuse
• Inability to cope with stress and frustrations

Mental disorders

• Eating disorders
• Personality disorders
• Depression
• Anxiety
• Post-traumatic stress disorder (PTSD)

TREATMENTS AND DRUGS

Talk therapy, also called psychotherapy, can help a child who has been abused learn to trust again, as well as teach the child about normal behavior and relationships. Therapy can also teach children conflict management and boost self-esteem. Several different types of therapy may be effective, such as:

• Trauma-focused cognitive behavioral therapy. This type of therapy helps an abused child to better manage distressing feelings and to deal with trauma-related memories. Eventually, the nonabusing parent and the child are seen together so the child can let the nonabusing parent know exactly what happened.
• Child-parent psychotherapy. This treatment focuses on improving the parent-child relationship and on building a stronger attachment between the two.

Psychotherapy can help parents discover the roots of abuse, learn effective ways to cope with life's inevitable frustrations and learn healthy parenting strategies. If the child is still in the home, social services may schedule home visits and make sure essential needs, such as food, are available.

Children who are placed in foster care because their home situation is too dangerous will also need mental health services and therapies.

Places to turn for help

If you need help because you're at risk of abusing a child or you think someone else has abused or neglected a child, there are organizations that can provide you with information and referrals, such as:

• Childhelp National Child Abuse Hotline: 800-4-A-CHILD (800-422-4453)
• Prevent Child Abuse America: 800-CHILDREN (800-244-5373)

LIFESTYLE AND HOME REMEDIES

You can take simple steps to protect your child from exploitation and child abuse, as well as prevent child abuse in your neighborhood or community. For example:

• Offer your child love and attention.Nurturing your child, listening and being involved in his or her life can develop trust and good communication. This encourages your child to tell you if there's a problem.
• Don't respond in anger. If you feel overwhelmed or out of control, take a break. Don't take out your anger on your child. Talk with your doctor or therapist about ways you can learn to cope with stress and better interact with your child.
• Think supervision. Don't leave young children home alone. In public, keep a close eye on your child. Volunteer at school and for activities so that you get to know the adults who spend time with your child. Don't allow your child to go anywhere or accept anything without your permission. When your child is old enough to leave home without parental supervision, encourage your child to stay away from strangers and to hang out with friends rather than alone — and to tell you where he or she is at all times. Make sure you know who is supervising your child when he or she is out of your care, such as at a sleepover.
• Know your child's caregivers. Check references for baby sitters and other caregivers. Make irregular, but frequent, unannounced visits to observe what's happening. Don't ever allow substitutes for your usual child care provider if you don't know the substitute.
• Emphasize the importance of saying no.Make sure your child understands that he or she doesn't have to do anything that seems scary or uncomfortable. Encourage your child to leave a threatening or frightening situation immediately and seek help from a trusted adult. If something does happen, encourage your child to talk to you or another trusted adult about the episode. Assure your child that it's OK to talk and that he or she won't get in trouble.
• Teach your child how to stay safe online.Place the computer in a common area of your home. Use the parental controls to restrict the types of websites your child can visit, and check your child's privacy settings on social networking sites. Consider it a red flag if your child is secretive about online activities. Cover ground rules, such as not sharing personal information, not responding to inappropriate, hurtful or frightening messages, not sharing photos or videos online, and not arranging to meet an online contact in person without your permission. Tell your child to let you know if an unknown person makes contact through a social networking site. Report online harassment or inappropriate senders to your service provider and to local authorities, if necessary.
• Reach out. Meet the families in your neighborhood, including both parents and children. Consider joining a parent support group so you have an appropriate place to vent your frustrations. If a friend or neighbor seems to be struggling, offer to baby-sit or help in another way.

If you worry that you might abuse your child

If you're concerned that you might abuse your child, seek help immediately, especially if you were abused as a child. If you were a victim of any type of child abuse, get counseling to assure you don't continue the abuse cycle or teach those destructive behaviors to your child. These organizations can provide information and referrals:

• Childhelp National Child Abuse Hotline: 800-4-A-CHILD (800-422-4453)
• Prevent Child Abuse America: 800-CHILDREN (800-244-5373)

Or you can start by talking with your family doctor. He or she may offer a referral to a parent education class, counseling or a support group for parents to help you learn appropriate ways to deal with your anger. If you're abusing alcohol or drugs, ask your doctor about treatment options. Remember, child abuse is preventable — and often a symptom of a problem that may be treatable. Ask for help today.

COPING AND SUPPORT

If a child tells you he or she is being abused, take the situation seriously. The child's safety is most important. Here's what you can do:

• Encourage the child to tell you what happened. Remain calm as you assure the child that it's OK to talk about the experience, even if someone has threatened him or her to keep silent.  But don't ask leading questions (questions that suggest specific answers) — leave detailed questioning to the professionals.
• Remind the child that he or she isn't responsible for the abuse. The responsibility for child abuse belongs to the abuser. Say "It's not your fault" over and over again.
• Offer comfort. You might say, "I'm so sorry you were hurt," "I'm glad that you told me," and "I'll do everything I can to help you." Let the child know you're available to talk or simply listen at any time.
• Report the abuse. Contact a local child protective agency or the police department. Authorities will investigate the report and, if necessary, take steps to ensure the child's safety.
• Seek medical attention. If necessary, help the child seek appropriate medical care.
• Help the child remain safe. Don't let the child be alone with the abuser. If that's not possible, do what you can to eliminate the abuser's access to the child. Make sure the child knows how to call for emergency help if needed.
• Consider additional support. You might help the child seek counseling or other mental health treatment. Age-appropriate support groups also can be helpful.

If the abuse has occurred at school, make sure the principal of the school is aware of the situation, in addition to reporting it to the local or state child protection agency.

Diabetic retinopathy

basicbiology2.blogspot.com

DEFINITION

Diabetic retinopathy (die-uh-BET-ik ret-ih-NOP-uh-thee) is a diabetes complication that affects eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina).

At first, diabetic retinopathy may cause no symptoms or only mild vision problems. Eventually, it can cause blindness.

The condition can develop in anyone who has type 1 or type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely you are to develop this eye complication.

SYMPTOMS

You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, diabetic retinopathy symptoms may include:

• Spots or dark strings floating in your vision (floaters)
• Blurred vision
• Fluctuating vision
• Impaired color vision
• Dark or empty areas in your vision
• Vision loss

Diabetic retinopathy usually affects both eyes.

When to see a doctor

Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see your eye doctor for a yearly eye exam with dilation — even if your vision seems fine. Pregnancy may worsen diabetic retinopathy, so if you're pregnant, your eye doctor may recommend additional eye exams throughout your pregnancy.

Contact your eye doctor right away if your vision changes suddenly or becomes blurry, spotty or hazy.

CAUSES

Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don't develop properly and can leak easily.

There are two types of diabetic retinopathy:

• Early diabetic retinopathy. In this more common form — called nonproliferative diabetic retinopathy (NPDR) — new blood vessels aren't growing (proliferating).
  When you have NPDR, the walls of the blood vessels in your retina weaken. Tiny bulges (microaneurysms) protrude from the vessel walls of the smaller vessels, sometimes leaking fluid and blood into the retina. Larger retinal vessels can begin to dilate and become irregular in diameter, as well. NPDR can progress from mild to severe, as more blood vessels become blocked.
  Nerve fibers in the retina may begin to swell. Sometimes the central part of the retina (macula) begins to swell (macular edema), a condition that requires treatment.
• Advanced diabetic retinopathy. Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy. In this type, damaged blood vessels close off, causing the growth of new, abnormal blood vessels in the retina, and can leak into the clear, jelly-like substance that fills the center of your eye (vitreous).
  Eventually, scar tissue stimulated by the growth of new blood vessels may cause the retina to detach from the back of your eye. If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure may build up in the eyeball. This can damage the nerve that carries images from your eye to your brain (optic nerve), resulting in glaucoma.

RISK FACTORS

Anyone who has diabetes can develop diabetic retinopathy. Risk of developing the eye condition can increase as a result of:

• Duration of diabetes — the longer you have diabetes, the greater your risk of developing diabetic retinopathy
• Poor control of your blood sugar level
• High blood pressure
• High cholesterol
• Pregnancy
• Tobacco use
• Being black, Hispanic or Native American

COMPLICATIONS

Diabetic retinopathy involves the abnormal growth of blood vessels in the retina. Complications can lead to serious vision problems:

• Vitreous hemorrhage. The new blood vessels may bleed into the clear, jelly-like substance that fills the center of your eye. If the amount of bleeding is small, you might see only a few dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely block your vision.
  Vitreous hemorrhage by itself usually doesn't cause permanent vision loss. The blood often clears from the eye within a few weeks or months. Unless your retina is damaged, your vision may return to its previous clarity.
• Retinal detachment. The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This may cause spots floating in your vision, flashes of light or severe vision loss.
• Glaucoma. New blood vessels may grow in the front part of your eye and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build up (glaucoma). This pressure can damage the nerve that carries images from your eye to your brain (optic nerve).
• Blindness. Eventually, diabetic retinopathy, glaucoma or both can lead to complete vision loss.

PREPARING FOR YOUR APPOINTMENT

The American Diabetes Association (ADA) recommends that anyone who's older than 10 with type 1 diabetes have his or her first eye exam within five years of being diagnosed with diabetes.

If you have type 2 diabetes, the ADA advises getting your initial eye exam soon after being diagnosed with diabetes, because you may have had diabetes for some time without knowing it.

After the initial exam, the ADA recommends that people with diabetes get an annual eye exam. If you've had repeated normal exams and your blood sugar control is good, you may be able to extend the time between exams to two to three years. If you have retinopathy that's worsening, you may need more-frequent eye exams. Ask your eye doctor what he or she recommends.

The ADA recommends that women with diabetes who become pregnant have an eye exam during the first trimester of pregnancy and be closely followed during the pregnancy and up to one year after giving birth. Pregnancy can sometimes cause diabetic retinopathy to develop or worsen.

Here's some information to help you get ready for your eye appointment.

What you can do

• Write a brief summary of your diabeteshistory, including when you were diagnosed; medications you have taken for diabetes, now and in the past; recent average blood sugar levels; and your last few hemoglobin A1C readings, if you know them.
• List other medications, vitamins and supplements you take, and the dosage.
• List your symptoms, if any. Include any that may seem unrelated to potential eye problems.
• Ask a family member or friend to go with you, if possible. Someone who accompanies you can help remember the information you receive. Also, because your eyes have been dilated, a companion can drive you home.
• List questions for your doctor.

For diabetic retinopathy, some basic questions to ask your doctor include:

• How is diabetes affecting my vision?
• Do I need other tests?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• What side effects might I expect from treatment?
• I have other health conditions. How can I best manage them together?
• If I control my blood sugar, will my eye symptoms go away?
• What do my blood sugar goals need to be to protect my eyes?
• Can you recommend services for people with visual impairment?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• Do you have eye symptoms, such as blurred vision or floaters?
• How long have you had symptoms?
• In general, how well are you controlling your diabetes?
• What was your last hemoglobin A1C?
• Do you have other health conditions, such as high blood pressure or high cholesterol?
• Have you had eye surgery?

TESTS AND DIAGNOSIS

Diabetic retinopathy is best diagnosed with a dilated eye exam. For this exam, drops placed in your eyes widen (dilate) your pupils to allow your doctor to better view inside your eyes. The drops may cause your close vision to blur until they wear off, several hours later.

During the exam, your eye doctor will look for:

• Abnormal blood vessels
• Swelling, blood or fatty deposits in the retina
• Growth of new blood vessels and scar tissue
• Bleeding in the clear, jelly-like substance that fills the center of the eye (vitreous)
• Retinal detachment
• Abnormalities in your optic nerve

In addition, your eye doctor may:

• Test your vision
• Measure your eye pressure to test for glaucoma
• Look for evidence of cataracts

Fluorescein angiography

With your eyes dilated, your doctor takes pictures of the inside of your eyes. Then your doctor will inject a special dye into your arm and take more pictures as the dye circulates through your eyes. Your doctor can use the images to pinpoint blood vessels that are closed, broken down or leaking fluid.

Optical coherence tomography

Your eye doctor may request an optical coherence tomography (OCT) exam. This imaging test provides cross-sectional images of the retina that show the thickness of the retina, which will help determine whether fluid has leaked into retinal tissue. Later, OCT exams can be used to monitor how treatment is working.

TREATMENTS AND DRUGS

Treatment, which depends largely on the type of diabetic retinopathy you have and how severe it is, is geared to slowing or stopping progression of the condition.

Early diabetic retinopathy

If you have mild or moderate nonproliferative diabetic retinopathy, you may not need treatment right away. However, your eye doctor will closely monitor your eyes to determine when you might need treatment.

Work with your diabetes doctor (endocrinologist) to determine if there are ways to improve your diabetes management. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression.

Advanced diabetic retinopathy

If you have proliferative diabetic retinopathy or macular edema, you'll need prompt surgical treatment. Depending on the specific problems with your retina, options may include:

• Focal laser treatment. This laser treatment, also known as photocoagulation, can stop or slow the leakage of blood and fluid in the eye. During the procedure, leaks from abnormal blood vessels are treated with laser burns.
  Focal laser treatment is usually done in your doctor's office or eye clinic in a single session. If you had blurred vision from macular edema before surgery, the treatment might not return your vision to normal, but it's likely to reduce the chance the macular edema may worsen.
• Scatter laser treatment. This laser treatment, also known as panretinal photocoagulation, can shrink the abnormal blood vessels. During the procedure, the areas of the retina away from the macula are treated with scattered laser burns. The burns cause the abnormal new blood vessels to shrink and scar.
  It's usually done in your doctor's office or eye clinic in two or more sessions. Your vision will be blurry for about a day after the procedure. Some loss of peripheral vision or night vision after the procedure is possible.
• Vitrectomy. This procedure uses a tiny incision in your eye to remove blood from the middle of the eye (vitreous) as well as scar tissue that's tugging on the retina. It's done in a surgery center or hospital using local or general anesthesia.

Surgery often slows or stops the progression of diabetic retinopathy, but it's not a cure. Because diabetes is a lifelong condition, future retinal damage and vision loss are still possible. Even after treatment for diabetic retinopathy, you'll need regular eye exams. At some point, additional treatment may be recommended.

Researchers are studying new treatments for diabetic retinopathy, including medications that may help prevent abnormal blood vessels from forming in the eye. Some of these medications are injected directly into the eye to treat swelling or abnormal blood vessels. These treatments appear promising, but more study is needed.

LIFESTYLE AND HOME REMEDIES

You can't always prevent diabetic retinopathy. However, regular eye exams, good control of your blood sugar and blood pressure, and early intervention for vision problems can help prevent severe vision loss.

If you have diabetes, reduce your risk of getting diabetic retinopathy by doing the following:

• Manage your diabetes. Make healthy eating and physical activity part of your daily routine. Try to get at least 150 minutes of moderate aerobic activity, such as walking, each week. Take oral diabetesmedications or insulin as directed.
• Monitor your blood sugar level. You may need to check and record your blood sugar level several times a day — more-frequent measurements may be required if you're ill or under stress. Ask your doctor how often you need to test your blood sugar.
• Ask your doctor about a glycosylated hemoglobin test. The glycosylated hemoglobin test, or hemoglobin A1C test, reflects your average blood sugar level for the two- to three-month period before the test. For most people, the A1C goal is to be under 7 percent.
• Keep your blood pressure and cholesterol under control. Eating healthy foods, exercising regularly and losing excess weight can help. Sometimes medication is needed, too.
• If you smoke or use other types of tobacco, ask your doctor to help you quit.Smoking increases your risk of various diabetes complications, including diabetic retinopathy.
• Pay attention to vision changes. Contact your eye doctor right away if you experience sudden vision changes or your vision becomes blurry, spotty or hazy.

Remember, diabetes doesn't necessarily lead to vision loss. Taking an active role in diabetesmanagement can go a long way toward preventing complications.

ALTERNATIVE MEDICINE

Several alternative therapies have suggested some benefits for people with diabetic retinopathy, but more research is needed to understand whether these treatments are effective and safe.

Be sure to let your doctor know if you are taking any herbs or supplements. They have the potential to interact with other medications, or cause complications in surgery, such as excessive bleeding.

It's vital not to delay standard treatments to try unproven therapies. Early treatment is the best way to prevent vision loss.

COPING AND SUPPORT

The thought that you might lose your sight can be frightening, and you may benefit from talking to a therapist or finding a support group. Ask your doctor for referrals.

If you've already lost vision, ask your doctor about low-vision products, such as magnifiers, and services that can make daily living easier.

Diabetic neuropathy

basicbiology2.blogspot.com

DEFINITION

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet.

Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild; for others, diabetic neuropathy can be painful, disabling and even fatal.

Diabetic neuropathy is a common serious complication of diabetes. Yet you can often prevent diabetic neuropathy or slow its progress with tight blood sugar control and a healthy lifestyle.

SYMPTOMS

There are four main types of diabetic neuropathy. You may have just one type or symptoms of several types. Most develop gradually, and you may not notice problems until considerable damage has occurred.

The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and which nerves are affected.

Peripheral neuropathy

Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include:

• Numbness or reduced ability to feel pain or temperature changes
• A tingling or burning sensation
• Sharp pains or cramps
• Increased sensitivity to touch — for some people, even the weight of a bed sheet can be agonizing
• Muscle weakness
• Loss of reflexes, especially in the ankle
• Loss of balance and coordination
• Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain

Autonomic neuropathy

The autonomic nervous system controls your heart, bladder, lungs, stomach, intestines, sex organs and eyes. Diabetes can affect the nerves in any of these areas, possibly causing:

• A lack of awareness that blood sugar levels are low (hypoglycemiaunawareness)
• Bladder problems, including urinary tract infections or urinary retention or incontinence
• Constipation, uncontrolled diarrhea or a combination of the two
• Slow stomach emptying (gastroparesis), leading to nausea, vomiting, bloating and loss of appetite
• Difficulty swallowing
• Erectile dysfunction in men
• Vaginal dryness and other sexual difficulties in women
• Increased or decreased sweating
• Inability of your body to adjust blood pressure and heart rate, leading to sharp drops in blood pressure after sitting or standing that may cause you to faint or feel lightheaded
• Problems regulating your body temperature
• Changes in the way your eyes adjust from light to dark
• Increased heart rate when you're at rest

Radiculoplexus neuropathy (diabetic amyotrophy)

Radiculoplexus neuropathy affects nerves in the thighs, hips, buttocks or legs. Also called diabetic amyotrophy, femoral neuropathy or proximal neuropathy, this condition is more common in people with type 2 diabetes and older adults.

Symptoms are usually on one side of the body, though in some cases symptoms may spread to the other side. Most people improve at least partially over time, though symptoms may worsen before they get better. This condition is often marked by:

• Sudden, severe pain in your hip and thigh or buttock
• Eventual weak and atrophied thigh muscles
• Difficulty rising from a sitting position
• Abdominal swelling, if the abdomen is affected
• Weight loss

Mononeuropathy

Mononeuropathy involves damage to a specific nerve. The nerve may be in the face, torso or leg. Mononeuropathy, also called focal neuropathy, often comes on suddenly. It's most common in older adults.

Although mononeuropathy can cause severe pain, it usually doesn't cause any long-term problems. Symptoms usually diminish and disappear on their own over a few weeks or months. Signs and symptoms depend on which nerve is involved and may include:

• Difficulty focusing your eyes, double vision or aching behind one eye
• Paralysis on one side of your face (Bell's palsy)
• Pain in your shin or foot
• Pain in your lower back or pelvis
• Pain in the front of your thigh
• Pain in your chest or abdomen

Sometimes mononeuropathy occurs when a nerve is compressed. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes.

Signs and symptoms of carpal tunnel syndrome include:

• Numbness or tingling in your fingers or hand, especially in your thumb, index finger, middle finger and ring finger
• A sense of weakness in your hand and a tendency to drop things

When to see a doctor

Seek medical care if you notice:

• A cut or sore on your foot that doesn't seem to be healing, is infected or is getting worse
• Burning, tingling, weakness or pain in your hands or feet that interferes with your daily routine or your sleep
• Dizziness
• Changes in your digestion, urination or sexual function

These signs and symptoms don't always indicate nerve damage, but they may signal other problems that require medical care. Early diagnosis and treatment offer the best chance for controlling symptoms and preventing more-severe problems.

Even minor sores on the feet that don't heal can turn into ulcers. In the most severe cases, untreated foot ulcers may become gangrenous — a condition in which the tissue dies — and require surgery or even amputation of your foot. Early treatment can help prevent this from happening.

CAUSES

Damage to nerves and blood vessels

Prolonged exposure to high blood sugar can damage delicate nerve fibers, causing diabetic neuropathy. Why this happens isn't completely clear, but a combination of factors likely plays a role, including the complex interaction between nerves and blood vessels.

High blood sugar interferes with the ability of the nerves to transmit signals. It also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.

Other factors

Other factors that may contribute to diabetic neuropathy include:

• Inflammation in the nerves caused by an autoimmune response. This occurs when your immune system mistakenly attacks part of your body as if it were a foreign organism.
• Genetic factors unrelated to diabetes that make some people more susceptible to nerve damage.
• Smoking and alcohol abuse, which damage both nerves and blood vessels and significantly increase the risk of infections.

RISK FACTORS

Anyone who has diabetes can develop neuropathy, but these factors make you more susceptible to nerve damage:

• Poor blood sugar control. This is the greatest risk factor for every complication of diabetes, including nerve damage. Keeping blood sugar consistently within your target range is the best way to protect the health of your nerves and blood vessels.
• Length of time you have diabetes. Your risk of diabetic neuropathy increases the longer you have diabetes, especially if your blood sugar isn't well-controlled.
• Kidney disease. Diabetes can cause damage to the kidneys, which may increase the toxins in the blood and contribute to nerve damage.
• Being overweight. Having a body mass index greater than 24 may increase your risk of developing diabetic neuropathy.
• Smoking. Smoking narrows and hardens your arteries, reducing blood flow to your legs and feet. This makes it more difficult for wounds to heal and damages the integrity of the peripheral nerves.

COMPLICATIONS

Diabetic neuropathy can cause a number of serious complications, including:

• Loss of a limb. Because nerve damage can cause a lack of feeling in your feet, cuts and sores may go unnoticed and eventually become severely infected or ulcerated — a condition in which the skin and soft tissues break down. The risk of infection is high because diabetes reduces blood flow to your feet. Infections that spread to the bone and cause tissue death (gangrene) may be impossible to treat and require amputation of a toe, foot or even the lower leg.
• Charcot joint. This occurs when a joint, usually in the foot, deteriorates because of nerve damage. Charcot joint is marked by loss of sensation, as well as swelling, instability and sometimes deformity in the joint itself. Early treatment can promote healing and prevent further damage.
• Urinary tract infections and urinary incontinence. Damage to the nerves that control your bladder can prevent it from emptying completely. This allows bacteria to multiply in your bladder and kidneys, leading to urinary tract infections. Nerve damage can also affect your ability to feel when you need to urinate or to control the muscles that release urine.
• Hypoglycemia unawareness. Normally, when your blood sugar drops too low — below 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L) — you develop symptoms such as shakiness, sweating and a fast heartbeat. Autonomic neuropathy can interfere with your ability to notice these symptoms.
• Low blood pressure. Damage to the nerves that control circulation can affect your body's ability to adjust blood pressure. This can cause a sharp drop in pressure when you stand after sitting (orthostatic hypotension), which may lead to dizziness and fainting.
• Digestive problems. Nerve damage in the digestive system can cause constipation or diarrhea — or alternating bouts of constipation and diarrhea — as well as nausea, vomiting, bloating and loss of appetite. It can also cause gastroparesis, a condition in which the stomach empties too slowly or not at all. This can interfere with digestion and cause nausea, vomiting and bloating, and severely affect blood sugar levels and nutrition.
• Sexual dysfunction. Autonomic neuropathy often damages the nerves that affect the sex organs, leading to erectile dysfunction in men and problems with lubrication and arousal in women.
• Increased or decreased sweating. When the sweat glands don't function normally, your body isn't able to regulate its temperature properly. A reduced or complete lack of perspiration (anhidrosis) can be life-threatening. Autonomic neuropathy may also cause excessive sweating, particularly at night or while eating.

PREPARING FOR YOUR APPOINTMENT

If you don't already see an endocrinologist, you'll likely be referred to one if you start showing signs of diabetes complications. An endocrinologist is a doctor who specializes in treating metabolic disorders, such as diabetes. You may also be referred to a doctor who specializes in treating nervous system problems (neurologist).

To prepare for your appointment, you may want to:

• Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements you're taking.
• Write down your recent blood sugar levels, if you check them at home.
• Ask a family member or friend to come with you. It can be difficult to remember everything your doctor tells you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Preparing a list of questions can help you make the most of your time with your doctor. For diabetic neuropathy, some basic questions include:

• Is diabetes the most likely cause of my symptoms?
• Do I need tests to confirm the cause of my symptoms? Do these tests require any special preparation?
• Is this condition temporary or long lasting?
• If I control my blood sugar, will these symptoms improve or go away?
• Are there treatments available, and which do you recommend?
• What types of side effects can I expect from treatment?
• I have other health conditions. How can I best manage them together?
• Are there brochures or other printed material I can take with me? What websites do you recommend?
• Do I need to see other doctors, a certified diabetes educator or a dietitian?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• How is your blood sugar control?
• When did you begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• What aspects of diabetes management do you find most challenging?
• What might help you manage your diabetes better?

TESTS AND DIAGNOSIS

Diabetic neuropathy is usually diagnosed based on your symptoms, your medical history and a physical exam. During the exam, your doctor is likely to check your muscle strength and tone, tendon reflexes, and sensitivity to touch, temperature and vibration.

Your doctor may also conduct tests that include:

• Filament test. Sensitivity to touch may be tested using a soft nylon fiber called a monofilament.
• Nerve conduction studies. This test measures how quickly the nerves in your arms and legs conduct electrical signals. It's often used to diagnose carpal tunnel syndrome.
• Electromyography (EMG). Often performed along with nerve conduction studies, electromyography measures the electrical discharges produced in your muscles.
• Quantitative sensory testing. This noninvasive test is used to assess how your nerves respond to vibration and changes in temperature.
• Autonomic testing. If you have symptoms of autonomic neuropathy, your doctor may request special tests to look at your blood pressure in different positions and assess your ability to sweat.

The American Diabetes Association recommends that all people with diabetes have a comprehensive foot exam — either by a doctor or by a foot specialist (podiatrist) — at least once a year. In addition, your feet should be checked for sores, cracked skin, calluses, blisters, and bone and joint abnormalities at every office visit.

TREATMENTS AND DRUGS

Diabetic neuropathy has no known cure. Treatment for diabetic neuropathy focuses on:

• Slowing progression of the disease
• Relieving pain
• Managing complications and restoring function

Slowing progression of the disease

Consistently keeping blood sugar within a target range can help prevent or delay the progression of diabetic neuropathy and may even improve some of the symptoms you already have. Your doctor will determine the best target range for you based on several factors, such as your age, how long you've had diabetes, and your overall health and the presence of other medical conditions.

For many people who have diabetes, Mayo Clinic generally recommends target blood sugar levels that are:

• Between 80 and 120 mg/dL, or 4.4 and 6.7 mmol/L, for people age 59 and younger who have no other underlying medical conditions
• Between 100 and 140 mg/dL, or 5.6 and 7.8 mmol/L, for people age 60 and older, or those who have other medical conditions, such as heart, lung or kidney disease

To help slow nerve damage:

• Follow your doctor's recommendations for good foot care
• Keep your blood pressure under control
• Follow a healthy-eating plan
• Get plenty of physical activity
• Maintain a healthy weight
• Stop smoking
• Avoid alcohol or, if drinking is allowed, drink only in moderation

Relieving pain

Several medications are used to relieve nerve pain, but they don't work for everyone and most have side effects that must be weighed against the benefits they offer. There are also a number of alternative therapies, such as capsaicin cream (made from chili peppers), physical therapy or acupuncture, that may help with pain relief. Doctors frequently use them in conjunction with medications, but some may be effective on their own.

Pain-relieving treatments may include:

• Anti-seizure medications. Although drugs such as gabapentin (Gralise, Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Tegretol) are used to treat seizure disorders (epilepsy), they're also prescribed for nerve pain. Side effects may include drowsiness, dizziness and swelling.
• Antidepressants. Tricyclic antidepressant medications, such as amitriptyline, desipramine (Norpramin) and imipramine (Tofranil), may provide relief for mild to moderate symptoms by interfering with chemical processes in your brain that cause you to feel pain, but they also cause a number of side effects, such as dry mouth, sweating, weight gain, constipation and dizziness.
  For some people, antidepressants called serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta), can relieve pain with fewer side effects. Possible side effects of SNRIs include nausea, sleepiness, dizziness, decreased appetite and constipation.

Managing complications and restoring function

Specific treatments exist for many of the complications of neuropathy, including:

• Urinary tract problems. Antispasmodic medications (anticholinergics), behavioral techniques such as timed urination, and devices such as pessaries — rings inserted into the vagina to prevent urine leakage — may be helpful in treating loss of bladder control. A combination of therapies may be most effective.
• Digestive problems. To relieve mild signs and symptoms of gastroparesis — indigestion, belching, nausea or vomiting — doctors suggest eating smaller, more-frequent meals, reducing fiber and fat in the diet, and, for many people, eating soups and pureed foods. Dietary changes and medications may help relieve diarrhea, constipation and nausea.
• Low blood pressure on standing (orthostatic hypotension). This is often helped with simple lifestyle measures, such as avoiding alcohol, drinking plenty of water, and sitting or standing slowly. Your doctor may recommend an abdominal binder, a compression support for your abdomen, and compression stockings. Several medications, either alone or together, may be used to treat orthostatic hypotension.
• Sexual dysfunction. Sildenafil (Revatio, Viagra), tadalafil (Adcirca, Cialis) and vardenafil (Levitra) may improve sexual function in some men, but these medications aren't effective or safe for everyone. Mechanical vacuum devices may increase blood flow to the penis. Women may find relief with vaginal lubricants.

LIFESTYLE AND HOME REMEDIES

You can help prevent or delay diabetic neuropathy and its complications by keeping your blood sugar consistently well-controlled, taking good care of your feet and following a healthy lifestyle.

Blood sugar control

Keeping your blood sugar tightly controlled requires continuous monitoring and, if you take insulin, frequent doses of medication. But keeping your blood sugar consistently within your target range is the best way to help prevent neuropathy and other complications of diabetes. Consistency is important because shifts in blood sugar levels can accelerate nerve damage.

The American Diabetes Association recommends that people with diabetes have a blood test called the A1C test at least twice a year to find out your average blood sugar level for the past two to three months. If your blood sugar isn't well-controlled or you change medications, you may need to get tested more often.

Foot care

Foot problems, including sores that don't heal, ulcers and even amputation, are a common complication of diabetic neuropathy. But you can prevent many of these problems by having a comprehensive foot exam at least once a year, having your doctor check your feet at each office visit and taking good care of your feet at home.

To protect the health of your feet:

• Check your feet every day. Look for blisters, cuts, bruises, cracked and peeling skin, redness and swelling. Use a mirror or ask a friend or family member to help examine parts of your feet that are hard to see.
• Keep your feet clean and dry. Wash your feet every day with lukewarm water and mild soap. Avoid soaking your feet. Dry your feet and between your toes carefully by blotting or patting with a soft towel.
  Moisturize your feet thoroughly to prevent cracking. Avoid getting lotion between your toes, however, as this can encourage fungal growth.
• Trim your toenails carefully. Cut your toenails straight across, and file the edges carefully so there are no sharp edges.
• Wear clean, dry socks. Look for socks made of cotton or moisture-wicking fibers that don't have tight bands or thick seams.
• Wear cushioned shoes that fit well.Always wear shoes or slippers to protect your feet from injury. Make sure that your shoes fit properly and allow your toes to move. A podiatrist can teach you how to buy properly fitted shoes and to prevent problems such as corns and calluses.
  If problems do occur, your doctor can help treat them to prevent more-serious conditions. Even small sores can quickly turn into severe infections if left untreated.
  If you qualify for Medicare, your plan may cover the cost of at least one pair of shoes each year. Talk to your doctor or diabeteseducator for more information.

ALTERNATIVE MEDICINE

There are a number of alternative treatments that may help relieve the pain of diabetic neuropathy, such as:

• Capsaicin. When applied to the skin, capsaicin cream can reduce pain sensations in some people. Side effects may include a burning feeling and skin irritation.
• Alpha-lipoic acid. This powerful antioxidant is found in some foods and may help relieve the symptoms of peripheral neuropathy.
• Transcutaneous electrical nerve stimulation (TENS). Your doctor may prescribe this therapy, which can help prevent pain signals from reaching your brain. TENS delivers tiny electrical impulses to specific nerve pathways through small electrodes placed on your skin. Although safe and painless, TENS doesn't work for everyone or for all types of pain.
• Acupuncture. Acupuncture may help relieve the pain of neuropathy, and generally doesn't have any side effects. Keep in mind that you may not get immediate relief with acupuncture and will likely require more than one session.

COPING AND SUPPORT

Living with diabetic neuropathy can be difficult and frustrating. If you find yourself getting down, it may help to talk to a counselor or therapist.

Members of support groups can also offer you encouragement, as well as advice about living with diabetic neuropathy. Ask your doctor about support groups in your area, or for a referral to a therapist. The American Diabetes Association offers online support through its website.