Nature Creation ArticlesHealth, Pain, Therapy, Solution

Tweet This Post

What Is Sleep Apnea?

Sleep apnea is a com­mon dis­or­der in which you have one or more pauses in breath­ing or shal­low breaths while you sleep.

Breath­ing pauses can last from a few sec­onds to min­utes. They often occur 5 to 30 times or more an hour. Typ­i­cally, nor­mal breath­ing then starts again, some­times with a loud snort or chok­ing sound.

Sleep apnea usu­ally is a chronic (ongo­ing) con­di­tion that dis­rupts your sleep 3 or more nights each week. You often move out of deep sleep and into light sleep when your breath­ing pauses or becomes shallow.

This results in poor sleep qual­ity that makes you tired dur­ing the day. Sleep apnea is one of the lead­ing causes of exces­sive day­time sleepi­ness.
Overview

Sleep apnea often goes undi­ag­nosed. Doc­tors usu­ally can’t detect the con­di­tion dur­ing rou­tine office vis­its. Also, there are no blood tests for the condition.

Most peo­ple who have sleep apnea don’t know they have it because it only occurs dur­ing sleep. A fam­ily mem­ber and/or bed part­ner may first notice the signs of sleep apnea.

The most com­mon type of sleep apnea is obstruc­tive sleep apnea. This most often means that the air­way has col­lapsed or is blocked dur­ing sleep. The block­age may cause shal­low breath­ing or breath­ing pauses.

When you try to breathe, any air that squeezes past the block­age can cause loud snor­ing. Obstruc­tive sleep apnea hap­pens more often in peo­ple who are over­weight, but it can affect anyone.

The ani­ma­tion below shows how obstruc­tive sleep apnea occurs. Click the “start” but­ton to play the ani­ma­tion. Writ­ten and spo­ken expla­na­tions are pro­vided with each frame. Use the but­tons in the lower right cor­ner to pause, restart, or replay the ani­ma­tion, or use the scroll bar below the but­tons to move through the frames.
The ani­ma­tion shows how air flow to the lungs can be blocked, caus­ing sleep apnea.

The ani­ma­tion shows how air flow to the lungs can be blocked, caus­ing sleep apnea.

Cen­tral sleep apnea is a less com­mon type of sleep apnea. It hap­pens when the area of your brain that con­trols your breath­ing doesn’t send the cor­rect sig­nals to your breath­ing mus­cles. You make no effort to breathe for brief periods.

Cen­tral sleep apnea often occurs with obstruc­tive sleep apnea, but it can occur alone. Snor­ing doesn’t typ­i­cally hap­pen with cen­tral sleep apnea.

Untreated sleep apnea can:

* Increase the risk for high blood pres­sure, heart attack, stroke, obe­sity, and dia­betes
* Increase the risk for or worsen heart fail­ure
* Make irreg­u­lar heart­beats more likely
* Increase the chance of hav­ing work-related or dri­ving accidents

Lifestyle changes, mouth­pieces, surgery, and/or breath­ing devices can suc­cess­fully treat sleep apnea in many peo­ple.

Other Names for Sleep Apnea

* Sleep-disordered breath­ing
* Cheyne-Stokes breathing

What Causes Sleep Apnea?

When you’re awake, throat mus­cles help keep your air­way stiff and open so air can flow into your lungs. When you sleep, these mus­cles are more relaxed. Nor­mally, the relaxed throat mus­cles don’t stop your air­way from stay­ing open to allow air into your lungs.

But if you have obstruc­tive sleep apnea, your air­ways can be blocked or nar­rowed dur­ing sleep because:

* Your throat mus­cles and tongue relax more than nor­mal.
* Your tongue and ton­sils (tis­sue masses in the back of your mouth) are large com­pared to the open­ing into your wind­pipe.
* You’re over­weight. The extra soft fat tis­sue can thicken the wall of the wind­pipe. This causes the inside open­ing to nar­row and makes it harder to keep open.
* The shape of your head and neck (bony struc­ture) may cause a smaller air­way size in the mouth and throat area.
* The aging process lim­its the abil­ity of brain sig­nals to keep your throat mus­cles stiff dur­ing sleep. This makes it more likely that the air­way will nar­row or collapse.

Not enough air flows into your lungs when your air­ways are fully or partly blocked dur­ing sleep. This can cause loud snor­ing and a drop in your blood oxy­gen levels.

When the oxy­gen drops to dan­ger­ous lev­els, it trig­gers your brain to dis­turb your sleep. This helps tighten the upper air­way mus­cles and open your wind­pipe. Nor­mal breaths then start again, often with a loud snort or chok­ing sound.

The fre­quent drops in oxy­gen lev­els and reduced sleep qual­ity trig­ger the release of stress hor­mones. These com­pounds raise your heart rate and increase your risk for high blood pres­sure, heart attack, stroke, and irreg­u­lar heart­beats. The hor­mones also raise the risk for or worsen heart failure.

Untreated sleep apnea also can lead to changes in how your body uses energy. These changes increase your risk for obe­sity and dia­betes.

Who Is At Risk for Sleep Apnea?

It’s esti­mated that more than 12 mil­lion Amer­i­can adults have obstruc­tive sleep apnea. More than half of the peo­ple who have this con­di­tion are overweight.

Sleep apnea is more com­mon in men. One out of 25 middle-aged men and 1 out of 50 middle-aged women have sleep apnea.

Sleep apnea becomes more com­mon as you get older. At least 1 out of 10 peo­ple over the age of 65 has sleep apnea. Women are much more likely to develop sleep apnea after menopause.

African Amer­i­cans, His­pan­ics, and Pacific Islanders are more likely to develop sleep apnea than Caucasians.

If some­one in your fam­ily has sleep apnea, you’re more likely to develop it.

Peo­ple who have small air­ways in their noses, throats, or mouths also are more likely to have sleep apnea. Smaller air­ways may be due to the shape of these struc­tures or aller­gies or other med­ical con­di­tions that cause con­ges­tion in these areas.

Small chil­dren often have enlarged ton­sil tis­sues in the throat. This can make them prone to devel­op­ing sleep apnea.

Other risk fac­tors for sleep apnea include smok­ing, high blood pres­sure, and risk fac­tors for stroke or heart fail­ure.

What Are the Signs and Symp­toms of Sleep Apnea?

One of the most com­mon signs of obstruc­tive sleep apnea is loud and chronic (ongo­ing) snor­ing. Pauses may occur in the snor­ing. Chok­ing or gasp­ing may fol­low the pauses.

The snor­ing usu­ally is loud­est when you sleep on your back; it may be less noisy when you turn on your side. Snor­ing may not hap­pen every night. Over time, the snor­ing may hap­pen more often and get louder.

You’re asleep when the snor­ing or gasp­ing occurs. You will likely not know that you’re hav­ing prob­lems breath­ing or be able to judge how severe the prob­lem is. Your fam­ily mem­bers or bed part­ner will often notice these prob­lems before you do.

Not every­one who snores has sleep apnea.

Another com­mon sign of sleep apnea is fight­ing sleepi­ness dur­ing the day, at work, or while dri­ving. You may find your­self rapidly falling asleep dur­ing the quiet moments of the day when you’re not active.
Other Signs and Symptoms

Oth­ers signs and symp­toms of sleep apnea may include:

* Morn­ing headaches
* Mem­ory or learn­ing prob­lems and not being able to con­cen­trate
* Feel­ing irri­ta­ble, depressed, or hav­ing mood swings or per­son­al­ity changes
* Uri­na­tion at night
* A dry throat when you wake up

In chil­dren, sleep apnea can cause hyper­ac­tiv­ity, poor school per­for­mance, and aggres­sive­ness. Chil­dren who have sleep apnea also may have unusual sleep­ing posi­tions, bed­wet­ting, and may breathe through their mouths instead of their noses dur­ing the day.

How Is Sleep Apnea Diagnosed?

Doc­tors diag­nose sleep apnea based on your med­ical and fam­ily his­to­ries, a phys­i­cal exam, and results from sleep stud­ies. Usu­ally, your pri­mary care doc­tor eval­u­ates your symp­toms first. He or she then decides whether you need to see a sleep specialist.

These spe­cial­ists are doc­tors who diag­nose and treat peo­ple with sleep prob­lems. Such doc­tors include lung, nerve, or ear, nose, and throat spe­cial­ists. Other types of doc­tors also can be sleep spe­cial­ists.
Med­ical and Fam­ily Histories

Your doc­tor will ask you and your fam­ily ques­tions about how you sleep and how you func­tion dur­ing the day. To help your doc­tor, con­sider keep­ing a sleep diary for 1 to 2 weeks. Write down how much you sleep each night, as well as how sleepy you feel at var­i­ous times dur­ing the day.

You can find a sam­ple sleep diary in the National Heart, Lung, and Blood Institute’s “Your Guide to Healthy Sleep.”

Your doc­tor also will want to know how loudly and often you snore or make gasp­ing or chok­ing sounds dur­ing sleep. Often you’re not aware of such symp­toms and must ask a fam­ily mem­ber or bed part­ner to report them.

If you’re a par­ent of a child who may have sleep apnea, tell your child’s doc­tor about your child’s signs and symptoms.

Let your doc­tor know if any­one in your fam­ily has been diag­nosed with sleep apnea or has had symp­toms of the disorder.

Many peo­ple aren’t aware of their symp­toms and aren’t diag­nosed.
Phys­i­cal Exam

Your doc­tor will check your mouth, nose, and throat for extra or large tis­sues. The ton­sils often are enlarged in chil­dren with sleep apnea. A phys­i­cal exam and med­ical his­tory may be all that’s needed to diag­nose sleep apnea in children.

Adults with the con­di­tion may have an enlarged uvula or soft palate. The uvula is the tis­sue that hangs from the mid­dle of the back of your mouth. The soft palate is the roof of your mouth in the back of your throat.
Sleep Studies

A sleep study is the most accu­rate test for diag­nos­ing sleep apnea. It cap­tures what hap­pens with your breath­ing while you sleep.

A sleep study is often done in a sleep cen­ter or sleep lab, which may be part of a hos­pi­tal. You may stay overnight in the sleep cen­ter.
Polysomnogram

A polysomno­gram (poly-SOM-no-gram), or PSG, is the most com­mon study for diag­nos­ing sleep apnea. This test records:

* Brain activ­ity
* Eye move­ment and other mus­cle activ­ity
* Breath­ing and heart rate
* How much air moves in and out of your lungs while you’re sleep­ing
* The amount of oxy­gen in your blood

A PSG is pain­less. You will go to sleep as usual, except you will have sen­sors on your scalp, face, chest, limbs, and fin­ger. The staff at the sleep cen­ter will use the sen­sors to check on you through­out the night.

A sleep spe­cial­ist reviews the results of your PSG to see whether you have sleep apnea and how severe it is. He or she will use the results to plan your treatment.

How Is Sleep Apnea Treated?

The goals of treat­ing obstruc­tive sleep apnea are to:

* Restore reg­u­lar breath­ing dur­ing sleep
* Relieve symp­toms such as loud snor­ing and day­time sleepiness

Treat­ment may help other med­ical prob­lems linked to sleep apnea, such as high blood pres­sure. Treat­ment also can reduce your risk for heart dis­ease, stroke, and dia­betes.
Spe­cific Types of Treatment

Lifestyle changes, mouth­pieces, breath­ing devices, and/or surgery are used to treat sleep apnea. Cur­rently, there are no med­i­cines to treat sleep apnea.

If you have sleep apnea, talk to your doc­tor or sleep spe­cial­ist about the treat­ment options that are most appro­pri­ate for your spe­cific condition.

Lifestyle changes and/or mouth­pieces may be enough to relieve mild sleep apnea. Peo­ple who have mod­er­ate or severe sleep apnea may need breath­ing devices or surgery.
Lifestyle Changes

If you have mild sleep apnea, some changes in daily activ­i­ties or habits may be all that you need.

* Avoid alco­hol and med­i­cines that make you sleepy. They make it harder for your throat to stay open while you sleep.
* Lose weight if you’re over­weight or obese. Even a lit­tle weight loss can improve your symp­toms.
* Sleep on your side instead of your back to help keep your throat open. You can sleep with spe­cial pil­lows or shirts that pre­vent you from sleep­ing on your back.
* Keep your nasal pas­sages open at night with nose sprays or allergy med­i­cines, if needed. Talk to your doc­tor about whether these treat­ments might help you.
* Stop smoking.

Mouth­piece

A mouth­piece, some­times called an oral appli­ance, may help some peo­ple who have mild sleep apnea. Your doc­tor also may rec­om­mend a mouth­piece if you snore loudly but don’t have sleep apnea.

A den­tist or ortho­don­tist can make a custom-fit plas­tic mouth­piece for treat­ing sleep apnea. (An ortho­don­tist spe­cial­izes in cor­rect­ing teeth or jaw prob­lems.) The mouth­piece will adjust your lower jaw and your tongue to help keep your air­ways open while you sleep.

If you use a mouth­piece, it’s impor­tant that you check with your doc­tor about dis­com­fort or pain while using the device. You may need peri­odic office vis­its so your doc­tor can adjust your mouth­piece to fit better.

Breath­ing Devices

Con­tin­u­ous pos­i­tive air­way pres­sure (CPAP) is the most com­mon treat­ment for mod­er­ate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gen­tly blows air into your throat.

The air presses on the wall of your air­way. The air pres­sure is adjusted so that it’s just enough to stop the air­ways from becom­ing nar­rowed or blocked dur­ing sleep.

Treat­ing sleep apnea may help you stop snor­ing. But stop­ping snor­ing doesn’t mean that you no longer have sleep apnea or can stop using CPAP. Sleep apnea will return if CPAP is stopped or not used correctly.

Usu­ally, a tech­ni­cian will come to your home to bring the CPAP equip­ment. The tech­ni­cian will set up the CPAP machine and adjust it based on your doctor’s orders. After the ini­tial setup, you may need to have the CPAP adjusted on occa­sion for the best results.

CPAP treat­ment may cause side effects in some peo­ple. These side effects include a dry or stuffy nose, irri­tated skin on your face, sore eyes, and headaches. If your CPAP isn’t prop­erly adjusted, you may get stom­ach bloat­ing and dis­com­fort while wear­ing the mask.

If you’re hav­ing trou­ble with CPAP side effects, work with your sleep spe­cial­ist, his or her nurs­ing staff, and the CPAP tech­ni­cian. Together, you can take steps to reduce these side effects. These steps include adjust­ing the CPAP set­tings or the size/fit of the mask, or adding mois­ture to the air as it flows through the mask. A nasal spray may relieve a dry, stuffy, or runny nose.

There are many dif­fer­ent kinds of CPAP machines and masks. Be sure to tell your doc­tor if you’re not happy with the type you’re using. He or she may sug­gest switch­ing to a dif­fer­ent kind that may work bet­ter for you.

Peo­ple who have severe sleep apnea symp­toms gen­er­ally feel much bet­ter once they begin treat­ment with CPAP.

Surgery

Some peo­ple who have sleep apnea may ben­e­fit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea.

Surgery is done to widen breath­ing pas­sages. It usu­ally involves remov­ing, shrink­ing, or stiff­en­ing excess tis­sue in the mouth and throat or reset­ting the lower jaw.

Surgery to shrink or stiffen excess tis­sue in the mouth or throat is done in a doctor’s office or a hos­pi­tal. Shrink­ing tis­sue may involve small shots or other treat­ments to the tis­sue. A series of such treat­ments may be needed to shrink the excess tis­sue. To stiffen excess tis­sue, the doc­tor makes a small cut in the tis­sue and inserts a small piece of stiff plastic.

Surgery to remove excess tis­sue is only done in a hos­pi­tal. You’re given med­i­cine that makes you sleep dur­ing the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks.

Surgery to remove the ton­sils, if they’re block­ing the air­way, may be very help­ful for some chil­dren. Your child’s doc­tor may sug­gest wait­ing some time to see whether these tis­sues shrink on their own. This is com­mon as small chil­dren grow.

Key Points

* Sleep apnea is a com­mon breath­ing dis­or­der in which you have one or more pauses in breath­ing or shal­low breaths while you sleep.
* Sleep apnea usu­ally is a chronic (ongo­ing) con­di­tion that dis­rupts your sleep 3 or more nights each week.
* Sleep apnea often goes undi­ag­nosed. Doc­tors usu­ally can’t detect the con­di­tion dur­ing rou­tine office vis­its. Also, there are no blood tests for the con­di­tion. Most peo­ple who have sleep apnea don’t know they have it because it only occurs dur­ing sleep.
* The most com­mon type of sleep apnea is obstruc­tive sleep apnea. This most often means that the air­way has col­lapsed or is blocked dur­ing sleep. This may cause shal­low breath­ing or breath­ing pauses.
* Sleep apnea can cause day­time sleepi­ness, increase the risk for or worsen some med­ical con­di­tions, and increase the chance of hav­ing a work– or driving-related acci­dent.
* It’s esti­mated that more than 12 mil­lion Amer­i­can adults have sleep apnea. More than half of the peo­ple who have this con­di­tion are over­weight.
* The most com­mon signs of sleep apnea are loud snor­ing and chok­ing or gasp­ing dur­ing sleep and being very sleepy dur­ing the day.
* Doc­tors diag­nose sleep apnea based on your med­ical and fam­ily his­to­ries, a phys­i­cal exam, and results from sleep stud­ies.
* Treat­ment is aimed at restor­ing reg­u­lar breath­ing dur­ing sleep and reliev­ing symp­toms. Treat­ment also may help other med­ical prob­lems linked to sleep apnea.
* Lifestyle changes, mouth­pieces, breath­ing devices, and/or surgery are used to treat sleep apnea. Con­tin­u­ous pos­i­tive air­way pres­sure (CPAP) is the most com­mon treat­ment for mod­er­ate to severe sleep apnea.
* Sleep apnea can be very seri­ous. How­ever, fol­low­ing an effec­tive treat­ment plan can often improve your qual­ity of life quite a bit. Fol­low up with your doc­tor reg­u­larly to make sure your treat­ment is work­ing. Tell him or her if the treat­ment causes side effects that you can’t han­dle.
* Fam­ily mem­bers can help a per­son who snores loudly or stops breath­ing dur­ing sleep by encour­ag­ing him or her to get med­ical help.
* Treat­ment may improve your over­all health and hap­pi­ness as well as your qual­ity of sleep (and pos­si­bly your family’s qual­ity of sleep).

Tweet This Post

What is a mammogram?

A mam­mo­gram is a safe, low-dose x-ray exam of the breasts to look for changes that are not nor­mal. The results are recorded on x-ray film or directly into a com­puter for a doc­tor called a radi­ol­o­gist to examine.

A mam­mo­gram allows the doc­tor to have a closer look for changes in breast tis­sue that can­not be felt dur­ing a breast exam. It is used for women who have no breast com­plaints and for women who have breast symp­toms, such as a change in the shape or size of a breast, a lump, nip­ple dis­charge, or pain. Breast changes occur in almost all women. In fact, most of these changes are not can­cer and are called “benign,” but only a doc­tor can know for sure. Breast changes can also hap­pen monthly, due to your men­strual period.

What is the best method of detect­ing breast can­cer as early as possible?

A mam­mo­gram plus a clin­i­cal breast exam, an exam done by your doc­tor, is the most effec­tive way to detect breast can­cer early. Find­ing breast can­cer early greatly improves a woman’s chances for suc­cess­ful treatment.

Like any test, mam­mo­grams have both ben­e­fits and lim­i­ta­tions. For exam­ple, some can­cers can’t be found by a mam­mo­gram, but they may be found in a clin­i­cal breast exam.

Check­ing your own breasts for lumps or other changes is called a breast self-exam (BSE). Stud­ies so far have not shown that BSE alone helps reduce the num­ber of deaths from breast can­cer. BSE should not take the place of rou­tine clin­i­cal breast exams and mammograms.

If you choose to do BSE, remem­ber that breast changes can occur because of preg­nancy, aging, menopause, men­strual cycles, or from tak­ing birth con­trol pills or other hor­mones. It is nor­mal for breasts to feel a lit­tle lumpy and uneven. Also, it is com­mon for breasts to be swollen and ten­der right before or dur­ing a men­strual period. If you notice any unusual changes in your breasts, con­tact your doctor.

How is a mam­mo­gram done?

You stand in front of a spe­cial x-ray machine. The per­son who takes the x-rays, called a radi­o­logic tech­ni­cian, places your breasts, one at a time, between an x-ray plate and a plas­tic plate. These plates are attached to the mam­mo­gram machine and com­press the breasts to flat­ten them. This spreads the breast tis­sue out to obtain a clearer pic­ture. You will feel pres­sure on your breast for a few sec­onds. It may cause you some dis­com­fort; you might feel squeezed or pinched. This feel­ing only lasts for a few sec­onds, and the flat­ter your breast, the bet­ter the pic­ture. Most often, two pic­tures are taken of each breast — one from the side and one from above. A screen­ing mam­mo­gram takes about 20 min­utes from start to finish.

Are there dif­fer­ent types of mammograms?

• Screen­ing mam­mo­grams are done for women who have no symp­toms of breast can­cer. It usu­ally involves two x-rays of each breast. Screen­ing mam­mo­grams can detect lumps or tumors that can­not be felt. They can also find micro­cal­ci­fi­ca­tions (my-kro-kal-si-fi-KAY-shuns) or tiny deposits of cal­cium in the breast, which some­times mean that breast can­cer is present.
• Diag­nos­tic mam­mo­grams are used to check for breast can­cer after a lump or other symp­tom or sign of breast can­cer has been found. Signs of breast can­cer may include pain, thick­ened skin on the breast, nip­ple dis­charge, or a change in breast size or shape. This type of mam­mo­gram also can be used to find out more about breast changes found on a screen­ing mam­mo­gram, or to view breast tis­sue that is hard to see on a screen­ing mam­mo­gram. A diag­nos­tic mam­mo­gram takes longer than a screen­ing mam­mo­gram because it involves more x-rays in order to obtain views of the breast from sev­eral angles. The tech­ni­cian can mag­nify a prob­lem area to make a more detailed pic­ture, which helps the doc­tor make a cor­rect diagnosis.

A dig­i­tal mam­mo­gram also uses x-ray radi­a­tion to pro­duce an image of the breast, but instead of stor­ing the image directly on film, it stores the image of the breast directly on a com­puter. This allows the recorded data to be mag­ni­fied for the doc­tor to take a closer look. Cur­rent research has not shown that dig­i­tal images are bet­ter at show­ing can­cer than x-ray film images in gen­eral. But, women with dense breasts who are pre– or per­i­menopausal, or who are younger than age 50, may ben­e­fit from hav­ing a dig­i­tal rather than a film mam­mo­gram. Dig­i­tal mam­mog­ra­phy may offer these benefits:

• Long-distance con­sults with other doc­tors may be eas­ier because the images can be shared by computer.
• Slight dif­fer­ences between nor­mal and abnor­mal tis­sues may be eas­ily noted.
• The num­ber of follow-up tests needed may be fewer.
• Fewer repeat images may be needed, reduc­ing expo­sure to radiation.

How often should I get a mammogram?

• Women 40 years and older should get a mam­mo­gram every 1–2 years.
• Women who have had breast can­cer or other breast prob­lems or who have a fam­ily his­tory of breast can­cer might need to start get­ting mam­mo­grams before age 40, or they might need to get them more often. Talk to your doc­tor about when to start and how often you should have a mammogram.

What can mam­mo­grams show?

The radi­ol­o­gist will look at your x-rays for breast changes that do not look nor­mal and for dif­fer­ences in each breast. He or she will com­pare your past mam­mo­grams with your most recent one to check for changes. The doc­tor will also look for lumps and calcifications.

• Lump or mass. The size, shape, and edges of a lump some­times can give doc­tors infor­ma­tion about whether or not it may be can­cer. On a mam­mo­gram, a growth that is benign often looks smooth and round with a clear, defined edge. Breast can­cer often has a jagged out­line and an irreg­u­lar shape.
• Cal­ci­fi­ca­tion. A cal­ci­fi­ca­tion is a deposit of the min­eral cal­cium in the breast tis­sue. Cal­ci­fi­ca­tions appear as small white spots on a mam­mo­gram. There are two types:
  • Macro­cal­ci­fi­ca­tions are large cal­cium deposits often caused by aging. These usu­ally are not a sign of cancer.
  • Micro­cal­ci­fi­ca­tions are tiny specks of cal­cium that may be found in an area of rapidly divid­ing cells.

If cal­ci­fi­ca­tions are grouped together in a cer­tain way, it may be a sign of can­cer. Depend­ing on how many cal­cium specks you have, how big they are, and what they look like, your doc­tor may sug­gest that you have other tests. Cal­cium in the diet does not cre­ate cal­cium deposits, or cal­ci­fi­ca­tions, in the breast.

What if my screen­ing mam­mo­gram shows a problem?

If you have a screen­ing test result that sug­gests can­cer, your doc­tor must find out whether it is due to can­cer or to some other cause. Your doc­tor may ask about your per­sonal and fam­ily med­ical his­tory. You may have a phys­i­cal exam. Your doc­tor also may order some of these tests:

• Diag­nos­tic mam­mo­gram, to focus on a spe­cific area of the breast
• Ultra­sound, or imag­ing test that uses a device with sound waves to cre­ate a pic­ture of your breast. The pic­tures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not can­cer. But a solid mass may be can­cer. After the test, your doc­tor can store the pic­tures on video or print them out. This exam may be used along with a mammogram.
• Mag­netic res­o­nance imag­ing (MRI), which uses a pow­er­ful mag­net linked to a com­puter. MRI makes detailed pic­tures of breast tis­sue. Your doc­tor can view these pic­tures on a mon­i­tor or print them on film. MRI may be used along with a mammogram.
• Biopsy, a test in which fluid or tis­sue is removed from your breast to help find out if there is can­cer. Your doc­tor may refer you to a sur­geon or to a doc­tor who is an expert in breast dis­ease for a biopsy.

Where can I get a high-quality mammogram?

Women can get high qual­ity mam­mo­grams in breast clin­ics, hos­pi­tal radi­ol­ogy depart­ments, mobile vans, pri­vate radi­ol­ogy offices, and doc­tors’ offices. The Food and Drug Admin­is­tra­tion (FDA) cer­ti­fies mam­mog­ra­phy facil­i­ties that meet strict qual­ity stan­dards for their x-ray machines and staff and are inspected every year. You can ask your doc­tor or the staff at the mam­mog­ra­phy cen­ter about FDA cer­ti­fi­ca­tion before mak­ing your appoint­ment. A list of FDA-certified facil­i­ties can be found on the Inter­net at: http://www.fda.gov/cdrh/mammography/certified.html.

Your doc­tor, local med­ical clinic, or local or state health depart­ment can tell you where to get no-cost or low-cost mam­mo­grams. You can also call the National Can­cer Institute’s Can­cer Infor­ma­tion Ser­vice toll free at 1–800-422‑6237 (TTY: 1–800-332‑8615). Visit them online at http://www.cancer.gov.

What if I have breast implants?

Women with breast implants should con­tinue to have mam­mo­grams. A woman who had an implant after breast can­cer surgery should ask her doc­tor whether she needs a mam­mo­gram of the recon­structed breast.

If you have breast implants, be sure to tell your mam­mog­ra­phy facil­ity that you have them when you make your appoint­ment. The tech­ni­cian and radi­ol­o­gist must be expe­ri­enced in x-raying patients with breast implants. Implants can hide some breast tis­sue, mak­ing it harder for the radi­ol­o­gist to see a prob­lem when look­ing at your mam­mo­gram. To see as much breast tis­sue as pos­si­ble, the x-ray tech­ni­cian will gen­tly lift the breast tis­sue slightly away from the implant and take extra pic­tures of the breasts.

How do I get ready for my mammogram?

First, check with the place you are hav­ing the mam­mo­gram for any spe­cial instruc­tions you may need to fol­low before you go. Here are some gen­eral guide­lines to follow:

• If you are still hav­ing men­strual peri­ods, try to avoid mak­ing your mam­mo­gram appoint­ment dur­ing the week before your period. Your breasts will be less ten­der and swollen. The mam­mo­gram will hurt less and the pic­ture will be better. 
• If you have breast implants, be sure to tell your mam­mog­ra­phy facil­ity that you have them when you make your appointment.
• Wear a shirt with shorts, pants, or a skirt. This way, you can undress from the waist up and leave your shorts, pants, or skirt on when you get your mammogram.
• Don’t wear any deodor­ant, per­fume, lotion, or pow­der under your arms or on your breasts on the day of your mam­mo­gram appoint­ment. These things can make shad­ows show up on your mammogram.
• If you have had mam­mo­grams at another facil­ity, have those x-ray films sent to the new facil­ity so that they can be com­pared to the new films.

Are there any prob­lems with mammograms?

Although they are not per­fect, mam­mo­grams are the best method to find breast changes. If your mam­mo­gram shows a breast change, some­times other tests are needed to bet­ter under­stand it. Even if the doc­tor sees some­thing on the mam­mo­gram, it does not mean it is cancer.

As with any med­ical test, mam­mo­grams have lim­its. These lim­its include:

• They are only part of a com­plete breast exam. Your doc­tor also should do a clin­i­cal breast exam. If your mam­mo­gram finds some­thing abnor­mal, your doc­tor will order other tests.
• Find­ing can­cer does not always mean sav­ing lives. Even though mam­mog­ra­phy can detect tumors that can­not be felt, find­ing a small tumor does not always mean that a woman’s life will be saved. Mam­mog­ra­phy may not help a woman with a fast grow­ing can­cer that has already spread to other parts of her body before being found.
• False neg­a­tives can hap­pen. This means every­thing may look nor­mal, but can­cer is actu­ally present. False neg­a­tives don’t hap­pen often. Younger women are more likely to have a false neg­a­tive mam­mo­gram than are older women. The dense breasts of younger women make breast can­cers harder to find in mammograms.
• False pos­i­tives can hap­pen. This is when the mam­mo­gram results look like can­cer is present, even though it is not. False pos­i­tives are more com­mon in younger women, women who have had breast biop­sies, women with a fam­ily his­tory of breast can­cer, and women who are tak­ing estro­gen, such as hor­mone replace­ment therapy.
• Mam­mo­grams (as well as den­tal x-rays and other rou­tine x-rays) use very small doses of radi­a­tion. The risk of any harm is very slight, but repeated x-rays could cause prob­lems. The ben­e­fits nearly always out­weigh the risk. Talk to your doc­tor about the need for each x-ray. Ask about shield­ing to pro­tect parts of the body that are not in the pic­ture. You should always let your doc­tor and the tech­ni­cian know if there is any chance that you are pregnant.

Tweet This Post

The U.S. Pre­ven­tive Ser­vices Task Force (USPSTF) is a group of health experts that reviews pub­lished research and makes rec­om­men­da­tions about pre­ven­tive health care. The USPSTF has issued new mam­mo­gram guide­lines. These rec­om­men­da­tions include:

* Screen­ing mam­mo­grams should be done every two years begin­ning at age 50 for women at aver­age risk of breast can­cer.
* Doc­tors should not teach women to do breast self-exams.
* There is insuf­fi­cient evi­dence that mam­mo­gram screen­ing is effec­tive for women age 75 and older, so it’s not rec­om­mended for this age group.

Dif­fer­ing mam­mo­gram guide­lines

Mean­time, the ACS says the breast self-exam is optional in breast can­cer screening.

Accord­ing to the USPSTF, women who have screen­ing mam­mo­grams die of breast can­cer less fre­quently than do women who don’t get mam­mo­grams. How­ever, the USPSTF says the ben­e­fits of screen­ing mam­mo­grams don’t out­weigh the harms for women ages 40 to 49. Poten­tial harms may include false-positive results that lead to unneeded breast biop­sies and accom­pa­ny­ing anx­i­ety and distress.

A three-tiered approach is used which includes:

* Breast self-exam to iden­tify breast abnor­mal­i­ties and allow a woman to become famil­iar with her breasts so that she can tell her doc­tor about any changes
* Clin­i­cal breast exam per­formed by a health care provider and rec­om­mended annu­ally begin­ning at age 40
* Screen­ing mam­mog­ra­phy begin­ning at age 40

Screen­ing mam­mo­grams have detected abnor­mal­i­ties in women in their 40s. These women have then had biop­sies and learned they had inva­sive breast can­cer. There are many sto­ries about younger women who have found can­cer early as a result of screen­ing. And it’s impor­tant to remem­ber that most women who get breast can­cer have no fam­ily his­tory or other risk fac­tors for the disease.

Screen­ing mam­mog­ra­phy is not a per­fect exam. There will be a lot of new data pub­lished in the com­ing months, and it will take time to ana­lyze the results and see what infor­ma­tion can be gained to deter­mine how best to use mam­mog­ra­phy as a screen­ing tool.

In the mean­time, women should meet with their health care providers to dis­cuss the ben­e­fits, risks and lim­i­ta­tions of screen­ing mam­mo­grams. If you’re con­cerned about screen­ing mam­mo­grams, talk to your doc­tor and learn what’s right for you based on your indi­vid­ual risks. It’s impor­tant that the two of you work together to develop a screen­ing plan.

from Sand­hya Pruthi, M.D.

Tweet This Post

Do you know when to use ice and when to use heat on a sports injury? Most ath­letes know to apply ice to an acute injury, like a sprained ankle, but aren’t so sure when to use heat. The fol­low­ing guide­lines will help you sort it out.

Acute and Chronic Pain

# There are two basic types of ath­letic injuries: acute and chronic. Acute Pain is of rapid onset and short-lived, or
# Chronic Pain devel­ops slowly and is per­sis­tent and long-lasting.

Acute and Chronic Injuries

Acute injuries are sud­den, sharp, trau­matic injuries that occur imme­di­ately (or within hours) and cause pain (pos­si­bly severe pain). Most often acute injuries result from some sort of impact or trauma such as a fall, sprain, or col­li­sion and it’s pretty obvi­ous what caused the injury.

Acute injuries also cause com­mon signs and symp­toms of injury such as pain, ten­der­ness, red­ness, skin that is warm to the touch, swelling and inflam­ma­tion. If you have swelling, you have an acute injury.

Chronic injuries, on the other hand, can be sub­tle and slow to develop. They some­times come and go, and may cause dull pain or sore­ness. They are often the result of overuse, but some­times develop when an acute injury is not prop­erly treated and doesn’t heal.

Cold Ther­apy with Nature Cre­ation Herbal Pack
Cold ther­apy with nature Cre­ation Herbal pack is the best imme­di­ate treat­ment for acute injuries because it reduces swelling and pain. Cold herbal pack is a vaso-constrictor (it causes the blood ves­sels to nar­row) and it lim­its inter­nal bleed­ing at the injury site. Apply Nature Cre­ation Cold Herbal pack to the affected area for 10 to 15 min­utes at a time. Allow the skin tem­per­a­ture to return to nor­mal before apply­ing the pack a sec­ond or third time. You can use Nature Cre­ation pack on an acute injury sev­eral times a day for up to three days.

Cold ther­apy is also help­ful in treat­ing some overuse injuries or chronic pain in ath­letes. An ath­lete who has chronic knee pain that increases after run­ning may want to ice the injured area after each run to reduce or pre­vent inflam­ma­tion. It’s not help­ful to ice a chronic injury before exercise.

Heat Ther­apy
Heat is gen­er­ally used for chronic injuries or injuries that have no inflam­ma­tion or swelling. Sore, stiff, nag­ging mus­cle or joint pain is ideal for the use of heat ther­apy. Ath­letes with chronic pain or injuries may use heat ther­apy before exer­cise to increase the elas­tic­ity of joint con­nec­tive tis­sues and to stim­u­late blood flow. Heat can also help relax tight mus­cles or mus­cle spasms. Don’t apply heat after exer­cise. After a work­out, ice is the bet­ter choice on a chronic injury.

Because heat increases cir­cu­la­tion and raises skin tem­per­a­ture, you should not apply heat to acute injuries or injuries that show signs of inflam­ma­tion. Safely apply heat to an injury 15 to 20 min­utes at a time and use enough lay­ers between your skin and the heat­ing source to pre­vent burns.

Moist heat is best, so you could try using a hot Nature Cre­ation Herbal Pack. Never leave the hot herbal pack on for more than 20 min­utes at a time or while sleeping.

Because some injuries can be seri­ous, you should see your doc­tor if your injury does not improve (or gets worse) within 48 hours.

Tweet This Post

Arthri­tis is inflam­ma­tion of one or more joints, which results in pain, swelling, stiff­ness, and lim­ited move­ment. There are over 100 dif­fer­ent types of arthritis.

Causes, inci­dence, and risk factors

Arthri­tis involves the break­down of car­ti­lage. Car­ti­lage nor­mally pro­tects the joint, allow­ing for smooth move­ment. Car­ti­lage also absorbs shock when pres­sure is placed on the joint, like when you walk. With­out the usual amount of car­ti­lage, the bones rub together, caus­ing pain, swelling (inflam­ma­tion), and stiffness.

You may have joint inflam­ma­tion for a vari­ety of rea­sons, including:

* Bro­ken bone
* Infec­tion (usu­ally caused by bac­te­ria or viruses)
* An autoim­mune dis­ease (the body attacks itself because the immune sys­tem believes a body part is for­eign)
* Gen­eral “wear and tear” on joints

Often, the inflam­ma­tion goes away after the injury has healed, the dis­ease is treated, or the infec­tion has been cleared.

With some injuries and dis­eases, the inflam­ma­tion does not go away or destruc­tion results in long-term pain and defor­mity. When this hap­pens, you have chronic arthri­tis. Osteoarthri­tis is the most com­mon type and is more likely to occur as you age. You may feel it in any of your joints, but most com­monly in your hips, knees or fin­gers. Risk fac­tors for osteoarthri­tis include:

* Being over­weight
* Pre­vi­ously injur­ing the affected joint
* Using the affected joint in a repet­i­tive action that puts stress on the joint (base­ball play­ers, bal­let dancers, and con­struc­tion work­ers are all at risk)

Arthri­tis can occur in men and women of all ages. About 37 mil­lion peo­ple in Amer­ica have arthri­tis of some kind, which is almost 1 out of every 7 people.

Other types or cause of arthri­tis include:

* Rheuma­toid arthri­tis (in adults)
* Juve­nile rheuma­toid arthri­tis (in chil­dren)
* Sys­temic lupus ery­the­mato­sus (SLE)
* Gout
* Scle­ro­derma
* Pso­ri­atic arthri­tis
* Anky­los­ing spondyli­tis
* Reiter’s syn­drome (reac­tive arthri­tis)
* Adult Still’s dis­ease
* Viral arthri­tis
* Gono­coc­cal arthri­tis
* Other bac­te­r­ial infec­tions (non-gonococcal bac­te­r­ial arthri­tis )
* Ter­tiary Lyme dis­ease (the late stage)
* Tuber­cu­lous arthri­tis
* Fun­gal infec­tions such as blastomycosis

Symptoms

If you have arthri­tis, you may experience:

* Joint pain
* Joint swelling
* Stiff­ness, espe­cially in the morn­ing
* Warmth around a joint
* Red­ness of the skin around a joint
* Reduced abil­ity to move the joint

Signs and tests

First, your doc­tor will take a detailed med­ical his­tory to see if arthri­tis or another mus­cu­loskele­tal prob­lem is the likely cause of your symptoms.

Next, a thor­ough phys­i­cal exam­i­na­tion may show that fluid is col­lect­ing around the joint. (This is called an “effu­sion.”) The joint may be ten­der when it is gen­tly pressed, and may be warm and red (espe­cially in infec­tious arthri­tis and autoim­mune arthri­tis). It may be painful or dif­fi­cult to rotate the joints in some direc­tions. This is known as “lim­ited range-of-motion.”

In some autoim­mune forms of arthri­tis, the joints may become deformed if the dis­ease is not treated. Such joint defor­mi­ties are the hall­marks of severe, untreated rheuma­toid arthritis.

Tests vary depend­ing on the sus­pected cause. They often include blood tests and joint x-rays. To check for infec­tion and other causes of arthri­tis (like gout caused by crys­tals), joint fluid is removed from the joint with a nee­dle and exam­ined under a micro­scope. See the spe­cific types of arthri­tis for fur­ther infor­ma­tion.
Treatment

Treat­ment of arthri­tis depends on the par­tic­u­lar cause, which joints are affected, sever­ity, and how the con­di­tion affects your daily activ­i­ties. Your age and occu­pa­tion will also be taken into con­sid­er­a­tion when your doc­tor works with you to cre­ate a treat­ment plan.

If pos­si­ble, treat­ment will focus on elim­i­nat­ing the under­ly­ing cause of the arthri­tis. How­ever, the cause is NOT nec­es­sar­ily cur­able, as with osteoarthri­tis and rheuma­toid arthri­tis. Treat­ment, there­fore, aims at reduc­ing your pain and dis­com­fort and pre­vent­ing fur­ther disability.

It is pos­si­ble to greatly improve your symp­toms from osteoarthri­tis and other long-term types of arthri­tis with­out med­ica­tions. In fact, mak­ing lifestyle changes with­out med­ica­tions is prefer­able for osteoarthri­tis and other forms of joint inflam­ma­tion. If needed, med­ica­tions should be used in addi­tion to lifestyle changes.

Exer­cise for arthri­tis is nec­es­sary to main­tain healthy joints, relieve stiff­ness, reduce pain and fatigue, and improve mus­cle and bone strength. Your exer­cise pro­gram should be tai­lored to you as an indi­vid­ual. Work with a phys­i­cal ther­a­pist to design an indi­vid­u­al­ized pro­gram, which should include:

* Range of motion exer­cises for flex­i­bil­ity
* Strength train­ing for mus­cle tone
* Low-impact aer­o­bic activ­ity (also called endurance exercise)

A phys­i­cal ther­a­pist can apply heat and cold treat­ments as needed and fit you for splints or orthotic (straight­en­ing) devices to sup­port and align joints. This may be par­tic­u­larly nec­es­sary for rheuma­toid arthri­tis. Your phys­i­cal ther­a­pist may also con­sider water ther­apy, ice mas­sage, or tran­scu­ta­neous nerve stim­u­la­tion (TENS).

Rest is just as impor­tant as exer­cise. Sleep­ing 8 to 10 hours per night and tak­ing naps dur­ing the day can help you recover from a flare-up more quickly and may even help pre­vent exac­er­ba­tions. You should also:

* Avoid posi­tions or move­ments that place extra stress on your affected joints.
* Avoid hold­ing one posi­tion for too long.
* Reduce stress, which can aggra­vate your symp­toms. Try med­i­ta­tion or guided imagery. And talk to your phys­i­cal ther­a­pist about yoga or tai chi.
* Mod­ify your home to make activ­i­ties eas­ier. For exam­ple, have grab bars in the shower, the tub, and near the toilet.

Other mea­sures to try include:

* Tak­ing glu­cosamine and chon­droitin — these form the build­ing blocks of car­ti­lage, the sub­stance that lines joints. These sup­ple­ments are avail­able at health food stores or super­mar­kets. While some stud­ies show such sup­ple­ments may reduce osteoarthri­tis symp­toms, oth­ers show no ben­e­fit. How­ever, since these prod­ucts are regarded as safe, they are rea­son­able to try and many patients find their symp­toms improve.
* Eat a diet rich in vit­a­mins and min­er­als, espe­cially antiox­i­dants like vit­a­min E. These are found in fruits and veg­eta­bles. Get sele­nium from Brewer’s yeast, wheat germ, gar­lic, whole grains, sun­flower seeds, and Brazil nuts. Get omega-3 fatty acids from cold water fish (like salmon, mack­erel, and her­ring), flaxseed, rape­seed (canola) oil, soy­beans, soy­bean oil, pump­kin seeds, and wal­nuts.
* Apply cap­saicin cream (derived from hot chili pep­pers) to the skin over your painful joints. You may feel improve­ment after apply­ing the cream for 3–7 days.

MEDICATIONS

Your doc­tor will choose from a vari­ety of med­ica­tions as needed. Gen­er­ally, the first drugs to try are avail­able with­out a pre­scrip­tion. These include:

* Aceta­minophen (Tylenol) — rec­om­mended by the Amer­i­can Col­lege of Rheuma­tol­ogy and the Amer­i­can Geri­atrics Soci­ety as first-line treat­ment for osteoarthri­tis. Take up to 4 grams a day (2 extra-strength Tylenol every 6 hours). This can pro­vide sig­nif­i­cant relief of arthri­tis pain with­out many of the side effects of pre­scrip­tion drugs. DO NOT exceed the rec­om­mended doses of aceta­minophen or take the drug in com­bi­na­tion with large amounts of alco­hol. These actions may dam­age your liver.
* Aspirin, ibupro­fen, or naproxen — these non­s­teroidal anti-inflammatory (NSAID) drugs are often effec­tive in com­bat­ing arthri­tis pain. How­ever, they have many poten­tial risks, espe­cially if used for a long time. They should not be taken in any amount with­out con­sult­ing your doc­tor. Poten­tial side effects include heart attack, stroke, stom­ach ulcers, bleed­ing from the diges­tive tract, and kid­ney dam­age. In 2005, the U.S. Food and Drug Admin­is­tra­tion (FDA) asked mak­ers of NSAIDs to include a warn­ing label on their prod­uct that alerts users of an increased risk for heart attack, stroke, and gas­troin­testi­nal bleed­ing. If you have kid­ney or liver dis­ease, or a his­tory of gas­troin­testi­nal bleed­ing, you should not take these med­i­cines unless your doc­tor specif­i­cally rec­om­mends them.

Pre­scrip­tion med­i­cines include:

* Cyclooxygenase-2 (COX-2) inhibitors — These drugs block an inflammation-promoting enzyme called COX-2. This class of drugs was ini­tially believed to work as well as tra­di­tional NSAIDs, but with fewer stom­ach prob­lems. How­ever, numer­ous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and ben­e­fits of the COX-2s. Cele­coxib (Cele­brex) is still avail­able, but labeled with strong warn­ings and a rec­om­men­da­tion that it be pre­scribed at the low­est pos­si­ble dose for the short­est dura­tion pos­si­ble. Talk to your doc­tor about whether COX-2s are right for you.
* Cor­ti­cos­teroids (“steroids”) — these are med­ica­tions that sup­press the immune sys­tem and symp­toms of inflam­ma­tion. They are com­monly used in severe cases of osteoarthri­tis, and they can be given orally or by injec­tion. Steroids are used to treat autoim­mune forms of arthri­tis but should be avoided in infec­tious arthri­tis. Steroids have mul­ti­ple side effects, includ­ing upset stom­ach and gas­troin­testi­nal bleed­ing, high blood pres­sure, thin­ning of bones, cataracts, and increased infec­tions. The risks are most pro­nounced when steroids are taken for long peri­ods of time or at high doses. Close super­vi­sion by a physi­cian is essen­tial.
* Disease-modifying anti-rheumatic drugs — these have been used tra­di­tion­ally to treat rheuma­toid arthri­tis and other autoim­mune causes of arthri­tis. These drugs include gold salts, peni­cil­lamine, sul­fasalazine, and hydrox­y­chloro­quine. More recently, methotrex­ate has been shown to slow the pro­gres­sion of rheuma­toid arthri­tis and improve your qual­ity of life. Methotrex­ate itself can be highly toxic and requires fre­quent blood tests for patients on the med­ica­tion.
* Bio­log­ics– these are the most recent break­through for the treat­ment of rheuma­toid arthri­tis. Such med­ica­tions, includ­ing etan­er­cept (Enbrel), inflix­imab (Rem­i­cade) and adal­i­mumab (Humira), are admin­is­tered by injec­tion and can dra­mat­i­cally improve your qual­ity of life. Newer bio­log­ics include Oren­cia (abat­a­cept) and Rit­uxan (rit­ux­imab).
* Immuno­sup­pres­sants — these drugs, like aza­thio­prine or cyclophos­phamide, are used for seri­ous cases of rheuma­toid arthri­tis when other med­ica­tions have failed.

It is very impor­tant to take your med­ica­tions as directed by your doc­tor. If you are hav­ing dif­fi­culty doing so (for exam­ple, due to intol­er­a­ble side effects), you should talk to your doctor.

SURGERY AND OTHER APPROACHES

In some cases, surgery to rebuild the joint (arthro­plasty) or to replace the joint (such as a total knee joint replace­ment) may help main­tain a more nor­mal lifestyle. The deci­sion to per­form joint replace­ment surgery is nor­mally made when other alter­na­tives, such as lifestyle changes and med­ica­tions, are no longer effective.

Nor­mal joints con­tain a lubri­cant called syn­ovial fluid. In joints with arthri­tis, this fluid is not pro­duced in ade­quate amounts. In some cases, a doc­tor may inject the arthritic joint with a man-made ver­sion of joint fluid. The syn­thetic fluid may post­pone the need for surgery at least tem­porar­ily and improve the qual­ity of life for per­sons with arthritis.

Expec­ta­tions (prognosis)

A few arthritis-related dis­or­ders can be com­pletely cured with treat­ment. Most are chronic (long-term) con­di­tions, how­ever, and the goal of treat­ment is to con­trol the pain and min­i­mize joint dam­age. Chronic arthri­tis fre­quently goes in and out of remis­sion.
Complications

* Chronic pain
* Lifestyle restric­tions or disability

Call­ing your health care provider

Call your doc­tor if:

* Your joint pain per­sists beyond 3 days.
* You have severe unex­plained joint pain.
* The affected joint is sig­nif­i­cantly swollen.
* You have a hard time mov­ing the joint.
* Your skin around the joint is red or hot to the touch.
* You have a fever or have lost weight unintentionally.

Prevention

If arthri­tis is diag­nosed and treated early, you can pre­vent joint dam­age. Find out if you have a fam­ily his­tory of arthri­tis and share this infor­ma­tion with your doc­tor, even if you have no joint symptoms.

Osteoarthri­tis may be more likely to develop if you abuse your joints (injure them many times or over-use them while injured). Take care not to over­work a dam­aged or sore joint. Sim­i­larly, avoid exces­sive repet­i­tive motions.

Excess weight also increases the risk for devel­op­ing osteoarthri­tis in the knees, and pos­si­bly in the hips and hands. See the arti­cle on body mass index to learn whether your weight is healthy.

Tweet This Post

A headache is pain or dis­com­fort in the head, scalp, or neck. Seri­ous causes of headaches are extremely rare. Most peo­ple with headaches can feel much bet­ter by mak­ing lifestyle changes, learn­ing ways to relax, and occa­sion­ally by tak­ing medications.

Com­mon Causes

Ten­sion headaches are due to tight, con­tracted mus­cles in your shoul­ders, neck, scalp, and jaw. They are often related to stress, depres­sion, or anx­i­ety. Over­work­ing, not get­ting enough sleep, miss­ing meals, and using alco­hol or street drugs can make you more sus­cep­ti­ble to them. Headaches can be trig­gered by choco­late, cheese, and monosodium glu­ta­mate (MSG). Peo­ple who drink caf­feine can have headaches when they don’t get their usual daily amount.

Other com­mon causes include:

* Hold­ing your head in one posi­tion for a long time, like at a com­puter, micro­scope, or type­writer
* Poor sleep posi­tion
* Overex­ert­ing your­self
* Clench­ing or grind­ing your teeth

Ten­sion headaches tend to be on both sides of your head. They often start at the back of your head and spread for­ward. The pain may feel dull or squeez­ing, like a tight band or vice. Your shoul­ders, neck, or jaw may feel tight and sore.

Migraine headaches are severe, recur­rent headaches gen­er­ally accom­pa­nied by other symp­toms like visual dis­tur­bances or nau­sea. They tend to begin on one side of your head, although the pain may spread to both sides. You may have an “aura” (warn­ing symp­toms that start before your headache) and feel throb­bing, pound­ing, or pul­sat­ing pain.

For infor­ma­tion on migraine, see migraine headache.

Other types of headaches:

* Clus­ter headaches are sharp, extremely painful headaches that tend to occur sev­eral times per day for months and then go away for a sim­i­lar period. They are far less com­mon.
* Sinus headaches cause pain in the front of your head and face. They are due to inflam­ma­tion in the sinus pas­sages that lie behind the cheeks, nose, and eyes. The pain tends to be worse when you bend for­ward and when you first wake up in the morn­ing. Post­nasal drip, sore throat, and nasal dis­charge usu­ally occur with these headaches.

Headaches may occur if you have a cold, the flu, fever, or pre­men­strual syndrome.

If you are over age 50 and are expe­ri­enc­ing headaches for the first time, a con­di­tion called tem­po­ral arteri­tis may prove to be the cause. Symp­toms of this con­di­tion include impaired vision and pain aggra­vated by chew­ing. There is a risk of becom­ing blind with this con­di­tion. There­fore, it must be treated by your doc­tor right away.

Rare causes of headache include:

* Brain aneurysm — a weak­en­ing of the wall of a blood ves­sel that can rup­ture and bleed into the brain
* Brain tumor
* Stroke or TIA
* Brain infec­tion like menin­gi­tis or encephalitis

Home Care

Keep a headache diary to help iden­tify the source or trig­ger of your symp­toms. Then mod­ify your envi­ron­ment or habits to avoid future headaches. When a headache occurs, write down the date and time the headache began, what you ate for the past 24 hours, how long you slept the night before, what you were doing and think­ing about just before the headache started, any stress in your life, how long the headache lasts, and what you did to make it stop. After a period of time, you may begin to see a pattern.

A headache may be relieved by rest­ing with your eyes closed and head sup­ported. Relax­ation tech­niques can help. A mas­sage or heat applied to the back of the upper neck can be effec­tive in reliev­ing ten­sion headaches.

Try aceta­minophen, aspirin, or ibupro­fen for ten­sion headaches. DO NOT give aspirin to chil­dren because of the risk of Reye syndrome.

Migraine headaches may respond to aspirin, naproxen, or com­bi­na­tion migraine medications.

If over-the-counter reme­dies do not con­trol your pain, talk to your doc­tor about pos­si­ble pre­scrip­tion medications.

Pre­scrip­tion med­ica­tions used for migraine headaches include ergo­t­a­mine, dihy­droer­go­t­a­mine, ergo­t­a­mine with caf­feine (Cafer­got), isomethep­tene (Midrin), and trip­tans like suma­trip­tan (Imitrex), riza­trip­tan (Max­alt), eletrip­tan (Rel­pax), almotrip­tan (Axert), and zolmitrip­tan (Zomig). Some­times med­ica­tions to relieve nau­sea and vom­it­ing are help­ful for other migraine symptoms.

If you get headaches often, your doc­tor may pre­scribe med­ica­tion to pre­vent headaches before they occur. Exam­ples of these include:

* Anti­de­pres­sants such as nor­tripty­line (Pamelor), amitripty­line (Elavil), flu­ox­e­tine (Prozac, Sarafem), ser­tra­line (Zoloft), or parox­e­tine (Paxil) for ten­sion or migraine headache
* Beta-blockers such as pro­pra­nolol (Inderal) for fre­quent migraine headaches
* Cal­cium chan­nel block­ers such as ver­a­pamil for fre­quent migraine headaches
* Anti-epileptic med­i­cines such as top­i­ra­mate (Topamax)

If you are using pain med­ica­tions more than 2 days a week, you may be suf­fer­ing from rebound headaches. Rebound headaches are caused by a cycle of using pain med­ica­tions for short-term relief, fol­lowed by the headache pain return­ing for increas­ingly longer peri­ods of time despite tak­ing more pain medications.

All types of pain pills (includ­ing over-the-counter drugs), mus­cle relax­ants, some decon­ges­tants, and caf­feine can cause this pat­tern. If you think this may be a prob­lem for you, talk to your health care provider.
Call your health care provider if

Take the fol­low­ing symp­toms seri­ously. If you can­not see your health care provider imme­di­ately, go to the emer­gency room or call 911:

* Your headache comes on sud­denly and is explo­sive or vio­lent.
* You would describe your headache as “your worst ever”, even if you are prone to headaches.
* Your headache is asso­ci­ated with slurred speech, change in vision, prob­lems mov­ing your arms or legs, loss of bal­ance, con­fu­sion, or mem­ory loss.
* Your headache gets pro­gres­sively worse over a 24-hour period.
* Your headache is accom­pa­nied by fever, stiff neck, nau­sea, and vom­it­ing.
* Your headache occurs with a head injury.
* Your headache is severe and local­ized to one eye with red­ness in that eye.
* You are over age 50 and your headaches just began, espe­cially with impaired vision and pain while chewing.

See your provider soon if:

* Your headaches wake you up from sleep.
* A headache lasts more than a few days.
* Headaches are worse in the morn­ing.
* You have a his­tory of headaches but they have changed in pat­tern or inten­sity.
* You have headaches fre­quently, and there is no known cause.

What to expect at your health care provider’s office

Your health care provider will obtain your med­ical his­tory and will per­form an exam­i­na­tion of your head, eyes, ears, nose, throat, neck, and ner­vous system.

The diag­no­sis is usu­ally based on your his­tory of symp­toms. A “headache diary” may be help­ful for record­ing infor­ma­tion about headaches over a period of time. Your doc­tor may ask ques­tions such as the following:

* Is the headache located in the fore­head, around the eyes, in the back of the head, near the tem­ples, behind the eye­ball, or all over?
* Is the headache on one side only?
* Is this a new type of headache for you?
* Would you describe the headache as throb­bing?
* Is there a pres­sure or band-like sen­sa­tion?
* When does the headache occur? How long have you had headaches? How long does each headache last?
* Does the headache awaken you from sleep? Are the headaches worse dur­ing the day and bet­ter at night?
* Did other symp­toms begin shortly after the headaches began? Do headaches occur repeat­edly?
* Does the headache reach max­i­mum inten­sity over 1 to 2 hours?
* Are the headaches worse when you are lying down? Stand­ing up?
* Are the headaches worse when you cough or strain?
* Do they occur at a spe­cific time related to your men­strual period?
* What home treat­ment have you tried? How effec­tive was it?

Diag­nos­tic tests that may be per­formed include the following:

* Head CT scan
* Head MRI
* Sinuses x-rays
* Tem­po­ral artery biopsy
* Lum­bar puncture

If a migraine is diag­nosed, med­ica­tions that con­tain ergot may be pre­scribed. Tem­po­ral arteri­tis must be treated with steroids to help pre­vent blind­ness. Other dis­or­ders are treated as is appropriate.

Prevention

The fol­low­ing healthy habits can lessen stress and reduce your chance of get­ting headaches:

* Get­ting ade­quate sleep
* Eat­ing a healthy diet
* Exer­cis­ing reg­u­larly
* Stretch­ing your neck and upper body, espe­cially if your work involves typ­ing or using a com­puter
* Learn­ing proper pos­ture
* Quit­ting smok­ing
* Learn­ing to relax using med­i­ta­tion, deep breath­ing, yoga, or other techniques

Tweet This Post

Tweet This Post

From acupunc­ture to chi­ro­prac­tic, from mas­sage to med­i­ta­tion, alter­na­tive treat­ments are in great demand. That’s espe­cially true for peo­ple with pain-related ill­nesses such as fibromyal­gia. Alter­na­tive med­i­cine, includ­ing herbal ther­apy and home­opa­thy, it is used in place of con­ven­tional med­i­cine. These sys­tems are based on the belief that the body has the power to heal itself with mul­ti­ple tech­niques includ­ing those that involve the mind, body and spirit. Com­ple­men­tary med­i­cine is used together with con­ven­tional medicine.

For peo­ple with fibromyal­gia, some alter­na­tive treat­ments work well. That’s because holis­tic ther­a­pies influ­ence your total being. In that way, they may allow you to reduce your med­ica­tions and increase your nor­mal activities.

Study find­ings show that stan­dard acupunc­ture may be effec­tive in treat­ing some peo­ple with fibromyal­gia. Both biofeed­back and elec­troacupunc­ture have also been used for relief of fibromyal­gia symp­toms. How­ever, before you try alter­na­tive treat­ments, talk with your doc­tor. Check to see what lim­i­ta­tions might apply to you. Work­ing with your doc­tor, you can find an accept­able way to blend con­ven­tional med­i­cine with alter­na­tive treat­ments or nat­ural reme­dies. When you do, you may be able to increase rest­ful sleep and reduce your fibromyal­gia pain.
Can acupunc­ture treat fibromyalgia?

With acupunc­ture, a prac­ti­tioner inserts one or more dry nee­dles into the skin and under­ly­ing tis­sues at spe­cific points. Gen­tly twist­ing or oth­er­wise manip­u­lat­ing the nee­dles causes a mea­sur­able release of endor­phins into the blood­stream. Endor­phins are the body’s nat­ural opi­oids. In addi­tion, accord­ing to acupunc­ture prac­ti­tion­ers, energy blocks are removed. Remov­ing them is said to restore the flow of energy along the merid­i­ans, which are spe­cific energy channels.

Stud­ies show that acupunc­ture may alter brain chem­istry. It appears to do this by chang­ing the release of neu­ro­trans­mit­ters. These neu­ro­trans­mit­ters stim­u­late or inhibit nerve impulses in the brain that relay infor­ma­tion about exter­nal stim­uli and sen­sa­tions such as pain. In this way, the patient’s pain tol­er­ance is increased. One acupunc­ture treat­ment in some patients may last weeks to help alle­vi­ate chronic pain.
What is electroacupuncture?

Elec­troacupunc­ture is another way of stim­u­lat­ing the acupunc­ture points. It uses a nee­dle hooked up to small wires con­nected to very slight elec­tri­cal cur­rents. Heat — mox­i­bus­tion — and mas­sage — acu­pres­sure — can also be used dur­ing this elec­troacupunc­ture process.

Laser acupunc­ture is yet another off­shoot of this alter­na­tive ther­apy. It may occa­sion­ally be effec­tive for the treat­ment of carpal tun­nel syn­drome. While it uses the same points, there are no nee­dles involved.

There are pre­cau­tions to take if you want to try acupunc­ture. First, make sure you find a licensed acupunc­tur­ist who has a lot of expe­ri­ence. Also, make sure the acupunc­tur­ist uses only dis­pos­able needles.

There are mul­ti­ple styles of acupunc­ture. The style used depends on where the prac­ti­tioner stud­ied. For instance, Chi­nese acupunc­ture depends on larger bore nee­dles and the prac­ti­tioner may be more aggres­sive with mov­ing them. Japan­ese acupunc­ture uses thin­ner bore nee­dles with a rel­a­tively gen­tle approach. You’ll need to find the style that suits your fibromyal­gia needs.

How can chi­ro­prac­tic help fibromyalgia?

Chi­ro­prac­tic care is a very com­mon alter­na­tive treat­ment for fibromyal­gia pain. Peo­ple use it to treat pain of pres­sure points, back pain, neck pain, shoul­der pain, headaches, and pain from mus­cu­loskele­tal injuries. Chi­ro­prac­tic may be effec­tive for fibromyal­gia because it helps improve pain lev­els and increase cer­vi­cal and lum­bar ranges of motion.

Chi­ro­prac­tic is based on the prin­ci­ple that the body is a self-healing organ­ism. To reduce pain and increase heal­ing, the doc­tor of chi­ro­prac­tic uses spinal adjust­ments. The goal is to increase the mobil­ity between spinal ver­te­brae, which have become restricted, locked, or slightly out of proper position.

Chi­ro­prac­tors do this by using hand adjust­ments. With gen­tle pres­sure or stretch­ing, mul­ti­ple gen­tle move­ments of one area, or spe­cific high-velocity thrusts, the adjust­ments are said to help return the bones to a more nor­mal posi­tion or motion. This return is said to relieve pain and reduce ill health.
Can mas­sage ease fibromyal­gia pain?

With Swedish mas­sage, the prac­ti­tioner uses a sys­tem of long strokes, knead­ing, and fric­tion tech­niques. With these, the prac­ti­tioner mas­sages the more super­fi­cial lay­ers of the mus­cles. The mas­sage is com­bined with active and pas­sive move­ments of the joints.

Oil is usu­ally used to facil­i­tate the stroking and knead­ing of the body, thereby stim­u­lat­ing metab­o­lism and cir­cu­la­tion. The mas­sage ther­a­pist applies pres­sure and rubs the mus­cles in the same direc­tion as the flow of blood return­ing to the heart.

Deep tis­sue mas­sage may be help­ful for those with fibromyal­gia. The rea­son is ther­a­pists use greater pres­sure than is used in Swedish mas­sage. In so doing, they tar­get the deep lay­ers of mus­cle. Using a series of slow strokes and direct pres­sure, the ther­a­pist will strive to release chronic pat­terns of mus­cu­lar ten­sion. Some­times, the ther­a­pists use their elbows or thumbs to push hard into the deep­est grain of the mus­cle to reduce tension.

Neu­ro­mus­cu­lar mas­sage com­bines the basic prin­ci­ples of ancient Ori­en­tal ther­a­pies, such as acu­pres­sure and shi­atsu, with spe­cific hands-on deep tis­sue ther­apy. The goal is to reduce chronic mus­cle or myofas­cial (soft-tissue) pain.
How does biofeed­back work to ease fibromyalgia?

To indi­vid­u­al­ize the reduc­tion of stress in the treat­ment of fibromyal­gia, biofeed­back is often rec­om­mended. This mind/body relax­ation tech­nique uses elec­tron­ics to mea­sure stress-related responses in the body. The idea behind biofeed­back is that peo­ple can use infor­ma­tion about their body’s inter­nal processes to learn to con­trol those processes.

A con­sen­sus state­ment from the National Insti­tutes of Health indi­cates there is good evi­dence that biofeed­back might help relieve many types of chronic pain. For exam­ple, it might be use­ful in treat­ing ten­sion and migraine headaches. In one study at the Uni­ver­sity of South Alabama, 80% of chil­dren with migraines were symptom-free after receiv­ing inten­sive biofeed­back train­ing. In other research, some headache patients who were able to increase hand tem­per­a­ture using ther­mal biofeed­back also expe­ri­enced fewer and less intense migraine headaches.

How does biofeed­back work to ease fibromyal­gia? continued…

With biofeed­back, you are con­nected to a machine that informs you and your ther­a­pist when you are phys­i­cally relax­ing your body. Sen­sors detect mus­cle ten­sion, heart rate, breath­ing pat­tern, the amount of sweat pro­duced, or body tem­per­a­ture. Any one or all of these can let the trained biofeed­back ther­a­pist know if you are learn­ing to relax.

The instru­ments mag­nify sig­nals that you might not oth­er­wise notice. As a result, you can use this visual or audi­tory response to learn how to con­trol cer­tain bod­ily func­tions. The ulti­mate goal of biofeed­back is to use this skill out­side the therapist’s office when you are fac­ing real stressors.

With fibromyal­gia pain, you know the “real stres­sor” is the pain itself. Nev­er­the­less, other daily stres­sors can cause your fibromyal­gia to flare. What you want to do is respond in a healthy way to the chronic stres­sors. If learned prop­erly, elec­tronic biofeed­back can help you con­trol your heart rate, blood pres­sure, breath­ing pat­terns, and mus­cle ten­sion, poten­tially reduc­ing pain.
What is home­o­pathic medicine?

Home­opa­thy is a ther­a­peu­tic sys­tem of med­i­cine that started in the late 18th cen­tury. Home­opa­thy is based on the prin­ci­ple of “like cures like.” That means that reme­dies that would cause a poten­tial prob­lem in large doses will actu­ally encour­age the body to heal more rapidly if given in small doses. Prac­ti­tion­ers use small diluted for­mu­las of plant, min­eral, and ani­mal sub­stances to treat var­i­ous ail­ments. The hope is these for­mu­las will stim­u­late the body to throw off the offender.
Can herbal med­i­cine help fibromyalgia?

Herbal reme­dies have been used for gen­er­a­tions. They can be put in tea or soup or taken in other forms. While some herbal ther­a­pies have not been shown to have a spe­cific ben­e­fit for fibromyal­gia symp­toms, some patients have found improved sleep or more energy with herbal sup­ple­ments.
How can med­i­ta­tion help fibromyalgia?

With med­i­ta­tion, you allow your thoughts to take a break from daily ana­lyt­i­cal rou­tines and give sup­port to the spir­i­tual dimen­sion of life. When you med­i­tate, your body switches from the pump­ing “fight or flight” response to a calmer, more peace­ful mood. Stud­ies show that med­i­ta­tion pro­duces brain waves con­sis­tent with seren­ity and hap­pi­ness. Med­i­ta­tion pro­vides nour­ish­ment for your soul, sati­ates inner spir­i­tual hunger, and helps you to develop your abil­ity to pay atten­tion to all areas of life with­out dis­trac­tion.
What should I remem­ber if I want to try an alter­na­tive treatment?

It’s impor­tant to be openly dis­crim­i­nat­ing when choos­ing alter­na­tive treat­ments. The fact that some­thing is called “nat­ural” does not mean it is safe. Work­ing with your doc­tor, look for the alter­na­tive ther­a­pies that will best boost sleep and decrease pain. The right ther­apy can help get you on the healthy road again.

Tweet This Post

Symp­toms of fibromyal­gia include:

* Chronic mus­cle pain, mus­cle spasms or tight­ness, weak­ness in the limbs, and leg cramps
* Mod­er­ate or severe fatigue and decreased energy
* Insom­nia or wak­ing up feel­ing just as tired as when you went to sleep
* Stiff­ness upon wak­ing or after stay­ing in one posi­tion for too long
* Dif­fi­culty remem­ber­ing, con­cen­trat­ing, and per­form­ing sim­ple men­tal tasks
* Abdom­i­nal pain, bloat­ing, nau­sea, and con­sti­pa­tion alter­nat­ing with diar­rhea (irri­ta­ble bowel syn­drome)
* Ten­sion or migraine headaches
* Jaw and facial ten­der­ness
* Sen­si­tiv­ity to one or more of the fol­low­ing: odors, noise, bright lights, med­ica­tions, cer­tain foods, and cold
* Feel­ing anx­ious or depressed
* Numb­ness or tin­gling in the face, arms, hands, legs, or feet
* Increase in uri­nary urgency or fre­quency (irri­ta­ble blad­der)
* Reduced tol­er­ance for exer­cise and mus­cle pain after exer­cise
* A feel­ing of swelling (with­out actual swelling) in the hands and feet
* Painful men­strual peri­ods
* Dizziness

Fibromyal­gia symp­toms may inten­sify depend­ing on the time of day — morn­ing, late after­noon, and evening tend to be the worst times, while 11 a.m. to 3 p.m. tends to be the best time. They may also get worse with fatigue, ten­sion, inac­tiv­ity, changes in the weather, cold or drafty con­di­tions, overex­er­tion, hor­monal fluc­tu­a­tions (such as just before your period or dur­ing menopause), stress, depres­sion, or other emo­tional factors.

If the con­di­tion is not diag­nosed and treated early, symp­toms can go on indef­i­nitely, or they may dis­ap­pear for months and then recur.
Call Your Doc­tor About Fibromyal­gia If:

You have chronic mus­cle pain and over­whelm­ing fatigue.

Tweet This Post