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Please note that this page is under construction and will be
an ongoing project.
Depression
Facts about depression:
-
Depression affects nearly 17 million Americans.
-
It is the most common mental illness, yet fewer than half of depressed people
seek help.
-
Depression affects one in five people at some point in their life.
-
It is the leading cause of suicide.
-
It reportedly afflicts twice as many women as men (although some observers
speculate that this
could be because fewer men admit they need treatment).
-
Depression affects four times as many people over age 65 as those in other age
groups.
-
Depression has affected countless accomplished people throughout history,
including Abraham
Lincoln, Ernest Hemingway, Peter Tchaikovsky, Charles Dickens, Virginia Woolf,
and Mary Shelley.
-
The number of people who experience depression has increased with every
generation since World War II.
Nice To Know:
Perhaps nowhere is the connection between mind, body, wellness, and illness more
striking than in depression. It is now believed that human emotions, including
sadness, elation, and anxiousness, are governed to some extent by chemical
reactions in the brain. That is only the beginning. Scientists have only
recently begun to unravel the complex interplay between factors that contribute
to depression. Illness, heredity, psychological traits, and social environment
are all believed to play a role.
Depression is an illness that involves feelings of sadness lasting for two weeks
or longer, often
accompanied by a loss of interest in life, hopelessness, and decreased energy.
Such distressing
feelings can affect one's ability to perform the usual tasks and activities of
daily living.
This is considered to be clinical depression. It is very different from a
temporary case of "the
blues" triggered by an unhappy event or stressful situation.
Depression affects the mind, but this doesn't mean "it's all in your head."
Depression is a
medical illness linked to changes in the biochemistry of the brain.
Depression is not a weakness of character. Being depressed doesn't mean a person
is inadequate. It means the person has a medical illness that is just as real as
diabetes or ulcers. Like other medical disorders, clinical depression should not
be ignored or dismissed. A clinically depressed person cannot simply "snap out
of it" any more than a person with an ulcer could simply will it away.
But depression is highly treatable in the vast majority of cases. Up to 90% of
depressed people
respond positively to treatment. Sometimes psychotherapy or counseling is all
that is needed, but there is also a wide array of effective antidepressant
medications and alternatives available.
Clinical depression is an umbrella term used to describe the most common forms
of depression,
which include:
-
Major depression, also known as melancholia or unipolar depression, can last up
to a year if not
treated. A person experiencing an episode of major depression will experience
some physical
problems, such as headaches or digestive upset, in addition to emotional
difficulties.
-
Bipolar disorder, once called manic depression, causes mood swings that soar to
unusual elation, and then plummet to depression. A person with severe bipolar
disorder may also see or hear things that are not there and experience paranoia
(a feeling that they are in danger).
-
Dysthymia is a chronic (ongoing), low-grade depression. It often begins in
childhood or
adolescence and may last for many years in adulthood if not treated. It is a
less severe form of
clinical depression, but at times it can be almost as disabling as major
depression.
-
Seasonal affective disorder (SAD) is a form of depression thought to be
triggered by a decrease
in exposure to sunlight. In the Northern Hemisphere, the condition usually
occurs in late fall
and winter, when daylight hours are short, and it is more common in geographical
areas that have
four clearly defined seasons.
Depression
information taken from
http://health.yahoo.com/health/centers/depression/1.html and
http://health.yahoo.com/ency/adam/000147/overview
Top
High Blood Pressure
When you have your blood pressure taken, your
health care provider is measuring the pressure, or
tension, that blood exerts on the walls of the blood vessels as it travels
around the body. In a
healthy person, this pressure is just enough for the blood to reach all the
cells of the body,
but not so much that it strains blood vessel walls.
Blood pressure is measured in millimeters of mercury (mm HG).
- A typical normal blood pressure is 120/80 mm Hg, or "120 over 80."
- The first number represents the pressure when the heart contracts
- The second number represents the pressure when the heart relaxes
- Blood pressure greater than 140/90 mm Hg is considered high
Generally, blood pressure will go up at certain times - for instance, if you
smoke a cigarette,
win the lottery, or witness a car crash - and will return to normal when the
stressful or
exciting event has passed.
But when blood pressure is high all the time, the continuous increased force on
blood vessel
walls can damage blood vessels and organs, including the heart, kidneys, eyes,
and brain.
The medical term for high blood pressure is hypertension
Need to Know:
Systolic and Diastolic Blood Pressure
Blood travels through blood vessels much like water through a garden hose. The
blood in the
vessels is under pressure just like the water in a hose when the tap is turned
on.
With each heartbeat more blood is pumped into the vessels - like turning up the
tap - so the
pressure rises. This is the systolic blood pressure, the first number in the
blood pressure
measurement, which is normally around 120.
Between heartbeats, while the heart is resting, the pressure in the arteries is
lower. This is
the diastolic pressure, second number in the blood pressure measurement, which
is normally around
80.
You can increase the pressure in a hose either by turning up the tap or by
putting a crimp in the
hose (that is, by narrowing the hose). In this same way, the blood pressure in
blood vessels will
rise if fluid flows more forcefully or if the arteries are narrowed.
Pressure in a hose can be regulated either by controlling the rate at which
fluid passes through
it or by widening it. Likewise, the pressure in the blood vessels can be
controlled, with
medications that act on the heart or blood vessels and with certain lifestyle
modifications.
Although high blood pressure can be extremely dangerous, it usually causes no
symptoms - so many
people don't even realize they have it. High blood pressure can only be detected
with accurate and
repeated measurements of a person's blood pressure. That's one reason why it's
so important to
have regular medical checkups.
Even though high blood pressure can be treated safely and effectively, only
about one-quarter of
people who have high blood pressure take the necessary steps to keep their blood
pressure within
a normal range.
There are three types of hypertension:
- Primary hypertension (essential hypertension). This is high blood pressure for
which no cause can
be found. Most people with high blood pressure (90 to 95 percent) have this type
of hypertension.
Doctors suspect that a combination of lifestyle, diet, heredity, age, gender,
race/ethnicity,
hormone levels, and other factors all contribute to high blood pressure.
- Secondary hypertension (non-essential hypertension). This is high blood pressure
for which a
definite cause can be found. This type of high blood pressure accounts for only
5 to 10 percent
of all cases of hypertension. Some of these causes are temporary or controllable
- for instance,
pregnancy or the use of certain medications - while others are chronic
conditions like hormonal
diseases, kidney disease, or head injuries.
- Isolated systolic hypertension (ISH). Older people are sometimes susceptible to
another form of
high blood pressure, called isolated systolic hypertension. In people with this
condition, blood
pressure is higher than normal when the heart beats, but returns to normal in
between beats of
the heart. The large difference in pressure can place additional strain on
artery walls.
Facts about high blood pressure:
- High blood pressure is a condition in which the pressure, or tension, that blood
exerts on the
walls of blood vessels goes up and stays high, which can damage the blood
vessels, the heart, and
other organs.
- It is estimated that more than 50 million Americans have high blood pressure.
- High blood pressure is one of the most serious health problems in the United
States; yet, because
high blood pressure has no symptom, millions of people do not even know they
have it.
- As many as one in four adults in the United States has high blood pressure.
- High blood pressure affects people of all ages, racial and ethnic groups, and
walks of life.
- Doctors do not know what causes high blood pressure in 90 to 95 percent of
people who have it.
- High blood pressure is one of the most important risk factors for coronary heart
disease.
- High blood pressure is the most important risk factor for stroke, which is the
third leading
cause of death in the United States.
- High blood pressure is a common cause of heart failure, the leading cause of
death in the United
States
- High blood pressure is a common cause of kidney disease.
Information on HBP taken from
http://health.yahoo.com/centers/heart/8.html.
Top
Heart
Disease/Stroke
Heart Disease
Heart disease involves any disorder that affects the heart's ability to function
normally. The
most common cause of heart disease is narrowing or blockage of the coronary
arteries, which
supply blood to the heart itself. Some patients are born with abnormalities
(congenital heart
disease). Other causes include the following:
- Abnormal function of the heart valves
- Abnormal electrical rhythm of the heart
- Weakening of the heart's pumping function caused by infection or toxins
Various forms of heart disease include:
- Alcoholic cardiomyopathy
- Aortic regurgitation
- Aortic stenosis
- Arrhythmias
- Cardiogenic shock
- Congenital heart disease dilated cardiomyopathy
- Endocarditis
- Heart attack (myocardial infarction)
- Heart failure
- Heart tumor
- Hypertrophic cardiomyopathy
- Idiopathic cardiomyopathy
- Ischemic cardiomyopathy
- Mitral regurgitation; acute
- Mitral regurgitation; chronic
- Mitral stenosis
- Mitral valve prolapse
- Peripartum cardiomyopathy
- Pulmonary stenosis
- Stable angina
- Unstable angina
- Tricuspid regurgitation
Heart disease information taken from
http://health.yahoo.com/centers/heart/1.
Stroke
A stroke is a "brain attack" that happens when a part of the brain experiences a
problem with
blood flow. This disruption in blood flow cuts off the supply of oxygen to the
cells in that part
of the brain, and these cells begin to die.
Damage to the brain can cause loss of speech, vision, or movement in an arm or a
leg, depending on the part of the brain that is affected.
Stroke is the major form of cerebrovascular disease , or CVD, a term that
sometimes is used
interchangeably with stroke.
There are two main types of stroke:
- Stroke caused by a blockage in the artery supplying blood to a particular region
of the brain
(called cerebral infarction). This is the most common type of stroke.
- Stroke caused by bleeding within the brain (called intracerebral hemorrhage).
In addition, some people experience brief warning signals that a major stroke is
going to happen
in the future. The medical term to describe these symptoms is transient ischemic
attack or TIA.
Sometimes called "mini-strokes," TIAs are exactly like a stroke, but they last
only a few minutes
(or sometimes as long as an hour) and leave no disability.
In many cases, a stroke will affect only one side of the body:
- A stroke that damages the right side of the brain will affect the left side of
the body.
-
A stroke that damages the left side of the brain will affect the right side of
the body.
Stroke Caused By Blocked Blood Flow
About 85% of all strokes happen because not enough blood gets to the brain.
Blood flow stops when an artery carrying blood to the brain becomes blocked. The
technical name for this type of brain attack is cerebral infarction. It is also
called ischemic stroke. "Ischemic" refers to a
condition caused by a decreased supply of oxygenated blood to a body part.
The blockage can be caused either by a blood clot that forms in an artery in the
brain, or by a
blood clot formed elsewhere in the body that travels through the bloodstream to
the brain. If
this clot becomes stuck in an artery in the brain, a stroke can result.
Clots are more likely to form in arteries that are damaged by atherosclerosis ,
also called
"hardening of the arteries," due to the buildup of cholesterol and other thick,
rough, fatty
deposits in the arteries.
The blockage also can be caused by a small piece of tissue, usually a blood
clot, that has
traveled through the bloodstream from elsewhere in the body.
In ischemic stroke, one of two major arteries is usually involved:
- The carotid artery (most commonly involved site)
- The basilar artery
The carotid arteries start at the aorta (just above the heart) and lead up
through the neck,
around the windpipe, and into the brain. The basilar artery is formed at the
base of the skull
from the arteries that run up along the spine, and branches off in the brain.
Stroke Caused By Bleeding In The Brain
The other 15% of strokes happen when an artery carrying blood to the brain
bursts suddenly. The
bursting can happen because of a weak spot in the wall of an artery called an
aneurysm . This
type of brain attack is called a hemorrhagic stroke.
Two kinds of stroke are caused by bleeding in the brain:
- A subarachnoid hemorrhage occurs when a blood vessel on the brain bursts and
bleeds into the
fluid-filled space between the brain and the skull. This type of stroke can
happen at any age.
- An intracerebral hemorrhage occurs when an artery bursts inside the brain,
flooding the
surrounding brain tissue with blood. This type of stroke is often associated
with high blood
pressure.
What Are "Mini-Strokes"?
A "mini-stroke" is exactly like a stroke, but it lasts only a short time and
leaves no
disability. The term for this event is transient ischemic attack or TIA.
A TIA happens when a blood clot clogs an artery temporarily, cutting off blood
flow and,
consequently, the supply of oxygen to cells. But the difference between a TIA
and a stroke is
that, with TIA, the blood clot dissolves on its own and blood flow is restored
before permanent
damage to the brain can occur.
TIAs are an extremely important warning sign for stroke and should never be
ignored.
About 10% to 15% of strokes are preceded by TIAs, which can happen days, weeks,
or even months
before a major stroke. However, not everyone who experiences a TIA will have a
stroke in the
future.
General recovery guidelines for stroke show:
- 10% of stroke survivors recover almost completely
- 25% recover with minor impairments
- 40% experience moderate to severe impairments requiring special care
- 10% require care in a nursing home or other long-term care facility
- 15% die shortly after a stroke
Nearly 4 million people in the United States have survived a stroke and are
living with the
after-effects. Each year, more than 500,000 Americans have a stroke. Although
stroke is still the third leading killer in the United States, the death rate
from strokes has been cut nearly in half over the last two decades. A stroke is
always serious. Cells in the brain that become damaged cannot be repaired or
regenerated. But other areas of the brain may take over the work of the damaged
portion. Most people know they should seek emergency medical help immediately if
they are having symptoms of a heart attack. But the average stroke patient waits
more than 12 hours before going to a hospital emergency department, losing
precious time that could be critical to treatment.
Stroke was first recognized more than 2,400
years ago by Hippocrates, the father of medicine, who described a condition
marked by the sudden onset of paralysis. There are steps you can take to help
prevent a stroke. Healthy living is very important in stroke prevention. There
also are successful treatments if it does happen.
Stroke information taken from
http://health.yahoo.com/health/centers/heart/115.html.
Top
Lung Cancer
Lung cancer is an uncontrolled growth of abnormal cells in one
or both of the lungs.
The body is made up of different types of cells that normally divide and
multiply in an orderly
way. These new cells replace older cells. This process of cell birth and renewal
occurs
constantly in the body.
Cancer, also known as a malignant growth, occurs when:
Some cells in the body begin to multiply in an uncontrolled manner
The body's natural defenses, such as certain parts of the immune system, cannot
stop the
uncontrolled cell division. These abnormal cells become greater and greater in
number, and come together to form a tumor, which is a cellular growth that forms
a progressively enlarging mass. A tumor is benign - that is, not a cancer -
unless it tends to invade surrounding tissues and organs, in which case it is
malignant or cancerous.
Cancerous tumors grow out of control and can invade, replace, and destroy normal
cells near the tumor. In some cases, cancer cells spread to other areas of the
body.
Lung cancer generally takes many years to develop even though damage to the
lungs may occur shortly after a person is exposed to cancer-causing substances.
About The Lungs
The air we breathe is taken into the two lungs, situated within the chest.
Inside the lungs,
oxygen is extracted from the air and carbon dioxide, a waste product from the
body, is breathed
out. The lungs are cone-shaped and are made up of lobes. The right lung has
three lobes and the left lung has two lobes.
Inside the lungs are air tubes, called bronchi. The right and left main bronchi
come off the main
breathing pipe, and then split up into much smaller tubes within each lung.
Those, in turn,
branch into thousands of very small airways called bronchioles.
The chest cavity in which the lungs sit is known as the pleural cavity. The
smooth lining that
surrounds and protects the lungs, enabling them to smoothly expand and contract
as we breathe, is called pleura.
Different Types Of Lung Cancer
There are different types of cells in the lung, of varying size, for the
different functions of
the lung. This has resulted in the classification of two main types of lung
cancer:
- Cancer developing from the smaller cells in the lung is known as small-cell lung
cancer.
- Other types of cancers in the lung are known as non-small-cell lung cancer.
- Some lung cancers are a mixture of both types and are generally called
mixed-small-cell/large-cell cancer.
The different types of lung cancers tend to grow and spread differently and are
therefore not
treated in the same way.
Non-small-cell lung cancer is the more common type, accounting for about 80% of
lung cancers. It is this more common type of lung cancer that grows and spreads
more slowly. This less common type of cancer, small-cell cancer, is the type
that grows more quickly and has a
greater chance of spreading to other parts of the body.
Since the more common non-small cell group of cells in the lung are themselves
made up of
differing kinds of cells, three distinct types of non-small cell lung cancer are
recognized. They
are:
- Squamous cell carcinoma, found usually in the central part of the lung.
- Adenocarcinoma, mostly occurring in the outer part of the lung.
- Undifferentiated carcinoma, which can occur anywhere in the lung.
People with adenocarcinoma have a more favorable outlook. Undifferentiated
carcinoma is the least common and has the poorer prognosis.
In general, the choice of treatment and the chances of recovery from lung cancer
following
treatment will depend on:
- How advanced the cancer is at the time of diagnosis
- How healthy the person generally is
Recognizing The Symptoms
The symptoms that may suggest lung cancer are similar to symptoms of other lung
conditions that
may not be as serious as lung cancer.
The main symptoms suggesting lung cancer are:
- Coughing up blood
- Coughing that does not seem to improve and gets worse with time
Other symptoms may include:
- Chest pain
- Shortness of breath
- Recurrent episodes of pneumonia
- Weight loss
- Feeling tired
Weight loss and feeling tired can be symptoms of cancer in general.
Facts About Lung Cancer
- Over 80% of all lung cancers are caused directly by smoking.
- Stopping smoking can reduce the risk for developing lung cancer.
- Lung cancer is more common in men; they are 25% more likely to develop lung
cancer.
- When initially diagnosed, only about 15% of lung cancers are found to still be
in the early
stage, while 85% have already spread locally or to more distant sites in the
body.
- The five-year survival rate is approximately 50% in those cases when the cancer
is still in the
early stage when first diagnosed - but only 15% of lung cancers are discovered
this early.
- In the USA, in 1998, there were about 171,500 new cases of lung cancer,
accounting for 14% of all
cancer diagnoses. In the USA in 1998, 28% of all cancer deaths were due to lung
cancer.
- Since 1987, more women have died each year of lung cancer than breast cancer.
Information on lung cancer from
http://health.yahoo.com/health/centers/lung_cancer/1.html.
Top
Emphysema
Definition
A lung disease which involves damage to the air sacs (alveoli) in the lungs. The
air sacs are
unable to completely deflate (hyperinflation) and are therefore unable to fill
with fresh air to
ensure adequate oxygen supply to the body.
Causes, incidence, and risk factors
Cigarette smoking is the most common cause of emphysema. Tobacco smoke and other
pollutants are thought to cause the release of chemicals from within the lungs
that damage the walls of the air sacs. This damage becomes worse over time,
affecting the exchange of oxygen and carbon dioxide in the lungs.
A naturally-occurring substance in the lungs called alpha-1 antitrypsin may
protect against this
damage. People with alpha-1 antitrypsin deficiency are at an increased risk for
this disease.
Prevention
- Avoiding smoking -- or quitting if you do smoke -- can greatly decrease risk for
this disease.
Symptoms
- shortness of breath
- chronic cough with or without sputum production
- wheezing
Additional symptoms that may be associated with this disease:
- anxiety
- unintentional weight loss
- ankle, feet, and leg swelling
- fatigue
Signs and tests
A physical examination may show decreased breath sounds, wheezing, and/or
prolonged exhalation (exhalation takes more than twice as long as inspiration).
There may be an increased
front-to-back diameter of the chest (barrel shaped chest). There may be signs of
chronically
insufficient oxygen levels in the blood.
These tests help confirm the diagnosis:
- pulmonary function tests
- chest X-ray
This disease may also alter the results of the following
tests:
- arterial blood gases showing reduced oxygen
- pulmonary ventilation/perfusion scan
- chest CT scan
Information on emphysema from
http://health.yahoo.com/ency/adam/000136/overview.
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Breast Cancer
I lost my "second mom" to breast cancer. I've seen the pain it can
bring to a family even years after the loss.
Breast cancer is cancer that affects the breast.
The vast majority of breast cancer occurs in
women, although men can develop breast cancer too.
'Cancer' is the name for a group of diseases in which the body's cells are
changed in appearance and function. Such abnormal cells can grow out of control
and form a mass or 'tumor.' When abnormal cells originate in the breast tissue,
the mass is called a breast tumor.
A breast tumor is considered benign if it is limited to a few cell layers and
does not invade
surrounding tissues or organs. Yet if the tumor spreads to surrounding tissues
or organs, it is
considered malignant, or cancerous. Carcinoma is the term used to describe most
common cancers that arise from epithelial (surface or lining) tissues. By
contrast, sarcoma is the term used to define tumors that arise from bone,
muscle, fat, or connective tissue.
The breasts are, in essence, a collection of fatty tissue and glands that have
been adapted to
secrete milk after a woman gives birth. The glands that produce milk are called
lobules and the
tubes that connect them to the nipples are called ducts. Correspondingly,
carcinoma of the breast develops when malignant changes occur in the cells that
line the lobules or, more commonly, the ducts.
There are two major types of breast cancer:
- lobular carcinoma
- ductal carcinoma
They can be either invasive (spreading) or noninvasive (generally known as 'in
situ' - confined
to the original site). The majority of breast cancers (70% - 80%) arise from the
ducts, which
make up the bulk of breast tissue. Since lobular and ductal cells are found in
the glandular
tissues of the upper, central, and outer regions of the breast, this is where
most breast cancers
occur. Breast tumors rarely arise in the fatty or nonglandular tissues. Such
tumors, when they
appear, are usually sarcomas.
Cells from the tumor may break away, travel, and grow within other parts of the
body. This
process is known as metastasis. Breast cancer often metastasizes to sites such
as the lung, bone, liver, and brain. If breast cancer is detected at an early
stage - for example, before metastasis - it usually can be cured; however, as
the disease progresses, the possibility of effective treatment is diminished.
Fortunately, though, many breast "lumps" are caused by benign breast diseases
that do not spread beyond the breasts and are not life-threatening.
Facts About Breast Cancer:
- A diagnosis of breast cancer is alarming, but the good news is that most women
recover from it.
Improvements in breast cancer detection have helped to limit the harmful
potential of this
disease. In fact, during the last decade, the majority of breast cancers
reported in the U.S.
were small, very treatable, early-stage tumors.
- Overall, about 83% of women survive breast cancer, as shown by recent 5-year
survival statistics. Although these numbers don't guarantee that a person will
be in the 'favorable' statistical group, they do show that the likelihood of
beating breast cancer is good. If breast cancer is detected and treated in the
early stages, the chances of complete recovery are even better.
- With the exception of skin cancer, breast cancer is the most common cancer among
American women. Recent findings from the National Cancer Institute (NCI)
indicate that an American woman has a one in eight chance of developing breast
cancer during her lifetime. And the American Cancer Society predicts that about
184,200 new cases of invasive breast cancer will be diagnosed in the year 2000.
- Breast cancer also can strike men, although cancer of the male breast accounts
for only 5% of all diagnosed breast cancers.
- Over the last 5 years, patients have benefited from many advances in breast
cancer treatment.
- Breast conservation - the saving of the breast - has increased enormously
because of early
diagnosis and the widespread use of mammograms (x-rays of the breast). In
addition, new
anti-cancer drugs such as paclitaxel (Taxol®) and trastuzumab (Herceptin®) have
been approved by the Food and Drug Administration (FDA) and show promise in the
treatment of people with advanced disease.
- The progress made in breast cancer detection and treatment is perhaps best
reflected by mortality (death rate) figures. U.S. statistics show that breast
cancer mortality decreased significantly between 1992 and 1996 - with the
largest decline seen in younger women. Therefore, although breast cancer is a
major concern among American women, it can be managed successfully. The
following sections will explain the causes and treatment of breast cancer, as
well as some of the methods used to overcome the far-reaching effects of this
disease.
Information on breast cancer from
http://health.yahoo.com/health/centers/breast_cancer/1.html.
Top
Osteoporosis
Definition
Osteoporosis is a condition characterized by the progressive
loss of bone density and thinning of bone tissue.
Alternative Name(s):
Causes, incidence, and risk
factors
Osteoporosis is the most common type of metabolic
bone disease.
There are currently an estimated 10 million Americans suffering from
osteoporosis as well as another 18 million who have low bone mass, or osteopenia.
Osteoporosis occurs when the body fails to form enough new
bone, or when too much old bone is reabsorbed by the body, or both. Calcium and
phosphate are two minerals that are essential for normal bone formation.
Throughout youth, the body uses these minerals to produce
bones. If calcium intake is not sufficient, or if the body does not absorb
enough calcium from the diet, bone production and bone tissues may suffer.
As people age, calcium and phosphate may be reabsorbed back
into the body from the bones, which makes the bone tissue weaker. Both
situations can result in brittle, fragile bones that are subject to
fractures,
even in the absence of trauma.
Usually, the loss occurs gradually over years. Many times, a
person will sustain a
fracture
before becoming aware that the disease is present. By the time this occurs, the
disease is in its advanced stages and damage is profound.
While there are a number of causes of osteoporosis, hormone
deficiencies (estrogen in women and testosterone in men) are the leading cause.
Women, especially over the age of 50, are the most frequent sufferers of the
disease. This is due to the loss of ovarian function and subsequent reduction in
estrogen production that occurs at the time of
menopause.
Other causes include corticosteroid excess from
Cushing's
syndrome,
hyperthyroidism,
hyperparathyroidism, immobilization, and bone malignancies.
Researchers estimate that 13% to 18% of American women over
the age of 50 have osteoporosis. In addition, 30% of them have osteopenia, which
is abnormally low bone density that may eventually deteriorate into
osteoporosis, if not treated.
From these figures, researchers estimate that 50% of women
over the age of 50 will suffer a fracture of the hip, wrist, or vertebra. Fewer
men over the age of 50 have osteoporosis, with researchers estimating that 3-6%
suffer from this disorder. In 1995, direct medical expenditures relating to
osteoporotic fractures totaled $13.8 billion.
Risk factors, in addition to menopause and advanced age,
include genetic and ethnic background. Women who are white, especially those
with a family history of osteoporosis, have a greater risk of developing
osteoporosis. In fact, it is estimated that one out of two white women will
experience a fracture relating to osteoporosis at some point in her life.
Smoking,
eating
disorders, low body weight, low amount of calcium in the diet, heavy
alcohol
consumption, early menopause, absence of menstrual periods (amenorrhea), and
use of certain medications, such as steroids and anticonvulsants, are also risk
factors.
Symptoms
There are no symptoms associated with the early disease. As
such, osteoporosis is a silent risk factor for fracture.
Symptoms occurring late in the disease:
Signs and tests
- Bone mineral density (BMD) testing as performed in
dual-energy
X-ray
absorptiometry (DEXA) provides a quantitative measure for demineralization of
the bones. This has become the gold standard for evaluation for osteoporosis.
BMD testing should be performed on all postmenopausal women with fractures,
all women under 65 with an additional risk factor for osteoporosis (besides
menopause), and all women 65 and over, as recommended by the National
Osteoporosis Foundation.
- A
spine CT
can show demineralization. Quantitative computed tomography (QCT) can be used
to evaluate bone density at a number of sites, but is much less accessible,
and is more expensive than DEXA.
- A
spine or
hip X-ray may show fracture or vertebral collapse in severe cases.
- Measurement of urinary calcium can provide suggestive
evidence of increased bone turnover predisposing to osteoporosis, but is of
limited clinical utility. A number of newer tests to evaluate bone turnover
are becoming available including measurement of urinary N-telopeptide (Osteomark)
and may in the future enhance physician's ability to diagnose early
osteoporosis.
Treatment
Treatments for osteoporosis focus on slowing down or stopping
bone loss, preventing bone
fractures
by minimizing the risk of falls, and controlling pain associated with the
disease.
MEDICATIONS:
There are several different kinds of drugs used to treat
osteoporosis. They vary in their side effects, benefits, and costs.
BIPHOSPHONATES
Biphosphonates are a type of drug used for both the prevention
and treatment of osteoporosis in postmenopausal women. The two biphosphonates
currently approved for osteoporosis -- alendronate (Fosamax) and risedronate (Actonel)
-- prevent existing bone loss and reduce the risk of spinal and hip fractures.
While side effects are generally mild, potential side effects
include stomach upset and irritation of the esophagus. Because biphosphonates
are difficult to absorb, these medicines should be taken on an empty stomach.
The patient should not lie down or consume food or beverages (other than water)
for at least 30 minutes after taking the medicine. The physician may also
recommend taking calcium and Vitamin D supplements.
Actonel is approved for use in men with osteoporosis. Both
Actonel and Fosamax prevent and treat osteoporosis in men and women taking daily
steroids for chronic conditions like asthma and arthritis.
RALOXIFENE
Raloxifene (Evista) is another drug used for the prevention
and treatment of osteoporosis. Raloxifene is similar to the breast cancer drug
tamoxifen. Raloxifene can reduce the risk of spinal fractures by almost 50%. (It
does not appear to prevent other fractures, including those in the hip.) It may
have protective effects against heart disease and breast cancer, though more
studies are required.
The most serious side effect of raloxifene is a very small
risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs
(pulmonary embolus).
ESTROGEN REPLACEMENT THERAPY
Estrogen can slow or stop bone loss and, if estrogen treatment
begins at menopause, it can reduce the risk of hip fractures up to 50%. Therapy
is most effective if started at
menopause,
as most bone loss occurs 3-6 years after the onset of menopause.
Many post-menopausal women choose estrogen replacement therapy
(ERT) because of its proven usefulness in slowing the progress of or preventing
osteoporosis. In some cases, ERT alleviates some of the irritating symptoms of
menopause. This method of therapy is fairly inexpensive compared to the newer
medications for osteoporosis discussed below.
If estrogen replacement therapy is discontinued, bone loss
will resume. Maximal protection from osteoporosis may indeed require lifelong
dosing. Studies show that women who take estrogen for at least seven years
between the onset of menopause and the age of 75 have a 50% reduction in risk of
fractures.
However after age 75, the risk is about the same as for those
who did not take estrogen at all. In the 75 years and older group, bone mass
only differs by about 2% between women who have taken estrogen for 10 years, and
those who have never taken it.
Some women hesitate to use estrogen supplements because of the
numerous potential risks that have been associated with long-term use. Before
beginning ERT, the benefits and consequences of the treatment should be weighed
and discussed thoroughly with a health care provider.
Women who have had a hysterectomy may take estrogen alone.
Women with an intact uterus must take a combination of estrogen and
progesterone. The decision to take estrogen for preservation of bone density is
complicated by its effects on other diseases, including a relatively small
increase in the risk of breast cancer.
ERT has classically been thought to reduce the risk of
coronary artery disease in post-menopausal women. Recent studies have brought
controversy to this issue by providing evidence that women may have a higher
incidence of coronary events during the first year on ERT.
CALCITONIN
Calcitonin, marketed under the names Miacalcin (nasal spray)
and Calcimar (injectable), is a medication that slows the rate of bone loss and
relieves bone pain. The main side effects of calcitonin are nasal irritation
from the spray form, and nausea from the injectable form.
While calcitonin slows bone loss and reduces the risk of
fractures, it appears to be less effective than ERT or biphosphonates. As with
some of the other newer medications, it is significantly more expensive than ERT.
LIFESTYLE CHANGES:
Regular
exercise
can reduce the likelihood of bone fractures associated with osteoporosis.
Studies show that exercises requiring muscles to pull on bones cause the bones
to retain and, perhaps, even gain density. Researchers found that women who walk
a mile a day have four to seven more years of bone in reserve than women who
don't. Some of the recommended exercises include:
- Weight-bearing exercises
- Riding stationary bicycles
- Using rowing machines
- Walking
- Jogging
IMPORTANT: Any exercise that presents a risk of falling should
be avoided.
Fall prevention is an essential component of any comprehensive
osteoporosis treatment program. Measures such as making sure the patient's
vision is good and appropriately corrected, avoiding sedating medications, and
removing household hazards can significantly reduce the risk of fracture. Other
ways to prevent falling include wearing good-fitting shoes, avoiding walking
alone on icy days, and using bars in the bathtub, when needed.
A diet that includes an adequate amount of calcium,
Vitamin D,
and protein
should be maintained. While this will not completely stop bone loss, it will
guarantee that a supply of the materials the body uses for bone formation and
maintenance is available.
Supplemental calcium should be taken as needed to achieve
recommended daily calcium dietary intake. Current recommendations are for
nonpregnant, menstruating women to consume 1000mg/day, pregnant women need
1200mg/day, and postmenopausal or nursing mothers should consume 1500 mg/day.
High-calcium foods include low-fat milk, yogurt, ice cream and
cheese, tofu, salmon and sardines (with the bones), and leafy green vegetables,
such as spinach and collard greens. Vitamin D aids in calcium absorption and
400-800 IU per day should be taken by all individuals with increased risk of
calcium deficiency and osteoporosis.
MONITORING:
Women taking estrogen should have routine mammograms, pelvic
exams, and Pap smears.
Patient response to treatment can be monitored with serial
bone mineral density measurements every 1-2 years, though such monitoring is
controversial, expensive, and not universally performed. In the future, use of
less elaborate measurements of bone turnover, such as the N-telopeptide (Osteomark)
urine test (discussed above) may become a standard means for following
osteoporosis, though experience is presently limited.
Expectations (prognosis)
Progression of the disease can sometimes be slowed or stopped
with treatment. Some people become severely disabled, as a result of weakened
bones. Hip
fractures, which are frequently sustained by people with osteoporosis, leave
about 50% of victims unable to walk independently.
This is one of the major reasons people are admitted to
nursing homes. Although osteoporosis is debilitating, it does not affect life
expectancy.
Complications
- Compression
fractures
of the spine
- Hip fractures and wrist fractures
- Disability caused by severely weakened bones
- Loss of ability to walk, due to hip fractures
Calling your health care
provider
Call your health care provider if you have symptoms of
osteoporosis, or if you are interested in testing available for diagnosis or
early detection.
Prevention
Throughout life, dietary intake of calcium is essential for
bone formation and maintenance of healthy bone. Dietary
Vitamin D,
which aids in the absorption of calcium, is also essential. Maintaining a
healthy diet as recommended by the FDA, which includes a sufficient amount of
calcium, phosphorous, and Vitamin D, is very important.
Avoiding smoking and excess alcohol consumption can help
prevent osteoporosis.
Regular exercise can reduce the likelihood of bone
fractures.
Studies show that exercises requiring muscles to pull on bones cause the bones
to retain, and maybe even gain density.
Post-menopausal women, especially those with reduced bone
density, may consider intervention with estrogen replacement therapy. This may
prevent bone loss or
fracture
in some people.
There are a number of side effects associated with estrogen
replacement therapy, and the option should be discussed thoroughly with your
health care provider. A number of new medications for the prevention of
osteoporosis, including raloxifene and alendronate, are currently available and
FDA approved.
Information on osteoporosis taken from
http://health.yahoo.com/centers/strongbones/000360.html.
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Osteoarthritis
The word arthritis literally means
"joint inflammation" - that is, a joint that is painful, warm to the touch,
possibly red, swollen, and associated with a loss of function. "Osteo" is Greek
for "bone".
Arthritis is not a single ailment. In fact,
more than 100 different conditions can affect the joints and their adjacent
bones, muscles, and tissues. They are classified into various major types of
arthritis, depending on whether or not inflammation, infection or bleeding is
the major component. All of these types of arthritis are completely different,
with different presentations, symptoms and treatment.
Osteoarthritis (OA) is the most common form of arthritis.
It is a 'non-inflammatory' type of arthritis, which means that
inflammation is not the key component. It is completely different from the less
common rheumatoid arthritis, which is an inflammatory arthritis in which
the body's immune system attacks its own tissues, causing inflammation, and from
all other types of arthritis.
- The causes and treatments of these other arthritis-related
diseases differ from OA.
- While OA sometimes may be painful, it is not always
disabling, and unlike rheumatoid arthritis, is unlikely to produce severe
deformity of the joints.
- Osteoarthritis can involve a number of joints, but it is
not a disease that spreads to involve other tissues or joints throughout the
body.
Osteoarthritis (OA) has been called a "degenerative" condition
because it is caused, in part, by wear-and-tear of a joint over time. Its impact
is significant:
- OA occurs in both men and women and usually develops after
age 45.
- More than 16 million Americans, including over 50% of
people over 65, have some degree of osteoarthritis.
- Older people often don't realize that they have OA if they
are free of pain and other symptoms. However, x-rays often reveal some OA of
the spine or fingers in elderly individuals.
Osteoarthritis develops in a joint when cartilage - the
smooth shiny tissue that lines and cushions the ends of the bones inside a
joint, -begins to break down. This can happen from:
- Prolonged "wear-and-tear" as we age
- Prior injury or damage to the joint from trauma or
infection
- Cartilage that is altered by other disease or is
genetically weak.
But in most cases we simply don't know what causes it.
Unfortunately, damaged cartilage cannot heal to become normal
again, though tremendous research is underway developing methods to restore
damaged cartilage.
How It Progresses
Here is how OA progresses:
- The smooth cartilage that lines and protects the bone ends
begins to retain water, and changes occur in some of the chemical substances
that make up the cartilage
- Tiny cracks develop in the cartilage, which then splits
further forming clefts
- The ends of the bones begin to thicken and grow out from
the joint margin. These small bone growths are called osteophytes or "spurs".
Actually, these spurs are nature's way of trying to help the damaged joint by
allowing the load through the joint to be redistributed. But these bony
outgrowths often interfere with the mechanism of joint movement.
- Cysts, which are small cavities, develop in the bone just
beneath the damaged cartilage
- Fragments of damaged cartilage or bone may break off and
float around freely in the joint as 'loose bodies' and may cause additional
problems.
- As the cartilage becomes more damaged, the joint space
becomes narrower and narrower.
- The erosion of cartilage within a joint can irritate and
inflame the inner lining of the joint called the synovial membrane. and
cause it to produce excess fluid. It normally produces a lubricant called
synovial fluid, which helps to lessen friction in the joint.
- The fluid may then build up within the joint and lead to
detectable swelling.
When the cushioning system of the joint is lost, the bones may
grind painfully against each other. The joint can begin to stiffen, and movement
is impaired.
Some people are fortunate in that despite having these rather
severe osteoarthritis changes in a joint, they experience very little, or no
pain at all.
Osteoarthritis typically strikes the:
- Weight-bearing joints (knees, hips, back, feet)
- Hands
- Spine
The knee is the most commonly affected joint.
If osteoarthritis develops in the hips or knees, it often
occurs in only one joint but may affect any number of joints.
If the hands are affected, a few finger joints may become
arthritic at the same time.
- Bony lumps that arise in the middle finger joints are
called Bouchard's nodes.
- Lumps that arise in the last finger joints are called
Heberden's nodes. Heberden's nodes occur most often in women, who are also
prone to experience osteoarthritis of the hands in general, as well as the
knees.
Q: What is the difference between osteoarthritis (OA) and
rheumatoid arthritis (RA) ?
A: The principle features of the two
conditions are not the same, and their treatment is very different. In OA, the
cartilage in the joint becomes damaged and, ultimately, the joint degenerates.
The joint is not primarily inflamed, although inflammation may occur as a late
result.
On the other hand, in RA, there is initial
inflammation of the lining of the joint. This produces a soft, tender swelling
in contrast to the bony enlargement of OA. Cartilage damage occurs later as a
result of this inflammation. The pain of OA is often least troublesome in the
morning but may gradually worsen during the day. With RA, the pain and stiffness
usually is worst on waking, but gradually improves during the day. Rheumatoid
arthritis is not just a disease of the joints. Abnormalities occur in the blood
vessels, circulating cells and proteins, as well as connective tissue. Not
surprisingly, RA is associated with more generalized disturbances - such as
anemia (low red blood cell count) - which are proportional to the activity of
the arthritis. Usually more than one joint is involved in RA, with the hands
almost always affected.
Facts About Osteoarthritis
- Osteoarthritis is an inevitable part of aging and can
affect any joint.
- It is the oldest discovered health problem having been
found in dinosaur joints and Egyptian mummies.
- Osteoarthritis is the most widespread form of arthritis,
affecting about 16 million people throughout the United States. The Arthritis
Foundation estimates that some 59 million Americans - nearly 20% of the
population - will have arthritis by the year 2020, as age catches up with the
baby boomers.
- Exciting research to replace damaged cartilage is showing
much promise
Information on OA taken from
http://health.yahoo.com/centers/arthritis_pain/1.
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