The Food and Drug Administration yesterday approved the first birth control pill that eliminates a woman's monthly period.
Taken daily, the contraceptive, called Lybrel, continuously administers slightly lower doses of the same hormones in many standard birth control pills to suppress menstruation. It is designed for women who find their periods too painful, unpleasant or inconvenient and want to be free of them.
"This will be the first and only oral contraceptive designed to be taken 365 days a year, allowing women to put their periods on hold," said Amy Marren of Wyeth Pharmaceuticals, which expects Lybrel to be available with a prescription by July. "There are a lot of women who think that's a great option to have."
Company studies involving more than 2,400 women showed that Lybrel is as effective at preventing pregnancy as standard birth control pills and that it completely suppresses menstruation for many women within the first year, although some experience sporadic bleeding, the FDA said.
Advocates of birth control welcomed Lybrel, saying it provides women with another option.
"Every woman's birth control needs are different, and the best methods are those that fit a woman's lifestyle and meet her needs," said Vanessa Cullins, vice president for medical affairs at the Planned Parenthood Federation of America.
But others questioned whether enough research had been done to be sure that Lybrel is safe to suppress menstruation in the long term.
"There may be important health consequences that we don't know about," said Christine L. Hitchcock, an endocrinology researcher at the University of British Columbia. "I don't think we understand everything that the menstrual cycle does well enough to say with confidence that you can abolish it and not have any consequences."
Some criticized Lybrel for fueling biases and misconceptions about menstruation.
"I think it sends the wrong message about menstruation in women's lives, especially for young women," said Ingrid Johnston-Robledo, an associate professor of psychology and women's studies at the State University of New York at Fredonia. "It perpetuates a lot of negative attitudes and taboos about menstruation -- that it's something that's bothersome and dirty and debilitating and shameful."
Wyeth and the FDA said that there is no evidence of any long-term risks and that suppressing the menstrual cycle can have many benefits, especially for women who experience cramps, bloating and mood swings. There is no reason to think it would pose any additional health hazards, they said.
"The risks of using Lybrel are similar to other conventional oral contraceptives," said Daniel Shames, deputy director of the FDA's Center for Drug Evaluation and Research. "We don't suspect there are going to be any surprises in terms of long-term use of this product."
Monday, December 17, 2007
New Pills for Migration Headaches
Migration survivors tell their tales of long hours and lots of uncertainty while everyone's at home fluffing their pillows
Although large data migration jobs often mean long hours and lots of uncertainty for storage administrators, a few who feared the worst had an easier time than expected with new tools.
Traditionally, data migration projects are long processes that can be unpredictable, especially when large SANs are involved. The process can take days, and that’s if everything goes right. Migration tools usually don’t do a good job of shortening the process, or providing a good idea of how long it will take.
“Pick your poison,” one analyst who asked not to be named says when discussing migration tools. “There are a ton of data migration products -- Softek, StoreAge, Kashya, EMC’s SRDF, EMC SANcopy, NetApp SNAPmirror. Like I said, ‘Pick your poison.’”
But ask around, and it appears there are some solutions popping up that may be easier to swallow than others -- depending on your circumstances. New forms of help could be on the way. Last week Brocade launched its Tapestry Data Migration Manager (DMM) product, and today Xosoft announced InMotion software and Softek and EMC rolled out a collaboration on mainframe migration software called Logical Data Migration Facility (LDMF).
For example, Randy Simons, director of data center operations at Rancho Santiago Community College in California, found predictability an advantage in using Brocade’s DMM. (See Brocade Rolls Out Gear .)
DMM uses Brocade software running over a SilkWorm Fabric AP7420 switch to perform migrations. Brocade claims DMM can keep users informed about how long a migration is expected to take -- thereby helping to save some guesswork.
Simons found it took a lot less time than expected. He planned a migration from an HP EVA 5000 to a larger EVA 8000 over Labor Day weekend because it had to be a time when the college was shut down. He was prepared for the worst until an HP rep pointed out Brocade’s new DMM.
“When everybody’s home fluffing their pillows, we’re working away,” Simons says. “We were thinking it would be long hours, and a normal forklift upgrade. Instead it took a day and a half.”
That said, Simons said the migration project did require extensive training from Brocade and HP support people to get the job done properly.
RBC Product Development had a smaller but more urgent migration project to carry out. The Kansas City firm tests and develops applications for the medical industry. That’s highly collaborative work, and RBC CEO Carl Mayer says most of his company’s business is conducted over email.
“Exchange Server is the backbone of the way we work,” Mayer says.
So it was a big problem when one of RBC’s two Exchange Servers locked up in September and the IT staff couldn’t get it back. “We tried Service Packs, hot fixes, nothing worked,” Mayer says. “We had to migrate Exchange from the existing box to a new server, rebuild the server, and then swing Exchange back.”
Mayer says he looked at migration applications from NSI Software and XOSoft. He chose XOSoft’s new InMotion application, which was announced this week, mainly because of cost -- NSI’s application cost $3,000 per server compared to InMotion at $9 per user (or roughly $450 for Mayer's application). With two servers and about 50 users involved, Mayer found the savings significant enough to give the new package a shot.
But there was something else he liked about InMotion. “It’s not a move, it’s a copy, which is comforting,” he says. “You don’t want to crash halfway through a move, or you’re in a world of hurt. With InMotion, if you're halfway through and it crashes, you pick up from where you left off.”
Mayer didn’t have any crashes and was able to complete each copy in about an hour. On the downside, InMotion only supports Exchange, so it wouldn't have worked for a more general or comprehensive data center migration.
Although large data migration jobs often mean long hours and lots of uncertainty for storage administrators, a few who feared the worst had an easier time than expected with new tools.
Traditionally, data migration projects are long processes that can be unpredictable, especially when large SANs are involved. The process can take days, and that’s if everything goes right. Migration tools usually don’t do a good job of shortening the process, or providing a good idea of how long it will take.
“Pick your poison,” one analyst who asked not to be named says when discussing migration tools. “There are a ton of data migration products -- Softek, StoreAge, Kashya, EMC’s SRDF, EMC SANcopy, NetApp SNAPmirror. Like I said, ‘Pick your poison.’”
But ask around, and it appears there are some solutions popping up that may be easier to swallow than others -- depending on your circumstances. New forms of help could be on the way. Last week Brocade launched its Tapestry Data Migration Manager (DMM) product, and today Xosoft announced InMotion software and Softek and EMC rolled out a collaboration on mainframe migration software called Logical Data Migration Facility (LDMF).
For example, Randy Simons, director of data center operations at Rancho Santiago Community College in California, found predictability an advantage in using Brocade’s DMM. (See Brocade Rolls Out Gear .)
DMM uses Brocade software running over a SilkWorm Fabric AP7420 switch to perform migrations. Brocade claims DMM can keep users informed about how long a migration is expected to take -- thereby helping to save some guesswork.
Simons found it took a lot less time than expected. He planned a migration from an HP EVA 5000 to a larger EVA 8000 over Labor Day weekend because it had to be a time when the college was shut down. He was prepared for the worst until an HP rep pointed out Brocade’s new DMM.
“When everybody’s home fluffing their pillows, we’re working away,” Simons says. “We were thinking it would be long hours, and a normal forklift upgrade. Instead it took a day and a half.”
That said, Simons said the migration project did require extensive training from Brocade and HP support people to get the job done properly.
RBC Product Development had a smaller but more urgent migration project to carry out. The Kansas City firm tests and develops applications for the medical industry. That’s highly collaborative work, and RBC CEO Carl Mayer says most of his company’s business is conducted over email.
“Exchange Server is the backbone of the way we work,” Mayer says.
So it was a big problem when one of RBC’s two Exchange Servers locked up in September and the IT staff couldn’t get it back. “We tried Service Packs, hot fixes, nothing worked,” Mayer says. “We had to migrate Exchange from the existing box to a new server, rebuild the server, and then swing Exchange back.”
Mayer says he looked at migration applications from NSI Software and XOSoft. He chose XOSoft’s new InMotion application, which was announced this week, mainly because of cost -- NSI’s application cost $3,000 per server compared to InMotion at $9 per user (or roughly $450 for Mayer's application). With two servers and about 50 users involved, Mayer found the savings significant enough to give the new package a shot.
But there was something else he liked about InMotion. “It’s not a move, it’s a copy, which is comforting,” he says. “You don’t want to crash halfway through a move, or you’re in a world of hurt. With InMotion, if you're halfway through and it crashes, you pick up from where you left off.”
Mayer didn’t have any crashes and was able to complete each copy in about an hour. On the downside, InMotion only supports Exchange, so it wouldn't have worked for a more general or comprehensive data center migration.
Wednesday, November 21, 2007
Allergy, Allergy Proofing Your Home, Anaphylaxis (Severe Allergic Reaction), Chronic Rhinitis, Cold / Flu / Allergies, Food Allergy, Hives, Latex Allergy, Sinusitis
Alzheimer's Disease, Alzheimer's Warning Signs, Bladder Incontinence, Dementia, Senior Health
Ankylosing Spondylitis, Fibromyalgia, Gout, Lupus, Osteoarthritis, Psoriatic Arthritis, Reactive Arthritis, Rheumatoid Arthritis
Air Filtration, Asthmatic Complexities, Asthma, Asthma: Over The Counter Treatment
Cancer Causes, Cancer Detection, Cancer - General, Brain Tumor, Bladder Cancer, Breast Cancer, Cervical Cancer, Colon Polyps, Liver Cancer, Lung Cancer, Pancreatic Cancer, Prostate Cancer, Skin Cancer, Testicular Cancer
Cholesterol, Fiber, HDL, LDL, Heart, Stroke Prevention, Triglycerides
Chronic PainAcupuncture, Acute and Chronic Pain, Cortisone Injection, Degenerative Disc, Low Back Pain
Aches, Pain, Fever, Chronic Cough, Cold, Flu, Allergy: (OTC Remedies), Common Cold, Encephalitis and Meningitis, Eustachian Tube Problems, Flu (Influenza), Flu Vaccination, Immunizations, Pneumonia, Pneumonia Vaccination, SARS, Sinusitis, Sore Throat, Strep Throat, Tonsillitis and Adenoiditis
Bipolar Disorder, Depression, Dysthymia, Panic Disorder, Post Traumatic Stress Disorder, Seasonal Affective Disorder (SAD), Stress
DiabetesDiabetes Mellitus, Diabetic Home Care and Monitoring, Diabetes Insipidus, Insulin, Insulin Pump
Abdominal Pain, Appendicitis, Ulcerative Colitis, Constipation, Crohn's Disease, Diarrhea, Dyspepsia (Indigestion), Inflammatory Bowel Disease (IBD), Intestinal Gas, GERD (Heartburn, Acid Reflux), Hemorrhoids, Irritable Bowel Syndrome (IBS), Lactose Intolerance, Laxatives for Constipation, Motion Sickness, Ulcerative Colitis
Disease Prevention, Exercise & Activity, First Aid, Home and Family, Nutrition: Healthy Eating, Obesity
Cataracts, Eye Allergy, Eye Care, Glaucoma, LASIK Eye Surgery, Macular Degeneration, Pink Eye (Conjunctivitis), Retinal Detachment, Sjogren's Syndrome
Deafness, Eustachian Tubes, Ear Wax, Hearing Loss, Tinnitus, Vertigo (Dizziness)
Angina, Atherosclerosis Prevention, Congenital Heart Disease, Coronary Angiogram, Coronary Angioplasty, Coronary Artery Bypass, Heart Attack, Heart Murmurs, Heart Palpitations, High Cholesterol, Stroke
Cirrhosis of the Liver, Essential Mixed Cryoglobulinemia, Hepatitis B, Hepatitis C, Hepatitis A and B Immunizations, Jaundice, Lichen Planus, Liver Cancer, Non-Hodgkin's Lymphomas
High Blood Pressure (Hypertension), Pulmonary Hypertension
Acquired Immunodeficiency Disease (AIDS) and Human Immunodeficiency Virus (HIV)
Botulism, Dengue Fever, Mad Cow Disease, Malaria, Meningitis, MRSA, Rabies, Staph Infection, Thrush, West Nile Virus
Cirrhosis of the Liver, Non-alcoholic Fatty Liver, Hemochromatosis (Iron Overload), Hepatitis B, Hepatitis C, Jaundice, Liver Blood Tests, Primary Biliary Cirrhosis (PBC), Primary Sclerosing Cholangitis (PSC)
Asthma, Chronic Obstructive Pulmonary Disease (COPD), Emphysema, Lung Cancer, Pneumonia, Severe Acute Respiratory Syndrome (SARS), Smoker's Lung Photo Essay, Smoking and Quitting Smoking
Depression, Hormone Creams, Hormone Replacement Therapy, Hot Flashes - Alternative Treatments, Menopause, Vitamin and Calcium Supplements
Angina, Benign Prostatic Hyperplasia (BPH), Erectile Dysfunction (Impotence), Hair Loss (Baldness), Prostate Cancer, Prostatitis, Sexually Transmitted Diseases, Testicular Cancer, Vasectomy, Viagra
A-Z List of related mental health articles, Acute Stress Disorder, How To Eat Smart, Postpartum depression, Social Phobia, What Makes Marriage Work?
Cluster Headaches, Headache, Migraine Headaches and Prevention, Tension Headache
Bone Density, Calcium Supplements, Estradiol, Hormone Replacement Therapy, Menopause, Osteoporosis Prevention
Attention Deficit Disorder (ADD), Bedwetting, Birth Defects, Chickenpox, Colic, Diaper Rash, Lactose Intolerance, Nosebleeds, Pink Eye, Measles, Mumps, Tonsillectomy, Vaccinations and Immunizations
Arthroscopy, Celebrex, Cortisone Injection, Remicade, Total Hip Replacement, Total Knee Replacement
Alzheimer's Disease, Anemia, Angina, Cataracts, Dementia, Glaucoma, Macular Degeneration, Hearing Loss, Heart Attack Prevention, Osteoporosis, Sleep Disturbance, Stroke, Wrinkles
Acne, Actinic Keratosis, Atopic Dermatitis (Eczema), Boils, Bumps and Bruises, Burns, Dandruff, Hives, Itch, Keloid, Melanoma, Nail Fungus, Poison Ivy, Psoriasis, Rash (Dermatitis), Rosacea, Scleroderma, Shingles, Skin Cancer, Warts, Wrinkles
Insomnia, Jet Lag, Narcolepsy, Sleep, Sleep Apnea, Snoring (Somnoplasty)
Hyperthyroidism, Hypothyroidism, Hypothyroidism During Pregnancy, Synthroid (levothyroxine sodium), Thyroid Cancer, Thyroid Nodules
Blood In Urine (Hematuria), Cystinuria, Interstitial Cystitis, Kidney Stone, Prostatitis, Urinalysis, Urinary Incontinence, Urinary Tract Infections
Anorexia Nervosa, Bulimia, Calories Burned During Exercise, Cellulite, Obesity and Weight Loss, Weight Loss
Birth Control, Breast Cancer, Breastfeeding, Hormone Therapy, Hysterectomy, Menopause, Miscarriage, Osteoporosis, Ovarian Cancer, Ovarian Cysts, PMS (Premenstrual Syndrome), Sexually Transmitted Diseases (STDs), Uterine Cancer, Varicose Veins, Yeast Infections
Medical Tips
Hypothermia
Hypothermia is not an illness that strikes only mountaineers. Some people can become sick from hypothermia in temperatures in the low 50s. Prevention is the best medicine.
Wear a synthetic pile or wool sweater. These materials keep you warm even when wet. In addition, the synthetic materials dry very quickly.
The worst material is cotton, which loses all of its warmth when wet.
If wind or rain is a factor, make sure to bring a shell along.
And if you expect temperatures below 40 or so, you should probably consider taking a down parka with you.
Training for the Big Trip
A long hiking trip is just that: walking for a very long time in the outdoors. And that is, in fact, the best way to train for it.
Seek opportunities to walk such as going to the store, taking the dog for a walk, or spending some time with a friend.
Try taking the stairs instead of the elevator.
This is great work to prepare for any climbing you may do on your trip. Keep in mind that the better condition you are in, the better you'll feel, and therefore the more fun you'll have.
Clean Water for a Healthy Body
Clean water is essential for good health. But in the outdoors safe water may not be so easy to come by. Three ways to make it safe are:
Boil it: This will kill any germ or virus.
Filtration: Filters are convenient and easy to use.
Chemical Treatment: Tablets and drops can be added.
Poison Ivy
Poison ivy and poison oak symptoms can range from an itchy rash to overall body hives.
Mild cases will have an itchy rash with blisters and sometimes get a little crusty.
Keep the area clean with soap and water.
You should probably also treat it with cortisone cream and Benadryl to prevent itching.
If your case is more serious you should seek your physician for treatment.
Building a Medical Kit
Here are some general guidelines to follow when putting your medical kit together.
Various band-aids, gauze and medical tape.
SAM Splint for sprains and fractures.
Elastic bandage or ACE bandage.
Bring extra medication in case your hike goes longer than expected.
Snake Bites
First and foremost, don't panic.
One of the best methods is an extractor you can buy at an outdoors store.
Select the right sized suction cup, attach it to the syringe, then put it over the bite with the plunger fully extended.
Push the plunger in as it begins to suck to your skin.
Leave it there for about five minutes and then remove the plunger.
Wipe any venom away.
Keep the injured part at the same level or below the rest of the body.
Sprains
Walking outdoors is much more dangerous than walking on a sidewalk. The ground is usually uneven and covered with rocks, roots and puddles. Sprains and fractures are the most common injuries encountered in the outdoors. Prevention comes down to being careful and wearing boots with some ankle support. If a sprain occurs, do whatever you can to keep the area from moving. Remember RICE:
R est
I ce
C ompression
E levation
If you don't feel better after a few days there is probably something more serious going on and you should see your physician.
Lyme Disease
Ticks can be rather unpleasant on their own, but Lyme disease can make you hate them even more. Although cases of Lyme disease have risen, the condition is still very rare. If you are bitten by a tick, wait for signs of a fever or rash within four weeks of when you were bitten. Your physician can administer a blood test in order to make a definite diagnosis.
Monitoring Your Heart Rate
Cardiovascular fitness can ultimately improve your ability to complete a long hike. This fitness is the ability of your heart and lungs to maintain movement over a sustained period of time at a certain level of intensity. If you can comfortably carry on a conversation, then you are probably working at the right intensity. If you can sing a song, then you are probably not working hard enough. And if you are gasping for air, then you are probably working too hard. To regulate your heart rate more accurately, you'll need to find your target heart rate. Once you know this, then you can determine how hard your heart is really working.
Target Heart Rate Formula
220 minus your age (30) = 190 Minus your resting heart rate (62 beats per minute) = 128 Multiply by 60% = 76.8 Add resting heart rate = 138.8 Divide by 6 = 23 (beats every 10 seconds)
High Altitude Pulmonary Edema
The most common serious illness related to altitude is high altitude pulmonary edema (HAPE). This condition is excess fluid in the lungs caused by ascending elevation too quickly. HAPE is the number-one cause of high-altitude deaths. One of the first signs you may notice is shortness of breath. But for the type of hiking that most of us are doing, deaths are rare. If you think you or your companion are experiencing altitude sickness, the best cure is simply to descend elevation.
Blisters
If you're planning for a long hike you'd better take the moleskin along. Because no matter how careful you are, chances are you will get a blister. With good preparation, blisters can be easily remedied or avoided so that you can continue to enjoy your hike in the great outdoors.
When a blister does occur, cut a piece of moleskin that is large enough to cover the blister evenly on all sides by at least a quarter of an inch.
Then cut a small hole in the middle to make room to expose the blister.
Make sure you've got clean socks.
Exhaustion
Prevention of exhaustion involves a lot of common sense.
First and foremost, know your limits.
It helps to be in shape and use your fuel efficiently. That's where conditioning comes in.
Be prepared with the right clothing and equipment.
Continue to fuel up the entire time that you are exercising.
Choose foods with sugar for quick energy and carbohydrates for a more sustained fuel source.
Water is also necessary for expending any energy and prevents dehydration.
Trying to Beat the Heat
Because we are warm-blooded animals, our bodies perform best when we maintain 98.6¡. However if it is hot outside, then it is difficult for our bodies to keep that temperature. People who are prone to getting hot easily are subject to a number of problems.
You should always drink plenty of water because as your temperature rises, you will begin to lose water and could become dehydrated.
Wear good protective clothing such as a hat; a thin, light-colored, long-sleeve shirt; and a pair of pants. These items will offer you more protection than shorts and a t-shirt.
Hypothermia is not an illness that strikes only mountaineers. Some people can become sick from hypothermia in temperatures in the low 50s. Prevention is the best medicine.
Wear a synthetic pile or wool sweater. These materials keep you warm even when wet. In addition, the synthetic materials dry very quickly.
The worst material is cotton, which loses all of its warmth when wet.
If wind or rain is a factor, make sure to bring a shell along.
And if you expect temperatures below 40 or so, you should probably consider taking a down parka with you.
Training for the Big Trip
A long hiking trip is just that: walking for a very long time in the outdoors. And that is, in fact, the best way to train for it.
Seek opportunities to walk such as going to the store, taking the dog for a walk, or spending some time with a friend.
Try taking the stairs instead of the elevator.
This is great work to prepare for any climbing you may do on your trip. Keep in mind that the better condition you are in, the better you'll feel, and therefore the more fun you'll have.
Clean Water for a Healthy Body
Clean water is essential for good health. But in the outdoors safe water may not be so easy to come by. Three ways to make it safe are:
Boil it: This will kill any germ or virus.
Filtration: Filters are convenient and easy to use.
Chemical Treatment: Tablets and drops can be added.
Poison Ivy
Poison ivy and poison oak symptoms can range from an itchy rash to overall body hives.
Mild cases will have an itchy rash with blisters and sometimes get a little crusty.
Keep the area clean with soap and water.
You should probably also treat it with cortisone cream and Benadryl to prevent itching.
If your case is more serious you should seek your physician for treatment.
Building a Medical Kit
Here are some general guidelines to follow when putting your medical kit together.
Various band-aids, gauze and medical tape.
SAM Splint for sprains and fractures.
Elastic bandage or ACE bandage.
Bring extra medication in case your hike goes longer than expected.
Snake Bites
First and foremost, don't panic.
One of the best methods is an extractor you can buy at an outdoors store.
Select the right sized suction cup, attach it to the syringe, then put it over the bite with the plunger fully extended.
Push the plunger in as it begins to suck to your skin.
Leave it there for about five minutes and then remove the plunger.
Wipe any venom away.
Keep the injured part at the same level or below the rest of the body.
Sprains
Walking outdoors is much more dangerous than walking on a sidewalk. The ground is usually uneven and covered with rocks, roots and puddles. Sprains and fractures are the most common injuries encountered in the outdoors. Prevention comes down to being careful and wearing boots with some ankle support. If a sprain occurs, do whatever you can to keep the area from moving. Remember RICE:
R est
I ce
C ompression
E levation
If you don't feel better after a few days there is probably something more serious going on and you should see your physician.
Lyme Disease
Ticks can be rather unpleasant on their own, but Lyme disease can make you hate them even more. Although cases of Lyme disease have risen, the condition is still very rare. If you are bitten by a tick, wait for signs of a fever or rash within four weeks of when you were bitten. Your physician can administer a blood test in order to make a definite diagnosis.
Monitoring Your Heart Rate
Cardiovascular fitness can ultimately improve your ability to complete a long hike. This fitness is the ability of your heart and lungs to maintain movement over a sustained period of time at a certain level of intensity. If you can comfortably carry on a conversation, then you are probably working at the right intensity. If you can sing a song, then you are probably not working hard enough. And if you are gasping for air, then you are probably working too hard. To regulate your heart rate more accurately, you'll need to find your target heart rate. Once you know this, then you can determine how hard your heart is really working.
Target Heart Rate Formula
220 minus your age (30) = 190 Minus your resting heart rate (62 beats per minute) = 128 Multiply by 60% = 76.8 Add resting heart rate = 138.8 Divide by 6 = 23 (beats every 10 seconds)
High Altitude Pulmonary Edema
The most common serious illness related to altitude is high altitude pulmonary edema (HAPE). This condition is excess fluid in the lungs caused by ascending elevation too quickly. HAPE is the number-one cause of high-altitude deaths. One of the first signs you may notice is shortness of breath. But for the type of hiking that most of us are doing, deaths are rare. If you think you or your companion are experiencing altitude sickness, the best cure is simply to descend elevation.
Blisters
If you're planning for a long hike you'd better take the moleskin along. Because no matter how careful you are, chances are you will get a blister. With good preparation, blisters can be easily remedied or avoided so that you can continue to enjoy your hike in the great outdoors.
When a blister does occur, cut a piece of moleskin that is large enough to cover the blister evenly on all sides by at least a quarter of an inch.
Then cut a small hole in the middle to make room to expose the blister.
Make sure you've got clean socks.
Exhaustion
Prevention of exhaustion involves a lot of common sense.
First and foremost, know your limits.
It helps to be in shape and use your fuel efficiently. That's where conditioning comes in.
Be prepared with the right clothing and equipment.
Continue to fuel up the entire time that you are exercising.
Choose foods with sugar for quick energy and carbohydrates for a more sustained fuel source.
Water is also necessary for expending any energy and prevents dehydration.
Trying to Beat the Heat
Because we are warm-blooded animals, our bodies perform best when we maintain 98.6¡. However if it is hot outside, then it is difficult for our bodies to keep that temperature. People who are prone to getting hot easily are subject to a number of problems.
You should always drink plenty of water because as your temperature rises, you will begin to lose water and could become dehydrated.
Wear good protective clothing such as a hat; a thin, light-colored, long-sleeve shirt; and a pair of pants. These items will offer you more protection than shorts and a t-shirt.
Monday, November 19, 2007
Tips for Common Symptoms
Allergies or Itchy Eyes
For minor symptoms:
Avoid the problem agent if possible
Take an antihistamine: Benadryl, chlorpheniramine, or Claritin
Use eye drops such as Naphcon-A for allergic conjunctivitis
Use a decongestant such as Sudafed for nasal congestion, but do not use if you have high blood pressure
Apply hydrocortisone cream to bites or allergic skin rash
See your health care clinician if:
Throat or chest tightness, swelling of lips or tongue — call immediately.
Problem recurs frequently or doesn't respond to over-the-counter medications.
Colds
For minor symptoms:
Get rest and drink plenty of fluids
Take pain relievers: ibuprofen, aspirin, acetaminophen (do not use aspirin for children under 16)
Take a decongestant such as Sudafed to relieve nasal congestion, but do not use if you have high blood pressure.
Take a cough suppressant such as Robitussin DM for hacking cough
See your health care clinician if:
Cold or cough lingers more than one week.
Fever persists for more than a few days.
You have painful breathing or shortness of breath.
You have discolored mucous.
You have severe headache or sinus pain.
Cold Sores or Fever Blisters
For minor symptoms:
Apply ice for 5-10 minutes to reduce pain
Apply topical agents such as Herpecin-L® or Campho-phenique® for comfort
Use moisturizers such as Blistex® to hasten healing
Take pain relievers: ibuprofen, aspirin, acetaminophen (do not use aspirin for children under 16)
Be patient: cold sores usually go away in 7-10 days
Be cautious: cold sores may be due to herpes simplex virus and may be contagious
See your health care clinician if:
Sores are excessive or do not heal.
Pain prevents you from eating or drinking.
You have severe or frequently recurring sores.
Constipation
For minor symptoms:
Increase dietary fiber and fluid intake
Take a stool softener such as Colace or fiber product as Metamucil®
DO NOT use laxatives, such as Ex-Lax, regularly
Increase activity and exercise
See your health care clinician if:
Condition persists for several days.
You have a fever.
You experience stomach cramping, bloating, rectal bleeding or nausea.
Cuts and Scrapes
For minor symptoms:
Wash thoroughly with soap and warm water
Stop any bleeding by applying direct pressure
Keep area clean and dry
See your health care clinician if:
Wound is deep.
You cut yourself on something rusty or dirty.
Bleeding won't stop.
Red streak appears around wound.
Wound doesn't heal.
You haven't had a tetanus booster in 10 years.
Diarrhea or Vomiting
For minor symptoms:
Rest and sip clear fluids such as ginger ale, Gatorade® or broth
Eat light foods such as crackers or toast
If diarrhea persists, take Imodium A-D
Avoid caffeine and alcohol
See your health care clinician if:
Symptoms last more than two days.
Fluids won't stay down.
You experience high fever or dizziness.
There is blood in stool.
You have diarrhea during the night.
Headaches
For minor symptoms:
Take pain relievers: ibuprofen, aspirin, acetaminophen (do not use aspirin for children under 16)
Apply hot or cold packs
Avoid bright lights
Take sinus medication if head/nose is congested, but do not use Sudafed if you have high blood pressure
See your health care clinician if:
Headache persists or recurs.
Headache follows injury or trauma.
You experience fever, vomiting, drowsiness, or confusion.
The headache is severe or associated with neck stiffness.
Heartburn/Indigestion
For minor symptoms:
Avoid spicy, acidic or other aggravating foods, and alcohol
Stop smoking
Eat smaller amounts of food at one time, especially if near bedtime
Take antacids, such as Maalox, or acid-suppressants such as Pepcid-AC
Avoid aspirin and ibuprofen products
See your health care clinician if:
Problem recurs or pain is severe.
Pain occurs with shortness of breath or other symptoms that suggest heart problems.
Sore Throat
For minor symptoms:
Gargle with warm salt water to soothe throat
Take pain relievers: ibuprofen, aspirin, acetaminophen (do not use aspirin for children under 16)
Use throat lozenges
Increase fluids
See your health care clinician if:
Sore throat lasts more than a week.
Fever accompanies the sore throat.
You have difficulty swallowing, breathing or speaking.
There are white patches on back of throat or tonsils.
You have been exposed to someone diagnosed with strep throat.
You have tender neck lymph nodes.
Sprains or Strains
For minor symptoms:
Apply ice
Rest and elevate injured area
Take pain relievers: ibuprofen, aspirin, acetaminophen
See your health care clinician if:
Problem lasts more than three days or pain is severe.
There is dislocation or misalignment.
You have difficulty moving the affected area.
There is black and blue discoloration.
Sunburn
For minor symptoms:
Avoid further exposure to the sun
Apply cool compresses to the area or take a cool bath
Take pain relievers: ibuprofen, aspirin, acetaminophen (note warning for children under 16)
Drink plenty of non-alcoholic fluids
Apply aloe gel to soothe area
To avoid sunburn, wear protective clothing and sunscreen
See your health care clinician if:
Burn is accompanied by fever, vomiting, drowsiness or confusion.
Blisters form on large areas of the skin.
Blisters break and appear infected.
This information will be taken from http://web.mit.edu/
For minor symptoms:
Avoid the problem agent if possible
Take an antihistamine: Benadryl, chlorpheniramine, or Claritin
Use eye drops such as Naphcon-A for allergic conjunctivitis
Use a decongestant such as Sudafed for nasal congestion, but do not use if you have high blood pressure
Apply hydrocortisone cream to bites or allergic skin rash
See your health care clinician if:
Throat or chest tightness, swelling of lips or tongue — call immediately.
Problem recurs frequently or doesn't respond to over-the-counter medications.
Colds
For minor symptoms:
Get rest and drink plenty of fluids
Take pain relievers: ibuprofen, aspirin, acetaminophen (do not use aspirin for children under 16)
Take a decongestant such as Sudafed to relieve nasal congestion, but do not use if you have high blood pressure.
Take a cough suppressant such as Robitussin DM for hacking cough
See your health care clinician if:
Cold or cough lingers more than one week.
Fever persists for more than a few days.
You have painful breathing or shortness of breath.
You have discolored mucous.
You have severe headache or sinus pain.
Cold Sores or Fever Blisters
For minor symptoms:
Apply ice for 5-10 minutes to reduce pain
Apply topical agents such as Herpecin-L® or Campho-phenique® for comfort
Use moisturizers such as Blistex® to hasten healing
Take pain relievers: ibuprofen, aspirin, acetaminophen (do not use aspirin for children under 16)
Be patient: cold sores usually go away in 7-10 days
Be cautious: cold sores may be due to herpes simplex virus and may be contagious
See your health care clinician if:
Sores are excessive or do not heal.
Pain prevents you from eating or drinking.
You have severe or frequently recurring sores.
Constipation
For minor symptoms:
Increase dietary fiber and fluid intake
Take a stool softener such as Colace or fiber product as Metamucil®
DO NOT use laxatives, such as Ex-Lax, regularly
Increase activity and exercise
See your health care clinician if:
Condition persists for several days.
You have a fever.
You experience stomach cramping, bloating, rectal bleeding or nausea.
Cuts and Scrapes
For minor symptoms:
Wash thoroughly with soap and warm water
Stop any bleeding by applying direct pressure
Keep area clean and dry
See your health care clinician if:
Wound is deep.
You cut yourself on something rusty or dirty.
Bleeding won't stop.
Red streak appears around wound.
Wound doesn't heal.
You haven't had a tetanus booster in 10 years.
Diarrhea or Vomiting
For minor symptoms:
Rest and sip clear fluids such as ginger ale, Gatorade® or broth
Eat light foods such as crackers or toast
If diarrhea persists, take Imodium A-D
Avoid caffeine and alcohol
See your health care clinician if:
Symptoms last more than two days.
Fluids won't stay down.
You experience high fever or dizziness.
There is blood in stool.
You have diarrhea during the night.
Headaches
For minor symptoms:
Take pain relievers: ibuprofen, aspirin, acetaminophen (do not use aspirin for children under 16)
Apply hot or cold packs
Avoid bright lights
Take sinus medication if head/nose is congested, but do not use Sudafed if you have high blood pressure
See your health care clinician if:
Headache persists or recurs.
Headache follows injury or trauma.
You experience fever, vomiting, drowsiness, or confusion.
The headache is severe or associated with neck stiffness.
Heartburn/Indigestion
For minor symptoms:
Avoid spicy, acidic or other aggravating foods, and alcohol
Stop smoking
Eat smaller amounts of food at one time, especially if near bedtime
Take antacids, such as Maalox, or acid-suppressants such as Pepcid-AC
Avoid aspirin and ibuprofen products
See your health care clinician if:
Problem recurs or pain is severe.
Pain occurs with shortness of breath or other symptoms that suggest heart problems.
Sore Throat
For minor symptoms:
Gargle with warm salt water to soothe throat
Take pain relievers: ibuprofen, aspirin, acetaminophen (do not use aspirin for children under 16)
Use throat lozenges
Increase fluids
See your health care clinician if:
Sore throat lasts more than a week.
Fever accompanies the sore throat.
You have difficulty swallowing, breathing or speaking.
There are white patches on back of throat or tonsils.
You have been exposed to someone diagnosed with strep throat.
You have tender neck lymph nodes.
Sprains or Strains
For minor symptoms:
Apply ice
Rest and elevate injured area
Take pain relievers: ibuprofen, aspirin, acetaminophen
See your health care clinician if:
Problem lasts more than three days or pain is severe.
There is dislocation or misalignment.
You have difficulty moving the affected area.
There is black and blue discoloration.
Sunburn
For minor symptoms:
Avoid further exposure to the sun
Apply cool compresses to the area or take a cool bath
Take pain relievers: ibuprofen, aspirin, acetaminophen (note warning for children under 16)
Drink plenty of non-alcoholic fluids
Apply aloe gel to soothe area
To avoid sunburn, wear protective clothing and sunscreen
See your health care clinician if:
Burn is accompanied by fever, vomiting, drowsiness or confusion.
Blisters form on large areas of the skin.
Blisters break and appear infected.
This information will be taken from http://web.mit.edu/
Wednesday, November 7, 2007
Heartburn
Heartburn Overview
Heartburn is an uncomfortable but common feeling of burning or warmth in the chest. Although the pain of heartburn is felt in the chest, heartburn has nothing to do with your heart. Instead, heartburn is caused by stomach acid (see Media file 1).
Continual bouts of heartburn can be a symptom of a more serious condition called gastroesophageal reflux disease or GERD. Frequent or severe heartburn may limit daily activities and lead to further complications such as ulcers in the esophagus. With proper understanding of heartburn and treatment, relief can be obtained from this condition.
About 30% of adults experience occasional heartburn, while 10% experience heartburn every day. About 25% of pregnant women have heartburn or related symptoms.
Heartburn Causes
The food that is swallowed travels from the mouth to the stomach through a hollow tube called the esophagus (or food pipe). Before entering the stomach, food must pass through a tight muscle at the lower part of the esophagus called the lower esophageal sphincter (LES). The lower esophageal sphincter prevents food from traveling backward into the esophagus.
Once in the stomach, stomach acid digests the food. This acid is very strong and can damage most parts of the body. Fortunately, the stomach is protected from its own acid by a special mucous layer. The esophagus, however, does not have any such special protection. If the lower esophageal sphincter does not close completely, the lower part of the esophagus can be damaged by stomach acid. When this happens, heartburn may be experienced.
The lower esophageal sphincter may not close completely thus allowing stomach acid into the esophagus for these reasons:
Certain foods and drinks are known to loosen the lower esophageal sphincter. These include chocolate, peppermint, caffeine-containing beverages (such as coffee, tea, and soft drinks), fatty foods, and alcohol.
Heartburn often depends on the body's position. It is easier for stomach acid to flow back into the esophagus if you are lying down or bending over.
Anything that increases the pressure on the stomach and forces stomach acid backward into the esophagus can also cause heartburn. This is why lifting, straining, coughing, tight clothing, obesity, and pregnancy can worsen heartburn.
People who suffer from certain medical conditions may have an increased chance of heartburn. These conditions include hiatal hernia, diabetes, and many autoimmune diseases (CREST syndrome, Raynaud phenomenon, and scleroderma).
Many prescription medications can loosen the lower esophageal sphincter, including certain blood pressure and heart medications, and the asthma drug theophylline.
Many substances directly irritate the lining of the esophagus and can contribute to heartburn. These include spicy foods, citrus fruits and juices, tomatoes and tomato sauces, cigarette smoke, aspirin, ibuprofen (with brand names such as Motrin and Advil), and medicines for osteoporosis.
Heartburn Symptoms
The pain of heartburn is described as a burning feeling in the chest. Often, the sensation may spread up into the throat, jaw, arms, or back. That's why heartburn is often mistaken for chest pain due to a heart attack. However, do not second guess yourself. If you are having chest pain for any reason, seek medical attention immediately, if only to rule out a heart attack.
Heartburn (often called acid indigestion) typically occurs 30-60 minutes after meals. The pain is worse when lying down, bending forward, and straining to pass stools. The pain is relieved by standing upright, swallowing saliva or water, or by taking antacids.
If small amounts of stomach acid or food travel beyond the esophagus and up into the mouth, you may experience bitter or sour taste. This is known as regurgitation. It is common after meals, especially if you are lying down, bending over, or straining.
Stomach acid can also affect the respiratory tract, causing asthma, hoarseness, chronic cough, sore throat, or tooth damage (acid eats the enamel on teeth). You may feel as if you have a lump in your throat.
If the acid exposure continues for long periods of time, the esophagus becomes damaged. You may then have difficulty swallowing. In more serious cases, you may lose weight and become dehydrated. Very rarely, the esophagus may bleed or tear completely because it is so damaged. In severe cases, you may vomit blood or have small amounts of blood in your bowel movements. However, all these are uncommon.
When to Seek Medical Care
Call your health care provider if your heartburn continues to bother you despite lifestyle modifications and use of antacids or low doses of acid blockers. Call if you have heartburn more than 3 times a week for over 2 weeks. Your provider will prescribe medications or make other recommendations to help your pain.
Seek emergency medical care. Chronic heartburn can sometimes lead to serious complications that require immediate medical attention. Go to a hospital's emergency department if you have any of the following symptoms:
Throwing up blood or passing blood in your stools
Severe pain, dizziness, or lightheadedness
Difficulty swallowing
Dehydration
Unintentional weight loss
NOTE: The pain of heartburn can often be confused with pain that is actually due to more serious heart problems, such as a heart attack. If you or a family member has a history of heart disease, you need to be particularly aware of this possibility. If your pain is accompanied by sweating, nausea, vomiting, difficulty breathing, or is worse with activity, you may need to have your heart evaluated immediately.
Exams and Tests
Heartburn may be obvious from your symptoms, so your health care provider may not need to perform any tests or do an extensive exam. You may be advised about lifestyle modifications, diet, or medications to begin immediately.
Your provider may order certain procedures if the diagnosis is unclear or if prescribed medications are not relieving your heartburn.
The most common procedure is called an upper GI (gastrointestinal) endoscopy, also called esophagogastroduodenoscopy or EGD. You are lightly sedated. A special camera is placed through your mouth and into the esophagus and stomach. The doctor can then see how much damage has been done to the esophagus from stomach acid. The doctor will also be able to determine and possibly treat the complications of heartburn, such as problems swallowing or bleeding. In addition, an upper endoscopy will let your doctor see if there are other explanations for the pain, such as an infection.
You may undergo an upper GI series. In this test, you drink a liquid that coats your esophagus and stomach and shows up on x-rays that are taken.
If an upper endoscopy shows that everything is normal but you continue to have pain, the doctor may do further testing to clarify the diagnosis. This includes procedures to measure the weakness of the LES muscle. This procedure is called an esophageal manometry.
Another procedure is the 24-hour pH monitoring to measure the strength of your stomach acid. A very thin tube is passed through your nose into your esophagus. For the next 24 hours, the test measures the amount of acid reflux that occurs while you go about your regular activities, including eating. A new test uses a tiny capsule to measure acid reflux levels. The doctor uses an endoscope to attach the bean-sized capsule to your esophagus. It measures pH levels and delivers readings by radio wave to a receiver you wear on your belt. After about 48 hours, the capsule detaches and passes through your digestive system and is not recovered.
If your health care provider feels you are at risk for heart problems, additional tests may be performed to make sure your heart is healthy.
Heartburn Treatment
Antacids, acid blockers, and perhaps surgery may provide relief from heartburn and prevent it from turning into more serious disease.
Self-Care at Home
For mild or occasional symptoms, simple lifestyle modifications can be helpful.
Avoid large meals.
Avoid caffeine (coffee, teas, some soft drinks).
Avoid foods or drinks that reduce pressure on the lower esophageal sphincter such as chocolate, peppermint, caffeine-containing beverages, and fatty or fried foods.
Avoid foods that damage the esophagus such as spicy foods, citrus fruits and juices, tomatoes and tomato sauces.
After eating, beware of activities that force acid back into your esophagus. Such activities include lifting, straining, coughing, and wearing tight clothing.
Use gravity to your advantage. Avoid lying down within 3 hours of meals. If you suffer from nighttime heartburn, elevate the head of your bed when sleeping. Place 6-inch blocks underneath the head of the bed, or place a wedge under the mattress. Simply using more pillows under your head will not help. In fact, it may worsen the heartburn by increasing the pressure on your stomach.
Lose weight if you are overweight.
Stop smoking.
Limit alcohol intake.
Antacids such as Maalox, Mylanta, Tums, or Rolaids can also be helpful. Antacids work by neutralizing acid. They should be taken 1 hour after meals or when heartburn symptoms occur.
Low doses of drugs that block the production of stomach acid are available over-the-counter. Some examples include cimetidine (Tagamet), ranitidine (Zantac), and famotidine (Pepcid).
Medical Treatment
Your health care provider will recommend treating heartburn in a stepwise fashion.
Over-the-counter antacids are the oldest effective self-treatments for heartburn. Through the centuries, people have chewed on chalk (the active ingredient is calcium carbonate) to ease heartburn. Antacid tablets are slow to act. Tablets are less powerful in neutralizing stomach acid than liquid antacids.
Antacids are useful because they provide rapid relief of heartburn, especially if it is caused by foods or certain activity. But relief is only temporary. Over-the-counter antacids do not prevent heartburn from returning or allow an injured esophagus to heal. If you need antacids for more than 2 weeks, talk with your health care provider to get a better diagnosis of your condition and appropriate treatment.
Most varieties of antacids you can buy in drug stores are combinations of aluminum and magnesium hydroxide. Antacids containing these ingredients may produce unwanted diarrhea or constipation.
Antacids containing calcium carbonate are the most potent in neutralizing stomach acid. Popular brands are Tums and Titralac.
Follow label instructions and do not take more than the recommended daily dose. Most commonly, users take antacids after meals and at bedtime—or when you have symptoms.
Always tell your health care provider about your antacid use.
Medications
If you still have heartburn symptoms after lifestyle modifications and use of antacids, your health care provider may prescribe drugs.
The next group of drugs to be tried is called histamine-2 blockers. Examples include ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid). These tablets decrease the amount of acid your stomach produces. Many of these drugs can be bought over-the-counter at low doses but need a doctor's prescription for higher doses. They provide relief of symptoms within 30 minutes and are taken twice a day.
If you continue to have heartburn, the doctor may recommend adding a drug such as metoclopramide (Reglan). This type of drug empties food and acid quickly from the stomach so less can travel back into the esophagus. Reglan also helps tighten the LES muscle.
If you still have symptoms, the doctor will then recommend drugs called proton pump inhibitors. Examples of these drugs include omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), and pantoprazole (Protonix). These compounds prevent the stomach from secreting acid. They are very effective and are typically taken only once a day. These drugs are usually only prescribed if other drugs have not helped.
Surgery
If prescription drugs are not relieving heartburn, or if you have serious complications of heartburn, surgery may be required. The surgery is relatively simple and is called fundoplication. Its purpose is to tighten the lower esophageal sphincter muscle. The stomach is tied in such a way as to prevent acid from flowing backward into the esophagus. This surgery is successful for more than 85% of people.
Next Steps
Prevention
Many cases of heartburn can be prevented by simple lifestyle modifications in diet, activity, and habits. Watching what kinds of foods you eat and how much you eat can influence your symptoms. Also, pay attention to your body position after eating. Don't lie down. Limit alcohol intake, quit smoking, and lose weight to improve not only your heartburn symptoms but also your overall health.
Heartburn is an uncomfortable but common feeling of burning or warmth in the chest. Although the pain of heartburn is felt in the chest, heartburn has nothing to do with your heart. Instead, heartburn is caused by stomach acid (see Media file 1).
Continual bouts of heartburn can be a symptom of a more serious condition called gastroesophageal reflux disease or GERD. Frequent or severe heartburn may limit daily activities and lead to further complications such as ulcers in the esophagus. With proper understanding of heartburn and treatment, relief can be obtained from this condition.
About 30% of adults experience occasional heartburn, while 10% experience heartburn every day. About 25% of pregnant women have heartburn or related symptoms.
Heartburn Causes
The food that is swallowed travels from the mouth to the stomach through a hollow tube called the esophagus (or food pipe). Before entering the stomach, food must pass through a tight muscle at the lower part of the esophagus called the lower esophageal sphincter (LES). The lower esophageal sphincter prevents food from traveling backward into the esophagus.
Once in the stomach, stomach acid digests the food. This acid is very strong and can damage most parts of the body. Fortunately, the stomach is protected from its own acid by a special mucous layer. The esophagus, however, does not have any such special protection. If the lower esophageal sphincter does not close completely, the lower part of the esophagus can be damaged by stomach acid. When this happens, heartburn may be experienced.
The lower esophageal sphincter may not close completely thus allowing stomach acid into the esophagus for these reasons:
Certain foods and drinks are known to loosen the lower esophageal sphincter. These include chocolate, peppermint, caffeine-containing beverages (such as coffee, tea, and soft drinks), fatty foods, and alcohol.
Heartburn often depends on the body's position. It is easier for stomach acid to flow back into the esophagus if you are lying down or bending over.
Anything that increases the pressure on the stomach and forces stomach acid backward into the esophagus can also cause heartburn. This is why lifting, straining, coughing, tight clothing, obesity, and pregnancy can worsen heartburn.
People who suffer from certain medical conditions may have an increased chance of heartburn. These conditions include hiatal hernia, diabetes, and many autoimmune diseases (CREST syndrome, Raynaud phenomenon, and scleroderma).
Many prescription medications can loosen the lower esophageal sphincter, including certain blood pressure and heart medications, and the asthma drug theophylline.
Many substances directly irritate the lining of the esophagus and can contribute to heartburn. These include spicy foods, citrus fruits and juices, tomatoes and tomato sauces, cigarette smoke, aspirin, ibuprofen (with brand names such as Motrin and Advil), and medicines for osteoporosis.
Heartburn Symptoms
The pain of heartburn is described as a burning feeling in the chest. Often, the sensation may spread up into the throat, jaw, arms, or back. That's why heartburn is often mistaken for chest pain due to a heart attack. However, do not second guess yourself. If you are having chest pain for any reason, seek medical attention immediately, if only to rule out a heart attack.
Heartburn (often called acid indigestion) typically occurs 30-60 minutes after meals. The pain is worse when lying down, bending forward, and straining to pass stools. The pain is relieved by standing upright, swallowing saliva or water, or by taking antacids.
If small amounts of stomach acid or food travel beyond the esophagus and up into the mouth, you may experience bitter or sour taste. This is known as regurgitation. It is common after meals, especially if you are lying down, bending over, or straining.
Stomach acid can also affect the respiratory tract, causing asthma, hoarseness, chronic cough, sore throat, or tooth damage (acid eats the enamel on teeth). You may feel as if you have a lump in your throat.
If the acid exposure continues for long periods of time, the esophagus becomes damaged. You may then have difficulty swallowing. In more serious cases, you may lose weight and become dehydrated. Very rarely, the esophagus may bleed or tear completely because it is so damaged. In severe cases, you may vomit blood or have small amounts of blood in your bowel movements. However, all these are uncommon.
When to Seek Medical Care
Call your health care provider if your heartburn continues to bother you despite lifestyle modifications and use of antacids or low doses of acid blockers. Call if you have heartburn more than 3 times a week for over 2 weeks. Your provider will prescribe medications or make other recommendations to help your pain.
Seek emergency medical care. Chronic heartburn can sometimes lead to serious complications that require immediate medical attention. Go to a hospital's emergency department if you have any of the following symptoms:
Throwing up blood or passing blood in your stools
Severe pain, dizziness, or lightheadedness
Difficulty swallowing
Dehydration
Unintentional weight loss
NOTE: The pain of heartburn can often be confused with pain that is actually due to more serious heart problems, such as a heart attack. If you or a family member has a history of heart disease, you need to be particularly aware of this possibility. If your pain is accompanied by sweating, nausea, vomiting, difficulty breathing, or is worse with activity, you may need to have your heart evaluated immediately.
Exams and Tests
Heartburn may be obvious from your symptoms, so your health care provider may not need to perform any tests or do an extensive exam. You may be advised about lifestyle modifications, diet, or medications to begin immediately.
Your provider may order certain procedures if the diagnosis is unclear or if prescribed medications are not relieving your heartburn.
The most common procedure is called an upper GI (gastrointestinal) endoscopy, also called esophagogastroduodenoscopy or EGD. You are lightly sedated. A special camera is placed through your mouth and into the esophagus and stomach. The doctor can then see how much damage has been done to the esophagus from stomach acid. The doctor will also be able to determine and possibly treat the complications of heartburn, such as problems swallowing or bleeding. In addition, an upper endoscopy will let your doctor see if there are other explanations for the pain, such as an infection.
You may undergo an upper GI series. In this test, you drink a liquid that coats your esophagus and stomach and shows up on x-rays that are taken.
If an upper endoscopy shows that everything is normal but you continue to have pain, the doctor may do further testing to clarify the diagnosis. This includes procedures to measure the weakness of the LES muscle. This procedure is called an esophageal manometry.
Another procedure is the 24-hour pH monitoring to measure the strength of your stomach acid. A very thin tube is passed through your nose into your esophagus. For the next 24 hours, the test measures the amount of acid reflux that occurs while you go about your regular activities, including eating. A new test uses a tiny capsule to measure acid reflux levels. The doctor uses an endoscope to attach the bean-sized capsule to your esophagus. It measures pH levels and delivers readings by radio wave to a receiver you wear on your belt. After about 48 hours, the capsule detaches and passes through your digestive system and is not recovered.
If your health care provider feels you are at risk for heart problems, additional tests may be performed to make sure your heart is healthy.
Heartburn Treatment
Antacids, acid blockers, and perhaps surgery may provide relief from heartburn and prevent it from turning into more serious disease.
Self-Care at Home
For mild or occasional symptoms, simple lifestyle modifications can be helpful.
Avoid large meals.
Avoid caffeine (coffee, teas, some soft drinks).
Avoid foods or drinks that reduce pressure on the lower esophageal sphincter such as chocolate, peppermint, caffeine-containing beverages, and fatty or fried foods.
Avoid foods that damage the esophagus such as spicy foods, citrus fruits and juices, tomatoes and tomato sauces.
After eating, beware of activities that force acid back into your esophagus. Such activities include lifting, straining, coughing, and wearing tight clothing.
Use gravity to your advantage. Avoid lying down within 3 hours of meals. If you suffer from nighttime heartburn, elevate the head of your bed when sleeping. Place 6-inch blocks underneath the head of the bed, or place a wedge under the mattress. Simply using more pillows under your head will not help. In fact, it may worsen the heartburn by increasing the pressure on your stomach.
Lose weight if you are overweight.
Stop smoking.
Limit alcohol intake.
Antacids such as Maalox, Mylanta, Tums, or Rolaids can also be helpful. Antacids work by neutralizing acid. They should be taken 1 hour after meals or when heartburn symptoms occur.
Low doses of drugs that block the production of stomach acid are available over-the-counter. Some examples include cimetidine (Tagamet), ranitidine (Zantac), and famotidine (Pepcid).
Medical Treatment
Your health care provider will recommend treating heartburn in a stepwise fashion.
Over-the-counter antacids are the oldest effective self-treatments for heartburn. Through the centuries, people have chewed on chalk (the active ingredient is calcium carbonate) to ease heartburn. Antacid tablets are slow to act. Tablets are less powerful in neutralizing stomach acid than liquid antacids.
Antacids are useful because they provide rapid relief of heartburn, especially if it is caused by foods or certain activity. But relief is only temporary. Over-the-counter antacids do not prevent heartburn from returning or allow an injured esophagus to heal. If you need antacids for more than 2 weeks, talk with your health care provider to get a better diagnosis of your condition and appropriate treatment.
Most varieties of antacids you can buy in drug stores are combinations of aluminum and magnesium hydroxide. Antacids containing these ingredients may produce unwanted diarrhea or constipation.
Antacids containing calcium carbonate are the most potent in neutralizing stomach acid. Popular brands are Tums and Titralac.
Follow label instructions and do not take more than the recommended daily dose. Most commonly, users take antacids after meals and at bedtime—or when you have symptoms.
Always tell your health care provider about your antacid use.
Medications
If you still have heartburn symptoms after lifestyle modifications and use of antacids, your health care provider may prescribe drugs.
The next group of drugs to be tried is called histamine-2 blockers. Examples include ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid). These tablets decrease the amount of acid your stomach produces. Many of these drugs can be bought over-the-counter at low doses but need a doctor's prescription for higher doses. They provide relief of symptoms within 30 minutes and are taken twice a day.
If you continue to have heartburn, the doctor may recommend adding a drug such as metoclopramide (Reglan). This type of drug empties food and acid quickly from the stomach so less can travel back into the esophagus. Reglan also helps tighten the LES muscle.
If you still have symptoms, the doctor will then recommend drugs called proton pump inhibitors. Examples of these drugs include omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), and pantoprazole (Protonix). These compounds prevent the stomach from secreting acid. They are very effective and are typically taken only once a day. These drugs are usually only prescribed if other drugs have not helped.
Surgery
If prescription drugs are not relieving heartburn, or if you have serious complications of heartburn, surgery may be required. The surgery is relatively simple and is called fundoplication. Its purpose is to tighten the lower esophageal sphincter muscle. The stomach is tied in such a way as to prevent acid from flowing backward into the esophagus. This surgery is successful for more than 85% of people.
Next Steps
Prevention
Many cases of heartburn can be prevented by simple lifestyle modifications in diet, activity, and habits. Watching what kinds of foods you eat and how much you eat can influence your symptoms. Also, pay attention to your body position after eating. Don't lie down. Limit alcohol intake, quit smoking, and lose weight to improve not only your heartburn symptoms but also your overall health.
Tuesday, November 6, 2007
Heart Attack
Heart Attack Overview
If you are having pain or discomfort in your chest, jaw, shoulder, arm, or back and think you may be having a heart attack.
If you think you are having a heart attack, seek help immediately. Do not ignore chest pain or discomfort. Time is of vital importance. Go immediately to a hospital emergency department. Do not attempt to drive yourself or have someone else drive you. Call 911 for emergency transport.
The heart is a muscular pump located in the chest. Its job is to pump blood around the body via the circulatory system of blood vessels. The heart consists of 4 chambers: right atrium and right ventricle, and left atrium and left ventricle.
Blood is depleted of oxygen after circulating through the body. This blood returns into the right atrium. From there the blood flows into the right ventricle, which pumps the blood out to the lungs for oxygenation.
The oxygen-rich blood then returns to the left atrium. From there it flows into the left ventricle and is pumped out at high pressure into the arteries.
The high pressure is generated by powerful contraction of the heart muscle.
This raises the pressure of the blood and enables it to flow through the extensive network of arteries to every part of the body and return to the heart.
For this pumping action, the heart has to be strong.
The heart is nourished by the blood supplied directly to the heart muscle through the coronary arteries.
The strength of the heart muscle depends very much on this blood supply.
The coronary arteries are usually strong, elastic, and quite flexible. The inner lining of the arteries is normally smooth. This allows the blood to flow smoothly without clotting.
Heart attack is caused by sudden loss of blood and oxygen to your heart.
The most common condition that predisposes a person to heart attack is coronary heart disease, or coronary artery disease, due to atherosclerosis, or fatty build up of plaque on the inner lining of coronary arteries.
The plaque and resulting blood clots block the artery partially or completely, reducing the amount of blood that can flow through the artery to the heart.
This cuts off the oxygen supply to part of the heart muscle.
If the blood supply is cut off long enough, that part of the heart muscle dies. This is a heart attack.
If a large enough part of the heart muscle is affected, a dangerous rhythm disorder called ventricular fibrillation may occur.
If this happens, the heart may stop. This is called cardiac arrest, and most people who have cardiac arrest die.
Despite immense medical progress in the last 3 decades, heart disease continues to be a major health problem in both industrialized and developing nations.
About 1.5 million Americans suffer a heart attack each year (that’s 1 heart attack every 20 seconds).
Many people die before getting medical attention. Approximately 90-95% of people who reach a hospital alive after a heart attack will survive.
Overall, about one third of people who have a heart attack die.
Heart disease is the leading cause of death in the United States.
Clearly, time is of the essence. Recognizing the symptoms of a heart attack and seeking immediate medical attention may mean the difference between life and death.
Immediate death may be avoided if cardiopulmonary resuscitation (CPR) is begun within 4 minutes of the cardiac arrest.
CPR involves breathing for the person (mouth-to-mouth resuscitation) and performing chest compressions to keep the blood circulating. This provides at least a small amount of oxygen to the heart and brain.
Survival depends on quick action.
Emergency personnel will assess the situation quickly. They may record an electrocardiogram (ECG).
If the person has ventricular fibrillation or there is no pulse, they may administer electrical current to the chest (defibrillation) to "shock" the heart back to normal rhythm.
Other emergency treatments include medications and CPR.
Bystanders can help a cardiac arrest victim before emergency personnel arrive.
Ventricular fibrillation often can be treated successfully with a defibrillator.
Automated external defibrillators (AEDs) are now becoming available in many public places such as airports and airplanes, shopping malls, sports arenas, and office buildings.
These devices are designed so that they can be used in cardiac arrest by untrained bystanders.
Even if an AED is not available, you can take part in the "chain of survival" by performing CPR until help arrives.
Heart Attack Causes
With advancing age, cholesterol and calcium are deposited gradually in the walls of the coronary arteries. These deposits are called plaques. The process is known as atherosclerosis, or "hardening of the arteries."
A diet high in cholesterol combined with smoking and lack of exercise can accelerate this process.
As these plaques grow, they begin to impede the flow of blood.
The growing plaque is like a firm shell with a soft inner core containing cholesterol.
As blood hits a plaque during each heartbeat, the plaque may crack open and expose the inner cholesterol.
The cholesterol may cause a blood clot to begin to form.
The plaque and the blood clot block the artery partially or completely. The more the artery is blocked, the greater the resulting damage to the heart.
Atherosclerotic coronary artery disease
This most common type of heart disease is associated with several risk factors. The greater the number of risk factors you have, the more likely you are to have atherosclerosis. The most common risk factors are as follows:
Hereditary (runs in the family)
High cholesterol in blood, especially high levels of "bad cholesterol" (LDL, low-density lipoprotein) and low levels of "good cholesterol" (HDL, high-density lipoprotein)
Cigarette smoking or other tobacco use, including cigars and chewing tobacco
Obesity or excess weight
High blood pressure (hypertension)
Diabetes
Physical inactivity, lack of regular exercise (sedentary lifestyle)
High-fat diet
Emotional stress
Type-A personality (hard-driving, perfectionist)
Nonatherosclerotic coronary artery disease
Coronary arteries can be blocked by conditions other than atherosclerosis. These include inflammatory diseases of the arteries, trauma such as a cut or stab wound to the heart, and diseases that cause thickening of the coronary arteries.
Coronary embolization may cause a heart attack. Coronary embolization refers to a clot from elsewhere in the body breaking off and traveling to the heart.
Other causes of heart attack are blood or oxygen supply problems or outside influences such as cocaine abuse and complications from bypass or catheterization.
Certain heart problems leading to heart attack may be present from birth.
Heart Attack Symptoms
Chest pressure, discomfort, or a bandlike sensation around the chest with squeezing or heaviness is a common symptom of heart attack.
About one fourth of people having a heart attack have no pain ("silent" heart attack).
Silent heart attacks are more frequent in people with diabetes.
The following symptoms suggest a heart attack:
Chest pain or pressure (heaviness)
Jaw pain, or extension of pain into the arms or shoulder, especially the left arm
Unexplained shortness of breath
Unexplained sweating
Heartburn or feeling of indigestion
Nausea or vomiting
Back pain or upper abdominal pain
General lethargy or listlessness (malaise)
When to Seek Medical Care
Call your health care provider if you have these symptoms, which are warning signs of a heart attack.
Chest pain or pressure or feeling of indigestion on exertion
Shoulder or arm pain, left or right or both, during physical or stressful activity
Jaw pain
Unexplained shortness of breath (while at rest or comes on suddenly)
Unexplained nausea, vomiting, or sweating
Fainting spell
Palpitations (awareness of rapid or pounding heartbeat)
Dizziness
If these symptoms do not go away in 5 minutes, call 911 immediately for emergency medical transport to a hospital. Do not try to drive yourself.
Each year, thousands of Americans die because they did not seek medical attention in time.
It is good to be cautious and go to the hospital.
This may mean the difference between life and death.
Don't worry about "wasting everyone's time." You aren't.
If you are not having a heart attack, that's fine. You may be able to receive treatment for whatever is causing your symptoms.
Exams and Tests
A heart attack is not a quick event that lasts a few minutes and is over.
A heart attack is a process that continues over several hours.
Every minute that passes before treatment is begun, your heart sustains more damage.
You must seek medical attention as soon as you suspect you are having a heart attack.
If you arrive at the hospital in an ambulance, the staff will be ready for you.
They will evaluate your condition rapidly by examining you and, if you can answer, asking you questions about your symptoms.
They will obtain an electrocardiogram (ECG) right away to look for signs of heart attack.
A quick diagnosis is essential for starting treatment as soon as possible.
If you are thought to be having a heart attack, you may undergo the following tests upon arrival and/or during the next few days of your hospital stay.
Blood tests: Routine blood tests include blood cell counts, chemistry and electrolytes, and coagulation (clotting) function.
Cardiac enzymes: When heart muscle is damaged, certain muscle proteins are released into the bloodstream and can be measured. Elevations of the levels of certain of these proteins, known as cardiac enzymes, strongly suggest that a heart attack is in progress or has occurred recently. Repeated testing of blood samples for cardiac enzymes is helpful in making the diagnosis of a heart attack, especially when the ECG is not diagnostic.
Other enzymes: Some other enzymes tested include AST (SGOT, aspartate transferase) and LDH (lactate dehydrogenase).
The 2 most measured enzymes are creatine kinase (CK) and troponin.
Creatine kinase is released from the cardiac muscle cells as they die and as their membranes dissolve. The level of this enzyme takes a number of hours after the beginning of the heart attack to peak. It returns to normal by 24 hours after the beginning of the heart attack. A form of this enzyme called MB subform is quite specific in showing cardiac damage.
Troponin-I and troponin-T are very useful enzyme tests. The levels of these enzymes rise by 6-8 hours after the heart attack begins and remain elevated above normal for as long as a week. To some extent, the level of troponin can predict the likelihood of complications for a person with a heart attack. The levels may also helpful in deciding what treatments should be used.
Electrocardiogram: This test detects the electrical activity of the heart and records graphlike tracings of each heartbeat (waves).
It is safe and painless, and it takes only a few minutes.
An ECG is performed by taping electrodes on your arms, legs, and chest. The electrodes pick up the electrical impulses of your heart from different points of view in your chest.
ECG abnormalities diagnostic of heart attack are sometimes seen early in a heart attack, but the ECG may be normal at first and need to be repeated.
Sometimes existing ECG abnormalities may make the diagnosis difficult.
Chest x-ray: This is not always done, but it can show abnormalities in the size or shape of the heart and indicate if fluid is collecting in the lungs, a sign or poor circulation.
Echocardiogram (echo): This is an ultrasound examination of the heart. The ultrasound device uses sound waves to create a detailed "picture" of the heart, which are then transmitted to a video monitor.
This is a safe, noninvasive, and very helpful test.
Echo may show problems in the heart structure, such as abnormalities in the movements of the heart wall. A heart attack is a damaged heart wall.
It can show abnormal enlargement or pouching of the heart wall (aneurysm).
Echo may also visualize complications of heart attack including valve problems, rupture of the heart muscle, or accumulation of fluid in the cardiac sac (pericardial effusion).
The most important information obtained from the echo is the ejection fraction. This is a measurement of the strength of heart muscle. This information may be used to help predict outcome and to decide on treatment.
Coronary angiography: This is the best test for identifying blockages in the coronary arteries.
It often is performed for people with persistent pain and those who have not received "clot-busting" drugs to re-open their blocked artery.
At some hospitals, people are taken directly into the catheterization, or cath, lab from the emergency department after initial evaluation.
In the cath lab, a long, thin plastic tube (catheter) is put into the femoral artery (in the groin) or the brachial or radial artery (in the arm) and guided into the openings of the coronary arteries. Dye is injected into the arteries to make them stand out on x-ray. Pictures are recorded for later review.
Coronary angiography is an invasive test with potentially serious complications, but when performed by an experienced doctor, the risk of complications is relatively small.
An angiogram is the best test to determine which treatment is most appropriate: medication, angioplasty, stent placement, or bypass surgery.
A stress test may be performed before a person leaves the hospital, after the patient is stable and recovering from the heart attack and/or procedure.
Exercise stress testing involves recording an ECG while the heart is stressed and again at rest.
The "stress" is usually exercise, namely, walking on a treadmill.
Speed and elevation are gradually increased while recording the ECG.
Certain changes in the ECG indicate possible coronary artery blockage.
The exercise stress test is about 60-70% accurate in predicting increased risk of future heart attacks.
If the stress test indicates fairly severe blockage, coronary angiography may be needed to confirm the diagnosis and determine the need for further treatment.
Radionuclide stress testing is another type of stress testing.
It uses a special camera that sees blood flow after a tiny dose of a radioactive "dye" (isotope) is injected into the blood.
It measures the quantities of blood flow that reach the different parts of the heart muscle through the coronary arteries.
Like the exercise stress test, pictures are obtained with exercise on the treadmill and then with rest.
People who are unable to walk on the treadmill may be given medication to "stress" the heart muscle.
If a particular coronary artery is blocked partially or completely, the part of the heart supplied with blood by that artery would appear as a "cold spot" on the pictures because no radioactive isotope reaches that area.
This test is quite accurate in diagnosing coronary artery blockage. The small amount of radioactivity is not considered to be harmful.
Heart Attack Treatment
Self-Care at Home
If you think you are having a heart attack, seek help immediately. Do not ignore chest pain or discomfort. Time is of vital importance. Call 911 for emergency transport to the hospital. Do not try to drive yourself or being driven by someone else.
If you have regular-strength or baby aspirin available and you are not strongly allergic, chew and swallow 1 regular aspirin or a baby aspirin.
At this dose, aspirin may help maintain blood flow through a clot-filled artery by inhibiting blood clotting.
Chewing gets the aspirin into your system faster than swallowing it whole.
If you have had angina and been given nitroglycerin, take as recommended by your health care provider. Exact instructions will depend on the form of the nitroglycerin.
If you have had a heart attack before, or if you have several risk factors, the following steps may help prevent heart attacks and save you from severe disability or even death.
Take a low-dose aspirin tablet (160 or 325 mg) every day. Aspirin increases the risk of bleeding in some people. Ask your health care provider before taking daily aspirin.
If you smoke, quit. This is the single best lifestyle change you can make. After 3 years of not smoking, the risk of heart disease drops to the level of a nonsmoker. Your health care provider can help you quit smoking through behavioral changes, medications, or use of nicotine replacement products.
Lower the cholesterol level in your blood. Lowering your cholesterol, especially the level of "bad" LDL cholesterol, keeps plaques from building up in the coronary arteries. The total cholesterol level should be kept below 200 mg/dL, and the LDL cholesterol level below 130 mg/dL (under 100 mg/dL in those with known heart disease or diabetes). Some people are able to control their cholesterol level by changing what they eat, lose weight, and exercise more; others require medication.
Keep your intake of calories from fat under 30% of your total calories. This translates to an intake of less than 60 grams of fat per day for an adult. Most diets in Western countries contain more fat than is recommended.
Control blood pressure. Uncontrolled high blood pressure is one of the most common causes of heart disease.
Control diabetes carefully. Uncontrolled diabetes increases your risk of heart disease, heart attacks, and circulation problems.
If you take hormone replacement therapy (HRT), talk with your health care provider right away. HRT is no longer considered to protect women from heart disease and heart attacks.
Medical Treatment
Medical treatment may be started immediately, before a definite diagnosis of a heart problem is made.
General treatment measures include the following:
Oxygen through a tube in the nose or face mask
Nitroglycerin under the tongue
Pain medicines (morphine or meperidine)
Aspirin: Those with allergy to aspirin may be given clopidogrel (Plavix).
Clot-dissolving medicines: The tissue plasminogen activators (tPAs) can actually dissolve clots.
The earlier these drugs are given, the better the chance of dissolving the clot and opening the blocked artery, protecting the heart muscle from further injury.
If more than 12 hours has passed since the onset of chest pain, these drugs are less helpful.
Potential risks of this therapy include bleeding.
The most serious risk is a stroke (bleeding into the brain).
Angioplasty: Emergency coronary angiography and coronary balloon angioplasty (percutaneous transluminal coronary angioplasty, or PTCA) are available in hospitals equipped with a full-service cardiac catheterization laboratory. This is the most direct method of removing blockage in a coronary artery.
Coronary balloon angioplasty is an extension of coronary angiography.
A long, thin tube (catheter) is inserted in an artery in the groin or arm.
At the tip of the catheter is a tiny, elongated balloon, which is threaded over a hair-thin guidewire into the narrowed coronary artery.
Once the balloon is positioned at the blockage in the coronary artery, it is inflated.
The balloon pushes aside the plaque and clot that are blocking the artery, allowing blood to flow more freely.
The balloon is then deflated and removed with the catheter.
Stenting: A stent is a small, metal springlike device that may be inserted into a coronary artery after balloon angioplasty. After the catheter and balloon are removed, the stent stays in place, holding the artery open. A stent is better than angioplasty alone at keeping the artery from narrowing again.
Atherectomy: Sometimes the plaques are too rigid, bulky, or calcified to be treated by balloon angioplasty. In these cases, the plaque often can be removed by cutting it out with a drill-like rotary blade or a laser or other tool.
Medications
If you are having a heart attack, you will almost certainly be given some or all of these medications while you are in the hospital. Some you will continue taking at home.
Intravenous (IV) nitroglycerin has been shown to improve blood flow to the heart muscle by relaxing (dilating) the coronary arteries and increasing blood flow. It is usually given for 24-48 hours continuously.
Heparin is a "blood thinner," or anticoagulant, which may be given after a heart attack. Heparin does not remove an existing clot, but it reduces the tendency of blood to clot in the coronary arteries. Some newer forms of heparin have recently been introduced that can be given as a shot instead of through an IV line.
Beta-blockers are medications that decrease the heart rate and blood pressure. This reduces the heart's workload and thus the amount of oxygen it needs. Beta-blockers may help prevent heart irregularities/life threatening rhythm disorders and future heart attacks.
Angiotensin-converting enzyme (ACE) inhibitors may prevent repeat heart attacks and other problems when started early during a heart attack. They are especially useful in people with diabetes and those with a weakened heart muscle congestive heart failure).
Surgery
Sometimes cardiac catheterization reveals extensive coronary artery disease. In such cases, you will need to undergo coronary bypass surgery.
Standard coronary artery bypass grafting (CABG) is performed if many coronary arteries are narrowed or blocked. This is especially recommended when the left main coronary artery shows significant blockage. This is "open heart surgery," meaning that the chest wall is opened. When performing a bypass, heart surgeons use sections of the mammary artery from the chest, radial arteries from the arms, or veins from the legs to create detours around the blocked arteries. For this surgery, you will be connected to a bypass pump, which does the work of the heart during the operation. Although this sounds dangerous, this surgery is considered very safe and has a very low rate of complications.
Off-pump bypass surgery: Sometimes the surgeon can perform open heart surgery without using a bypass pump. The heart continues to beat during surgery. This type of surgery has even fewer complications than the standard procedure but is not always feasible.
Minimally invasive coronary bypass: If just the front or the right coronary artery needs bypass, the bypass may be performed via a small keyhole-type incision without a large incision in the chest. The internal mammary artery is used for the bypass.
Next Steps
Follow-up
If you have a heart attack, you will receive detailed instructions for your care after leaving the hospital. You should follow these instructions carefully. The following general guidelines apply to recovery from an uncomplicated heart attack.
You may return to work or prior activity levels after about 2 weeks, resume sexual activity in 7-10 days, drive a week after leaving the hospital, and continue commercial air travel after 2 weeks, if you are feeling fine and totally asymptomatic. Those with complicated heart attacks or who still have symptoms should wait at least 2-3 weeks after symptoms go away before driving.
After a heart attack, you will need close follow-up with your health care provider.
Coronary heart disease is a chronic (ongoing, long-term), progressive condition.
Changing your risk factors only slows its pace.
Angioplasty or bypass surgery only alleviates the symptoms and is not a cure. The disease may recur and progress.
Your health care provider will watch you carefully for the following developments:
Any new symptoms or signs of disease progression through clinical evaluation, physical examination, and periodic ECGs or stress tests
Silent ischemia by periodic treadmill or radionuclide stress tests or stress echocardiography
He or she will also manage the following aspects of your treatment and recovery:
Risk factor management by checking blood pressure and cholesterol levels periodically
Adjustment of medicines and management of their side effects
Prescription for an exercise program (cardiac rehabilitation)
Prevention
Heart attack prevention depends on monitoring and modifying certain risk factors. These risk factors are interrelated. Each of us may have one or more risk factors. If we make moderate change in one area of life, we may reduce other risk factors at the same time.
Keep blood cholesterol levels in check.
Everyone adult should know what his or her cholesterol level is.
According to the National Cholesterol Education Program guidelines, if your cholesterol level is greater than 240 mg/dL or if the level of bad cholesterol (LDL) is above 130 mg/dL, aggressive measures should be taken to lower it.
If you can't lower your levels through diet alone, medications can help.
Lipid- and cholesterol-lowering drugs such as statins can reduce the rate of progression of coronary heart disease and also reduce repeat heart attacks. They work by lowering cholesterol and modifying the inner lining of your arteries.
Eat a well-balanced diet.
Avoid eating large amounts of fat and cholesterol in your diet because these can accelerate the progression of hardening and clogging of coronary arteries.
A well-balanced diet is good not only for those with high cholesterol but also for everyone. It helps to control cholesterol level as well as weight.
The American Heart Association recommends that the maximum number of calories from fat be less than 30% of total calories.
Limit the amount of fast food you eat.
Most fast food is very high in fat, even the salads and other so-called "healthy" foods.
This may not be convenient but may provide significant benefit in the long run.
Drink alcohol in moderation, if at all.
Although some research suggests that alcohol can help protect against heart disease, limit your intake to 1-2 drinks per day.
Larger amounts can increase blood pressure, cause heart rhythm disturbances, and damage the heart muscle or liver.
Stop smoking.
Quitting smoking is the single best lifestyle change you can make.
Passive smoking, smoking cigars, or chewing tobacco are also dangerous to health.
Quitting is difficult for most people. Ask your health care provider for advice and support.
Increase your physical activity.
Exercise helps to lower the blood pressure, increase the level of good cholesterol (HDL), and control excess weight.
Start slowly if you need to, but try to reach the goal of at least 30 minutes of endurance exercise 3-5 times a week. Such exercises include walking, swimming, biking, and aerobics.
Almost everyone can take part in some form of physical activity.
Before beginning an exercise program, talk to your health care provider.
Lose extra weight.
Being overweight puts extra strain on the heart and blood vessels.
A high-fiber, low-fat diet and regular exercise can help you lose weight and keep it off.
Many diets are promoted by people with self-interest. Some of these may be unsafe.
Get advice from your health care provider before starting any nontraditional weight loss program.
Avoid "diet pills" (such as Fen-Phen). Some of these have been found to cause heart valve disease or other dangerous conditions in some users.
"Natural" weight-loss products such as ephedrine can be very dangerous.
If you are having pain or discomfort in your chest, jaw, shoulder, arm, or back and think you may be having a heart attack.
If you think you are having a heart attack, seek help immediately. Do not ignore chest pain or discomfort. Time is of vital importance. Go immediately to a hospital emergency department. Do not attempt to drive yourself or have someone else drive you. Call 911 for emergency transport.
The heart is a muscular pump located in the chest. Its job is to pump blood around the body via the circulatory system of blood vessels. The heart consists of 4 chambers: right atrium and right ventricle, and left atrium and left ventricle.
Blood is depleted of oxygen after circulating through the body. This blood returns into the right atrium. From there the blood flows into the right ventricle, which pumps the blood out to the lungs for oxygenation.
The oxygen-rich blood then returns to the left atrium. From there it flows into the left ventricle and is pumped out at high pressure into the arteries.
The high pressure is generated by powerful contraction of the heart muscle.
This raises the pressure of the blood and enables it to flow through the extensive network of arteries to every part of the body and return to the heart.
For this pumping action, the heart has to be strong.
The heart is nourished by the blood supplied directly to the heart muscle through the coronary arteries.
The strength of the heart muscle depends very much on this blood supply.
The coronary arteries are usually strong, elastic, and quite flexible. The inner lining of the arteries is normally smooth. This allows the blood to flow smoothly without clotting.
Heart attack is caused by sudden loss of blood and oxygen to your heart.
The most common condition that predisposes a person to heart attack is coronary heart disease, or coronary artery disease, due to atherosclerosis, or fatty build up of plaque on the inner lining of coronary arteries.
The plaque and resulting blood clots block the artery partially or completely, reducing the amount of blood that can flow through the artery to the heart.
This cuts off the oxygen supply to part of the heart muscle.
If the blood supply is cut off long enough, that part of the heart muscle dies. This is a heart attack.
If a large enough part of the heart muscle is affected, a dangerous rhythm disorder called ventricular fibrillation may occur.
If this happens, the heart may stop. This is called cardiac arrest, and most people who have cardiac arrest die.
Despite immense medical progress in the last 3 decades, heart disease continues to be a major health problem in both industrialized and developing nations.
About 1.5 million Americans suffer a heart attack each year (that’s 1 heart attack every 20 seconds).
Many people die before getting medical attention. Approximately 90-95% of people who reach a hospital alive after a heart attack will survive.
Overall, about one third of people who have a heart attack die.
Heart disease is the leading cause of death in the United States.
Clearly, time is of the essence. Recognizing the symptoms of a heart attack and seeking immediate medical attention may mean the difference between life and death.
Immediate death may be avoided if cardiopulmonary resuscitation (CPR) is begun within 4 minutes of the cardiac arrest.
CPR involves breathing for the person (mouth-to-mouth resuscitation) and performing chest compressions to keep the blood circulating. This provides at least a small amount of oxygen to the heart and brain.
Survival depends on quick action.
Emergency personnel will assess the situation quickly. They may record an electrocardiogram (ECG).
If the person has ventricular fibrillation or there is no pulse, they may administer electrical current to the chest (defibrillation) to "shock" the heart back to normal rhythm.
Other emergency treatments include medications and CPR.
Bystanders can help a cardiac arrest victim before emergency personnel arrive.
Ventricular fibrillation often can be treated successfully with a defibrillator.
Automated external defibrillators (AEDs) are now becoming available in many public places such as airports and airplanes, shopping malls, sports arenas, and office buildings.
These devices are designed so that they can be used in cardiac arrest by untrained bystanders.
Even if an AED is not available, you can take part in the "chain of survival" by performing CPR until help arrives.
Heart Attack Causes
With advancing age, cholesterol and calcium are deposited gradually in the walls of the coronary arteries. These deposits are called plaques. The process is known as atherosclerosis, or "hardening of the arteries."
A diet high in cholesterol combined with smoking and lack of exercise can accelerate this process.
As these plaques grow, they begin to impede the flow of blood.
The growing plaque is like a firm shell with a soft inner core containing cholesterol.
As blood hits a plaque during each heartbeat, the plaque may crack open and expose the inner cholesterol.
The cholesterol may cause a blood clot to begin to form.
The plaque and the blood clot block the artery partially or completely. The more the artery is blocked, the greater the resulting damage to the heart.
Atherosclerotic coronary artery disease
This most common type of heart disease is associated with several risk factors. The greater the number of risk factors you have, the more likely you are to have atherosclerosis. The most common risk factors are as follows:
Hereditary (runs in the family)
High cholesterol in blood, especially high levels of "bad cholesterol" (LDL, low-density lipoprotein) and low levels of "good cholesterol" (HDL, high-density lipoprotein)
Cigarette smoking or other tobacco use, including cigars and chewing tobacco
Obesity or excess weight
High blood pressure (hypertension)
Diabetes
Physical inactivity, lack of regular exercise (sedentary lifestyle)
High-fat diet
Emotional stress
Type-A personality (hard-driving, perfectionist)
Nonatherosclerotic coronary artery disease
Coronary arteries can be blocked by conditions other than atherosclerosis. These include inflammatory diseases of the arteries, trauma such as a cut or stab wound to the heart, and diseases that cause thickening of the coronary arteries.
Coronary embolization may cause a heart attack. Coronary embolization refers to a clot from elsewhere in the body breaking off and traveling to the heart.
Other causes of heart attack are blood or oxygen supply problems or outside influences such as cocaine abuse and complications from bypass or catheterization.
Certain heart problems leading to heart attack may be present from birth.
Heart Attack Symptoms
Chest pressure, discomfort, or a bandlike sensation around the chest with squeezing or heaviness is a common symptom of heart attack.
About one fourth of people having a heart attack have no pain ("silent" heart attack).
Silent heart attacks are more frequent in people with diabetes.
The following symptoms suggest a heart attack:
Chest pain or pressure (heaviness)
Jaw pain, or extension of pain into the arms or shoulder, especially the left arm
Unexplained shortness of breath
Unexplained sweating
Heartburn or feeling of indigestion
Nausea or vomiting
Back pain or upper abdominal pain
General lethargy or listlessness (malaise)
When to Seek Medical Care
Call your health care provider if you have these symptoms, which are warning signs of a heart attack.
Chest pain or pressure or feeling of indigestion on exertion
Shoulder or arm pain, left or right or both, during physical or stressful activity
Jaw pain
Unexplained shortness of breath (while at rest or comes on suddenly)
Unexplained nausea, vomiting, or sweating
Fainting spell
Palpitations (awareness of rapid or pounding heartbeat)
Dizziness
If these symptoms do not go away in 5 minutes, call 911 immediately for emergency medical transport to a hospital. Do not try to drive yourself.
Each year, thousands of Americans die because they did not seek medical attention in time.
It is good to be cautious and go to the hospital.
This may mean the difference between life and death.
Don't worry about "wasting everyone's time." You aren't.
If you are not having a heart attack, that's fine. You may be able to receive treatment for whatever is causing your symptoms.
Exams and Tests
A heart attack is not a quick event that lasts a few minutes and is over.
A heart attack is a process that continues over several hours.
Every minute that passes before treatment is begun, your heart sustains more damage.
You must seek medical attention as soon as you suspect you are having a heart attack.
If you arrive at the hospital in an ambulance, the staff will be ready for you.
They will evaluate your condition rapidly by examining you and, if you can answer, asking you questions about your symptoms.
They will obtain an electrocardiogram (ECG) right away to look for signs of heart attack.
A quick diagnosis is essential for starting treatment as soon as possible.
If you are thought to be having a heart attack, you may undergo the following tests upon arrival and/or during the next few days of your hospital stay.
Blood tests: Routine blood tests include blood cell counts, chemistry and electrolytes, and coagulation (clotting) function.
Cardiac enzymes: When heart muscle is damaged, certain muscle proteins are released into the bloodstream and can be measured. Elevations of the levels of certain of these proteins, known as cardiac enzymes, strongly suggest that a heart attack is in progress or has occurred recently. Repeated testing of blood samples for cardiac enzymes is helpful in making the diagnosis of a heart attack, especially when the ECG is not diagnostic.
Other enzymes: Some other enzymes tested include AST (SGOT, aspartate transferase) and LDH (lactate dehydrogenase).
The 2 most measured enzymes are creatine kinase (CK) and troponin.
Creatine kinase is released from the cardiac muscle cells as they die and as their membranes dissolve. The level of this enzyme takes a number of hours after the beginning of the heart attack to peak. It returns to normal by 24 hours after the beginning of the heart attack. A form of this enzyme called MB subform is quite specific in showing cardiac damage.
Troponin-I and troponin-T are very useful enzyme tests. The levels of these enzymes rise by 6-8 hours after the heart attack begins and remain elevated above normal for as long as a week. To some extent, the level of troponin can predict the likelihood of complications for a person with a heart attack. The levels may also helpful in deciding what treatments should be used.
Electrocardiogram: This test detects the electrical activity of the heart and records graphlike tracings of each heartbeat (waves).
It is safe and painless, and it takes only a few minutes.
An ECG is performed by taping electrodes on your arms, legs, and chest. The electrodes pick up the electrical impulses of your heart from different points of view in your chest.
ECG abnormalities diagnostic of heart attack are sometimes seen early in a heart attack, but the ECG may be normal at first and need to be repeated.
Sometimes existing ECG abnormalities may make the diagnosis difficult.
Chest x-ray: This is not always done, but it can show abnormalities in the size or shape of the heart and indicate if fluid is collecting in the lungs, a sign or poor circulation.
Echocardiogram (echo): This is an ultrasound examination of the heart. The ultrasound device uses sound waves to create a detailed "picture" of the heart, which are then transmitted to a video monitor.
This is a safe, noninvasive, and very helpful test.
Echo may show problems in the heart structure, such as abnormalities in the movements of the heart wall. A heart attack is a damaged heart wall.
It can show abnormal enlargement or pouching of the heart wall (aneurysm).
Echo may also visualize complications of heart attack including valve problems, rupture of the heart muscle, or accumulation of fluid in the cardiac sac (pericardial effusion).
The most important information obtained from the echo is the ejection fraction. This is a measurement of the strength of heart muscle. This information may be used to help predict outcome and to decide on treatment.
Coronary angiography: This is the best test for identifying blockages in the coronary arteries.
It often is performed for people with persistent pain and those who have not received "clot-busting" drugs to re-open their blocked artery.
At some hospitals, people are taken directly into the catheterization, or cath, lab from the emergency department after initial evaluation.
In the cath lab, a long, thin plastic tube (catheter) is put into the femoral artery (in the groin) or the brachial or radial artery (in the arm) and guided into the openings of the coronary arteries. Dye is injected into the arteries to make them stand out on x-ray. Pictures are recorded for later review.
Coronary angiography is an invasive test with potentially serious complications, but when performed by an experienced doctor, the risk of complications is relatively small.
An angiogram is the best test to determine which treatment is most appropriate: medication, angioplasty, stent placement, or bypass surgery.
A stress test may be performed before a person leaves the hospital, after the patient is stable and recovering from the heart attack and/or procedure.
Exercise stress testing involves recording an ECG while the heart is stressed and again at rest.
The "stress" is usually exercise, namely, walking on a treadmill.
Speed and elevation are gradually increased while recording the ECG.
Certain changes in the ECG indicate possible coronary artery blockage.
The exercise stress test is about 60-70% accurate in predicting increased risk of future heart attacks.
If the stress test indicates fairly severe blockage, coronary angiography may be needed to confirm the diagnosis and determine the need for further treatment.
Radionuclide stress testing is another type of stress testing.
It uses a special camera that sees blood flow after a tiny dose of a radioactive "dye" (isotope) is injected into the blood.
It measures the quantities of blood flow that reach the different parts of the heart muscle through the coronary arteries.
Like the exercise stress test, pictures are obtained with exercise on the treadmill and then with rest.
People who are unable to walk on the treadmill may be given medication to "stress" the heart muscle.
If a particular coronary artery is blocked partially or completely, the part of the heart supplied with blood by that artery would appear as a "cold spot" on the pictures because no radioactive isotope reaches that area.
This test is quite accurate in diagnosing coronary artery blockage. The small amount of radioactivity is not considered to be harmful.
Heart Attack Treatment
Self-Care at Home
If you think you are having a heart attack, seek help immediately. Do not ignore chest pain or discomfort. Time is of vital importance. Call 911 for emergency transport to the hospital. Do not try to drive yourself or being driven by someone else.
If you have regular-strength or baby aspirin available and you are not strongly allergic, chew and swallow 1 regular aspirin or a baby aspirin.
At this dose, aspirin may help maintain blood flow through a clot-filled artery by inhibiting blood clotting.
Chewing gets the aspirin into your system faster than swallowing it whole.
If you have had angina and been given nitroglycerin, take as recommended by your health care provider. Exact instructions will depend on the form of the nitroglycerin.
If you have had a heart attack before, or if you have several risk factors, the following steps may help prevent heart attacks and save you from severe disability or even death.
Take a low-dose aspirin tablet (160 or 325 mg) every day. Aspirin increases the risk of bleeding in some people. Ask your health care provider before taking daily aspirin.
If you smoke, quit. This is the single best lifestyle change you can make. After 3 years of not smoking, the risk of heart disease drops to the level of a nonsmoker. Your health care provider can help you quit smoking through behavioral changes, medications, or use of nicotine replacement products.
Lower the cholesterol level in your blood. Lowering your cholesterol, especially the level of "bad" LDL cholesterol, keeps plaques from building up in the coronary arteries. The total cholesterol level should be kept below 200 mg/dL, and the LDL cholesterol level below 130 mg/dL (under 100 mg/dL in those with known heart disease or diabetes). Some people are able to control their cholesterol level by changing what they eat, lose weight, and exercise more; others require medication.
Keep your intake of calories from fat under 30% of your total calories. This translates to an intake of less than 60 grams of fat per day for an adult. Most diets in Western countries contain more fat than is recommended.
Control blood pressure. Uncontrolled high blood pressure is one of the most common causes of heart disease.
Control diabetes carefully. Uncontrolled diabetes increases your risk of heart disease, heart attacks, and circulation problems.
If you take hormone replacement therapy (HRT), talk with your health care provider right away. HRT is no longer considered to protect women from heart disease and heart attacks.
Medical Treatment
Medical treatment may be started immediately, before a definite diagnosis of a heart problem is made.
General treatment measures include the following:
Oxygen through a tube in the nose or face mask
Nitroglycerin under the tongue
Pain medicines (morphine or meperidine)
Aspirin: Those with allergy to aspirin may be given clopidogrel (Plavix).
Clot-dissolving medicines: The tissue plasminogen activators (tPAs) can actually dissolve clots.
The earlier these drugs are given, the better the chance of dissolving the clot and opening the blocked artery, protecting the heart muscle from further injury.
If more than 12 hours has passed since the onset of chest pain, these drugs are less helpful.
Potential risks of this therapy include bleeding.
The most serious risk is a stroke (bleeding into the brain).
Angioplasty: Emergency coronary angiography and coronary balloon angioplasty (percutaneous transluminal coronary angioplasty, or PTCA) are available in hospitals equipped with a full-service cardiac catheterization laboratory. This is the most direct method of removing blockage in a coronary artery.
Coronary balloon angioplasty is an extension of coronary angiography.
A long, thin tube (catheter) is inserted in an artery in the groin or arm.
At the tip of the catheter is a tiny, elongated balloon, which is threaded over a hair-thin guidewire into the narrowed coronary artery.
Once the balloon is positioned at the blockage in the coronary artery, it is inflated.
The balloon pushes aside the plaque and clot that are blocking the artery, allowing blood to flow more freely.
The balloon is then deflated and removed with the catheter.
Stenting: A stent is a small, metal springlike device that may be inserted into a coronary artery after balloon angioplasty. After the catheter and balloon are removed, the stent stays in place, holding the artery open. A stent is better than angioplasty alone at keeping the artery from narrowing again.
Atherectomy: Sometimes the plaques are too rigid, bulky, or calcified to be treated by balloon angioplasty. In these cases, the plaque often can be removed by cutting it out with a drill-like rotary blade or a laser or other tool.
Medications
If you are having a heart attack, you will almost certainly be given some or all of these medications while you are in the hospital. Some you will continue taking at home.
Intravenous (IV) nitroglycerin has been shown to improve blood flow to the heart muscle by relaxing (dilating) the coronary arteries and increasing blood flow. It is usually given for 24-48 hours continuously.
Heparin is a "blood thinner," or anticoagulant, which may be given after a heart attack. Heparin does not remove an existing clot, but it reduces the tendency of blood to clot in the coronary arteries. Some newer forms of heparin have recently been introduced that can be given as a shot instead of through an IV line.
Beta-blockers are medications that decrease the heart rate and blood pressure. This reduces the heart's workload and thus the amount of oxygen it needs. Beta-blockers may help prevent heart irregularities/life threatening rhythm disorders and future heart attacks.
Angiotensin-converting enzyme (ACE) inhibitors may prevent repeat heart attacks and other problems when started early during a heart attack. They are especially useful in people with diabetes and those with a weakened heart muscle congestive heart failure).
Surgery
Sometimes cardiac catheterization reveals extensive coronary artery disease. In such cases, you will need to undergo coronary bypass surgery.
Standard coronary artery bypass grafting (CABG) is performed if many coronary arteries are narrowed or blocked. This is especially recommended when the left main coronary artery shows significant blockage. This is "open heart surgery," meaning that the chest wall is opened. When performing a bypass, heart surgeons use sections of the mammary artery from the chest, radial arteries from the arms, or veins from the legs to create detours around the blocked arteries. For this surgery, you will be connected to a bypass pump, which does the work of the heart during the operation. Although this sounds dangerous, this surgery is considered very safe and has a very low rate of complications.
Off-pump bypass surgery: Sometimes the surgeon can perform open heart surgery without using a bypass pump. The heart continues to beat during surgery. This type of surgery has even fewer complications than the standard procedure but is not always feasible.
Minimally invasive coronary bypass: If just the front or the right coronary artery needs bypass, the bypass may be performed via a small keyhole-type incision without a large incision in the chest. The internal mammary artery is used for the bypass.
Next Steps
Follow-up
If you have a heart attack, you will receive detailed instructions for your care after leaving the hospital. You should follow these instructions carefully. The following general guidelines apply to recovery from an uncomplicated heart attack.
You may return to work or prior activity levels after about 2 weeks, resume sexual activity in 7-10 days, drive a week after leaving the hospital, and continue commercial air travel after 2 weeks, if you are feeling fine and totally asymptomatic. Those with complicated heart attacks or who still have symptoms should wait at least 2-3 weeks after symptoms go away before driving.
After a heart attack, you will need close follow-up with your health care provider.
Coronary heart disease is a chronic (ongoing, long-term), progressive condition.
Changing your risk factors only slows its pace.
Angioplasty or bypass surgery only alleviates the symptoms and is not a cure. The disease may recur and progress.
Your health care provider will watch you carefully for the following developments:
Any new symptoms or signs of disease progression through clinical evaluation, physical examination, and periodic ECGs or stress tests
Silent ischemia by periodic treadmill or radionuclide stress tests or stress echocardiography
He or she will also manage the following aspects of your treatment and recovery:
Risk factor management by checking blood pressure and cholesterol levels periodically
Adjustment of medicines and management of their side effects
Prescription for an exercise program (cardiac rehabilitation)
Prevention
Heart attack prevention depends on monitoring and modifying certain risk factors. These risk factors are interrelated. Each of us may have one or more risk factors. If we make moderate change in one area of life, we may reduce other risk factors at the same time.
Keep blood cholesterol levels in check.
Everyone adult should know what his or her cholesterol level is.
According to the National Cholesterol Education Program guidelines, if your cholesterol level is greater than 240 mg/dL or if the level of bad cholesterol (LDL) is above 130 mg/dL, aggressive measures should be taken to lower it.
If you can't lower your levels through diet alone, medications can help.
Lipid- and cholesterol-lowering drugs such as statins can reduce the rate of progression of coronary heart disease and also reduce repeat heart attacks. They work by lowering cholesterol and modifying the inner lining of your arteries.
Eat a well-balanced diet.
Avoid eating large amounts of fat and cholesterol in your diet because these can accelerate the progression of hardening and clogging of coronary arteries.
A well-balanced diet is good not only for those with high cholesterol but also for everyone. It helps to control cholesterol level as well as weight.
The American Heart Association recommends that the maximum number of calories from fat be less than 30% of total calories.
Limit the amount of fast food you eat.
Most fast food is very high in fat, even the salads and other so-called "healthy" foods.
This may not be convenient but may provide significant benefit in the long run.
Drink alcohol in moderation, if at all.
Although some research suggests that alcohol can help protect against heart disease, limit your intake to 1-2 drinks per day.
Larger amounts can increase blood pressure, cause heart rhythm disturbances, and damage the heart muscle or liver.
Stop smoking.
Quitting smoking is the single best lifestyle change you can make.
Passive smoking, smoking cigars, or chewing tobacco are also dangerous to health.
Quitting is difficult for most people. Ask your health care provider for advice and support.
Increase your physical activity.
Exercise helps to lower the blood pressure, increase the level of good cholesterol (HDL), and control excess weight.
Start slowly if you need to, but try to reach the goal of at least 30 minutes of endurance exercise 3-5 times a week. Such exercises include walking, swimming, biking, and aerobics.
Almost everyone can take part in some form of physical activity.
Before beginning an exercise program, talk to your health care provider.
Lose extra weight.
Being overweight puts extra strain on the heart and blood vessels.
A high-fiber, low-fat diet and regular exercise can help you lose weight and keep it off.
Many diets are promoted by people with self-interest. Some of these may be unsafe.
Get advice from your health care provider before starting any nontraditional weight loss program.
Avoid "diet pills" (such as Fen-Phen). Some of these have been found to cause heart valve disease or other dangerous conditions in some users.
"Natural" weight-loss products such as ephedrine can be very dangerous.
Genital Warts HPV Infection
Genital Warts (HPV) Overview
Genital warts are flesh–colored or gray growths found in the genital area and anal region in both men and women. It is the most common sexually transmitted disease caused by a virus. The warts are caused by the human papillomavirus (HPV). Infection with genital warts may not be obvious.
Genital warts affect both men and women and can occur at any age.
Most patients with genital warts are seen between the ages of 17–33 years. Genital warts are highly contagious. You have a 60% risk of getting the infection in a single sexual contact with someone who has genital warts.
In children younger than three years, genital warts are thought to be transmitted by nonsexual modes such as direct manual contact. The presence of genital warts in children should raise the suspicion for sexual abuse.
Genital Warts Causes (HPV)
Genital warts are caused by the human papillomavirus (HPV). Over 100 types of HPVs have been identified; about 40 of these types have the potential to infect the genital area.
About 90% of genital warts are caused by two specific types of the virus (6 and 11), and these HPV types are considered "low risk," having a low cancer–causing potential. Other HPV types have been strongly associated with premalignant changes and cervical cancers in women. HPV–16 is responsible for about 50% of cervical cancers, and types 16, 18, 31, and 45 together account for 80% of cancers.
Common warts are not the same as genital warts and are caused by different HPV types that infect the skin.
The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet) period of months to years may occur.
Generally, two–thirds of people who have sexual contact with a partner who has genital warts develop them within three months (after one episode or many).
Genital warts are associated with use of birth control pills due to increased sexual contact without the use of barrier protection, multiple sex partners, and having sex at an early age.
Genital Warts Symptoms (HPV)
Although genital warts are painless, they may be bothersome because of their location, size, or due to itching.
The size may range from less than one millimeter across to several square centimeters when many warts join together.
Men and women with genital warts will often complain of painless bumps, itching, and discharge.
In rare cases, bleeding or urinary obstruction may be the initial problem when the wart involves the urethral opening (the opening where urine exits the body.)
Warts in more than one area are common.
There may be a history of previous sexually transmitted diseases.
Specific descriptions
In men, genital warts can infect the urethra, penis, scrotum, and rectal area. The warts can appear as soft, raised masses with a surface that can be smooth (on the penile shaft) or rough with many fingerlike projections (anal warts). Others may appear pearly, cauliflower–like, or rough with a slightly dark surface. Most lesions are raised, but some may be flat with only slight elevation above the skin surface. Infection with HPV may be dormant or undetectable, with some lesions hidden by hair or in the inner aspect of the uncircumcised foreskin in males.
In women, genital warts have a similar appearance and usually occur in the moist areas of the labia minora and vaginal opening. Lesions visible on the outer genitals require a thorough examination of the vaginal canal, cervix, and anorectal area. Most vaginal warts occur without symptoms. Rarely, women may experience bleeding after sexual intercourse, itching, or vaginal discharge.
When to Seek Medical Care
If you have genital warts, see your doctor and discuss treatment options.
Bleeding of warts that cannot be controlled with direct pressure should be seen by a doctor. Warts that obstruct the urethral opening and don't allow you to urinate are an emergency and should be treated as soon as possible.
Exams and Tests
Diagnosis is often based on findings from the history and appearance of the genital warts.
Sometimes, lesions are only visible with an enhancing technique called acetowhitening. This technique involves the application of 5% acetic acid solution to the lesion for about 5–10 minutes. Infected areas will turn white.
Magnification of the area (colposcopy) using a scope may be necessary to see the lesions. In females, a colposcope may be used to look for lesions in the vaginal canal and on the cervix.
A routine Pap smear should always be done in order to look for evidence of HPV infection and abnormal cells on the cervix.
A biopsy can be performed if the lesion appears unusual or recurs after treatment.
Special tests can also be used to confirm the presence of HPV infection.
Genital Warts Treatment (HPV)
Self–Care at Home
Because genital warts essentially have no symptoms, there is little need for home treatment. It is important, however, to recognize that the warts exist.
You need to take the necessary precautions to prevent trauma to the area, which can result in bleeding.
You should take care to prevent transmission to sexual partners.
Because the warts themselves are infectious, avoid touching them. Do not pick or squeeze the warts.
Medical Treatment
No single treatment is effective in eliminating warts and preventing them from coming back. Genital warts may go away on their own in about 10–20% of people over a period of three to four months.
Cryotherapy: This technique freezes the wart using liquid nitrogen or a "cryoprobe." It is an excellent first–line treatment because response rates are high with few side effects.
Laser treatment: This treatment is used for extensive or recurrent genital warts. It may require local, regional, or general anesthesia. The laser physically destroys the HPV–induced lesion. Disadvantages include high cost, increased healing time, scarring, and potentially infectious viral particles in the air caused by the laser plume.
Electrodesiccation: This technique uses an electric current to destroy the warts. It can be done in the office with local anesthesia. The resulting smoke plume may be infectious.
Medications
Several medications exist for treating genital warts and can be used as an alternative to other treatments.
podophyllum resin (Pod–Ben–25, Podofin) – Topically applied by a doctor
podofilox (Condylox) – Can be topically applied at home, higher cure rates than Podophyllum resin, useful for prevention
trichloroacetic acid – Topically applied, response is often incomplete and recurrence is higher, may cause pain and burning
5–Fluorouracil (Efudex) – Applied as a cream, long treatment time, can cause burning and irritation, many side effects
Interferon alpha–n3 (Alferon N) – Used as an injection for warts that do not respond to other therapies, many side effects
imiquimod (Aldara) – New treatment, applied as a cream, local skin irritation is a common side effect
Genital warts are flesh–colored or gray growths found in the genital area and anal region in both men and women. It is the most common sexually transmitted disease caused by a virus. The warts are caused by the human papillomavirus (HPV). Infection with genital warts may not be obvious.
Genital warts affect both men and women and can occur at any age.
Most patients with genital warts are seen between the ages of 17–33 years. Genital warts are highly contagious. You have a 60% risk of getting the infection in a single sexual contact with someone who has genital warts.
In children younger than three years, genital warts are thought to be transmitted by nonsexual modes such as direct manual contact. The presence of genital warts in children should raise the suspicion for sexual abuse.
Genital Warts Causes (HPV)
Genital warts are caused by the human papillomavirus (HPV). Over 100 types of HPVs have been identified; about 40 of these types have the potential to infect the genital area.
About 90% of genital warts are caused by two specific types of the virus (6 and 11), and these HPV types are considered "low risk," having a low cancer–causing potential. Other HPV types have been strongly associated with premalignant changes and cervical cancers in women. HPV–16 is responsible for about 50% of cervical cancers, and types 16, 18, 31, and 45 together account for 80% of cancers.
Common warts are not the same as genital warts and are caused by different HPV types that infect the skin.
The viral particles are able to penetrate the skin and mucosal surfaces through microscopic abrasions in the genital area, which occur during sexual activity. Once cells are invaded by HPV, a latency (quiet) period of months to years may occur.
Generally, two–thirds of people who have sexual contact with a partner who has genital warts develop them within three months (after one episode or many).
Genital warts are associated with use of birth control pills due to increased sexual contact without the use of barrier protection, multiple sex partners, and having sex at an early age.
Genital Warts Symptoms (HPV)
Although genital warts are painless, they may be bothersome because of their location, size, or due to itching.
The size may range from less than one millimeter across to several square centimeters when many warts join together.
Men and women with genital warts will often complain of painless bumps, itching, and discharge.
In rare cases, bleeding or urinary obstruction may be the initial problem when the wart involves the urethral opening (the opening where urine exits the body.)
Warts in more than one area are common.
There may be a history of previous sexually transmitted diseases.
Specific descriptions
In men, genital warts can infect the urethra, penis, scrotum, and rectal area. The warts can appear as soft, raised masses with a surface that can be smooth (on the penile shaft) or rough with many fingerlike projections (anal warts). Others may appear pearly, cauliflower–like, or rough with a slightly dark surface. Most lesions are raised, but some may be flat with only slight elevation above the skin surface. Infection with HPV may be dormant or undetectable, with some lesions hidden by hair or in the inner aspect of the uncircumcised foreskin in males.
In women, genital warts have a similar appearance and usually occur in the moist areas of the labia minora and vaginal opening. Lesions visible on the outer genitals require a thorough examination of the vaginal canal, cervix, and anorectal area. Most vaginal warts occur without symptoms. Rarely, women may experience bleeding after sexual intercourse, itching, or vaginal discharge.
When to Seek Medical Care
If you have genital warts, see your doctor and discuss treatment options.
Bleeding of warts that cannot be controlled with direct pressure should be seen by a doctor. Warts that obstruct the urethral opening and don't allow you to urinate are an emergency and should be treated as soon as possible.
Exams and Tests
Diagnosis is often based on findings from the history and appearance of the genital warts.
Sometimes, lesions are only visible with an enhancing technique called acetowhitening. This technique involves the application of 5% acetic acid solution to the lesion for about 5–10 minutes. Infected areas will turn white.
Magnification of the area (colposcopy) using a scope may be necessary to see the lesions. In females, a colposcope may be used to look for lesions in the vaginal canal and on the cervix.
A routine Pap smear should always be done in order to look for evidence of HPV infection and abnormal cells on the cervix.
A biopsy can be performed if the lesion appears unusual or recurs after treatment.
Special tests can also be used to confirm the presence of HPV infection.
Genital Warts Treatment (HPV)
Self–Care at Home
Because genital warts essentially have no symptoms, there is little need for home treatment. It is important, however, to recognize that the warts exist.
You need to take the necessary precautions to prevent trauma to the area, which can result in bleeding.
You should take care to prevent transmission to sexual partners.
Because the warts themselves are infectious, avoid touching them. Do not pick or squeeze the warts.
Medical Treatment
No single treatment is effective in eliminating warts and preventing them from coming back. Genital warts may go away on their own in about 10–20% of people over a period of three to four months.
Cryotherapy: This technique freezes the wart using liquid nitrogen or a "cryoprobe." It is an excellent first–line treatment because response rates are high with few side effects.
Laser treatment: This treatment is used for extensive or recurrent genital warts. It may require local, regional, or general anesthesia. The laser physically destroys the HPV–induced lesion. Disadvantages include high cost, increased healing time, scarring, and potentially infectious viral particles in the air caused by the laser plume.
Electrodesiccation: This technique uses an electric current to destroy the warts. It can be done in the office with local anesthesia. The resulting smoke plume may be infectious.
Medications
Several medications exist for treating genital warts and can be used as an alternative to other treatments.
podophyllum resin (Pod–Ben–25, Podofin) – Topically applied by a doctor
podofilox (Condylox) – Can be topically applied at home, higher cure rates than Podophyllum resin, useful for prevention
trichloroacetic acid – Topically applied, response is often incomplete and recurrence is higher, may cause pain and burning
5–Fluorouracil (Efudex) – Applied as a cream, long treatment time, can cause burning and irritation, many side effects
Interferon alpha–n3 (Alferon N) – Used as an injection for warts that do not respond to other therapies, many side effects
imiquimod (Aldara) – New treatment, applied as a cream, local skin irritation is a common side effect
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